11 Fla. L. Weekly Supp. 1092a
Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — Subsequent claim for unpaid portion of bills — Where uncontradicted affidavit of PIP litigation specialist states that insurer made reasonable payments to different providers including plaintiff until such time as benefits were exhausted, there is no genuine issue of fact as to whether insurer acted in good faith in making payments, and summary judgment is granted in favor of insurer
BACK IN ACTION HEALTH, LLC, Plaintiff(s), vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant(s). County Court, 15th Judicial Circuit in and for Palm Beach County. Case No. 502001CC012841XXS2RE. September 17, 2004. Deborah D. Pucillo, Judge. Counsel: Jeff Vastola, West Palm Beach. Lynne M. French, Adams, Blackwell & Diaco, P.A., Miami.
ORDER GRANTING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS CAUSE came before the Court on Defendant’s Motion for Summary Judgment. The Court reviewed Defendant’s motion, the Affidavit of Nora Santana, Litigation Specialist for Progressive Express Insurance Company, Plaintiff’s Response to Defendant’s Motion for Summary Judgment, the Court file, arguments of counsel and all authority cited, Plaintiff did not submit an Affidavit in opposition to the Motion for Summary Judgment.
Facts
The facts in this case are not in dispute. Plaintiff received an assignment of benefits from Defendant’s insured Heather Broyles. Ms. Broyles assigned to Defendant her rights pursuant to an automobile insurance policy that provided $10,000 of personal injury protection benefits with no deductible. Plaintiff submitted medical bills to Defendant for payment. Defendant processed all bills submitted by Plaintiff and made payment within thirty (30) days. With respect to any bills submitted by Plaintiff which were not paid in their entirety, Defendant had reasonable proof to not make payment in full “based upon a review by an independent review company indicating the medical bills submitted were not for appropriate coding, were not reasonable or did not contain the proper supporting documentation” Affidavit of Nora Santana. The pay-out sheet indicates that Defendant paid all providers in the order requests were received and that many amounts paid to providers other than Plaintiff were for less than the amount billed. On or about October 28, 2003, Defendant had paid out more than the statutory and contracted limit of $10,000 thereby exhausting Ms. Broyles PIP benefits. It is undisputed that the Defendant treated Plaintiff in the same manner as it treated other providers in this case. There is no allegation or evidence that Defendant acted in bad faith in paying less than the entirety of some of Plaintiff’s bills. Some of Plaintiff’s bills were paid in full.Defendant Is Entitled to Summary JudgmentBecause the PIP Benefits Were Exhausted in Good Faith
Plaintiff as an assignee enjoys no greater rights than the assignor, Ms. Broyles. It is agreed in this case that the Defendant has satisfied its contractual obligation to pay $10,000.00 of PIP Broyles behalf. “In the absence of a showing of bad faith on the part of the Defendant, the Defendant cannot be required to pay an amount greater than the contractual coverage set forth in the insurance policy. State Farm Mutual Insurance Company v. Horkheimer, 814 So.2d 1069, 1071 (Fla. 4th DCA 2001), rev. denied, 835 20 2d 266 (Fla. 2002). In this case, Plaintiff has not alleged that Defendant acted in bad faith in making any of the payments, including the reduced payments to Defendant or any other provider. The uncontradicted affidavit of Defendant’s litigation specialist states that Defendant made reasonable payments to different providers including Plaintiff pursuant to Ms. Broyles PIP policy and pursuant to Florida Statute 627.736 until such time as the benefits were exhausted. There is no genuine issue of fact as to whether Defendant acted in good faith in this case.
WHEREFORE, it is hereby
ORDERED AND ADJUDGED that Defendant Motion for Summary Judgment is hereby GRANTED.
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