25 Fla. L. Weekly Supp. 226a
Online Reference: FLWSUPP 2503CORAInsurance — Personal injury protection — Coverage — Emergency medical condition — Confession of judgment — Where medical provider failed to provide determination that insured had EMC at time it filed claim for PIP benefits, provider was not forced into litigation by insurer’s failure to pay more than $2,500 in benefits, and trial court erred in finding that insurer’s payment of additional benefits after provider supplied post-suit determination that insured had EMC constituted confession of judgment
UNITED SERVICES AUTOMOBILE ASSOCIATION, Appellant, v. PHYSICIAN’S MEDICAL CENTER NORTHSIDE, INC., a/a/o Karina Cora, Appellee. Circuit Court, 17th Judicial Circuit (Appellate) in and for Broward County. Case No. CACE-14-022896 (AP). L.T. Case No. COCE-14-001413 (53). April 13, 2017. Appeal from the County Court for the Seventeenth Judicial Circuit, Broward County, Robert W. Lee, Judge. Counsel: Douglas H. Stein, Bowman and Brooke, Coral Gables, for Appellant. Todd A. Landau and Matthew C. Barber, Landau & Associates, P.A., Hallandale Beach, for Appellee.
OPINION
(PER CURIAM.) United Services Automobile Association (“USAA”) appeals an “Order of Dismissal and Order Vacating Judgment” in which the trial court determined that USAA’s payment of the disputed damages constituted a confession of judgment. After careful review of the briefs, the record, and applicable law, this Court dispenses with oral argument and finds the following:
USAA provided personal injury protection (“PIP”) coverage to Karina Cora (“Claimant”) at the time she was involved in a motor vehicle accident on or about April 15, 2013. Claimant assigned her PIP benefits to Physician’s Medical Center Northside, Inc. (“Provider”) for services rendered following the accident. Pursuant to section 627.736(1)(a)(4), Florida Statutes, USAA was only obligated to pay up to $2,500.00 unless an authorized medical provider determined that Claimant had an emergency medical condition (“EMC”). Because Provider did not indicate that Claimant had an EMC when it submitted its claim, USAA declined reimbursement after the $2,500.00 in benefits had been exhausted. In its Explanation of Reimbursement, USAA requested that Provider provide a determination that Claimant had an EMC so that further reimbursements could be made. Instead of complying with USAA’s request, Provider filed a complaint for breach of contract on January 20, 2014.
On September 26, 2014, the trial court entered summary judgment and final judgment in favor of USAA, finding that under section 627.736(1)(a)(4), PIP benefits are limited to $2,500.00 unless an authorized medical provider determines that the insured had an EMC, and the insurer has been notified of that determination. On September 29, 2014, Provider moved for a determination of confession of judgment, arguing that USAA’s payment, on September 14, 2014, of the outstanding amount requested by Provider constituted a confession of judgment. The trial court agreed, and on October 30, 2014, entered an amended order granting defendant’s motion for summary judgment (“amended order granting summary judgment”). However, in the amended order granting summary judgment, the trial court found that no determination had been made that Claimant had an EMC, noting that Dr. Joseph’s affidavit, which was served on USAA on September 2, 2014, was “the first notice ever provided to USAA that the patient in fact had an emergency medical condition.” Notwithstanding, the trial court, thereafter, determined that USAA’s request for a final judgment was moot because of the confession of judgment. On November 7, 2014, the trial court entered an order dismissing the case and vacating the final judgment.
The determination that USAA’s payment constituted a confession of judgment is reviewed de novo. See Johnson v. Omega Ins. Co., 200 So.3d 1207, 1213 (Fla. 2016) [41 Fla. L. Weekly S415a]. The confession of judgment “doctrine applies where the insurer has denied benefits the insured was entitled to, forcing the insured to file suit, resulting in the insurer’s change of heart and payment before judgment.” State Farm Florida Ins. Co. v. Lorenzo, 969 So. 2d 393, 397 (Fla. 5th DCA 2007) [32 Fla. L. Weekly D1791e]. “However, courts generally do not apply the doctrine where the insureds were not forced to sue to receive benefits.” Id. at 398.
In the instant case, the trial court erred in determining that USAA’s payment constituted a confession of judgment because at the time the action was filed, USAA had no legal obligation to pay beyond the $2,500.00 reimbursement limit because Claimant had not been determined to have an EMC. It was not until USAA was served with Dr. Joseph’s affidavit on September 2, 2014 that USAA was notified that Claimant had an EMC. Prior to September 2, 2014, PIP benefits were correctly limited to $2,500.00. Provider was not forced into litigation because USAA had no duty to reimburse beyond the $2,500.00 limit at the time the litigation started. USAA’s willingness to meet its contractual duty by paying the remaining bill after it received the documentation does not constitute a confession of judgment.
Accordingly, the county court’s order vacating final judgment and dismissing the case is REVERSED, and this case is REMANDED to the county court for further proceedings consistent with this Opinion. Further, Provider’s motion for attorney’s fees is DENIED, and USAA’s motion for attorney’s fees pursuant to section 768.79, Florida Statutes, is GRANTED, conditioned on USAA prevailing in the proceedings below and the trial court determining that USAA’s proposal for settlement is valid, enforceable, and made in good faith. (MURPHY, PERLMAN, and LEVENSON, JJ., concur.)
