20 Fla. L. Weekly Supp. 1073a
Online Reference: FLWSUPP 2011WILLInsurance — Personal injury protection — Coverage — Emergency services — Exhaustion of policy limits — Statute that requires insurer to reserve $5,000 for emergency medical service providers does not require insurer that paid bill of provider within that classification at reduced amount to reserve benefits for payment of disputed portion of bill
EMERGENCY MEDICAL ASSOCIATES OF FLORIDA, LLC, a/a/o NATHAN WILLIAMS, Plaintiff, vs. PROGRESSIVE SELECT INSURANCE COMPANY, Defendant. County Court, 6th Judicial Circuit in and for Pinellas County, Small Claims Division. Case No. 11-004605-SC-46. UCN 522011SC004605XXSCSC. August 27, 2013. Edwin B. Jagger, Judge. Counsel: James Douglas Underwood, Law Office of Russel Lazega, P.A., Dania Beach, for Plaintiff. Brian M. Giddings, Adams & Diaco, P.A., Tampa, for Defendant.
ORDER GRANTING DEFENDANT’S MOTION FORSUMMARY JUDGMENT AND DENYING PLAINTIFF’SCROSS MOTION FOR PARTIAL SUMMARY JUDGMENT
THIS CAUSE came before the Court on July 29, 2013, on the parties’ competing motions for summary judgment as it relates to the Defendant’s affirmative defense of exhaustion, and the Court having considered the motions, memoranda, and argument presented by counsel, and being otherwise duly advised in the premises, it is
ORDERED AND ADJUDGED that the Defendant’s Motion for Summary Judgment is GRANTED and the Plaintiff’s Cross Motion for Partial Summary Judgment is DENIED. The Court finds that the payments made by the Defendant exhausted all available PIP benefits and the Defendant had no further obligation to reserve benefits. See Progressive American Ins. Co. v. Stand-Up MRI of Orlando, 990 So.2d 3 (Fla. 5th DCA 2008) [33 Fla. L. Weekly D1746a] (there is no legal requirement that an insurer set aside a reserve fund for claims which are reduced or denied), relying on Simon v. Progressive Express Ins. Co., 904 So.2d 449 (Fla. 4th DCA 2005) [30 Fla. L. Weekly D1156b].
The Court is not persuaded to accept the Plaintiff’s argument that the Defendant was required to reserve the disputed portion of the bill, under section 627.736(4)(c), Florida Statutes, as it relates to the services and care of emergency providers. Here, at the time the Plaintiff submitted its bill, PIP benefits had not yet been fully paid out and, as such, there was more than $5,000 of funds available. The Defendant processed the claim and chose to pay same at a reduced amount; the remaining PIP benefits subsequently exhausted.1
The Court will reserve jurisdiction as to any issue related to attorney’s fees and costs, as well as to enter any further orders and/or judgments that are proper and consistent with this ruling.
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1This is unlike the situation presented in the reported county court decisions referenced by Plaintiff, where the insurers apparently ignored and/or failed to follow the statutory requirement to reserve $5,000 for certain classified providers and instead elected to pay the entire $10,000 of PIP benefits elsewhere; the courts, given that circumstance, rejected the insurer’s exhaustion of benefits defense. See Orthopaedic Clinic of Daytona Beach, P.A. a/a/o Charles Murray v. State Farm Mutual Automobile Ins. Co., 17 Fla. L. Weekly Supp. 1145a (Volusia County, Judge Henderson, 2010); Emergency Physicians of Central Florida, LLP, a/a/o Barbara Maughan, v. United Services Automobile Association, 19 Fla. L. Weekly Supp. 746a (Osceola County, Judge Draper, 2012).
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