Warren v. State Farm Mut. Auto. Ins. Co.
2005 Fla. LEXIS 593, 30 Fla. L. Weekly Supp. 197, 899 So.2d 1090 (2005)
Rule of Law:
Section 627.736(5)(b), Florida Statutes (1999), which mandates that non-emergency medical providers submit claims for services to insurers within 30 days or risk non-payment, is constitutional as it serves legitimate governmental purposes and does not violate equal protection, due process, or the right of access to the courts.
Facts:
- Dan Ray Warren was injured in a motor vehicle accident on March 22, 1999.
- Dr. Jack Rotstein provided medical treatment to Warren on May 27, June 16, and July 6, 1999, for injuries sustained in the accident.
- Dr. Rotstein did not submit statements for these medical services to State Farm Mutual Automobile Insurance Company until August 9, 1999.
- The statements were postmarked more than thirty days after the services were rendered.
- Under the provisions of section 627.736(5)(b), Florida Statutes (1999), State Farm was not required to pay for charges for treatment rendered more than 30 days before the postmark date of the statement.
- The statute also stipulated that Warren, as the injured party, was not liable for, and Dr. Rotstein, as the provider, could not bill Warren for, charges that were unpaid due to the provider's failure to comply with the thirty-day submission requirement.
Procedural Posture:
- Dan Ray Warren initiated an action for non-payment against State Farm Mutual Automobile Insurance Company in county court, eventually joining Dr. Jack Rotstein as a party plaintiff.
- The county court held section 627.736(5)(b), Florida Statutes (1999), unconstitutional as violative of Dr. Rotstein's rights to equal protection, due process, and access to the courts, and entered judgment for Dr. Rotstein for $1,640.25 plus interest, and awarded attorney's fees and costs.
- State Farm Mutual Automobile Insurance Company appealed the county court's decision to the Fifth District Court of Appeal.
- The Fifth District Court of Appeal reversed the county court's ruling, holding that section 627.736(5)(b) is constitutional.
- Dan Ray Warren and Dr. Jack Rotstein (Petitioners) sought review of the Fifth District's decision in the Supreme Court of Florida.
Premium Content
Subscribe to Lexplug to view the complete brief
You're viewing a preview with Rule of Law, Facts, and Procedural Posture
Issue:
Does section 627.736(5)(b), Florida Statutes (1999), which requires providers of non-emergency medical services and services not billed by a hospital to submit statements of charges to insurers within thirty days of service, violate the rights to equal protection, due process, or access to the courts under the Florida Constitution?
Opinions:
Majority - PER CURIAM
No, section 627.736(5)(b), Florida Statutes (1999), does not violate the rights to equal protection, due process, or access to the courts. The statute, part of Florida's No-Fault Law, was intended to impose time limits on medical billing to address concerns that charges could mount over long periods. The Court applied the rational relationship test for equal protection and due process, as no fundamental right or suspect classification was implicated. The Court found a rational basis for distinguishing between medical providers and hospital/ambulance services because medical providers often offer ongoing treatment where necessity is harder to determine, unlike immediate post-accident services. The legislative objectives of reducing unnecessary medical costs, lowering PIP premiums, reducing bulk billing, and ensuring charges are reasonable and accident-related are legitimate, and the thirty-day requirement is reasonably designed to achieve them. The statute is not discriminatory, arbitrary, or oppressive, as providers are given notice and can avoid non-payment by complying. For access to the courts, the Court held that the thirty-day provision does not abolish access but rather establishes a reasonable condition precedent to filing a claim for statutory insurance benefits. Compliance with the clear statutory requirement preserves the provider's right to seek payment in court, thus distinguishing it from situations where the right to redress is entirely eliminated without an alternative.
Concurring - Pariente, C.J.
Yes, I agree with the majority that section 627.736(5)(b) is not unconstitutional on its face. However, there may be specific circumstances where the statute could be unconstitutional as applied. The thirty-day submission period is very short, and a medical provider might fail to comply through no fault of their own, such as due to patient malfeasance or error in providing information. In such a scenario, where the provider had no means to comply, the 1999 version of the statute would bar recovery, potentially constituting an unconstitutional denial of access to the courts. The 2001 amendment to the statute allowing an extension for incorrect patient information suggests legislative recognition of this problem. In this particular case, however, there was no allegation that Dr. Rotstein’s failure to submit bills on time was due to incorrect information from the insured, so the statute was not unconstitutionally applied.
Dissenting - Lewis, J.
No, the very limited thirty-day billing deadline unconstitutionally infringes upon medical providers' fundamental rights of property, due process, and access to the courts. These are fundamental rights under the Florida Constitution, and legislation impacting them should be reviewed under strict scrutiny, requiring a compelling governmental interest and the least intrusive means, not the rational basis test applied by the majority. The statute forces health care professionals to absorb unpaid costs, which amounts to personal servitude without compensation or recourse, even due to no personal fault. This outcome is not justified by a compelling state interest. The majority's objectives of reducing bulk billing and assessing reasonableness are not compelling enough to justify such a severe encroachment. The statute is overbroad and arbitrary, penalizing all providers regardless of legitimate conduct or innocent mistakes, and offers no alternative for redress, thereby abolishing a core legal right in violation of Kluger v. White. This creates an unequal treatment of fundamental rights, prioritizing some over others.
Dissenting - Quince, J.
No, section 627.736(5)(b) is unconstitutional because it violates equal protection and access to the courts. The statute creates an arbitrary classification by exempting hospitals and ambulance providers from the thirty-day billing requirement while imposing it on other medical providers, even for similar emergency services. This disparity in treatment among similarly situated providers lacks a legitimate legislative objective and violates the principle of equal protection. Furthermore, this section undermines the stated purpose of the No-Fault Law, which is to ensure prompt medical attention for accident victims, by potentially causing medical providers to demand upfront payment or refuse services to patients relying on no-fault insurance, for fear of non-payment. By preventing providers from recovering fees from either insurers or patients due to a missed deadline, the statute effectively takes away their ability to be compensated for their labor, thereby denying them access to the courts for legitimate claims, as Justice Lewis also argues.
Analysis:
This case significantly reinforces the Florida Supreme Court's approach to constitutional challenges against economic regulations, particularly within the no-fault insurance scheme. By upholding the thirty-day billing requirement under the rational relationship test, the Court demonstrated deference to legislative judgments concerning economic and social welfare policies. The decision clarifies that a statutory condition precedent, even a stringent one, does not necessarily violate the right of access to courts if it provides clear notice and allows for compliance. However, the strong dissents and concurring opinion highlight ongoing judicial debate regarding the appropriate standard of review for fundamental rights and the potential for such regulations to create harsh outcomes in practice, potentially opening the door for 'as applied' challenges in future cases where compliance was genuinely impossible.
