UR Health Chiropractic Corp. v. Progressive Select Insurance Company, No. 0:2017cv62086 - Document 16 (S.D. Fla. 2018)
Court Description: ORDER granting 10 Defendant's Motion to Dismiss. Closing Case. Signed by Judge Federico A. Moreno on 1/18/2018. (da00) NOTICE: If there are sealed documents in this case, they may be unsealed after 1 year or as directed by Court Order, unless they have been designated to be permanently sealed. See Local Rule 5.4 and Administrative Order 2014-69.
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UR Health Chiropractic Corp. v. Progressive Select Insurance Company Doc. 16 UNI TED STATES DI STRI COURT FOR THE CT SO U TH ERN DI STRI OF FLO RI CT DA M i m iDi s on a vi i C as N um be 17e r: 62086- V - O R EN O Cl M UR HEALTH CHI ROPRACTI CORP. za o C , ll Oxa Kouzme na nko, behafofis l a a1 on l t ef nd 1 o he ssmia l st t t r i lry iuaed, Pl i if a ntf , V S. PROGRESSI SELECT I VE NSUM NCE COM PAN Y, Dee f ndant . O R D ER G M NT I G D EFEN D AN T' M O TI N T O D I I N S O SM SS Pl i if UR H e 1h Chiopr tc Cor aton br a ntf at r ac i por i ought t s a ton a ns D e e hi c i gai t f ndan t Pr r s i Se e t l ur nc Com pa t c le og e sve l c ns a e ny o ha l nge is r i bur e e pr c i s r a e t t e m s m nt a tce el t d o p ro a ij r p o e to b neis Pr g e sv s bsq e tymo e t d s s tec mplitf r es n l nu y r tcin e ft. o r sie u e u nl v d o imis h o an o f iur t sa e a cli upon whih r i ca be gr t d.Fort r a ons dic s d be o ,i i a l e o tt am c elef n an e he e s s us e l w t s ADJ UDGED t tPr es i smoton t dim isi GRAN TED. ha ogr sve' i o s s s The Part es i A. Rel evantNon- v part 1. Oxana Kouz enko m Ox n Ko z n o i a Flrd r sd n wh s san d ij re d rn a a t mo ie a a u me k s o ia e ie t o u t ie nu is u ig n u o b l ac i nt t t oc ur ed on A ug t 6, 201 A t t t tm e, Kouze e c de ha c r us 6. ha i m nko w a c r d unde a s ove e r n i ur nc polc i s d by Def nda Pr es i Sel c I ur nc Com pa ns a e i y s ue e nt ogr sve e t ns a e ny. The Polcy i p o ie Ko z n o wih p ro a ij r p oe to b n ft i a c r n e wih Flrd ' r vd d u me k t e s n l n u y rtcin e eis n c o da c t o ia s Dockets.Justia.com M o orVe c eNo- ul La .lKouzm enko a sg d t be t unde t sPolc t UR Heat t hil Fa t w s i ne he neks r hi i y o lh a d i e h n e UR He lhp o ie me ia sr c st hepte tKo z n ' ij re . n ,n xc a g , at r vd d dc l evie o l r a u me ko s n u is B. The Partes i 2 Pli # - UR He Ih Chio a tcCopo a in . ant at r pr ci r r to i s n owa d UR He t i a Fl i c por ton wih is p i i pl e of busne s i Br r a1h s orda or a i t t rncpal ac Co ny Flrd .t o ie c r p a tcsr ie t h l p te t wihav reyo ij re . u t, o ia Ipr vd s hio rci e vc s o ep ain s t a it f nu is J De nd nt Pr g e sv See t n u a eCo n . fe a - o r s ie lc I s r nc mpa y Pr es i Seec l ur e Compa i a f ei com or ton t t pr des a ong ogr sve l t ns anc ny s or gn a i ha ovi , m ot rt ngs a o obiei ur ncei Fl rda Pr e sves d an a o obie i ur epolcyt he hi , ut m l ns a n o i . ogr s i ol ut m l ns anc i o Ko uzme nko.Thi Polc wa i e f c a t tme ofKouz e s a om obie a ci nt whi s iy s n fe t t he i m nko' ut l c de , ch tig rd P o e sves o lg to t p o i e Ko z n wi t pes n lij r p o e to rg ee r g si ' b iain o r v