United States: Air Ambulance Operators Granted Summary Judgment On ADA Preemption Grounds

Judith R. "Judy" Nemsick is a Partner in our New York office

The U.S. District Court for the Southern District of Florida recently issued a significant preemption decision in Bailey v. Rocky Mountain Holdings, LLC,1 a putative class action lawsuit in which the plaintiff sought declaratory and injunctive relief and damages based on allegations that air ambulance service providers' billing and collection practices violate various Florida laws. The preemption ruling signals a complete victory for the defendants, coming on the heels of the court's decision denying the plaintiff's motion for class certification.2 

The plaintiff contended that the defendants' invoices for air ambulance services violated Florida's Personal Injury Protection (PIP) Statute,3 Deceptive and Unfair Trade Practices Act (FDUPTA),4 and Consumer Collection Practices Act (FCCPA)5 on the basis that defendants were statutorily prohibited from seeking to collect amounts in excess of those permitted by statute from the individuals transported by air ambulance. 

Florida's PIP Statute requires motor vehicle insurance policies to include personal injury protection (PIP coverage) of at least $10,000 to cover medical bills arising from injuries sustained by a driver or passenger in a motor vehicle accident.6 Under the PIP statute, an emergency care provider "may charge the insurer and injured party only a reasonable amount," which, for emergency air transport, is limited to 200 percent of Medicare rates.7 The insurer may further limit coverage to 80 percent of this amount. The statute further states that the provider "may not bill or attempt to collect from the insured any amount in excess of such limits, except for amounts that are not covered by the insured's personal injury protection coverage due to the ... maximum policy limits."8  The parties disputed the interpretation of this exception and whether it permits the provider to bill the insured for amounts not covered by PIP coverage. 

In the instant case, the charges for the defendants' helicopter transport and emergency care services had exceeded the standard PIP policy limits of $10,000.  The defendants had invoiced the plaintiff and his motor vehicle and health insurers for the total amount of its emergency transport services.  The motor vehicle insurer paid according to the PIP statute and the health insurer paid a lesser amount.  The efendants thereafter billed the patient for the outstanding balance, which the plaintiff contended was prohibited by the PIP statute.   

In moving for summary judgment, the defendants argued that the plaintiff's claims (and that of the purported class) were completely preempted by the Airline Deregulation Act, which prohibits states from enforcing any law or regulation relating to an air carrier's price, route or service.9  The district court agreed, recognizing the "broad nature" of the ADA's express preemption clause. The court determined that "each of Plaintiff's state and common law claims can only be fairly characterized as directly challenging Defendants' rates for its air ambulance services." Such claims would "naturally affect" defendants' provision of air services in addition to the prices of and payment for these services. 

In deciding that the plaintiff's lawsuit "is essentially a state enforcement action" with a very strong connection to the price, route or service of an air carrier, the court concluded that the plaintiff's state and common law challenges are "expressly disallowed by the ADA's express preemption provision, which intentionally leaves the price of such services to the competitive market."10

Importantly, the court rejected the plaintiff's argument that the McCarran-Ferguson Act (MFA) reverse preempts the ADA. Under the MFA, state insurance regulations are insulated from implied preemption by federal legislation, i.e., from federal laws that are construed to "invalidate, impair or supersede" state laws enacted for the purpose of regulating the business of insurance.11  The court held that the MFA does not apply to cases where Congress has "made plain its intent to altogether preempt state laws." As explained by the court, "[t]he MFA was intended only to protect state insurance regulation from inadvertent intrusion by the federal government, and not to insulate the same from every federal law." Where the intended effect of a federal statute like the ADA is to displace state regulation, the court must enforce this intent, regardless of whether insurance is involved.12


1. No. 13-62447 (S.D. Fla. Sept. 23, 2015).

2. Bailey v. Rocky Mountain Holdings, LLC, No. 13-62447 (S.D. Fla. August 10, 2015).  The court determined that individualized issues predominated over common ones in the proposed classes.  Plaintiff has filed a notice of appeal of both decisions.

3. Fla. Stat. § 627.736.  The PIP Statute is part of Florida's Motor Vehicle No-Fault Law, Fla. Stat. § 627.730, et. seq.

4. Fla. Stat. §§ 501.211(1) and 501.203(3)(c) (prohibiting unfair or deceptive acts in trade or commerce).

5. Fla. Stat. §§ 559.72(9) and (18) (prohibiting a party from enforcing debts that it knows are not legitimate and from contacting an individual known to be represented by counsel).  Plaintiff also asserted a common law claim of unjust enrichment, which also was held preempted.

6. Fla. Stat. § 627.736(1).

7. Id. at § 627.736(5)(a)(1)(a).

8. Id. at § 627.736(5)(a)(4).

9. 49 U.S.C. § 41713(b)(1)

10. Citing Crane v. Native Am. Ambulance, Inc., No. CV 06-092, 2007 WL 625917 (D. Ariz. Feb. 23, 2007).  Defendants also argued that the claims were impliedly preempted by the Federal Aviation Act or, alternatively, that the PIP statute permitted balance billing of patients and insurers. 

11. 15 U.S.C. § 1011, et seq.

12. Citing Lander v. Hartford Life & Annuity Ins. Co., 251 F.3d 101, 116-17 (2d Cir. 2001).

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Similar Articles
Relevancy Powered by MondaqAI
In association with
Related Topics
Similar Articles
Relevancy Powered by MondaqAI
Related Articles
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Registration (you must scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.


The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.


Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions