6 Fla. L. Weekly Supp. 185a
Insurance — Personal injury protection — Insurer does not breach contract with insured by failing to pay for medical expenses deemed to be unreasonable, unnecessary, or unrelated to accident — Insurer’s contractual obligation to defend and indemnify the insured if the provider sues for outstanding bills is enforceable
CHARLIE McQUEEN, Plaintiff, v. ALLSTATE INDEMNITY COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 98-07561 SP COCE 50. December 7, 1998. Peter B. Skolnik, Judge.
ORDER ON DEFENDANT’S MOTION FOR FINAL SUMMARY JUDGMENT
THIS CAUSE having come before me on Defendant’s Motion for Final Summary Judgment and the Court being duly advised in the premises, it is hereby:
ORDERED AND ADJUDGED
That based upon the pleadings, correspondence, affidavits and depositions there is a complete absence of any material issues of facts and accordingly, as a matter of law, the Defendant, ALLSTATE INDEMNITY COMPANY is entitled to summary judgment pursuant to Florida Rule of Civil Procedure 1.510(a).
Facts
The Plaintiffs entered into a contract of insurance with ALLSTATE and were insureds under the subject policy of insurance. On or about November 16, 1997 the Plaintiffs were involved in an automobile accident. As a result of the accident, the Plaintiffs treated with Riverside Medical Associates and SPL Rehabilitation Management, Inc. Riverside Medical Associates and SPL Rehabilitation Management, Inc., billed ALLSTATE for their services and those bills were submitted to ALLSTATE for payment.
Although ALLSTATE paid what they deemed to be reasonable charges for medically necessary services, the Plaintiffs filed a personal injury protection (PIP) suit against ALLSTATE for breach of contract and alleged that ALLSTATE did not fully pay for certain medical services rendered.
Under ALLSTATE’s policy of insurance governing payment of PIP benefits and the governing Florida Statutes, “ALLSTATE is obligated to pay only reasonable charges for necessary medical expenses; if an insureds/Plaintiffs incur medical expenses which ALLSTATE deems unreasonable, unnecessary, or unrelated, ALLSTATE may refuse to pay for those medical expenses and contest them; and if the insureds/Plaintiffs are sued by a medical services provider because ALLSTATE refuses to pay medical expenses deemed to be unreasonable, unnecessary or unrelated, ALLSTATE will pay resulting defense costs and any resulting judgment against the person insured.”
Law
This Court holds that an insurer does not breach their insurance contract with the insured by failing to pay for all, as opposed to only the reasonable, health care services provided to an insured. Furthermore, an insurer’s contractual obligation (similar to that contained within ALLSTATE’s policy) to defend and indemnify the insured if provider sued for outstanding bills is enforceable. LaMothe v. Auto Club Insurance Association, 543 N.W.2d 42,44,45 (Mich.App. 1995); McGill v. Automobile Association of Michigan, 526 N.W.2d 12, 13-14 (Mich.App. 1994).
This Court finds the Lamothe and McGill cases persuasive, the facts of this case analogous to those cases and grants ALLSTATE’s Motion for Final Summary Judgment in favor of ALLSTATE. This Order shall evidence the Final Judgment entered against the Plaintiffs and the Plaintiffs shall take nothing and go hence without day. This Court reserves jurisdiction to tax any applicable fees and costs.
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