d u me ko t he ro a n u y r tcin h be isi ude i t polc neft ncl d n he iy. II. Backzround Folwig t 2 6 a tmo ie a cd n , Ko z nk a sg d t pes n l ij r l n he 01 u o bl c ie t u me o sine he ro a nu y o pr eci n be isfom he Pr es i a omobie i ur nc polc t UR He t l t ' UR ot to neft r r ogr sve ut l ns a e iy o alh. n ul n, He 1 p o ie c io r ci sr ie t hep Ko z n rc ve fo t ep ro a ij re s e at r vd d hr p a tc e vc s o l u me ko e o r r m h es n l n u is h h s t i d durng t ac i nt Pr r s i s e nty r i btr e UR He t f c rai usane i he c de . og e sve ubs que l em zs d a1h or e t n me ca s r i e c r byt polc di l e v c s ove ed he iy. To c l ult t r i bur e nt owe t UR Heat unde Kouz e s i ur nce a c a e he em s me d o 1h r m nko' ns a polc Pr r s i a id M e c r s M uli e Pr ed e Pa nt Reduci Rul t UR iy, og e sve pple di a e' tpl oc ur yme ton e o H e t s bil f c r a tc s r i e . The M uli e Pr edur Pa e Red to Rul alh' ls or hi opr c i e v c s tpl oc e ym nt uc i n e whi a cou s f r t s ngs a efi i nces a hi ve whe a pr de pe f m s m uli e ch c nt o he avi nd fc e i c e d n ovi r ror tpl m e ca pr edur s i a sngl da r duc pa e t a he lhc e pr de by a s t di l oc e n i e y- e es ym nt o a t ar ovi r e lUndert Fl i M ot Vehi e No- tLaw , a o bi o rt smus h vepe s na ij r he orda or cl Faul utmo l peaor t a ro ln u y e p oe tonc e a et a pr de a la t$1 ,00 i c mbi d me c le e ea ls wa e c vea e r tci ov r g h t ovi s t e s 00 n o ne dia xp ns nd o t g o rg i tee e tofa a t mo l a cde tSe Fl. a . c 62 7 ( )a . n h v n n u o bie c i n . e a Stt Se . 7.36 l() pe c t e f s ond a s e ntpr dur spr de t t s r en ag or ec nd ubs que oce e ovi d o he ame pa inton t s me day. te he a Se 7 Fe Reg. 68, e d. 927. By a yi t M uli e Pr ed e Pa e Re ton Rul ppl ng he tpl oc ur ym nt duc i e, Pr r sve de r as t mnountofr mbur e og es i c e ed he ei s mentdibur e t UR He t s sd o alh. UR He 1 c n e e ta u d rFlrd ' p ro a ij r p oe to sau e a wela at o c d s h t n e o ia s e s n l n u y rtci n ttt s l s h Ko e uzm nko' a om obie i ur nc polc Pr r sve had t rght t utlze t M uli e s ut l ns a e i y, og es i he i o ii he tpl Pr e ePa ntRe i Rul t c l ult r mbur e towe t UR Heat f pr di oc dur yme ducton e o a c a e ei s men do 1h or ovi ng Ko z k wihp ro a ij r p oe to b n ft. He l as c n e e - or a la t d e u me o t e s n l nu y r tcin e eis UR at lo o c d s - , t e s, o s h no chal - t tPr e sve a cur t y a i d t M uli e Pr ed e Pa e Re ton t lenge ha ogr s i c ael pple he tpl oc ur ym nt duc i Rul t U R H e lh' bil . eo a t s ls H ow e r UR Hea t co e ve , lh nt nds t t Pr es i s il vi at d t 1 w by ar ta iy ha ogr s ve tl ol e he a bir r l a yi t M uli e Pr e e Pa e Reduc i Rul t s e he t r pr vi r bu not ppl ng he tpl oc dur ym nt ton e o om alhca e o de s t t o he s l a lge t tPr r s i di nota y t M uli e Pr edur Pa e Re ton o t r . t le s ha og e sve d ppl he tpl oc e ym nt duc i Rul t r duc r mbur e e o e e ei s ment a mount owe t t ag tc i ng pr de s' UR He t s d o i nosi/magi di ovi r . ' a1h a gue t tby a yi t M uli e Pr e e Pa ntRe ton Rul ç o pr de s lke t r s ha ppl ng he tpl oc dur yme duc i e k ovi r i he t Plitf ' a d ç r ta i c o l l NOT t a pl i t da n tci gn pr vd r, an if n i bi rl h osi