25 Fla. L. Weekly Supp. 902a
Online Reference: FLWSUPP 2510KEITInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where insurer made payment to medical provider other than plaintiff that exhausted remainder of insured’s PIP benefits, insurer had no further liability on unresolved pending claims irrespective of fact that medical provider that received final payment then returned portion of payment to insurer with expressed intent to preserve benefits for other medical providers — What receiving medical provider does with insurer’s payment is immaterial to insurer’s liability under policy
MIAMI-DADE COUNTY MRI CORP, a/a/o Aleshia Keith, Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, a Florida corporation, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County, Civil Division. Case No. 12-19975 SP 23 (06). September 6, 2017. Spencer Multack, Judge. Counsel: Kenneth J. Dorchak, for Plaintiff. Ari D. Neimand, for Defendant.
ORDER GRANTING DEFENDANT’S AMENDEDMOTION FOR FINAL SUMMARY JUDGMENTRE: EXHAUSTION OF BENEFITS
This matter having come before the Court on this 7th day of August 2017 on the Defendant’s Motion for Final Summary Judgment RE: Exhaustion of Benefits, and after having considered the argument of counsel present, having reviewed all the applicable documents in the Court file, after having reviewed all the case law provided by the attorneys and being fully advised of the premises thereof, the Court finds as follows:
This is an action for the recovery of PIP benefits pursuant to Fla. Stat. §627.736. The Defendant’s Motion for Final Summary Judgment alleges that it tendered the $10,000.00 policy limits and benefits are now exhausted. The facts of this case reveal that another medical provider, Quality Medical Group (“QMG”), received payments from the Defendant for medical treatment to the insured over the course of five years. The first demand for payment from QMG is dated February 2, 2012; the last demand letter, in the amount of $16,609.00 from QMG is dated June 28, 2016. The Defendant made payments to QMG on several occasions; the final payments were made on August 4, 2016 and August 5, 2016 in the amount of $1568.43 and $172.74 respectively. On September 19, 20161, QMG returned $172.74 in payments, “. .in order to preserve these remaining PIP benefits for the other medical providers that submitted bills for the above policy and the above claim number.” The reason or rationale for the return of payments, other than what is stated in the letter, is unknown. Prior to receipt of the QMG demand letter of June 28, 2016, the Defendant had tendered reimbursements in the amount of $8,431.57. The payment of $1,568.43 would have exhausted benefits, but for the return of $172.74.
Meanwhile, Miami Dade County MRI Corp (“MDC MRI”) filed suit on October 12, 2012 demanding a total of $134.22 in reimbursements for medical treatment provided to the insured. This protracted litigation has ensued since then. Of interest to this Court is the timing of the remaining payment of reimbursements in light of certain rulings by this Court. The Plaintiff filed its Motion for Summary Judgment on September 1, 2015, which dealt with the remaining2 issue of reasonableness. This Court denied3 that motion on July 29, 2016. As noted above, the Defendant exhausted benefits (the August 4 and August 5, 2016 payments to QMG’s demand of June 28, 2016) one week after the Court’s ruling. Shortly thereafter, on September 19, 2016, QMG inexplicably returned $172.74 to the Defendant. The Defendant’s Motion for Summary Judgment in regards to the Exhaustion of Benefits was filed on October 21, 2016. The Defendant contends the benefits exhausted upon the Augusts 4th and 5th payments to QMG; the Plaintiff contends the return of the payments from QMG to the Defendant does not constitute an exhaustion.
The question to be answered by this Court is whether the Defendant’s “payment” of the remaining demand constitutes an exhaustion of benefits even though the Plaintiff returned a portion of the benefit for “other medical providers.” There is no definition of “payment” within F.S. 627.736, thus the Court turns to a standard dictionary and related statutes to derive the common, ordinary meaning of the term. See Cason v. Florida Department of Management Services, 944 So.2d 306 (Fla. 2006) [31 Fla. L. Weekly S788a] (defining “taxpayer” where no definition exists in statute) citing Nehme v. Smithkline Beecham Clinical Labs., Inc., 863 So.2d 201, 205 (Fla. 2003) [28 Fla. L. Weekly S719a] (stating that where the Legislature has not defined a term, its plain and ordinary meaning can be taken from a dictionary); State v. Mitro, 700 So.2d 643, 645 (Fla.1997) [22 Fla. L. Weekly S532a] (“In the absence of a statutory definition, resort may be had to case law or related statutory provisions which define the term, and where a statute does not specifically define words of common usage, such words are construed in their plain and ordinary sense.”).
