19 Fla. L. Weekly Supp. 780a
Online Reference: FLWSUPP 1910SHIVInsurance — Personal injury protection — Exhaustion of policy limits — Where PIP benefits were exhausted after insurer was served with complaint filed by insured, insured could not thereafter maintain suit for interest or attorney’s fees on benefits that were denied prior to exhaustion of benefits — Error to enter summary judgment in favor of insured
USAA CASUALTY INSURANCE COMPANY, Appellant, vs. ANNA MARIE SHIVER, Appellee. Circuit Court, 1st Judicial Circuit (Appellate) in and for Escambia County. Case No. 10-AP-34, Division C. L.C. Case No. 09-CC-3221, Division V. October 18, 2011. On Appeal from the County Court for Escambia County. Honorable Patricia A. Kinsey, Judge. Counsel: Douglas H. Stein. T. Shane Rowe.
ORDER
(NOBLES, Judge.) Appellant appeals the trial court’s Final Judgment issued July 1, 2010. The Court, having reviewed the record on appeal, the briefs of the parties, and the relevant legal authority, finds as follows:
Appellee was injured in an automobile accident. At the time, she had an insurance policy with Appellant that provided for PIP benefits. After incurring medical expenses from a medical provider related to her injury, Appellee submitted the claims for payment. Appellant denied the claims. As a result, Appellee filed a complaint for damages, interest, and attorney’s fees. At the time she filed her complaint, her benefits had not been exhausted. Likewise, at the time she served her complaint, her benefits had not been exhausted. Several months later, Appellant made a payment to another medical provider that exhausted Appellee’s benefits. Both Appellant and Appellee moved for summary judgment. The trial court granted Appellee’ s motion finding that “[t]he paperwork submitted by plaintiff’s medical provider for payment was in substantial compliance with the applicable statute and case law at that time and therefore defendant should have paid those invoices submitted in compliance with the D & A form.” The trial court ruled “that because the benefits have been exhausted, plaintiff shall recover from defendant only interest due as well as reasonable attorneys fees and costs.” After the trial court entered its final judgment, Appellant filed its notice of appeal.
In Progressive American Insurance Co. v. Stand-Up MRI, 990 So. 2d 3 (Fla. 5th DCA 2008) [33 Fla. L. Weekly D1746a], a plaintiff submitted a claim to an insurance company for the payment of PIP benefits. The insurance company denied the claim and the plaintiff filed suit for the benefits. After the suit was filed, but before it was served, the insurance company made a payment to another medical provider which exhausted the benefits. In ruling that the plaintiff’s suit could not go forward, the Fifth District Court of Appeal found that the insurance company had met its obligation under the contract to pay the policy amount.
In Sheldon v. United Services Automobile Association, 53 So. 2d 593 (Fla. 1st DCA 2010) [36 Fla. L. Weekly D23a], a plaintiff submitted a claim to an insurance company for the payment of PIP benefits. The insurance company denied the claim and the plaintiff filed suit for the benefits, interest, penalties, and attorney’s fees. After the suit was filed, but before it was served, the insurance company made a payment to another medical provider which exhausted the benefits. Aware of the ruling in Stand-Up, the plaintiff sought to maintain his suit, but only for interest, penalties, and attorney’s fees. As in Stand-Up, the First District Court of Appeal ruled that the plaintiff’s suit could not go forward because the insurance company had met its obligation under the contract to pay the policy amount.
Relying on Stand-Up and Sheldon, Appellant argues that once it satisfied its contractual obligation to Appellee, it could not be liable for interest or attorneys fees. Appellee counters that the instant case is distinguishable from Stand-Up and Sheldon because 1) the benefits were exhausted after the complaint was served on Appellant; and 2) the trial court found that Appellant had wrongfully denied Appellee’s claims.
The analysis of both the Fifth District Court of Appeal and the First District Court of Appeal was whether the insurance company had fulfilled its contractual obligations to the plaintiff, not when it had fulfilled its obligations. It logically follows that once such a contract has been fulfilled, the reason for a denial of a claim is no longer relevant. As such, the distinctions between the instant case and Stand-Up and Sheldon are immaterial.
Accordingly, the Court REVERSES the trial court’s entry of summary judgment and final judgment for Appellee and REMANDS with directions to the trial court to enter summary judgment and final judgment for Appellant.
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