a r y ng o p y t o ig osi/ma ig o ie s' ' Pr r sve e ge i unl ul C srmi or c ogesi nga d n awf t ci nat y onduct' ( p. a 2. Fi ly, e n i di . Res t ) nal ve f ' Pr r s ve m a utlz t Paym e Pr uc i Rul f s e but not a l pr de s U R og es i y ii e he nt od ton e or om l- ovi r , Heat c e t tt i ur epolc mus f o des fcintnotc t t i ur ofghil lh ontnds ha he ns anc iy t ' vi ufi e pr ie o he ns eds t s dici naor prctce. (d. s rmi t y a i ' 1 4 ' Pr e sve m ant i t ti has no oblga i t e pl t Pa ogr s i i ans ha t i ton o m oy he ymentRe ton Rul duc i e u f ml f r a lpr de s ort notf i ur when i ap i t Pa nior y o 1 ovi r , o iy ns eds t ples he ymentRe ton Rul duc i e no unionnl l not t tU R Hea t of e s no s n- f y. t es ha lh f r uppor f is al- - hi r l or is no i t or t lor not ng u e t tce requiem ent. r 111 St . andard t'o s v ve a m oto t di m i s pl i if m us do m or t n m er l s a e l gal û - ur i l i n o s s , a ntf s t e ha ey t t e c l i , i t a pl ntfsmus S l e s oncusons' nse d ai if ' t i eg ome s cii f c ualba i f t e c l i or al pe fc a t ss or hos onc usons fc dimis oft i cl ms' Jac s v.BelsouhTee a e s sal her ai .' k on l t lcomm. 37 F.d 1 1 (11hCi. , 2 3 250, 263 t r 2004) W he r i on amoton t dimis ac tmus viw t c aiti t lgh mos . n ulng i o s s, our t e he ompl n n he i t t f vor bl t t pli if a a e t pl i ifs we lplade f c s a tue. Se St Josph' a a e o he antf nd cc pt he antf l- e d a t s r e . e s Hop.I c v Hop.Cop. fAm.7 5F.d9 8 9 3( 1hCi.1 8 ) Thi tn t h we e, o s s , n . . s r o , 9 2 4 , 5 1 t r 9 6 . s e e, o v r d e nota y t l lc us ons Se As r .f v I b l 1 9 S. .1 37 1 4 ( 0 ) Mo e v r ppl o ega oncl i . e hc o t . q a , 2 Ct 9 , 9 9 20 9 . r o e, kwl ielg lc n l so sc n p o d t efa wo kofac mpan ,h ymu tb s p o tdb i h l e a o cu in a rvie h r me r l o lit te s e u p re y fcu lalg to s' I a 1 0. Th e'ta t a alg to smu tb e o g t riearg t o a t a le ain . d t 95 ' os 'l cu l le ain s e n u h o as ih t g r if a ele bove t s c a i lvelon t a s he pe ul tve e he s umpton t tal oft c i ha 1 he ompl nts a lga i a e ai ' le tons r tu ' BelAt.Cor v Twombl 550 U. 544,545 ( r e. l l p. . ' y S. 2007) l s t t compl ntmus no . n hor, he ai t t mer l alegeam ic ey l s onduc ,butm us de o taet tt pl a i e il t r i . Se I , t t m nsr t ha he e der s ntted o elef e qbal 1 S.Ct a 1 0. 29 . t 95 l . Anal i V vss Flrd ' pes na ij r p o e to sau e a d Ko z n o' a tmo ie i u a c o ias ro l nu y r tcin ttt n u me k s u o b l ns rn e polc a horze Pr es i s us of t M uli e Pr e e Pa e Re ton Rul t i y ut i ogr s ve' e he tpl oc dur ym nt duc i e o c c a e r i bur em e ow e t U R Hea l U nde Kouz e al ul t e m s nt d o th. r m nko' polcy,Pr es i a ee t s i ogr s ve gr d o d y be ist ta i ur d pe s i e il t r eve pur ua t t Fl i M ot Ve ce t pa neft ha n ns e r on s ntted o ec i s nt o he orda or hi l No F ul La .. b c u eo b d l ij r '( s a 5. P o r si f te e plie t a te - a t w . e a s f o iy nu yv Re p. t ) r g e sve urh r x an d h t h ' ttl mo n o b n ft p i t l b s b e t oteCe trf rM e iaeS r ie c dn p lce o a a u t f e eis ad s l e u j c t h ne o dc r e vc s o ig o iis wi a pa m e me hodol es' whih i ude t M uli e Pr dur Payme Reduci Rul nd y nt t ogi , ' c ncl he tpl oce e nt ton e. (d a 6. Fo iasp ro a ij r p o e to sau ep o d sa dto a s p o tb e p e sy 1 . t ) lrd ' e s n l nu y r tcin ttt r vie d iin l u p r y x r sl r s r i i ur r 'rght t us She M edia ec ngpolc e a pay e me hodol i soft e e vng ns e s i s o e t t c r odi ii s nd m nt t og e he f de alCe e s f M e ca e a M edi ai Se vi es ...t det r i t a opra e a ou of e r nt r or di r nd c d r c o e m ne he ppr i t m nt ri sme tf medi ls r i s s is orc e....' a.SttAr j627. 