11 Fla. L. Weekly Supp. 826a
Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — Summary judgment is granted in favor of insurer where medical provider did not object to reduction of medical bills after receiving explanation of benefits or request that unpaid portion of reduced bills be placed in escrow or reserved prior to exhaustion of policy limits, and there is no allegation of bad faith on part of insurer
HEARTLAND REHABILITATION SERVICES OF FLORIDA, INC., Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Clay County. Case No. 2003-1314-SC, Division C. June 24, 2004. Timothy R. Collins, Judge. Counsel: Michael H. Johnson, Kane & Kane, Boca Raton, for Plaintiff. Patrick J. Snyder, James C. Rinaman, III & Associates, P.A., Jacksonville, for Defendant.
ORDER GRANTING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
This cause came on to be heard upon the Defendant’s Motion for Summary Judgment, and the Court having reviewed the pleadings, Motion for Summary Judgment, Affidavit in support thereof, and having further considered argument of Counsel, finds that there is no genuine issue of material fact, and that the Defendant is entitled to a judgment as a matter of law. This Court’s findings of fact and conclusions of law are as follows:
1. Defendant Progressive Express Insurance Company (hereinafter referred to as “Progressive”) insured Rebekah Smithen under a policy of insurance which provided for PIP benefits of $10,000.00.
2. Rebekah Smithen received medical treatment, as a result of an automobile accident, from the Plaintiff, Heartland Rehabilitation Services of Florida, Inc. (hereinafter referred to as “Heartland”).
3. Between December 6, 2002, and January 16, 2003, Heartland rendered medical treatment to Rebekah Smithen.
4. Heartland submitted bills for medical services rendered to Rebekah Smithen pursuant to an assignment of benefits. Progressive paid medical bills on behalf of Rebekah Smithen to the Plaintiff as follows:
Date of Service Date Bill Received Date Bill Paid Amount Billed Amount Allowed Amount Disallowed Amount Paid 12/06/02 01/03/03 01/29/03 $275.00 $262.00 $13.00 $209.60 12/11/02 01/03/03 01/29/03 $605.00 $566.00 $39.00 $452.80 12/18/02 01/13/03 02/05/03 $690.00 $651.00 $39.00 $520.80 01/02/03 01/20/03 02/20/03 $570.00 $531.00 $39.00 $424.80 01/16/03 02/10/03 02/27/03 $230.00 $217.00 $13.00 $173.60 01/08/03 01/27/03 02/27/03 $570.00 $570.00 -0- $456.00 12/24/03 01/16/03 03/06/03 $650.00 $611.00 $39.00 $488.80 TOTALS $3,590.00 $3,408.00 $182.00 $2,726.40
5. Heartland was advised as to the reason for the reductions in an explanation of benefits which was sent to the Progressive along with payment for medical services provided.
6. On May 3, 2003, Progressive paid bills from other medical providers which exhausted the personal injury protection benefits of the insured’s policy.
7. Heartland did not object to the reduction of benefits paid on the above dates after having received the explanation of benefits, and did not request that any funds be placed in escrow or reserved prior to the exhaustion of the benefits.
8. There are no allegations of bad faith by Progressive.
9. Heartland received seven payments totaling $2,726.40 from Progressive for medical expenses of the insured; Progressive reduced six of these claims by a total of $182.00; and Heartland now alleges it is due $145.60 pursuant to an assignment of benefits.
10. Heartland did not have an insurance contract with Progressive and, as assignee, must rely upon the contract of insurance entered into by Rebekah Smithen with Progressive. Under an assignment, an assignee has no greater rights under the contract than those rights enjoyed by the assignor.
11. The insured/assignor contracted with Progressive to provide $10,000.00 in personal injury protection benefits. The Defendant, Progressive, has fully complied with this contract by providing the limits of its policy for the benefit of the insured. Since the insured would be precluded from seeking new benefits over and above the policy limits, her assignee should likewise be precluded. To require Progressive to make payments over and above the policy limits would result in a judicial creation of additional coverage and would obligate Progressive to pay more than its contract required.
12. This Court recognizes that it is appropriate to pay claims as they are received. Progressive properly considered the claim, made a reduction of benefits based upon what it determined to be a reasonable amount, and rendered to Heartland an explanation of the reduction in its explanation of benefits. In the absence of an objection by Heartland and if the reductions were not made in bad faith, it is reasonable for Progressive to timely pay other legitimate claims.
12. Numerous County and Circuit Courts throughout the State have addressed this issue with differing results. This Court finds the Appellate decision of the 13th Judicial Circuit in MTM Diagnostic, Inc. v. State Farm Mutual Automobile Insurance Company, 9 Fla. L. Weekly Supp. 581 (13th Judicial Circuit, 2000) to be the more persuasive of the Circuit Court Appellate cases. This decision was followed by the Honorable Robert Schwartz in Neuro-Imaging Associates, P.A. v. Nationwide Insurance Company of Florida, 10 [Fla.] L. Weekly Supp. 738 (Palm Beach County Court 2002) which sets forth an excellent analysis of the issues and a common sense approach to this problem. The Neuro-Imaging case was cited with approval by the Honorable Charles G. Cofer, in Wise Diagnostic Solutions vs. Nationwide Mutual Fire Insurance Company, 11 Fla. L. Weekly Supp. 440, (Duval County Court 2004); by the Honorable Peter Evans, in Simon vs. Progressive Express Insurance Company, 11 Fla. L. Weekly Supp 470 (Palm Beach County Court, 2004); and the Honorable Richard R. Townsend, in Heartland Rehabilitation Services of Florida, Inc. v. Nationwide Mutual Fire Insurance Company (Clay County Court, Case #2003-50-SC-D). This Court finds the opinions of Judge Schwartz, Judge Cofer, Judge Evans, and Judge Townsend to be highly persuasive. It is upon due consideration,
ORDERED:
1. The Defendant’s Motion for Summary Judgment is granted.
2. The Plaintiff, Heartland Rehabilitation Services of Florida, Inc., shall take nothing by its Complaint, and the Defendant, Progressive Express Insurance Company, shall go hence without day.
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