Appellate Win – Insurance Carrier – Miami-Dade County

Miami Appellate Associate Francesca Stein and Appellate Partner Lissette Gonzalez successfully obtained a reversal of a trial court’s summary judgment on the issue of whether a major carrier’s policy required them to reimburse a charge according to the “calendar” year or the “service” year as written in the PIP statute. The Provider argued that the carrier’s policy was ambiguous and therefore, the carrier should have reimbursed accounting to the 2017 fee schedule. The Fourth District Court of Appeal disagreed and held that the carrier correctly paid the charge according to the service year as defined in the PIP statute. Specifically, the court said:

The policy at issue notes several times that the statute applies as amended and is thus incorporated into the policy “as amended,” clearly indicating an expectation by the insurer that the statute could change and obviating any need to continually update the policy language to reflect any periodic statutory changes after the policy was executed. Thus, the statute would apply to insurer payouts at the time when the payout was made. In the instant case, the expectation was clear that the post-amendment statute in effect at the time of the payouts would apply to the instant claim.

Final Judgment will be entered in favor of CSK’s client, a major auto coverage insurance carrier.

Our team is available to discuss the topics written here and ready to provide additional information contained in this article. Contact us for more information.

Jump to Page

Necessary Cookies

Necessary cookies enable core functionality such as security, network management, and accessibility. You may disable these by changing your browser settings, but this may affect how the website functions.

Analytical Cookies

Analytical cookies help us improve our website by collecting and reporting information on its usage. We access and process information from these cookies at an aggregate level.