19 Fla. L. Weekly Supp. 1090a
Online Reference: FLWSUPP 1913ARANInsurance — Personal injury protection — Coverage — Exhaustion of policy limits — In absence of any evidence of bad faith or manipulated payments, where benefits were exhausted in payment of other medical providers after plaintiff medical provider filed suit, insurer is entitled to summary judgment
MILLENNIUM RADIOLOGY, LLC, as assignee of Yesenia Arango, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County, Small Claims Division. Case No. 10 11846 SP 05 (06). Claim No. 59-A436-376. September 6, 2012. Honorable Gladys Perez, Judge. Counsel: Charles L. Vaccaro, for Plaintiff. Mark J. Rose, Roig, Tutan, Rosenberg, Martin & Stoller, P.A., Deerfield Beach, for Defendant.
AMENDED OPINION, Question certified, at FLWSUPP 2002ARAN
ORDER GRANTING DEFENDANT’S FINAL SUMMARYJUDGMENT AND FINAL JUDGMENT FOR DEFENDANT
THIS CAUSE having come before the Court on August 10, 2012, pursuant to Defendant’s Motion for Final Summary Judgment, and the Court having reviewed the file, considered the arguments and Memorandum of Law submitted by the parties, and being otherwise fully advised in this matter, does hereby make the following findings of fact and conclusions of law:
FINDINGS OF FACT
1. On October 19, 2009, Yesenia Arango (the “insured”) was involved in an automobile accident. At the time of the accident, Ms. Arango was insured by the Defendant, State Farm Mutual Automobile Insurance Company (“State Farm”), under a policy which provided personal injury protection (PIP) benefits in the amount of $10,000.00.
2. As a result of injuries sustained in the accident, Ms. Arango received medical treatment from two medical providers: Total Healthcare of Florida, Inc. and Millennium Radiology, LLC, the Plaintiff. The date of service in question involves two MRI’s, specifically CPT codes 72141 (a cervical MRI) and 72148 (a lumbar MRI), performed on March 10, 2010.
3. On March 9, 2010, Ms. Arango assigned her aforementioned PIP benefits to Plaintiff, Millennium Radiology, LLC.
4. After the March 10, 2010 MRI’s, Ms. Arango continued seeking treatment from Total Healthcare of Florida, Inc. through April 15, 2010. State Farm provided reimbursement for this treatment under the policy of PIP insurance.
5. On May 3, 2010, State Farm received a demand letter from the Plaintiff pursuant to Fla. Stat. § 627.736(10).
6. On July 22, 2010, Plaintiff filed the instant lawsuit by way of a one count Complaint for breach of contract.
7. On August 4, 2010, Defendant was served via electronic delivery by way of the Chief Financial Officer of the State of Florida.
8. On September 28, 2010, Defendant filed its Answer and Affirmative Defenses.
9. On October 15, 2010, State Farm issued a $202.58 payment to Total Healthcare of Florida, Inc., thereby exhausting all available PIP benefits for Ms. Arango.
10. Defendant subsequently amended their Affirmative Defenses to include an affirmative defense that Yesenia Arango’s policy limits had been reached and that no additional PIP benefits were available due to the exhaustion of the $10,000.00 in PIP benefits.
11. On February 6, 2012, Defendant filed its Motion for Final Summary Judgment based upon exhaustion of PIP policy benefits.
12. On August 10, 2012, Defendant’s Motion for Final Summary Judgment was heard before this Court, which is the subject of this Order.
13. The Plaintiff has not alleged that Defendant’s actions were done in bad faith or that there was any manipulation in the payments issued by State Farm.
CONCLUSIONS OF LAW
The issue presented to this Court is whether an insurance company which issued a personal injury protection (PIP) policy to an insured, has a legal obligation to pay an amount in excess of the $10,000.00 policy limits, based upon the following facts:
a) Plaintiff provided medical treatment to the insured when PIP benefits were available under the policy.
b) Plaintiff filed suit against Defendant when PIP benefits were still available under the policy.
c) PIP benefits available under the policy were exhausted after the suit was served upon the Defendant.
