MRI Associates of St. Pete, Inc. v. State Farm Mutual Automobile Insurance
2010 U.S. Dist. LEXIS 129696
| M.D. Fla. | 2010Background
- MRI provider sued State Farm over PIP payments for Florida residents' medical bills from auto accidents.
- Plaintiff asserted Defendants used the new PIP fee schedule (2007-2008) instead of the policy's reasonable amount methodology.
- New statute §627.736(5)(a)(2) and §627.7407(2) deem the fee schedule incorporated into PIP policies in effect after Jan 1, 2008.
- Plaintiff sought declaratory and injunctive relief plus individual breach of contract claim (Count III).
- Court held class action inappropriate; pre-suit notice and individual determination required; mediation ordered; Count III remains.
- PIP gap period (Oct–Dec 2007) is not germane; issues focus on reasonableness of amounts paid rather than the statutory fee schedule alone.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether a class action is appropriate for PIP benefits. | Plaintiff argues two methodologies; class-wide relief possible. | Defendants argue individual claims depend on reasonableness determinations. | Class action dismissed with prejudice. |
| Whether the new PIP fee schedule is incorporated and can be used in setting reasonable amounts. | Policy does not automatically allow using the fee schedule. | Statute incorporates the fee schedule into policies; permissible for reasonableness. | Statute incorporated; schedule permissible in calculation. |
| Whether Counts I–II should be dismissed and Count III survives. | Counts I-II seek declaratory/injunctive relief against use of schedule. | Declaratory relief improper if contract breach determined; Count III valid. | Counts I-II dismissed; Count III remains. |
| What procedural steps follow if claims are to be resolved by amendment? | Amendment to pursue declaratory/injunctive relief individually is possible. | Amendment futile if identical issues, adjudication unnecessary. | Amendment allowed unless futile; mediation ordered. |
Key Cases Cited
- Shenandoah Chiropractic, P.A. v. National Specialty Insurance Co., 526 F.Supp.2d 1283 (S.D. Fla. 2007) (class action inappropriate for PIP benefits due to case-specific reasonableness)
- State Farm Mut. Auto. Ins. Co. v. Sestile, 821 So.2d 1244 (Fla. 2d DCA 2002) (reasonableness varies by claim; not suitable for class action)
- Florida Farm Bureau Cas. Ins. Co. v. Cox, 943 So.2d 823 (Fla. 1st DCA 2006) (insurance policies incorporated by law with statutes)
- Medical Center Health Plan v. Brick, 572 So.2d 548 (Fla. 1st DCA 1990) (declaratory relief not available for unambiguous contract breach)