Court Sides With Allstate In Medical Fee Fight

Jul 14, 2016

Adding to a legal debate before the Florida Supreme Court, an appeals court Wednesday sided with Allstate Insurance in a dispute with medical providers about fees paid to care for auto-accident victims.

The ruling by the 3rd District Court of Appeal in five consolidated cases clashed with a decision last year by the 4th District Court of Appeal, which backed medical providers in similar cases.

The Supreme Court is scheduled to hear arguments Sept. 1 on Allstate's appeal of the decision by the 4th District Court of Appeal.

The disputes center on Florida's personal-injury protection, or PIP, insurance system, which provides coverage for people injured in auto accidents. The key issue in the cases is whether policies were clear that Allstate would reimburse health providers under a fee schedule from the Medicare program, which includes limits on payments for services.

In Wednesday's ruling in cases from Miami-Dade County, a three-judge panel of the 3rd District Court of Appeal rejected the medical providers' argument that policy language was ambiguous.

"The language used by Allstate is sufficient to place the insureds (policyholders) on notice of Allstate's election of the limitations allowed in the statutes," said the nine-page ruling, written by Judge Thomas Logue and joined by judges Linda Ann Wells and Ivan Fernandez.

Trying to bolster their arguments in the case before the Supreme Court, attorneys for Allstate quickly filed a notice Wednesday advising justices of the new appeals-court ruling.