18 Fla. L. Weekly Supp. 613a
Online Reference: FLWSUPP 1807PARIInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Following confession of judgment and payments by insurer exhausting remaining PIP benefits available under policy, medical provider is not entitled to any further benefits or interest for unpaid balance of medical bills
PEMBROKE PINES MRI, INC., Jack Paris, Plaintiff, vs. USAA CASUALTY INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 09-09458-51. April 8, 2011. Martin R. Dishowitz, Judge. Counsel: Charles J. Kane, Kane & Kane, P.A., Boca Raton, for Plaintiff. Reuven T. Herssein, Law Offices of Herssein & Herssein, P.A., North Miami, for Defendant.
[Editor’s note: Subsequent order on attorney’s fees published at FLWSUPP 1903PARI.]
Amended Final Judgment
On March 30, 2011 the Court heard Plaintiff’s Motion for Clarification of the Final Judgment issued by the Court February 22, 2011. Having heard argument of counsel and being fully advised the Court grants clarification. The judgment of February 22, 2011 is vacated and the following is rendered in lieu thereof.
Background
This is a PIP case brought to recover for breach of an insurance contract. Plaintiff is the assignee of Jack Paris who is USAA’s insured. Findings of Fact: Plaintiff, a provider of MRI services, submitted a CMS 1500/HCFA form to the Defendant for MRIs, billed on January 6, 2009, January 11, 2009, and January 25, 2009. The CMS 1500/HCFA forms were global bills, including charges for the technical and professional components of the MRIs at issue, billed as CPT Codes 72141, 72148 and 73721 RT, respectively. It is undisputed that Plaintiff did not include a professional license number in Box 31 of the CMS 1500/HCFA forms submitted to Defendant. Defendant denied payment of the bills based upon its position in its Explanation of Reimbursement (EOR) which states that the, “CMS 1500 form needs to be submitted with Box 31 completed pursuant to Florida PIP Statute 627.736. Box 31 should contain the name of the provider or supplier who rendered the service and their professional license number.” Defendant continued to make payments on claims received subsequent to receipt of the plaintiff’s said claims by the assignor’s other medical providers. However, in light of, and in accordance with the Fourth District Court of Appeal ruling in the case of USAA Casualty Insurance Company v. Pembroke Pines MRI Inc., (a/a/o/ Megan Cahill), 31 So.3d 234 (Fla. 4th DCA 2010) [35 Fla. L. Weekly D613b], Defendant tendered two payments to the Plaintiff on June 28, 2010 and October 13, 2010 confessing Plaintiff’s entitlement to fees and costs on each such occasion. The payment on October 13, 2010 exhausted all remaining PIP benefits available under the policy.
Regardless of the confessions of judgment payment and notification that the payment to the Plaintiff exhausted the remaining policy benefits, the Plaintiff continued to pursue its claim for a remaining asserted unpaid balance after set off for the said payments. USAA defended asserting the October 13, 2010 payment resulted in exhausting the available PIP policy benefits.
The Court heard cross motions for summary judgment on February 1, 2011 and ruled that the defense of exhaustion of benefits was valid and that Plaintiff could recover no further benefits than those already paid to it after suit commenced.
The Defendant has filed motions for fees and costs based on a proposal for settlement made on October 28, 2010, after advising the policy benefits exhausted to the Plaintiff, and a motion for sanctions pursuant to F.S.§57.105. The Plaintiff contests Defendant’s entitlement to fees and costs. Defendant’s entitlement to fees and costs are not addressed by this Order and jurisdiction is reserved to address that at a later date.
The Plaintiff has filed a motion for fees and costs and the Defendant agrees that the Plaintiff is entitled to reasonable attorney’s fees and costs, up to the October 13, 2010 confession of judgment and contests Plaintiff’s entitlement to fees and costs for any work thereafter.
Upon consideration, it is ordered and adjudged:
1. Plaintiff is awarded no further benefits or interest than that already received in this action and the Defendant shall go hence without day.
2. Plaintiff is entitled to reasonable attorneys’ fees and costs up to the date of the latest confession of judgment (October 13, 2010) previously filed, with the amounts of fees and costs yet to be determined.
3. Plaintiff’s further or additional entitlement to attorneys’ fees and costs after October 13, 2010 remains in dispute.
4. Defendant’s entitlement to fees and costs remains unresolved and is in dispute.
5. Jurisdiction is reserved to determine all unresolved questions on attorneys’ fees and costs that will be addressed separately from any hearing(s) on amounts.
