16 Fla. L. Weekly Supp. 364a
Online Reference: FLWSUPP 164MCCOR
Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — In absence of showing of bad faith, exhaustion of benefits extinguished any interest of insured and medical provider/assignee in benefits — There is no requirement that insurer set aside reserve fund for claims that are reduced or denied
DAVID A. LIBERT, M.D.d/b/a FIRST CHOICE MEDICAL CENTER, As assignee of Marc McCorkle, Plaintiff, v. USAA CASUALTY INSURANCE COMPANY, Defendant. County Court, 18th Judicial Circuit in and for Seminole County. Case No. 07-SC-5905-19-P-S. December 15, 2008. Donald L. Marblestone, Judge. Counsel: Tom Player and Justin Howard Presser, Weiss Legal Group, P.A., Maitland. Wendy L. Pepper, Rissman, Barrett, Hurt, Donahue & McLain, P.A., Tampa.
ORDER GRANTING DEFENDANT’S MOTION FOR FINAL SUMMARY JUDGMENT ON EXHAUSTION OF BENEFITS
THIS CAUSE having come to be heard on November 24, 2008, upon Defendant’s Motion for Final Summary Judgment, and this Court, having reviewed the file, considered the argument and pleadings submitted by the parties, and being otherwise fully advised in the premises:
IT IS HEREBY ORDERED and ADJUDGED that:
1. Plaintiff’s Renewed Motion for Continuance of Hearing is hereby DENIED.
2. Defendant’s Motion for Final Summary Judgment on exhaustion of benefits is hereby GRANTED.
3. Marc McCorkle was insured under a policy of insurance issued by USAA. This policy was in full force and effect on the date of the alleged accident and provided Ten Thousand Dollars ($10,000.00) in Personal Injury Protection (hereinafter “PIP”) benefits and Two Thousand Dollars ($2,000.00) in Medical Payments coverage (hereinafter “MedPay”).
4. Marc McCorkle assigned his benefits under this PIP policy of insurance to DAVID A. LIBERT, M.D., d/b/a FIRST CHOICE MEDICAL CENTER.
5. Plaintiff, DAVID A. LIBERT, M.D., d/b/a FIRST CHOICE MEDICAL CENTER as assignee of Marc McCorkle, (hereinafter “DAVID A. LIBERT”), originally filed suit on or about January 10, 2008 for reductions made by USAA during the processing of Plaintiff’s medical bills. An Amended Complaint was filed on or about August 1, 2008.
6. PIP and MedPay benefits under this policy of insurance were exhausted to a provider other than Plaintiff on August 21, 2008.
7. An insured cannot gain more from the insurance company than the contractual benefit amount in the absence of showing bad faith on the part of the insurer. See Progressive v. Stand-Up MRI (a/a/o Eusebio Isaac), 990 So.2d 3 (Fla. 5th DCA 2008); and GEICO v. Robinson, 581 So.2d 230 (Fla. 3rd DCA 1991); See also Allstate v. Shilling, 374 So.2d 611 (Fla. 4th DCA 1979); Atkins v. Bellefonte Insurance Co., 342 So.2d 837 (Fla. 3rd DCA 1977); Dixie Insurance Co. v. Lewis, 484 So.2d 89 (Fla. 2nd DCA 1986).
8. Based on the evidence presented at the hearing, this Court finds that there was no prima facie evidence of bad faith on the part of USAA.
9. Marc McCorkle entered into a contract with USAA for Ten Thousand Dollars ($10,000.00) in PIP benefits and Two Thousand Dollars ($2,000.00) in MedPay benefits. When the PIP and MedPay benefits were exhausted, Marc McCorkle received the maximum benefit of the policy from which he sought benefits.
10. When PIP and Med Pay benefits are exhausted, the insured and/or assignor has no further interest in the contract. To hold otherwise would create additional coverage and make the insurer responsible for more than which it was obligated by the policy of insurance. See MTM Diagnostic, Inc, etc., v. State Farm Mutual Automobile Insurance Co., 9 Fla. L. Weekly Supp. 581e (Hillsborough Cir. Ct., November 20, 2000).
11. Additionally, there is no requirement that an insurance company set aside a reserve fund for claims that are reduced or denied. See Progressive v. Stand-Up MRI (a/a/o Eusebio Isaac),990 So.2d at 5; and Dr. Robert D. Simon, M.D., PA, a/a/o Eric Hon, v. Progressive Express Insurance Company, 904 So.2d 449 (Fla. 4th DCA 2005). See also Nu-Best Whiplash Injury Center, Inc. a/a/o Shelia Tutor v. Progressive Auto Pro Insurance Company, 13 Fla. L. Weekly Supp. 830c (Hillsborough Cty. Ct., May 24, 2006). One of the obligations of an insurance company is to attempt to settle as many claims as possible. See Simon, 904 So. 2d at 449 citing Farinas v. Florida Farm Bureau General Insurance Co., 850 So.2d 555 (Fla. 2003). The court in Simon further stated: “It is also a prerogative of insurance companies to pay, reduce, or deny claims.” Id.
12. In the matter before this Court, USAA exercised its prerogative by denying and/or reducing the claim of the Plaintiff. USAA had no obligation to set aside any funds, despite this litigation. USAA continued to exercise its prerogative to pay, reduce or deny until such time as its obligation under the policy of Marc McCorkle was fulfilled.
13. Thus, because USAA’S PIP policy limit of $10,000.00 and MedPay policy limit of $2,000.00 was met, Marc McCorkle’s interest in the benefits, as well as that of any medical providers who may hold an assignment of those benefits, has been extinguished.
14. DAVID A. LIBERT, M.D., d/b/a FIRST CHOICE MEDICAL CENTER as assignee of Marc McCorkle, shall take nothing by this action and Defendant, USAA CASUALTY INSURANCE COMPANY, shall go hence without day.
15. The Court shall retain jurisdiction to determine Defendant, USAA CASUALTY INSURANCE COMPANY’s entitlement to attorney’s fees and costs.
