23 Fla. L. Weekly Supp. 753a
Online Reference: FLWSUPP 2307BROOInsurance — Personal injury protection — Coverage — Emergency medical condition — Demand letter and suit for benefits above the $2500 paid by insurer was prematurely filed before medical provider responded to insurer’s requests for documentation that insured had emergency medical condition — Insurer’s post-suit payment of additional amount upon receipt of the requested documentation did not amount to confession of judgment — Insurer’s motion for summary judgment is granted — Medical provider’s motion for attorney’s fees is denied
NEUROLOGY PARTNERS, P.A. dba EMAS SPINE & BRAIN a/a/o Steven Brooks, Plaintiff, v. USAA GENERAL INDEMNITY COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 16-2014-SC-005475-XXXX-MA. May 26, 2015. Honorable Emmet F. Ferguson, Judge. Counsel: Melissa R. Winer, Shuster & Saben, LLC, Jacksonville, for Plaintiff. Randall A. Wainoris, Dutton Law Group, P.A., Tampa, for Defendant.
ORDER GRANTING DEFENDANT’S MOTIONFOR SUMMARY JUDGMENT REGARDINGEMERGENCY MEDICAL CONDITION AND DENYINGPLAINTIFF’S MOTION TO TAX FEES AND COSTSWITH INTEREST FOR PARTIAL CONFESSIONOF JUDGMENT AND ORDER OF FINAL SUMAMRYJUDGMENT ON FAVOR OF DEFENDANT
This cause, having come before the Court on April 13, 2015 on DEFENDANT’S MOTION FOR SUMMARY JUDGMENT REGARDING EMERGENCY MEDICAL CONDITION, FAILURE TO RESPOND TO REQUEST FOR INFORMATION, AND PREMATURE DEMAND LETTER AND PLAINTIFF’S MOTION TO TAX FEES AND COSTS WITH INTEREST FOR PARTIAL CONFESSION OF JUDGMENT AND NOTICE OF INTENT TO CONTINUE LITIGATING OUTSTANDING BENEFITS, and this Court having heard argument of counsel, having reviewed the pleadings and being otherwise advised in these matters finds as follows:
1. The subject action arises out of a claim for personal injury protection insurance benefits (PIP benefits) filed by the Plaintiff. Defendant initially limited PIP benefits to $2500 as Defendant has not initially received written documentation of an emergency medical condition (EMC). Defendant made written requests for documentation of EMC from Plaintiff within their explanation of reimbursement forms, however Plaintiff never responded to these requests.
2. The Defendant subsequently received notice that a physician licensed under chapter 458 or chapter 459, had determined that the claimant had an emergency medical condition. Upon receipt of said notice, bills beyond the policy limits of $2,500.00 became payable and thereafter, payment/reimbursement was issued by the Defendant to Plaintiff for the services at issue.
3. Defendant made reimbursement as per the policy of insurance and § 627.736(a)(3)-(4), Fla. Stat. (2013) which states:
(3) Reimbursement for services and care provided in subparagraph 1. or subparagraph 2. up to $10,000 if a physician licensed under chapter 458 or chapter 459, a dentist licensed under chapter 466, a physician assistant licensed under chapter 458 or chapter 459, or an advanced registered nurse practitioner licensed under chapter 464 has determined that the injured person had an emergency medical condition.
(4) Reimbursement for services and care provided in subparagraph 1. or subparagraph 2. is limited to $2,500 if a provider listed in subparagraph 1. or subparagraph 2. determines that the injured person did not have an emergency medical condition.
4. Plaintiff’s pre-suit demand letter, and the instant lawsuit were premature as no payment above $2500.00 ever became due and owing prior to the submission and filing of both; Plaintiff additionally did not respond to Defendant’s requests for documentation regarding an emergency medical condition as authorized under § 627.736(6)(b), Fla. Stat. (2013).
5. Upon receipt of written documentation of an emergency medical condition, Defendant properly paid the requisite PIP benefits to Plaintiff and accordingly, there was no wrongful or unreasonable denial of benefits.
6. USAA’s post-suit payment was consistent with their legal position; USAA neither changed their position nor conceded its original defenses and accordingly, a confession of judgment did not occur.
WHEREFORE, it is hereby DONE AND ORDERED that:
PLAINTIFF’S MOTION TO TAX FEES AND COSTS WITH INTEREST FOR PARTIAL CONFESSION OF JUDGMENT AND NOTICE OF INTENT TO CONTINUE LITIGATING OUTSTANDING BENEFITS is DENIED
DFENDANT’S MOTION FOR SUMMARY JUDGMENT REGARDING EMERGENCY MEDICAL CONDITION, FAILURE TO RESPOND TO REQUEST FOR INFORMATION, AND PREMATURE DEMAND LETTER is GRANTED. Final Summary Judgment is hereby entered in favor of the Defendant, USAA GENERAL INDEMNITY COMPANY. Plaintiff, NEUROLOGY PARTNERS, P.A. dba EMAS SPINE & BRAIN a/a/o Steven Brooks shall take nothing from this action, and USAA GENERAL INDEMNITY COMPANY., shall go hence without day. The court reserves jurisdiction to determine taxable attorney’s fees and costs.
