13 Fla. L. Weekly Supp. 177a
Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — Summary judgment — Factual issues — Where medical provider resubmitted claim after partial payment was made and prior to exhaustion of benefits, there remains question of fact as to whether insurer fulfilled obligation to make prompt payment of claims — If claim was not handled competently, insurer would be liable for additional money plus interest
GARY H. DIBLASIO, M.D., P.A., (a/a/o Margaret Connell), Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 15th Judicial Circuit in and for Palm Beach County, Civil Division RD. Case No. 502004SC010479XXXXSB. September 20, 2005. Debra Moses Stephens, Judge. Counsel: Matt Hellman, Plantation. Glen E. Siegel, Kane and Kane, P.A., Boca Raton.
ORDER DENYING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS Court denies Defendant’s Motion For Summary Judgment. The court is mindful of the decision made in Simon v. Progressive, (opinion filed May 4, 2005), but finds that it does not apply because the facts are somewhat different.
In Simon, the Plaintiff accepted partial payment and failed to resubmit his claim before benefits were exhausted. In the instant case the claim was resubmitted on September 23, 2004. Benefits were not exhausted until January, 2005 for the insurance and May, 2005, for Med Pay. Therefore, there remains a question of fact for the jury as to whether the insurance company fulfilled its obligation under the “prompt pay” provision of Fla. Stat. §627.613 and 627.662(7). “It is the obligation of insurance companies to settle as many claims as possible. It is also a prerogative of insurance companies to pay, reduce or deny claims.” Simon quoting Farinas v. Fla. Farm Bureau Gen. Ins. Co., 850 So.2d 555, 560 (Fla. 2003).
This brings the court to the final issue. If the claim was not handled competently, then the insurance company would have to pay the additional money plus interest.
Based on the foregoing, it is
ORDERED AND ADJUDGED that the Motion For Summary Judgment is DENIED.
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