In terms of “payment”, the Court finds further guidance in Goble v. Frohman, 848 So.2d 406 (Fla. 2nd DCA 2004) [28 Fla. L. Weekly D1494a], which dealt with the issue of whether contractual discounts in a health insurance policy constituted payments. The Court in Frohman used the traditional definitions of “payment” in the analysis:
“Payment” is defined by Webster’s as “the act of paying or giving compensation,” “the discharge of a debt or an obligation,” “something given to discharge a debt or obligation or to fulfill a promise.” Webster’s Third New International Dictionary 1659 (1986). It has also been defined as “[p]erformance of an obligation, usu. by the delivery of money. Performance may occur by delivery and acceptance of things other than money, but there is a payment only if money or other valuable things are given and accepted in partial or full discharge of an obligation.” Black’s Law Dictionary 1150 (7th ed.1999).
Under F.S. 627.736 personal injury protection benefits are due to an insured, limited to $10,000 for injuries arising out of the ownership, maintenance, or use of a motor vehicle. The obligation of the insurance company to pay the insured is the basis of the contract of insurance entered into between the parties and is codified in F.S. 627.736. Without a doubt, the purpose of the no-fault statutory scheme is to “provide swift4 and virtually automatic payment so that the injured insured may get on with his [or her] life without undue financial interruption.” Geico Gen. Ins. Co. v. Virtual Imaging Services, Inc., 141 So.3d 147 (Fla. 2013) [38 Fla. L. Weekly S517a] citing, Ivey v. Allstate Ins. Co., 774 So.2d 679, 683-84 (Fla.2000) [25 Fla. L. Weekly S1103a].
The Court finds that the demand letter of June 28, 2016 from QMG complies with §627.736(10) F.S. (2011). Further, based on the above authority and definition of the word “payment,” the Defendant did in fact make a payment under the policy of insurance. This payment exhausted the remainder of the Defendant’s benefits. What the receiver of the payment does with the payment is immaterial. Once the PIP benefits are exhausted through the payment of valid claims, an insurer has no further liability on unresolved, pending claims, absent bad faith in the handling of the claim by the insurance company. Northwoods v. State Farm Insurance Company, 137 So.3d 1049 (Fla. 4th DCA 2014) [39 Fla. L. Weekly D491a]. No evidence of bad faith has been presented that would require the Defendant to pay more than the $10,000.00 of required benefits. See Geico v. Gables Insurance Recovery, 159 So.3d 151 (Fla. 3rd DCA 2014) [39 Fla. L. Weekly D2561a] (a showing of bad faith is required before the insurer can be held liable for benefits above the statutory limit.)
THEREFORE, based upon the above findings of fact and conclusions of law, this Court GRANTS the Defendant’s Motion for Final Summary Judgment and finds that the insured’s benefits exhausted upon payments made to QMG on August 4 and August 5, 2016.
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1The letter, although undated, contains USPS tracking number 7015-3430-0000-2326-5867. A check of usps.com indicates delivery on September 19, 2016 to zip code 33169.
2The parties stipulated the only issue remaining in this matter was one of reasonableness. See Notice of Filing Stipulation on August 19, 2015.
3This Court thereafter granted summary on rehearing on reasonableness on January 5, 2017.
4The last date of service to the insured was January 25, 2012. Benefits exhausted on August 4th and 5th, 2016. Nothing about the timing of this matter reflects a “swift and automatic payment” as contemplated by the Florida Supreme Court in Geico Gen. Ins. Co. v. Virtual Imaging Services, Inc
