5 Fla. L. Weekly Supp. 512a
Insurance — Personal injury protection — Where medical provider agreed to accept from insurer an amount less than 80% of the original bill in full satisfaction of insurerşs portion of bill, insured could be held responsible to medical provider for only 20% of the adjusted bill
MARIA VAZQUEZ, Appellant, v. FIDELITY NATIONAL INSURANCE COMPANY, Appellee. 11th Judicial Circuit in and for Dade County. Case No. 97-050AP. Lower Court Case No. 96-12821 CC05. March 27, 1998. An appeal from the County Court for Dade County, Harvey L. Goldstein, Judge. Counsel: Juan C. Montes, for Appellant/Petitioner. John C. Larrena, for Appellee/Respondent.
(Before Maxine Cohen Lando, Stanford Blake, Gill S. Freeman, JJ.)
(Maxine Cohen Lando, J.) Appellant, Maria A. Vazquez, appeals the lower court’s order granting Appellee, Fidelity National Insurance Companyşs motion for summary judgment and denying Appellant’s motion for leave to amend.
Appellee, Fidelity National Insurance Company, Defendant below, is an insurer of automobiles. Appellant, Maria Vazquez, Plaintiff below, is a policy holder of an automobile insurance policy with Appellee as required by section 627.736 Fla. Stat. (1997). Appellant was injured in an auto accident, and subsequently sought treatment from a doctor for her injuries. Appellant eventually submitted these medical bills to Appellee. Appellee failed to pay the bills in a timely manner, and Appellant filed the underlying action. One day after the action was filed, Appellee sent payment to the medical provider pursuant to an amount that was previously agreed to by Appellee and the medical provider. The amount to which Appellee and the medical provider agreed was less than 80% of the original medical bill. This agreement stated, however, that the amount would be in full satisfaction of Appellee’s portion of the bill. It also stated that the medical provider would not seek payment from Appellant for an amount greater than 20% of the original bill.
Appellee made a motion for summary judgment because the bill had been paid. Appellant objected stating that Appellee owes money to Appellant because their reduction agreement with the medical provider resulted in Appellant being responsible for greater than 20% of the renegotiated bill. She also stated that the Appellee was not entitled to a judgment because payment of the bill constituted a confession of judgment in favor of Appellant and hence the Appellee was not entitled to a judgment. Finally, she stated that she required leave of court to amend the complaint to state a cause of action for unilaterally reducing the 80% obligation of the bill without proportionate reduction in the obligation of the insured. The Court denied Appellant’s motion to amend the complaint, and granted the motion for summary judgment.
Section 627.736(1)(b) (Fla. l996) states …A Co-payment means no more than 20% of the reasonable amount, subsequently agreed, and the not the first billed amount. Botero v. Fidelity National Insurance Co. 96-045AP (11th Judicial Circuit of Fla. Appellate Div., 1996). In the instant case, Appellee has negotiated with the health care provider to reduce the amount of payment for Appellant’s medical expenses. Thus, the amount owed to the health care provider, overall has decreased. Plaintiff should only be responsible to the medical provider for 20% of that adjusted bill, and Appellee should reimburse Appellant for any amount over that 20% that she has paid to the health care provider.
Because of our above decision, there is no need to address Appellant’s motion to amend the complaint.
The order of the lower court is REVERSED AND REMANDED to determine the amounts payable, consistent with this opinion.
The Court GRANTS the Appellant’s motion for attorney’s fees and REMANDS this matter to the County Court for its determination of that issue. (Stanford Blake, Gill S. Freeman, JJ., concur.)
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