11 Fla. L. Weekly Supp. 440c
Insurance — Personal injury protection — Coverage — Medical bills — Exhaustion of policy limits on subsequently submitted bills — Where insurer exhausted all PIP benefits on medical bills submitted by other providers after making partial payment of provider/assignee’s bill, assignee did not provide insurer with notice requesting that disputed amount be reserved or escrowed prior to filing suit, and policy does not require insurer to preserve funds for payment of balance of medical bill after making partial payment, summary judgment is granted in favor of insurer
WISE DIAGNOSTIC SOLUTIONS, (as assignee of Gilberto Herdocia), Plaintiff, vs. NATIONWIDE MUTUAL FIRE INSURANCE COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 02-05476-CC-DIV-H. March 17, 2004. Charles G. Cofer, Judge. Counsel: Kevin J. Loftus. Hanton Walters, Capito & Polk, Longwood.
ORDER ON DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS MATTER having come on for hearing on February 18, 2004 on Defendant’s Motion for Summary Judgment in the above-styled matter, and the court having examined the entire court file, having heard arguments of counsel, having reviewed the case law tendered to the Court by counsel and being otherwise fully advised, hereby makes the following findings and/or rulings:
1. Gilberto Herdocia was insured under Oscar D. and Joanna M. Herdocia’s policy with the Defendant, Nationwide, for personal injury protection coverage.
2. The policy provided $10,000.00 in personal injury protection benefits. Medical benefits were to be paid at 80% and wage loss at 60%.
3. On September 1, 2001, Gilberto Herdocia was involved in an automobile accident, in which he suffered injuries and sought treatment from the Plaintiff, Wise Diagnostic Solutions.
4. Gilberto Herdocia completed an assignment appointing the Plaintiff and authorizing them to institute an action under said policy of insurance for treatment rendered by the Plaintiff related to the motor vehicle accident in question.
5. The only substantive benefits issue in this case involves Defendant’s denial of the Plaintiff’s bill for range of motion testing for date of service March 3, 2002 in the amount of $1220.00 based on a peer review concluding the charge was not reasonable, necessary nor related to the motor vehicle accident in question.
6. On May 2, 2002, the Plaintiff, Wise Diagnostic Solutions, filed a lawsuit requesting monies due for date of service March 3, 2002 for treatment rendered to Gilberto Herdocia under Oscar D. and Joanna M. Herdocia’s policy with Defendant, Nationwide.
7. At no time prior to the filing of this action did the Plaintiff provide Nationwide with any notice requesting the amount at issue be reserved or escrowed.
8. Nationwide received and paid medical bills submitted by other providers as outlined in the PIP log that was made part of the court file.
9. By paying the bills, Nationwide exhausted all of the PIP benefits contained in Oscar D. and Joanna M. Herdocia’s policy on September 16, 2002 for the motor vehicle accident of September 1, 2001.
10. Under Florida Law, an assignment gives an assignee no greater rights against the principal debtor and those held by the assignor.
11. The assignee in this case succeeds to the assignor’s rights and takes with it all of the burdens to which it is subjected, including the right of the debtor to pay.
12. Nowhere in the policy of Oscar D. and Joanna M. Herdocia does it require Nationwide to preserve any funds after they make payment in part under the provisions of the policy.
13. The Court finds that the Defendant’s exhaustion of benefits via payment to other providers was proper under the terms of Defendant’s insurance policy and in accordance with Florida Statute section 627.736.
14. This Court looked to the reasoning of the County and Circuit Courts and found Neuro-Imaging Associates, P.A. v. Nationwide Insurance Company of Florida, Inc., 10 Fla. L. Weekly Supp. 738a(Fla. 15th Judicial Circuit 2002) persuasive and in agreement with the Court’s analysis.
IT IS THEREFORE
ORDERED and ADJUDGED that Defendant’s Motion for Summary Judgment is GRANTED, based upon the exhaustion of PIP benefits available under the subject insurance policy with Defendant.
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