The decision in this case is controlled by Fla. Stat. § 627.730-627.7405, commonly known as the Florida Motor Vehicle No-Fault Law (“No-Fault Law”), the case law interpreting these statutes and the subject contract for insurance.
The Court first takes note that the instant lawsuit was brought pursuant to a one count Complaint for breach of contract seeking PIP benefits. The contract itself is a policy of No-Fault insurance issued by State Farm, “Florida Policy Form 9810.7”. The policy itself is clear as to how much State Farm will be obligated to pay under the No-Fault policy limits of the policy of automobile insurance. Specifically the policy states:
Limits of Liability
1. The most we pay.
The most we pay for each insured for all loss and expense from one accident shall be $10,000 less the amount of any reduction described under When Payments Are Reduced that applies to the insured.
Florida law is clear that the assignee of a contract takes the right with all the defenses to which it was subject in the hands of the assignor. See Florida East Coast Railway Co. v. Eno. 99 Fla. 887, 128 So. 622 (Fla. 1930). The assignee of a contract occupies the same position as the assigner, having the same rights, and being subject to the same equities, conditions and defenses. Id. Here the Plaintiff, Millennium Radiology, LLC, has no greater rights under the PIP contract than insured Yesenia Arango, and therefore is similarly limited to the $10,000.00 policy limit.
Plaintiff argues that because the policy limits were reached after suit was filed and served upon the Defendant, and after the Court had determined in separate Orders that the services provided by the Plaintiff were reasonable, medically necessary and causally related to the motor vehicle accident, that the Defendant should be required to pay above the $10,000.00 PIP policy limit. This Court disagrees with Plaintiff’s argument.
The Court, in reaching its decision, finds the following language in Simon v. Progressive Express Ins. Co., 904 So.2d 449 (Fla. 4th DCA 2005) [30 Fla. L. Weekly D1156b] controlling on this issue:
We decline to create a requirement that an insurance company set aside a ‘reserve’ fund for claims that are reduced or denied. Simon does not contend that the denial or reduction of its claim was in bad faith, or that Progressive had manipulated, or acted improperly, in reducing it.
Under such a theory, all potential payments to a service provider that were denied, or were subject to a reduction, would have to be held in reserve until the statute of limitations period expired or a suit was filed and concluded. This would delay and reduce availability of funds for the payment of claims to other providers and would be inconsistent with the PIP statute’s ‘prompt pay’ provisions. Id. at 450.
No evidence was presented by the Plaintiff that State Farm had acted in bad faith or manipulated payments in this case.
This Court finds that absent evidence of bad faith, manipulation, or paying bills not due and owing, pursuant to Coral Imaging, requiring State Farm to pay an amount in excess of the $10,000.00 policy limit would effectively require this Court to create a legally improper “reserve fund” and unilaterally modify the terms of the PIP insurance contract. See Coral Imaging Services (a/a/o Virgilio Reyes) v. Geico, 955 So.2d 11 (Fla. 3d DCA 2006) [31 Fla. L. Weekly D2478a], Progressive American Insurance v. Stand UP MRI of Orlando, 990 So.2d 3 (Fla. 5th DCA 2008) [33 Fla. L. Weekly D1746a] (Adopting reasoning of Simon, demand letter does not require an insurer to hold funds in reserve, but rather is merely a condition precedent to filing suit.)
Based on the foregoing, this Court finds that the Court in Simon, and later Stand Up MRI, contemplated that an insurance company would continue to receive claims after a lawsuit was filed and served and that no exception was created to expand an insurance contract’s policy limits solely because benefits exhausted after the inception of that lawsuit.
WHEREFORE, it is ORDERED and ADJUDGED as follows:
1. That Defendant’s Motion for Final Summary Judgment is hereby GRANTED.
2. Judgment is entered in favor of the Defendant and the Plaintiff shall take nothing by this action and the Defendant shall go hence without day.
3. The Court reserves jurisdiction with respect to the Defendant’s entitlement to attorneys’ fees and taxable costs.
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