Florida/Georgia Personal Injury & Workers Compensation

...automatically amended to meet minimum requirements of the statute. The policy contained a "1st renewal" date of 2/6/91, and continued in effect every six months thereafter. Bell moved for judgment arguing its entitlement to payment based in part on section 627.94071(2), effective October 1, 1992, which specifically invalidates the policy clause upon which the insurer successfully relied below: Minimum standards for home health care benefits A long-term care insurance policy ......

...(2) Requiring that the insured or claimant first or simultaneously receive nursing or therapeutic services in a home setting or community setting before home health care services are covered. (Emphasis added). Bell argued that since Beckerman's policy had been "renewed" a number of times after the 1992 effective date of section 627.94071, the section applied in 2005 and 2006 when the services at issue were rendered....

...Appleman, Insurance Law and Practice, § 7041, at 175-76 (1981) (observing "where an existing policy is renewed, although the results vary, the better rule is to regard the statute as applicable to the extended contract"). By the time Bell rendered the services at issue to Beckerman, section 627.94071 had been in effect for some thirteen years and her policy had been repeatedly "renewed" with full payment of all the premiums....

...Because the decision to raise renewal rates was thus left in the hands of the insurer, so long as it provided its insured's timely notification and treated holders of the same type of policies in the same manner, in accordance with Moore, no unconstitutional impairment of contract resulted from the application of section 627.94071 to Beckerman's policy....

...This is precisely the type of *19 financial incentive for a health care provider that the legislature determined is harmful to the public's safety and welfare. (Emphasis added). We consider the stratagem involved here just as unacceptable. And, again, its harmful nature is supported by the legislature's enactment of section 627.94071, which, of course, specifically bars that result....

...Hous. Corp., 737 So.2d 494, 499 (Fla.1999), that rule does not apply. Bell seeks to recover for services provided to the insured in 2005 and 2006. These dates of service did not occur and were not completed until many years after the 1992 creation of section 627.94071. Thus, in order to invalidate conditions of the Continental policy, we do not apply the statute retroactively. IV. Accordingly, we hold that Continental was required to comply with section 627.94071....

...organization that specializes in giving nursing care or therapeutic services in the home that is licensed to provide such care or services." Even though Chouloute was licensed as a CNA, Bankers Life stated that "an independent caregiver is not covered under the policy." Section 627.94071, Florida Statutes (2015), provides the "Minimum standards for home health care benefits." The statute sets forth requirements for policies containing a home health care benefit, stating as follows: A long-term care insurance p...

...(8) Requiring that the insured/claimant have an acute condition before home health care services are covered. (9) Limiting benefits to services provided by Medicare- certified agencies or providers. (10) Excluding coverage for adult day care services. § 627.94071. The key statutory language at issue here is the requirement that long-term care insurance policies, certificates, or riders "must meet or exceed the minimum standards specified in this section" and may not exclude benefits by "[e]x...

...Co., 25 So. 3d 13, 15 (Fla. 3d DCA 2009) (quoting Metro. Prop. & Liab. Ins. Co. v. Gray, 446 So. 2d 216, 218 (Fla. 5th DCA 1984)). Walker entered into the policy agreement with Bankers Life on June 27, 1996, and he renewed the policy annually. Thus, section 627.94071(6), which provides that a long-term care policy "that contains a home health care benefit must meet or exceed the minimum standards specified in this section," is applicable to Walker's policy. Insurers must "make clear precisely what is excluded from coverage." Bell Care, 25 So....

...provider eligibility for the performance of such services under a Home Health Care Plan and that the Home Health Aide to be on staff with a Home Health Care Agency or nurse registry listed in Florida under Chapter 400." However, as noted previously, section 627.94071(6) provides that a policy's home health care benefit "must meet or exceed the minimum standards specified in this section" and may not exclude benefits by "[e]xcluding coverage for personal care services provided by a home health aide." The policy language here is inconsistent with the statutory definition of a home health care aide, effectively restricting 5 coverage rather than meeting or exceeding the minimum standards established by section 627.94071(6)....

...further proceedings. Reversed and remanded. CASANUEVA, J., Concurs. LABRIT, J., Dissents with opinion. LABRIT, Judge, Dissenting. Because the long-term care policy at issue did not "[e]xclud[e] coverage" for home health aide services as section 627.94071(6), Florida Statutes (2015), proscribes, I respectfully dissent. The policy, as amended via rider, includes the following as "COVERED EXPENSES": Charges for the following services and supplies under a written Home Hea...

...It isn't, so the traditional tenets of policy interpretation that largely favor insureds don't apply. Cf. Flores v. Allstate Ins. Co., 819 So. 2d 740, 744 (Fla. 2002) (explaining fundamental principles of policy interpretation). The 6 question is instead whether section 627.94071(6) invalidates the policy language above and precludes final summary judgment for the insurer. Based on the statutory text, I conclude that it doesn't. Several years ago, there was a paradigm shift in our jurisprudence that changed how courts must interpret statutes....

...t meanings were intended." Burgess v. State, 198 So. 3d 1151, 1157 (Fla. 2d DCA 2016) (first citing Reiter v. Sonotone Corp., 442 U.S. 330, 339 (1979); and then quoting Maddox v. State, 923 So. 2d 442, 446 (Fla. 2006)). Here, the whole text of section 627.94071 is enlightening, and it's determinative in my view....

...(8) Requiring that the insured/claimant have an acute condition before home health care services are covered. (9) Limiting benefits to services provided by Medicare- certified agencies or providers. (10) Excluding coverage for adult day care services. § 627.94071....

...Subsection (6) specifically prevents an insurer from "[e]xcluding coverage" for home health aide services. See id. We must interpret this subsection in context, and there are numerous clues that tell us what it means—and doesn't mean. For one thing, section 627.94071 conspicuously uses different terms to describe the various things it prohibits....

...The policy language at issue is much 9 more akin to a limitation or restriction on coverage for home health aide services, as opposed to an exclusion that bars or prevents these services from being covered altogether. And section 627.94071(6) plainly precludes an exclusion, not a limitation.1 For these reasons, I agree with the trial court that section 627.94071(6) does not prevent an insurer from placing certain limitations or parameters on home health aide coverage....

...The policy here contained limitations but did not "[e]xclud[e] coverage" as the statute contemplates, so I would affirm the judgment the trial court entered. Opinion subject to revision prior to official publication. 1 I am mindful that section 627.94071 requires a long-term care policy to "meet or exceed the minimum standards specified in this section." But the policy meets these standards because it does not exclude coverage for home health aide services and instead includes them as covered expenses with restrictions, which the text of section 627.94071(6) does not prohibit. 10