11 Fla. L. Weekly Supp. 470a
Insurance — Personal injury protection — Coverage — Medical bills — Exhaustion of policy limits on subsequently submitted bills — Insurer who pays reduced amount for medical bills is not liable for reduced portion of charge where policy limits have been exhausted before notice of challenge to reduced payment is made by provider — Summary judgment in favor of insurer granted — Question certified
ROBERT D. SIMON, (Eric Hon), Plaintiff(s), vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendants(s). County Court, 15th Judicial Circuit in and for Palm Beach County. Case No. 50 2002 CC 029872 RJ. Division RJ. January 30, 2004. Peter M. Evans, Judge. Counsel: Jeff Vastola, West Palm Beach, for Plaintiff. Heather A. Wallace, Williams, Leininger & Cosby, P.A., West Palm Beach, for Defendant.
AFFIRMED. 30 Fla. L. Weekly D1156b
FINAL SUMMARY JUDGMENT FOR DEFENDANT
THIS MATTER came before the Court for hearing on Defendant’s Motion for Summary Judgment. Both parties were present. The Court has considered the arguments and authority submitted by the parties. See, Neuro-Imaging Associates, P.A. v. Nationwide Insurance Co., 10 Fla. L. Weekly Supp. 738a, (15th Judicial Circuit Appellate-Civil); Robert C. Nucci, M.D. v. Progressive Express Insurance Co. (Pinellas County, August 18, 2003, Judge Karl Grube). The Court has reviewed the several cases cited by Plaintiff which would require an insurer to set aside “reserves” each time a claim is reduced based upon the criteria set forth in the no fault statute. If the Plaintiff’s argument is applied it would result in a situation where the insurer would be risking further exposure, over and above their policy benefits, every time it reduced a claim and subsequent claims are made which would exhaust policy limits. The cases referred to by Plaintiff would suggest that as long as the insured or medical care provider acting by virtue of an assignment, filed a claim within the statute of limitations period, the insurance company could be required to pay even if all benefits were exhausted. The situation would result that all payments requested subsequent to the reduction or denial would be held in limbo until the statute of limitations period expired, or suit was filed and concluded. In the argument set forth by Plaintiff, this would apparently result whether the insurer did or did not have notice of the challenge to the reduction prior to paying a bill to a subsequent provider. The resulting confusion would make it impossible for an insurer to act properly in handling the PIP claim. The Court does not believe that this is the legislative intent behind the statute. Based upon the foregoing, it is thereupon;
ORDER AND ADJUDGED that Defendant’s Motion for Summary Judgment is GRANTED. Plaintiff, ROBERT D. SIMON, (Eric Hon), take nothing by this action and that Defendant, PROGRESSIVE EXPRESS INSURANCE COMPANY shall go hence without day. It is further;
ORDERED AND ADJUDGED that the Court finds that this issue has potential effect on judgments throughout the State of Florida and there does not seem to be any decisions of any of the District Courts of Florida on this issue. The judges of the County Courts are in need of guidance as to how to proceed on this issue and until such time as a District Court rules there will be conflicting decisions throughout the state. There continues to be disagreement even within the same counties. The County Courts are in need of a decision on this topic. In addition, the public and insurance companies are in need of guidance to determine how to handle these matters in the future. Until such time as a decision is rendered by the District Court of Appeals or Supreme Court, this issue will result in conflicting decisions and much confusion in the handling of these cases. This will have serious impact on injured citizens throughout the State of Florida and the issue needs to be resolved. The Court certifies the following issue to be of great public importance and certifies the following issue to the District Court of Appeals: Is an insurer, who pays a properly submitted bill for services under the PIP Statute, and makes a reduction based on criteria set forth in the PIP statute, potentially liable for the “reduced” portion of the charges, after all remaining benefits are processed and/or paid to other medical care providers, before notice of the challenge is made by the provider challenging the reduction of benefits?
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