24 Fla. L. Weekly Supp. 364b
Online Reference: FLWSUPP 2405SOLOInsurance — Personal injury protection — Declaratory actions — Motion to dismiss count seeking declaratory relief is granted where medical provider does not allege any true uncertainty as to whether it possesses rights under PIP contract, but merely seeks declaration as to whether policy is ambiguous as to payment method
CRESPO AND ASSOCIATES, P.A., a/a/o Matthew Solomon, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 13th Judicial Circuit in and for Hillsborough County, Civil Division. Case No. 14-CC-036962, Division K. May 23, 2016. Walter R. Heinrich, Judge. Counsel: Anthony Prieto, Prieto, Prieto and Goan, Tampa, for Plaintiff. Robert H. Oxendine, Oxendine and Oxendine, P.A., Tampa, for Defendant.
ORDER GRANTING DEFENDANT’S MOTIONTO DISMISS COUNT I OF THE PLAINTIFF’SAMENDED STATEMENT OF CLAIM
THIS CAUSE having come to be heard on April 28, 2016, upon the Defendant’s Motion to Dismiss, and the Court having reviewed the file, having heard arguments from counsel, and being otherwise fully advised in the premises, the Court makes the following findings of fact and conclusions of law:
PLAINTIFF’S ALLEGATIONS
1. The Plaintiff has brought the instant lawsuit seeking, in part, a declaratory judgment pertaining to an automobile policy issued by the Defendant, and pertaining to Personal Injury Protection (“PIP”) and Medical Payment (“MedPay”) coverage provided under said insurance policy.
2. The Plaintiff alleges that the claimant, MATTHEW SOLOMON, was injured in an automobile accident on or about April 25, 2014 and that as a result, he received medical care and treatment from the Plaintiff, CRESPO AND ASSOCIATES, P.A.
3. In Count I of its Amended Statement of Claim seeking relief under the declaratory judgment statute, Plaintiff alleges that Defendant “has unlawfully processed and paid PIP and/or MPC benefits based on a Hybrid Method of reimbursement which commingles subsections (1)(a), (5)(a) and (5)(a)1-5 of F.S. 627.736.” See Plaintiff’s Amended Statement of Claim, ¶¶ 1, 3,18. The Plaintiff therefore requests a declaration from this Court surrounding whether the Defendant “is required to pay a reasonable amount for medically necessary, reasonable[,] and casually related services and disability benefits . . . .” Id. at p. 5. Significantly, Plaintiff specifically does not seek any benefits or damages from Defendant in its claim for declaratory relief, yet seeks attorneys’ fees from Defendant pursuant to Florida Statute § 627.428. Id.
CONCLUSIONS OF LAW
4. A motion to dismiss presents a question of law which tests the legal sufficiency of the Plaintiff’s complaint. It is well settled law that all reasonable inferences in the complaint are to be taken as true and a court is not to look beyond the four corners of the complaint and its attachments in making its decision on a motion to dismiss. See Swope Rodante, P.A. v. Harmon, 85 So. 3d 508, 509 (Fla. 2d DCA 2012) [37 Fla. L. Weekly D725c] (citing Al-Hakim v. Holder, 787 So. 2d 939, 941 (Fla. 2d DCA 2001) [26 Fla. L. Weekly D1380d]); Fla. R. Civ. P. 1.131(b).
5. In order to maintain an action for declaratory relief, the pleader must demonstrate that (1) there is a bona fide, actual, present practical need for the declaration; (2) the declaration deals with a present, ascertained, or ascertainable state of facts or controversy; (3) that there is some person who has or reasonably may have and actual, present, adverse, and antagonistic interest in the subject matter; and (4) that the relief sought is not merely the giving of legal advice by the Court. See Santa Rosa County v. Admin. Comm’N, Div. of Admin. Hearings, 661 So. 2d 1190, 1192-93 (Fla. 1995) [20 Fla. L. Weekly S333a] (citing May v. Holley, 50 So. 2d 636, 639 (Fla. 1952)). Absent a bona fide need for a declaration based on present, ascertainable facts, this Court lacks jurisdiction to render declaratory relief. Id. at 1193.
6. Plaintiff does not allege any true uncertainty as to whether it possesses rights, immunities, powers, or privileges under the contract. See Fla. Stat. § 86.011 (2015). Rather, Plaintiff simply alleges that Defendant’s method as to the manner in which it will pay reasonable medical expenses is ambiguous. The determination as to the payment method authorized under the policy and potential factual determination as to whether the amount of the bills submitted by Plaintiff were, in fact, reasonable is properly adjudicated in a breach of contract action. Simply requesting the Court to determine the existence of an ambiguity in the policy regarding payment without determining whether the insurer failed to pay a reasonable amount and, if so, determine appropriate damages, amounts to a request for an advisory opinion from this court. See Santa Rosa County, 661 So. 2d at 1192-93 (citing May, 50 So. 2d at 639); Progressive Medical Group, P.A. a/a/o Ambrose Jones v. State Farm Mut. Auto. Ins. Co., 23 Fla. L. Weekly Supp. 770a (Fla. 13th Jud. Cir., Hillsborough Cty. Ct., Nov. 10, 2015). This is not an appropriate function of the declaratory judgment statute. See Gables Ins. Recovery a/a/o Vivian A. Monteagudo Leiva v. Progressive American Ins. Co., 20 Fla. L. Weekly Supp. 810a (Fla. 11th Jud. Cir., Miami-Dade Cty. Ct., June 6, 2013); Suncare Orthopaedics, LLC a/a/o Roberto Rodriguez Sepulveda v. State Farm Mut. Auto. Ins. Co., Hillsborough Cty, Case. No. 15-CC-038858-J, Order on Defendant’s Partial Motion to Dismiss Count I Seeking Declaratory Relief (May 10, 2016).
Accordingly, it is hereby
ORDERDED AND ADJUDGED that the Defendant’s Motion to Dismiss is hereby GRANTED.
