16 Fla. L. Weekly Supp. 973a
Online Reference: FLWSUPP 1610AGTE
Insurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Once benefits have been exhausted, medical provider is not entitled to recover unless it can show that insurer acted in bad faith in denying claim — Denial of claim based on insufficiencies in disclosure and acknowledgment form cannot be in bad faith where there is case law which supports denial
MRI ASSOCIATES OF FLORIDA, INC., as assignee of Cristie Agtey, Plaintiff(s), vs. USAA CASUALTY INSURANCE COMPANY, Defendant(s). County Court, 17th Judicial Circuit in and for Broward County. Case No. 08-02281 COCE 56. August 11, 2009. Linda R. Pratt, Judge. Counsel: Cris E. Boyar, for Plaintiff. Miriam Merlo, Gaebe Mullen Antonelli Esco & Dimatteo, Coral Gables, for Defendant.
ORDER ON MOTION FOR SUMMARY JUDGMENT
THIS CAUSE is before the Court on Defendant’s Motion for Summary Judgment. Upon consideration of the record and applicable case law, the Court finds as follows:
Plaintiff seeks payment of a bill for one thousand seven hundred seven dollars and thirty-three cents ($1,707.33) for an MRI performed on Defendant’s insured. Defendant denied payment on the grounds that the bill was not accompanied by a proper disclosure and acknowledgement form, because the form submitted was left blank as to item #1 which requires a description of services actually rendered. The insured continued receiving treatment and subsequent bills were timely and properly paid until benefits were exhausted after this suit was filed.
Once benefits have been exhausted, the Court finds that Plaintiff is not entitled to recover unless it can show that Defendant acted in bad faith in denying Plaintiff’s bill. Simon v. Progressive Express Insurance Company, 904 So.2d 449 (Fla. 4DCA 2005). Plaintiff has alleged bad faith and that it only has to show Defendant “acted improperly” in denying its bill, referencing Simon v. Progressive Express Insurance Company, supra at 450. However, this Court’s reading of Simon and subsequent cases is that Defendant can’t be held liable for Plaintiff’s bill as long as it had a good faith basis to deny it at the time it was submitted. At the time Plaintiff submitted its bill, there was and still is case law which supports the denial.1 Although the Court disagrees with these cases, the Court finds as a matter of law that Defendant can not be in bad faith and held liable for Plaintiff’s bill as long as there was some legal support for the denial.
Based on the foregoing findings and conclusions, Defendant’s Motion for Summary Judgment is Granted, and Final Summary Judgment is hereby entered in favor of Defendant and against Plaintiff.
The Court reserves jurisdiction to tax fees and costs as may be appropriate.
__________________
1See for example: NW Broward Orthopaedic Associates, P.A. and MRI Radiology Network, P.A. v. UAIC 13 Fla. L. Weekly Supp 740a (Broward County Court, May 11, 2006); R&C First Medical Center v. Progressive American Insurance Company, 15 Fla. L. Weekly Supp. 372a (Orange County Court, December 13, 2007)