54 3 . embure n or ca e vce , upple , ar 'Fl a. m. 736()*() UR Heat expl ns howe r t t dgl is i not whehe t Dee nt c n lh ai , ve , ha tthe sue s t r he fnda a ge rly ap y (he Muli e Pr edur Pa ntRe ton Rul ,'but û t r ( orda' neal pl t tpl oc e yme duci e)' s he Fl i s whe p ro a ij r p oe to sau e alwsteDee d n t d srmi trl a pl ( e Mulpl es n l n u y rtcin ttt) l o h f n a t o ici nao iy p y t h t e i 4 Pr c d r P y n Re u t n Rue . UR He 1 ag e t a Pr g e sv ma n tuiiet e o e u e a me t d ci o l)' ' at r u s h t o rs ie y o tl h h z Pay e Red tonRul f onl s e butnotal pr vi r m nt uci e or y om l- o de s: The Pli ifaleg t ti t Defnda c est e oy (he antf l es ha f he e nt hoos o mpl t M utpe Pr c d r Pa me tRe u to Rul) i mus a py i t lil o e u e y n d cin e , t t p l t o al ei bl pr de s.Conve s y,i t De enda de i s no t l lgi e ovi r rel f he f nt cde t o a y ghe M uli e Pr dur Pa ntRed ton Rulj t n i ppl t tpl oce e yme uci e, he t c nnot a y i t a pr vi r Si e t De e nta e a a ppl t o ny o de . nc he f nda dopt d n abirr prcie of NOT a yi ghe M uli e Pr dur r tay a tc ppl ng t tpl oce e Pa nt Re ton Rul t dignosi pr der, t n i i yme duci el o a tc ovi s he t s pr cuded fom a yi i t t ot r pr de s s h a t el r ppl ng t o he he ovi r uc s he Pl i if a ntf . ( s . t5(mp ssi o ii al) Re p a e ha i n rgn l. UR He lh ra st sl tto it F o iasp ro a ij r p oe to saue a g n at e d hi i ain n o l rd ' es n l nu y r tcin tt t, ruig mi t a t e saue i efi o sn te p e sy alw t i u e t a pl (h M utp e Pr c d r h t h tt t t l s e o x r sl l he ns r r o p y t e lil o e u e s d o Pa n Red to Ru11'( s a 1 )Ac or ngt UR He 1h,S t Dee ntee t t yme t ucin e . Rep. t 0. c di o ' at t he fnda lcs o once us (heMuli ePr edur Pa ntRe tonRulj t sat edoesnotalow i t a yi t et tpl oc e yme duci e, he t ut l t o ppl t o onepr de whiea t s metmea birrl r us (i)t a pl i t ot rei bl pr vi r.' ovi r l t he a i r ta iy ef e sc o p y t o he lgi e o des' Thi i a i e esi a gume ,butby no me a mert i one.No pr son of s s n nt r tng r nt ans iorous ovii Fl i spes ij y prtci sauece tsac eofa tonwhe ea i ur a i t orda' ronal nur oe ton ttt rae aus ci r n ns er pples he Pa nt Reduc i Rul t s yme ton e o ome pr de s but notot r .Nor doe UR He t pr de a ovi r he s s alh ovi ny e r t xt ls xta-e ua uppor f isi emr tton oft saut ort ne s a y pr m ie unde l ng t t t or t nt ea i he t t e he ce s r e s ryi ha i em r tton ie.t tc nt ea i . , ha onduc i pr hi t d unl se es l a horze t s o bie es xpr sy ut i d. A le na i l Pr r s i post t t d he r alm otva i f t s l w s ti UR H e lh' t r tve y, og e s ve is ha i e t i ton or hi a ui s at s a pae tr s nme t t t P o r sie alg d y d e n t a pl t e (h M ut e P o e t e p rn e e t n ha r g e sv le e l o s o p y h te li r c dl pl r Pa