24 Fla. L. Weekly Supp. 530a
Online Reference: FLWSUPP 2407TLCInsurance — Personal injury protection — Coverage — Medical expenses — Where ledger indicates that insured made payment to medical provider that resulted in zero balance due, provider no longer has claim against insurer for PIP benefits — Provider’s arguments that it intended to return monies to insured if it prevailed in suit against insurer and that insured’s payment was intended only to reduce outstanding balance, not to be payment in full, are not supported by admissible evidence
T.L.C. CHIROPRACTIC, INC. (ASSIGNEE OF RAYMOND, CLAUDINE), Plaintiff, vs. TRAVELERS HOME AND MARINE INSURANCE COMPANY, Defendant. County Court, 2nd Judicial Circuit in and for Leon County, Civil Division. Case No. 2015 SC 001256. September 14, 2016. Augustus D. Aikens, Jr., Judge. Counsel: Abraham S. Ovadia, Christopher C. Casper, Florida P.I.P Law Firm, P.A., Boca Raton, for Plaintiff. David B. Kampf, Ramey & Kampf, P.A., Tampa, for Defendant.
FINAL SUMMARY JUDGMENT
THIS CAUSE, having come before the Court on August 4, 2016, on Defendant’s Motion for Final Summary Judgment Based on Prior Settlement, and the Court having heard argument of the parties and being presented evidence and otherwise being advised in the premise, it shall hereby be:
ORDERED and ADJUDGED that:
1. The undisputed facts reveal Plaintiff filed a cause of action seeking payment of no-fault benefits related to services rendered to the assignor at issue. Benefits were denied to the assignor as all the services at issue were rendered after an independent medical examination report provided that further chiropractic care was not necessary, reasonable or related to the accident.
2. The assignor initially obtained care and treatment in Hillsborough County and as related to an accident occurring in Hillsborough County. However, the assignor had moved to Tallahassee and initiated treatment with Plaintiff in Tallahassee albeit after the discontinuation of chiropractic benefits as noted above. All of the services of Plaintiff were denied resulting in the lawsuit wherein Plaintiff sought $667.84, the total amount of the services rendered. Plaintiff asserted that no amounts have been paid by Defendant or any other sources for the services.
3. During discovery, Defendant obtained a statement/ledger indicating that the patient and/or patient’s counsel paid Plaintiff $350.00 in 2013. The ledger indicated a balance due of zero. All other ledgers provided to Defendant did not identify the payment or that the balance due was zero. That further discovery and deposition of the Plaintiff’s treating doctor revealed that the payment resolved all pending medical bills although the payment had never been made known to the Defendant.
4. Defendant sought final summary judgment asserting that there were no damages in which the Plaintiff could obtain in the suit. Further, Defendant argues that if the assignor does not owe the assignee any amounts for medical services as a result of the injuries sustained in the motor vehicle accident, neither does Travelers as Travelers may not be obligated to pay more than the insured patient is obligated to pay.
5. This Court relies on the law presented by Defendant including the case of Clayton W. Hopkins, D.C. d/b/a Hopkins Clinic a/a/o Douglas Miller v. Travelers Home and Marine Insurance Company, Case No. 14-329 (Fla. 6th Jud. Cir., County Court February, 26, 2016) [24 Fla. L. Weekly Supp. 433b] , as well as other case law presented to the Court supporting the fact that there are no damages.
6. This Court finds that if the assignor no longer owes Plaintiff any outstanding balance for medical services then Plaintiff no longer has a claim with Travelers for no-fault benefits. The assignee maintains no greater rights than the assignor, and, more importantly, the lack of existence of damages precludes suit.
