10 Fla. L. Weekly Supp. 1018b
Insurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where insured’s PIP benefits were exhausted after medical provider filed suit against insurer, medical provider did not instruct insurer not to pay other PIP benefits until benefits claimed by provider had been adjudicated or amend complaint to specify any particular bills at issue and that any particular amount was to be retained, and there is no evidence that insurer’s exhaustion of benefits was taken in bad faith, medical provider has no cause of action against insurer for recovery of benefits
ORTHOPAEDIC SPECIALTIES OF TAMPA BAY, P.A., on behalf of DEBORAH RATH, Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 6th Judicial Circuit in and for Pinellas County. Case No. 02 8316 SC NPC. October 8, 2003. William B. Blackwood, Judge. Counsel: R. Stanley Gipe. Chandra L. Miller, Thompson Goodis Thompson Groseclose & Richardson, P.A., St. Petersburg.
ORDER GRANTING SUMMARY JUDGMENT
THIS MATTER came to be heard at Defendant’s Motion for Summary Judgment on September 29, 2003. The Court, having considered the argument of counsel, caselaw, and the affidavits and discovery, which was referenced by counsel in their argument. The Court thereupon found and ruled as follows:
1. The issue in this case is sufficiently crystalized to permit the Court to rule on the issue of Defendant’s liability for medical benefits as a matter of law. The undisputed material facts are as follows:
a. Plaintiff is a health care provider that took an assignment of benefits from the Defendant’s insured. A copy of the assignment was attached to Plaintiff’s Complaint marked Exhibit “A”. The Plaintiff has demanded payment for certain medical care and treatment rendered to the Defendant’s insured. The insured’s personal injury benefits were exhausted on February 22, 2003, after suit was filed. Defendant filed their Motion for Summary Judgment on March 27, 2003.
b. There is no evidence that the Plaintiff specifically instructed the Defendant not to pay other personal injury protection benefits until the benefits claimed by Plaintiff had been resolved or adjudicated.
c. Although Plaintiff’s Complaint was filed in October, 2002, and could have been subsequently amended, Plaintiff did not specify any particular bills which were at issue, and that any specific amount was to be retained.
d. There is no evidence that Defendant’s exhaustion of the insured’s benefits was taken in bad faith. To the contrary, the Defendant was obligated by law and contract to pay benefits in a timely fashion and did so, thereby exhausting the insured’s benefits.
2. The Court recognizes that under an assignment of benefits, the assignee obtains no greater rights under the contract than those rights enjoyed by the assignor. The assignee’s interest are extinguished when the interests of the assignor are extinguished. As such, when PIP benefits are exhausted, the insured has no further interest in the contract. To hold otherwise would create additional coverage and make Progressive responsible for more than what it was obligated to by the contract/policy of insurance. As the assignee of the insured, the Plaintiff is not entitled to receive any more than the insured is entitled.
3. Further, the Court recognizes that Defendant is not responsible for Plaintiff’s cost and fees in prosecution as Defendant is not liable for amounts in excess of the contract/policy so long as benefits were exhausted in good faith.
4. This Court has been advised of the case of Ruby Randal v. Allstate Insurance Company, 7 Fla. L. Weekly Supp. 301a (6th Judicial Circuit, Appellate, 1996) and finds this case distinguishable on the basis that Plaintiff did not request disputed benefits be set aside or escrowed.
WHEREFORE, this Court finds that the undisputed material facts indicate that Plaintiff has no cause of action for recovery of benefits, as Plaintiff’s assignor’s benefits have been exhausted and Defendant has fulfilled its obligations pursuant to Florida law. It is further
ORDERED AND ADJUDICATED that the Defendant’s Motion for Summary Judgment be and the same is herewith granted. The parties are responsible for their own costs and fees. Judgment shall be entered in favor of the Defendant.
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