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Florida Supreme Court to decide ‘PIP' payment dispute

TALLAHASSEE, Fla. – In a case with potential implications for insurers and health-care providers across the state, the Florida Supreme Court has agreed to take up a dispute about how much Progressive Select Insurance Co. should pay to a hospital for treating a man injured in an auto accident.

The Supreme Court issued a brief order Tuesday formally accepting the case, after Progressive Select appealed a Feb. 9 ruling by the 5th District Court of Appeal.

The Orange County case deals with calculation of payments to Florida Hospital under the personal-injury protection auto policy of Progressive customer Jonathan Parent.

Parent’s policy had a $1,000 deductible, and his total hospital charges were $2,781, according to the appeals-court ruling.

In seeking payment from the insurer, the hospital first subtracted the $1,000 deductible and then calculated the amount owed using a formula in the state’s so-called PIP law.

The hospital billed the insurer for $1,068. But Progressive used a different method that first applied part of the formula to reduce the overall $2,781 charge.

The insurer then subtracted Parent’s $1,000 deductible from the reduced amount, made another calculation under the formula and said it owed $868 to the hospital -- $200 less than what the hospital billed.

The crux of the dispute centers on whether the deductible should be subtracted from the overall charges or from the reduced amount. In a 2-1 decision, the appeals court said it should be applied to the overall charges, effectively forcing Progressive to pay more.

The 4th District Court of Appeal last week reached a different conclusion in a similar case involving State Farm Mutual Automobile Insurance Co.

The health-care provider in that Broward County case, Care Wellness Center, LLC, quickly filed a notice that is a first step in asking the Supreme Court to take up the issue.