27 Fla. L. Weekly Supp. 408c
Online Reference: FLWSUPP 2704JOSEInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Gratuitous payments — Where insurer exhausted PIP benefits by making payment to another medical provider whose claim insureds had already settled and paid, payment of that claim was gratuitous payment and should not be considered to have been made against policy limits — Summary judgment entered in favor of plaintiff medical provider
SPINE INSTITUTE OF SOUTH FLORIDA P.A. a/a/o Roselande Joseph, Plaintiff/Petitioner, v. WINDHAVEN INSURANCE COMPANY, Defendant/Respondent. County Court, 15th Judicial Circuit in and for Palm Beach County, County Civil Division RF. Case No. 50-2015-SC-002392-XXXX-MB. August 17, 2017. Frank S. Castor, Judge. Counsel: Glenn E. Siegel, West Palm Beach, for Plaintiff. Alyssa Delgado, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTIONFOR SUMMARY JUDGMENT AND DENYINGDEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS CAUSE came before the Court on August 14, 2017 upon Plaintiff’s Motion for Summary Judgment and Defendant’s Motion for Summary Judgment. Plaintiff was represented by Glenn Siegel, while Defendant was represented by Alyssa Delgado. The Court heard argument and was apprised of the facts and finds as follows:
1. Plaintiff filed suit for Breach of Contract on March 10, 2015 seeking PIP benefits coverage for an accident that occurred on October 1, 2014.
2. Defendant initially denied coverage, but did afford coverage on June 30, 2015.
3. Plaintiff’s bills totaling $8,400.00 were reasonable and medically necessary.
4. JFK Medical Center also provided a bill to Defendant for $23,584.00 for an earlier date of service than Plaintiff. However, JFK adjusted this amount to $3,537.60. On April 10, 2016, the insured, Roseande Joseph settled this amount with JFK for $2,500.00. (See Ex. E, Pl. M.S.J.). JFK received payment on May 18, 2016.
5. On June 30, 2016, Defendant paid JFK $10,000.00 in PIP benefits for the same bill the insured already had settled. Upon being notified of the JFK payment on June 29, 2016, Defendant did nothing to verify the JFK claim had been settled, or to recover their own $10,000.00 payment.
6. Defendant claims no payments are due Plaintiff because benefits were exhausted. According to Northwoods Sports Med. & Physical Rehab., Inc. v. Daniel, 137 So. 3d 1049, 1057 (Fla. 4th DCA 2014) [39 Fla. L. Weekly D491a], “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.”
7. The Court finds the payment to JFK was no longer a pending, valid claim at the time it was made. Rather, it was a gratuitous payment and should not be considered as having been made against the policy. Coral Imaging v. Geico, 955 So. 2d 11, 12 (Fla. 3rd DCA 2006) [31 Fla. L. Weekly D2478a].
Therefore, it is ORDERED AND ADJUDGED that Plaintiff’s Motion for Summary Judgment is GRANTED, and Defendant’s Motion for Summary Judgment is DENIED.
