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Will PIP Payments Be Affected By Court Battle Between State Farm and UF Jacksonville?

A fight between auto-insurer State Farm and hospital UF Health Jacksonville could affect the wallets of patients around Florida. Are hospitals being truthful about their billing after car accidents? Insurance giant State Farm wants to know if they’re paying too much to healthcare providers. The case went in front of the Florida Supreme Court last week. State Farm has sought copies of contracts between Shands Jacksonville Medical Center and health insurers, arguing that the contracts could help show whether State Farm is paying reasonable amounts when the hospital treats people injured in auto accidents. But the hospital, now known as UF Health Jacksonville, fought the request and won last year at the 1st District Court of Appeal.

During last week arguments, State Farm argued that unreasonable high charges prematurely deplete the benefits of the insured. The company alleged that paying too much hurts the customers’ benefits, and too little could lead to rising premiums. Justice Ricky Polston questioned UF Health Jacksonville, “If they pay a PIP claim that they think, eh, I don’t think this is a reasonable amount, how are they then, procedurally, appropriately entitled to discover how that amount is reasonable,” Counsel for UF Health replied if they [the insurer such as State Farm] question in then they can either not pay it or pay the portion they think is appropriate. These were not the only questions. There were a lot of questions by the justices. At one point, Justice Charles Canady asked counsel for UF Health Jacksonville, “What does cost mean? Does it mean billed charge?” Justices Peggy Quince and Barbara Pariente, meanwhile, noted that State Farm paid the 29 claims involved in the case before going to court to try to get the hospital’s contracts with health insurers.

The case comes after the governor started waging war with hospitals over price transparency.

WJHG asked both sides to comment after the oral arguments concluded. State Farm Attorney Alan Nisberg said he wasn’t authorized, while UF Health Jacksonville Attorney John Tucker said it’s now up to the justices. A circuit judge has already ruled in favor of State Farm, with the first district court of appeals siding with UF Health Jacksonville




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