Case Update- Emergency Medical Condition 1
The doctor didn’t say “emergency medical condition” but the judge decided that there was still an EMC because of the severity of the injuries….in this case a broken bone.22 Fla. L. Weekly Supp. 943a Online Reference: FLWSUPP 2208LORR
Insurance — Personal injury protection — Coverage — Emergency medical condition — Determination by qualified medical provider that insured had broken bone in her wrist that caused extreme pain and seriously interfered with her ability to function at work satisfied requirement for determination of emergency medical condition despite provider’s failure to use phrase “emergency medical condition” — Insured is entitled to reimbursement of medical expenses up to $10,000BEVERLY LORRAINE, Plaintiff, vs. ENTERPRISE LEASING COMPANY OF ORLANDO, LLC, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 2013-CC-016688-O. December 8, 2014. Honorable Faye L. Allen, Judge. Counsel: Eric W. Deming, Morgan & Morgan, P.A., Orlando, for Plaintiff. William J. McFarlane, III, Coral Springs, for Defendant.
ORDER AND FINAL SUMMARY JUDGMENT ON CROSS-MOTIONS FOR FINAL SUMMARY JUDGMENTThis matter came before the Court on November 12, 2014, upon the parties’ cross Motions for Summary Judgment. The Court, having heard argument of the Parties and being otherwise duly advised in the Matter, GRANTS Plaintiff’s Motion for Summary Judgment and DENIES Defendant’s Motion for Summary Judgment. The Court finds and rules as follows:
The legal issue before the court involves the emergency medical condition provision added to Section 627.736, Florida Statutes, by Laws 2012, c. 2012-197, which took effect on January 1, 2013. The only issue to be decided is whether Ms. Lorraine met the requirements necessary to entitle her to reimbursement of up to $10,000. Ms. Lorraine claimed she was entitled to reimbursement from Defendant of up to $10,000 pursuant to Sections 627.736(1)(a)(3), (4) and Section 627.732(16). Conversely, Defendant claimed that Beverly Lorraine’s reimbursement from it was limited to $2,500 pursuant to Sections 627.736(1)(a)(4).
The facts show that Ms. Lorraine was injured in a motor vehicle accident on February 19, 2013. Ms. Lorraine sought treatment with Myles Rubin Samotin, M.D. Dr. Samotin is a medical doctor licensed under Chapter 458, Florida Statutes that provided follow-up care and services to Ms. Lorraine on March 15 and April 12, 2013. It is undisputed those treatments were reasonable, related to her accident and medically necessary. Ms. Lorraine filed a post-suit affidavit of Dr. Samotin with an opinion supporting the reasonableness, relatedness and necessity of medical treatment as well as a discussion of his pre-suit determination that an emergency medical condition existed in Ms. Lorraine. However, Dr. Samotin did not specifically use the words “emergency medical condition” in his medical records which were provided to Defendant during the claims process prior to litigation of the claim. Defendant did not file any medical opinions in this case.
Dr. Samotin submitted and Defendant admitted it received the bills and records from Dr. Samotin related to Ms. Lorraine’s examinations and treatment on March 15, 2013 and April 12, 2013. Dr. Samotin noted on March 15, 2013 that Ms. Lorraine had been taken by ambulance to be examined in the emergency room. He also noted that Ms. Lorraine was experiencing extreme pain of 8/10 at worst. Dr. Samotin further diagnosed Ms. Lorraine with a broken trapezoid bone in her wrist. He indicated that as a result of the trapezoid fracture she was placed into a short-arm cast with a thumb spica attachment and would remain in the cast for up to six weeks. According to Dr. Samotin’s records, Ms. Lorraine ultimately remained in the cast for 4 weeks at which point she was strapped into a thumb spica brace which immobilized her thumb, which she was required to wear around the clock.
Defendant acknowledged that it was aware Dr. Samotin’s diagnosis of a broken left wrist in its Explanation of Benefits dated April 24, 2013 (responsive to March 15, 2013 billing by Dr. Samotin), which reflected diagnosis code: “814.06 closed fracture of trapezoid bone of wrist.” Defendant also received a signed doctor note from Dr. Samotin stating Ms. Lorraine’s injuries seriously interfered with her ability to function at work, leaving her unable to work as of March 26, 2013. The note reflected she would be reevaluated in three days.
Sections 627.736(1)(a)(3) and (4) provide the only statutory requirements with regard to determining of an emergency medical condition. These sections read as follows:
(3). Reimbursement for services and care provided in subparagraph 1. or subparagraph 2. up to $10,000 if a physician licensed under chapter 458 or chapter 459, a dentist licensed under chapter 466, a physician assistant licensed under chapter 458 or chapter 459, or an advanced registered nurse practitioner licensed under chapter 464 has determined that the injured person had an emergency medical condition.
Section 627.736(1)(a)(3), Florida Statutes.
(4.) Reimbursement for services and care provided in subparagraph 1. or subparagraph 2. is limited to $2,500 if a provider listed in subparagraph 1. or subparagraph 2. determines that the injured person did not have an emergency medical condition.
The Legislature went on to define what it considers to be an “emergency medical condition:
(16) “Emergency medical condition” means a medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain, such that the absence of immediate medical attention could reasonably be expected to result in any of the following:
(a) Serious jeopardy to patient health.
(b) Serious impairment to bodily functions.
(c) Serious dysfunction of any bodily organ or part.
The Florida Supreme Court has routinely held that the No-Fault statute must be liberally construed in order to effect the legislative purpose of providing broad PIP coverage. Blish v. Atlanta Casualty Company, 736 So.2d 1151 (Fla. 1999) [24 Fla. L. Weekly S204a]. When the language of the statute is clear and unambiguous and conveys a clear and definite meaning, there is no occasion for resorting to the rules of statutory interpretation and construction; the statute must be given it’s plain and obvious meaning. Holly v. Auld, 450 So.2d 217, 219 (Fla. 1984);Markham v. PPI, Inc., 843 So.2d 922 (Fla. 4th DCA 2003) [28 Fla. L. Weekly D755a]. Consequently, “Courts of this state are without power to construe an unambiguous statute in a way which would extend, modify, or limit, its express terms or its reasonable and obvious implications. To do so would be an abrogation of the legislative power.” Id.
There is nothing to suggest under Sections 627.736(1)(a)(3), (4) or 627.732(16) that there is a requirement of any particular form or “magic words” that a provider must submit to the Defendant to show its determination. If the legislature intended to require some “magic words” or special form, it would have said so. The Florida Legislature certainly knows how to create a condition precedent. Florida Medical & Injury Center, Inc. v. Progressive Express Insurance Company, 29 So.3d 329 (Fla. 5th DCA, 2010) [35 Fla. L. Weekly D215b]. The Court is not at liberty to rewrite the statute or create such a requirement when it does not exist in the statute. Id.
The determination by Dr. Samotin at the time he provided care, which was reflected in his medical records, was sufficient to meet any requirement of Section 627.736(1)(a)(3), (4) and the definition of emergency medical condition in 627.732(16) and Ms. Lorraine is accordingly entitled to reimbursement up to $10,000. The Court cannot decide that the doctor had not determined that there was an emergency medical condition just because the doctor did not write the words “emergency medical condition” in succession.