ntRe ton Rullt di tci ng medi lpr des' ( ot a 3 (mpha i i yme duci e o agnosi/magi ca ovi r.' M . t e ss n orgnal)Ho ve,Pr esi ac ur tl not t tSeve i UR He t wee cor c t t ii l. we r ogr sve c aey es ha s l n f g a1h r re t ha Pr r sve was not a yi t g uli e Pr edur Pa ogesi ppl ng he M tpl oc e yment Re ton Rul t duci ej o dignosi i gi pr desa t tPr r sve mu ta y t g tpl Pr ed e Pa nt a tc/ma ng ovi r nd ha ogesi s ppl he Muli e oc ur yme Re tonRul t s hpr vi r,t r woul bezeor i af dedt UR Heat asars t' duci el o uc o des hee d r elef for o 1h e ul. ' (d (mp a i i o i ial)I o h rwo d , v ni t esauerq rd P o rsi et u iiete 1 e h ss n rgn l. n t e r s e e f h tt t e uie r g e sv o tlz h M uli e Pr e e Pa tpl oc dur ymentReduc i Rul f di nosi a i ng pr de s UR He lh' ton e or ag tc nd magi ovi r , at s t t lr mbur e twoul notcha o a ei s men d nge. UR He l sfn la g me t z .t a e e i Flrd ' p ro a ij r p oe to sau e at i a r u n- c, h t v n f o i as e s n l nu y r tcin ttt h' p nnte Pr g e sv t a pl t eg ut eP o e u ePa me tRe u to Rue fro l s me e itd o r si e o p y h M lpl r c d r y n d cin ll o ny o i pr de s çtmus pr d a ovi r , s i t ovi e dequae notc t t i ur dst ti wildo s ' f isf t s me t ie o he ns e ha t l o' al or he a r s .He e t UR He t ose i y i nt a ca e of a ton.Not ng i t gove i ea ons r oo, alh t nsbl nve s us ci hi n he m ng saut orKo tt e uzme nko' i ur nc polc r quiesPr es i t pr de s h notce oralows s ns a e iy e r ogr sve o ovi uc i l UR He 1h t r ove i t a enc oft tno i .To bes e tesau esae t a Sani u e at o ec r n he bs e ha tce ur , h ttt tts h tt l ns rr l ma lm i pa y i t ymenta a horz by t spar gr ph onl i t i ur e polc i l sa no i s ut ied hi a a y f he ns anc iy nc ude tce a t tm eofis e orr ne t tt i ur rm a lmi pa ntpur ua t t s he eof t he i s uanc e wal ha he ns e y i t yme s nt o he c dul c ag s s cfe i ti p r g a h' Fl.Stt An j 6 77 6 *( ) Ho v r P oge sv h r e pe iid n h s aa r p . a a. n. 2 .3 ( 5 . we e, r r sie ' s tsi d t tr r m e by i l ng lnguag i Kouz e si ur nc polc r s r i t aite ha equie nt ncudi a en m nko' ns a e iy e e vng he rgh t utlz t M uli ePr e e Pa ntRt ton Rul i t o ii e he tpl oc dur yme duc i e. l s t UR He 1h s e t r c n hor, at e ks o e overf a c e ofa ton t tdoe note s .I c nnot or aus c i ha s xit t a pr vai u ra consr ton of t c e l nde ny tuci he ompli bec us i has notplad c za e c am f a nt a e t e ogni bl l i or y ' r if Thus con r r t UR Heat sa ur s esi t tPr r sve sm oto t dim isi ele . , ta y o lh' bs d ugg ton ha og es i ' in o s s s pr m aur be a e i da nce a gume st tgo t t m e isoft cai s' t Cour mus e t e c us t tdva s r nt ha o he rt he l m , he ' t t dim ist c s s he ompli . a nt Concl on usi Fort r a ons dic s i i ADJ he e s s us ed, t s UDGED t tPr es i ' M oton t Dimi st ha ogr sve s i o s s he Ame edCls Aci Compli ( E.1 ,fldonNove r15. 7i GRANTED. nd a s ton ant D. 0) e mbe 201 s DO N E AN D O RDERED i Cha be satM i m i Fl i t s n m r a , orda, hi 6 / oJur21 fa a 08 ny . ..> ' .-' .* . .. ' ' . . ' r .r .. .: '. '.J. . r I. : ..e . >N w .d *. . o ). FED ERI CO .M O REN O 1 TE A TES D I STRI J DG E CT U Copi s f nihe t e ur s d o: Co e ofR e or uns l c d
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