15 Fla. L. Weekly Supp. 1010a
Insurance — Personal injury protection — Declaratory judgment — Coverage — Where medical provider has failed to allege basis for doubt as to whether there is coverage, and insurer has raised no coverage defenses, summary judgment is entered in favor of insurer on claim for declaratory relief as to coverage — Where insurer paid charges until exhaustion of policy limits, there has been no breach of policy — Explanation of benefits — Where insurer did not reduce, omit or decline any payments to provider, failure to provide EOB did not constitute breach of contract
MRI ASSOCIATES OF SPRING HILL, INC. d/b/a SPRING HILL MRI, as Assignee of Omar Paulino Alcantara, Plaintiff, v. MGA INSURANCE COMPANY, Defendant. County Court, 13th Judicial Circuit in and for Hillsborough County, Civil Division. Case No. 08 06245, Div. H. June 24, 2008. Eric R. Myers, Judge. Counsel: Scott W. Dutton, Haas, Dutton & Lewis, P.L., Tampa, for Defendant. Timothy Patrick, Nicholas, Lipscomb & Patrick, P.A., Tampa, for Plaintiff.
SUMMARY JUDGMENT
This matter came on to be heard on June 4, 2008 on various motions filed by the Defendant, MGA INSURANCE COMPANY, to include a Motion to Dismiss Plaintiff’s Complaint or, in the Alternative, Motion for Judgment on the Pleadings or, in the Alternative, Motion for Summary Judgment. After reviewing the Court’s file, the record on file with the Court, and considered argument of counsel it is ORDERED AND ADJUDGED that the Defendant’s Motion for Summary Judgment is granted on the following grounds:
1. This case involves an alleged dispute over personal injury protection benefits.
2. The Plaintiff, MRI ASSOCIATES OF SPRING HILL, INC., d/b/a Spring Hill MRI, as Assignee of Omar Paulino Alcantara, sued the Defendant in a three-count Complaint. In Count I the Plaintiff alleged a claim for “Declaratory Relief — Coverage,” in Count II the Plaintiff alleged a claim for Breach of Contract for “Failure to Properly Reimburse Personal Injury Protection Benefits,” and Count III the Plaintiff alleged a breach of Section 627.736(4)(b) of the Florida Statutes as more fully set forth below:
COUNT I — PETITION FOR DECLARATORY RELIEF — COVERAGE
3. The basis for the claim for declaratory relief appears to be plead in paragraphs 12 and 14.
4. As to paragraph 12, the Plaintiff states that they “attempted to comply” with the pre-suit requirements found in Section 627.736(11) (the fifteen-day demand letter).
5. The Plaintiff alleges that the Defendant “failed to provide a response to Plaintiff’s fifteen-day demand letter.”
6. Although there is no duty to respond under Section 627.736(11) (2007), nevertheless the Defendant did file a response as set forth in a January 3, 2008 letter of Sandra Di Mare, the Defendant’s PIP Litigation Supervisor.
7. In paragraph 14 the Plaintiff alleges they are in doubt as to whether or not there is coverage, but again the Plaintiff has failed to allege any basis for their “doubt” about coverage.
8. The Defendant responded to his allegation as set forth in the Affidavit of Ms. DiMare that the Defendant has not raised any coverage defenses which would apply to the Plaintiff’s claim.
9. In sum, Count I of Plaintiff’s Complaint does not raise any factual or legal basis which requires this Court’s attention to declare or determine any rights, status, or other legal or equitable relations between the parties under Section 627.736 such as alleged by the Plaintiff
10. Thus Summary Judgment is entered on Count I in favor of the Defendant.
COUNT II — BREACH OF CONTRACT — FAILURE TO PROPERLY REIMBURSE PERSONAL INJURY PROTECTION BENEFITS
11. This claim alleges that it is an action in the amount of $1,070.78 for overdue no-fault benefits, interest on overdue no-fault benefits, and penalty and interest on late payment of no-fault benefits, for date of service 11/07/07.
12. In paragraph 29 the Plaintiff alleges that the Defendant did not make payment of all of the no-fault benefits, statutory interest, penalty, and postage due under the policy as required by Section 627.736(4)(b) and Florida Statute Section 627.736(11).
13. From the records before this Court, this allegation is false.
14. Rather, the Defendant paid the charges at issue as evidenced in the Affidavit of Ms. DiMare, PIP payout log and draft tendered by the insurer on December 7, 2007 as deposited by the Plaintiff, twenty (20) days before the date of the pre-suit demand letter addressed to the Defendant.
15. Upon payment of $1,056.06, benefits under the subject policy issued to the Plaintiff’s Assignor, Omar Paulino Alcantara, benefits were exhausted as of December 7, 2007.
16. Contrary to the allegations contained in Plaintiff’s Complaint, the Plaintiff’s charges were paid subject to the available benefits.
17. In sum, there has been no breach of the policy as alleged by the Defendant and that the total amount of available benefits were paid to the Plaintiff so that benefits were ultimately exhausted as of December 7, 2007.
18. Thus Summary Judgment is entered on Count II in favor of the Defendant.
COUNT III — BREACH OF CONTRACT — FAILURE TO COMPLY WITH FLORIDA STATUTE, SECTION 627.736(4)(b)
19. This Count alleged in paragraph 27 that within thirty (30) days of receipt of request for medical reimbursement from the Plaintiff, the Defendant did not provide an itemized specification or explanation (EOB) of each item that the insurer had reduced, omitted, or declined to pay pursuant to Section 627.736(4)(b) of the Florida Statutes.
20. In response, the Defendant urged that they did not “reduce, omit, or decline” to pay any payments to the Plaintiff.
21. Rather, all available benefits were paid to the Plaintiff on a timely basis on December 7th as set forth in the attached Affidavit of Ms. Dimare and PIP Log thereby exhausting the remaining available benefits.
22. Thus Summary Judgment is entered on Count III in favor of the Defendant.
Defendant having moved the court for a summary judgment, and it appearing to the Court that there is no genuine issue as to any material fact and that the Defendant is entitled to a judgment as a matter of law, it is
ORDERED AND ADJUDGED, that Summary Judgment is granted hereby in favor of defendant against Plaintiff, and that the Defendant shall go hence without day, with the Court reserving jurisdiction on fees and costs to the Defendant.
