23 Fla. L. Weekly Supp. 282b
Online Reference: FLWSUPP 2303RRIVInsurance — Personal injury protection — Coverage — Emergency medical condition — Insurer’s payment of additional benefits in response to receipt of determination of emergency medical condition after medical provider filed suit did not constitute confession of judgment where insurer did not wrongfully deny or withhold benefits resulting in filing of suit
SOUTH FLORIDA PAIN & REHABILITATION OF WEST BROWARD, INC. a/a/o Raul Rivera, Plaintiff, v. UNITED SERVICES AUTOMOBILE ASSOCIATION, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. COCE-14-014856, Division 56. June 10, 2015. Honorable Linda R. Pratt, Judge. Counsel: Joseph R. Dawson, Law Office of Joseph R. Dawson, P.A., Fort Lauderdale, for Plaintiff. Scott W. Dutton, Dutton Law Group, P.A., Tampa, for Defendant.
ORDER GRANTING DEFENDANTS MOTIONFOR SUMMARY JUDGMENT, DENYING PLAINTIFF’SMOTION FOR SUMMARY JUDGMENT DUE TOCONFESSION OF JUDGMENT, AND SUMMARYJUDGMENT FOR DEFENDANT
This matter came on to be heard on April 28, 2015 on Defendant, United Services Automobile Association (USAA) Motion for Summary Judgment as well as the Plaintiff’s, South Florida Pain & Rehabilitation of West Broward, Inc., Motion for Summary Judgment due to Confession of Judgment and after hearing argument of counsel, the Court grants the Defendant’s motion for summary judgment and denies the Plaintiff’s motion for confession of judgment based upon the following findings of fact and conclusions of law::
1. The subject case involves a claim for allegedly unpaid personal injury protection insurance benefits filed by the Plaintiff, South Florida Pain & Rehabilitation of West Broward, Inc. as assignee of Raul Rivera against the Defendant, United Services Automobile Association arising out of a motor-vehicle accident that allegedly occurred on March 26, 2014.
2. The Plaintiff submitted various charges to the Defendant for various dates of service to include April 28, 2014 and April 30, 2014.
3. The Defendant responded to the Plaintiff’s claim by the service of an Explanation of Reimbursement that informed the Plaintiff that payment of medical benefits had been limited to $2500 because the medical records did not show that a medical provider 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 had determined, at that time, that the claimant had an emergency medical condition.
4. The Plaintiff filed suit on August 7, 2014 for dates of service April 28, 2014 through April 30, 2014.
5. After suit was filed, on August 13, 2014, the Defendant received a determination that a qualified physician had determined that the claimant had an emergency medical condition.
6. Consequently, payment was timely issued by the Defendant to providers, including the Plaintiff, in accordance with the terms of the Policy and statute.
7. The Defendant argues that it is entitled to summary judgment and that once the emergency medical condition determination was received it timely paid the Plaintiff’s charges in accordance with provisions of the insurance Policy and Florida law.
8. In turn, the Plaintiff asserted in its Motion for Summary Judgment due to Confession of Judgment that these post suit payments resulted in a “confession of judgment” by post suit payment.
9. This Court has considered the emergency medical condition determination issue in several prior hearings and has ruled consistently that an emergency medical condition determination is required for medical benefits to be available up to $10,000. Otherwise, medical benefits are limited to $2500 for non-emergency medical conditions.
10. For the foregoing reasons, since the emergency medical condition determination was not received until after suit was filed, it has not been shown that Defendant wrongfully denied or withheld benefits resulting in the filing of suit. Therefore, the Defendants post suit payment after receiving the emergency medical condition determination did not, as the Plaintiff urges, result in a confession of judgment by payment.
IT IS THEREFORE ORDERED AND ADJUDGED that the Defendant’s Motion for Summary Judgment against the Plaintiff is GRANTED. It is further
ORDERED AND ADJUDGED that the Plaintiff take nothing by this action, and that summary judgment is hereby entered in favor of the Defendant, and the Defendant shall go hence without day. The court reserves jurisdiction to determine the entitlement to and the amount of attorney’s fees and taxable costs.
