13 Fla. L. Weekly Supp. 996a
Insurance — Personal injury protection — Fraud — Section 627.736(4)(g), which provides that insured’s commission of insurance fraud related to PIP coverage will void coverage, is not applicable to, and does not provide remedy for, insurance fraud committed by medical provider/assignee
ALL FAMILY CLINIC OF DAYTONA BEACH, INC. D/B/A FLORIDA MEDICAL ASSOCIATES, AS ASSIGNEE OF ANN SOFIE FORS, Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 7th Judicial Circuit in and for Volusia County. Case No. 2005-33269 COCI. August 3, 2006. Stasia Warren, Judge. Counsel: Kimberly P. Simoes, Susan W. Tolbert, P.L., Daytona Beach. Robert A. Kingsford, Maitland.
ORDER ON MOTION FOR SUMMARY JUDGMENT
This action was heard on Plaintiff’s Motion for Summary Judgment and the Court having heard arguments of Counsel and being otherwise fully advised in the premises
IT IS ADJUDGED that:
1. Plaintiff’s motion for summary judgment is granted.
2. Defendant made demand of return of payments to the Plaintiff pursuant to Section 627.736(4)(g).
3. Florida Statutes Section 627.736(4)(g) states, inter alia:
Benefits shall not be due or payable to or on the behalf of an insured person if that person has committed, by a material act or omission, any insurance fraud relating to personal injury protection coverage under his or her policy, if the fraud is admitted to in a sworn statement by the insured or if it is established in a court of competent jurisdiction. Any insurance fraud shall void all coverage arising from the claim related to such fraud under the personal injury protection coverage of the insured person who committed the fraud, irrespective of whether a portion of the insured person’s claim may be legitimate, and any benefits paid prior to the discovery of the insured person’s insurance fraud shall be recoverable by the insurer from the person who committed insurance fraud in their entirety. The prevailing party is entitled to its costs and attorney’s fees in any action in which it prevails in an insurer’s action to enforce its right of recovery under this paragraph.
4. Pursuant to Florida Statutes 627.736, personal injury protection benefits are not due or payable on behalf of an insured person if the insured person has committed insurance fraud relating to pip coverage under his or her policy, if the fraud is admitted to in a sworn statement by the insured person or if it is established in a court of competent jurisdiction.
5. The conduct of a health care provider/assignee cannot void the insured’s coverage under 627.736(4)(g). An insurance carrier has specific remedies to address fraud by a health care provider or assignee.
6. F.S. Section 627.736(4)(g) is not applicable to and does not provide a remedy for an insurance carrier claiming insurance fraud by a health care provider/assignee.
