18 Fla. L. Weekly Supp. 900a
Online Reference: FLWSUPP 1809RHOD Insurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Summary judgment is granted in favor of insurer in action brought by medical provider/assignee for unpaid portion of reduced medical bills where benefits were exhausted in payment of other providers’ bills, and provider does not allege that insurer acted in bad faith or processed bills inappropriately
RHODES & ANDERSON, D.C., P.A., d/b/a VENICE CHIROPRACTIC CENTER (a/a/o JESSICA DAY), Plaintiff, v. PROGRESSIVE AMERICAN INSURANCE COMPANY, Defendant. County Court, 12th Judicial Circuit in and for Sarasota County, Venice Small Claims Division. Case No. 2007-SC-2840-SC. January 31, 2008. Phyllis R. Galen, Judge.
AFFIRMED. 18 Fla. L. Weekly Supp. 925b
ORDER ON DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS CAUSE having been heard by the Court on Defendant’s Motion for Summary Judgment and the Court, having heard arguments of counsel, reviewed supplemental memoranda and case law submissions by both parties, and the Court having considered the Motion, and being otherwise advised in the premises finds as follows:
1. The Defendant insured the claimant, Jessica Day, and that policy provided ten thousand dollars ($10,000) in Personal Injury Protection (PIP) benefits, with no deductible and no medical payments coverage.
2. The Plaintiff, a medical provider, accepted an assignment of benefits from the defendant’s insured, filed this cause of action. The complaint seeks damages against the Defendant for underpaid PIP benefits, specifically medical benefits unilaterally reduced by the Defendant. At the time suit was filed, benefits were exhausted.
3. The bills submitted by the Plaintiff were reduced by the Defendant to reflect an amount that it determined to be “reasonable” for the services provided in the provider’s geographic region. Other than contesting the amount that Defendant reimbursed, The Plaintiff does not specifically allege bad faith nor does the Plaintiff specifically allege the Defendant otherwise processed the bills inappropriately.
4. The Plaintiff sent a pre-suit demand letter to the defendant on August 30, 2005, one year and eight months prior to the filing of this lawsuit.
5. The Defendant continued to pay all providers’ bills pursuant to the statute, as they were received. The Defendant exhausted benefits on March 22, 2007.
6. The lawsuit was filed on May 2, 2007. The Court does find it significant that all available benefits had been exhausted prior to the suit being filed by the Plaintiff.
7. This Court finds that Simon, a/a/o Erick Hon. v. Progressive Express Insurance Company, 904 So. 2d 449 (Fla. 4th DCA 2005) [30 Fla. L. Weekly D1156b], is controlling in this matter.
8. Pursuant to Simon, the Court finds that the Defendant is statutorily obligated to continue to pay bills submitted on behalf of an insured, even if that results in exhaustion of benefits.
9. This Court further finds that Fink, M.D., a/a/o Kim Copeland, v. Progressive American Insurance Company, 13. Fla. L. Weekly Supp. 718 (b) (Fla. 12th Jud. Cir. April 12, 2006) rendered by Judge Goldman, to be persuasive in this matter before the Court.
10. It is well settled law in the State of Florida that upon receiving an assignment, the assignee steps into the shoes of the assignor. Therefore, the assignee cannot obtain any greater rights than those of the assignor.
11.Therefore, pursuant to the authority cited above, The Defendant has met its contractual and statutory obligations and has paid the full ten thousand ($10,000.00). The Plaintiff is not entitled to recover anymore than that which the insured, Jessica Day, would have been entitled to recover under the policy of insurance. The Plaintiff is not entitled to seek recovery of any interest or statutory penalties. The Defendant is entitled to summary judgment based upon the exhaustion of benefits.
It is therefore ORDERED AND ADJUDGED that the Defendant’s Motion for Summary Judgment is hereby GRANTED.
