24 Fla. L. Weekly Supp. 691cO
nline Reference: FLWSUPP 2409HAMMInsurance — Personal injury protection — Coverage — Exhaustion of policy limits — In absence of any evidence of bad faith, where benefits were exhausted through payment of valid claims, insurer has no liability for medical provider’s claim — Provider lacks standing to argue that benefits would be available if insurer had not paid untimely submitted prescription claim — Moreover, although PIP statute provides that insurer is not required to pay untimely submitted claim, insurer can elect to do so
SUSANTI K. CHOWDHURY, MD, PA a/a/o Angela Hammel, Plaintiff, v. PROGRESSIVE AMERICAN INSURANCE COMPANY, Defendant. County Court, 6th Judicial Circuit in and for Pinellas County. Case No. 15-10383-SC. October 10, 2016. Kathleen T. Hessinger, Judge. Counsel: Brandon M. Daniels, Daniels & Hannan, P.A., Lakewood Ranch, for Plaintiff. Michael P. Liebgold, Progressive PIP House Counsel,Tampa, for Defendant.
FINAL SUMMARY JUDGMENT
This Cause came to be heard before this Court on Defendant’s Motion for Summary Judgment with the Parties present, through counsel, and this Court having reviewed the motion, the response to said motion, and the pleadings, and having heard argument of counsel and being otherwise advised of the premises, it is hereby Ordered and Adjudged as follows,
1. On December 11, 2015, Plaintiff, medical provider, sued Defendant, insurer, for breach of contract for PIP benefits. Defendant denied the allegations claiming exhausted benefits since December 22, 2010.
2. Defendant filed a Motion for Summary Judgment requesting this Court enter Final Judgment as the PIP benefits are exhausted. The undisputed facts prove the benefits were exhausted, on December 22, 2010, as the full PIP benefits were paid for medical benefits and wage loss. At the Motion for Summary Judgment, Plaintiff argued that Defendant unlawfully paid a prescription claim, in the amount of $7.19, on November 24, 2010, as it was submitted more than 35 days from the date the prescription was purchased. Plaintiff argued that had Defendant not paid that prescription claim then that $7.19 could have been paid towards its claim for PIP benefits. As such, Plaintiff requests this Court to determine that the prescription claim was unlawfully paid and require Defendant, the insurer, pay $7.19 to Plaintiff towards its outstanding PIP claim.
3. Plaintiff’s claim is without merit. Once the insurer exhausted all the insured’s PIP benefits, no further benefits were available; thus, Plaintiff has no claim against the insured’s benefits. See Progressive American Ins. Co. v. Stand-Up MRI, 990 So. 2d 3 (Fla. 5th DCA 2008) [33 Fla. L. Weekly D1746a]; Sheldon v. United Services Auto. Assoc., 55 So. 3d 593 (Fla. 1st DCA 2011) [36 Fla. L. Weekly D23a]; Simon v. Progressive Express Ins. Co., 904 So. 2d 449 (Fla. 4th DCA 2005) [30 Fla. L. Weekly D1156b].
4. Moreover, Plaintiff lacks standing to argue whether the insurer should or should not have paid a PIP claim by the insured or another provider. Plaintiff’s assignment from the insured gives the Plaintiff the insured’s rights and benefits under the policy to collect PIP benefits for Plaintiff only, not to dictate whether the insurer should or should not have paid a claim to the insured or another medical provider.
5. Beyond the standing issue, allowing one medical provider to file suit, or maintain a suit, against the insurer, after benefits are exhausted, on the grounds that “had the insurer not paid a PIP claim by another provider or the insured, then this Plaintiff/medical provider may have received the benefits” opens a Pandora’s Box that would keep insurers open to litigation, for years, after paying the required PIP benefits under the policy. Plaintiff’s argument is without merit as, at first, it would allow one medical provider to claim another medical provider’s treatment was not necessary thereby forcing the insurer and the other medical providers into litigation to prove every payment the insurer made to each provider was medically necessary. Second, what if other medical providers’ claims were not paid due to the exhausted benefits? Is the Plaintiff/medical provider entitled to the benefits because it brought the PIP suit? Do the other medical providers get interpleaded into the lawsuit? Must the other medical providers file lawsuits looking for PIP benefits from an exhausted PIP policy? Third, what if the Plaintiff/medical provider decides to contest whether the insured was entitled to reimbursement for her lost wages? Does the insurer now have to defend its payment to the insured against a medical provider with an assignment? Finally, the purpose of PIP is to have expeditious payment of benefits for insureds involved in motor vehicle accidents. Under Plaintiffs rationale, the insurer could never expeditiously pay the insured’s benefits due to concern that another medical provider might sue over PIP payments the insurer made for claims by other medical providers or the insured. The insurer would constantly be at risk for paying over the PIP policy limits.
6. As such, unless the insurer used bad faith in handling Plaintiff’s claim, once the PIP benefits are exhausted through the payment of valid claims, an insurer has no further liability to unpaid claims. Northwoods Sports Medicine and Physical Rehabilitation, Inc. v. State Farm Mutual Auto. Ins. Co., 137 So. 3d 1049, 1057 (Fla. 4th DCA 2014) [39 Fla. L. Weekly D491a]. The undisputed facts reflect Defendant did not act in bad faith in handling Plaintiff’s claims. Moreover, the Defendant’s payment of the prescription claim was well within the insurer’s statutory authority. Section 627.736(5)(c), Fla. Stat. states the “insurer is not required to pay charges for treatment or services rendered more than 35 days . . .” (emphasis added) The plain reading of the statute means that the insurer can pay it, but is not required to pay the claim. Although, this Court confirms the insurer’s lawful payment of the prescription claim, this Court need not do so. Plaintiff did not have a justiciable issue against the insurer once the PIP benefits were exhausted.
7. This Court will consider attorney’s fees for Defendant, pursuant to §57.105(1) or (2), Fla. Stat., as Plaintiff’s attorney knew or should have known that this claim was not supported by material facts.
It is therefore Ordered and Adjudged that Plaintiff, Susanti K. Chowdhury, M.D., P.A., a/a/o Angela Hammel, shall take nothing from this action and Defendant, Progressive American Insurance Company, shall go hence without day. This Court reserves jurisdiction to address any issues as to attorney’s fees and costs.