7. The Court rejects Plaintiff’s argument that it intended to return monies to the patient should Plaintiff prevail in this suit. First, there is no admissible evidence of any type of an agreement to return any funds. Plaintiff presents no evidence of an agreement with the insured that the payment from 2013 was not intended to resolve the patient’s bills. Nothing was presented that Plaintiff was holding the insured’s money in escrow pending the result of the lawsuit. It is clear the payment was intended to resolve the patient’s total bills. In any event, Plaintiff’s assertion as to the return of money is based on hearsay in hearsay as well as speculation. The Plaintiff’s doctor did not know if the money would be retuned, but simply alleged it may be returned and provided the accounting department may know more. In no way whatsoever is such testimony evidence. There is no evidence that the provider will reopen a prior settlement agreement to reallocate settlement payments more than three years after the settlement. The parole evidence rule also precludes the argument for those reasons raised during hearing.
8. Plaintiff’s creation of a new ledger indicating the amount due is now reduced by the payment of the patient, and that the balance is no longer zero, is not evidence and was not submitted as attached to an Affidavit or any testimony. Also, that ledger is nothing more than Plaintiff’s attempt to create an issue of fact via Plaintiff’s own inconsistent testimony. Further, Plaintiff’s new or alternate position that the payment just reduced the outstanding balance is completely inconsistent with Plaintiff’s argument and the admissible evidence presented. That is, Plaintiff initially asserts that there was an agreement that the money from the patient was payment in full for all services rendered, however, should Plaintiff prevail in suit aginst the insured, that entire amount is to be returned. Thus, it would not appear that the payment was intended to partially reduce the total outstanding amount, but was to resolve the total outstanding amount. Also, Plaintiff offered no evidence the insured did not intend the payment to resolve the full outstanding amount.
9. Plaintiff had every opportunity to submit evidence from the attorney for the insured, the insured or other sources indicating the prior settlement was not a settlement and that the insured remained responsible to pay. That the money was simply being held pending the outcome of the PIP litigation that commenced years later. The undisputed facts reveal the insured’s payment was settlement of the full outstanding amount. Also, this Court must not search for a reason to void the prior settlement or create new terms and conditions for which there is no evidence.
10. The Court further finds that Plaintiff is precluded from seeking the proverbial two bites of the apple. That is, seeking and obtaining money from the patient as payment in full as well as seeking the same money from Travelers. This is true even if the amount sought in this suit is the reduced amount sought per the inadmissible ledger. A settlement with the patient is a settlement. If the patient no longer owes any amounts to the provider, then the provider no longer has any claims against the patient. Thus, the provider has no claims against Travelers. In any event, this Court fails to see how Plaintiff could continue with the suit based on the prior settlement even if Plaintiff submitted admissible evidence that revealed that the funds would be returned. That such an agreement may not be permitted since the sole purpose is to allow the provider to obtain payment from two sources and then decide which source to retain. See Clayton W. Hopkins, D.C.
11. In any event, this Court finds that Plaintiff’s position must be that it entered into a settlement agreement that is contingent, voided and/or the consideration is materially altered pending the outcome of the suit against the insurer. Is Plaintiff of the position that there was a settlement with the patient or that there was not a settlement with the patient? This Court finds such a position is inappropriate and not supported by the law. Does Plaintiff assert there are two outstanding balances, one for the insurer and one for the patient? Such an arrangement is invalid. The facts reveal only one agreement occurred. That agreement was the patient paid $350 to resolve all outstanding balances.
12. Defendant asserts that Plaintiff’s conduct is an attempt to re-work the accounting books and ledgers and may constitute an unlawful accounting method for no purposes other than to pursue the suit. That even though the facts clearly show that Plaintiff has attempted to create new and different ledgers with different, this Court does not rule on this issue as it is unnecessary based upon the above and below facts and findings.
13. The Court does not address or enter rulings on Plaintiff’s Motion for Summary Judgment Based on Reasonableness, Necessity and Relatedness of Treatment. The Court does not enter any rulings or findings on Defendant’s Motion for Summary Judgment on the Invalidity of the Pre-suit Demand Letter.
Based on the above, it is hereby Ordered and Adjudged:
1. That final summary judgment shall thereby be entered in favor of Defendant and against Plaintiff for the foregoing reasons. That Plaintiff shall take nothing from this cause of action and Defendant shall go hence without a day.
2. This Court reserves jurisdiction to address Defendant’s entitlement to attorneys’ fees and costs and the reasonableness of fees and costs.
