7 Fla. L. Weekly Supp. 145a
Insurance — Personal injury protection — Insured’s action against insurer arising from insurer’s reduction of certain medical bills — Court rejects insurer’s contention that insured has no damages because policy contains an indemnification clause stating that insurer will defend and indemnify the insured in the event insured is sued by medical provider for a bill which insurer has determined to be unreasonable, unnecessary, or unrelated to automobile accident in question — Florida law does not require that insured be sued by medical provider prior to filing suit against PIP insurer — Notwithstanding existence of an indemnification clause, insured who is entitled to payment of bills and who could be liable for the balance of the bill properly states claim for damages under both section 627.736 and the insurance contract
ADELE DECKER, Plaintiff, vs. ALLSTATE PROPERTY CASUALTY INSURANCE COMPANY, Defendant. County Court of the 17th Judicial Circuit in and for Broward County. Case No. 99-06055(56). October 22, 1999. Linda R. Pratt, Judge.
ORDER ON DEFENDANT’S MOTION FOR FINAL SUMMARY JUDGMENT
THIS CAUSE having come before this Court on Defendant’s Motion for Final Summary Judgment filed July 12, 1999, and the Court having heard argument of counsel, and being otherwise fully advised in the premises, the Court finds as follows:
FINDINGS OF FACT
1. The Plaintiff filed suit for personal injury protection benefits because the Defendant insurer reduced certain medical bills. The Plaintiff demanded trial by jury. The Defendant filed an Answer and Affirmative Defenses.
2. The Defendant filed a Motion for Summary Judgment alleging the Plaintiff has no damages because the Defendant’s policy of insurance contains a provision stating the Defendant insurer will defend and indemnify the insured in the event the insured is sued by a medical provider for a bill it determines to be unreasonable, unnecessary or unrelated to the automobile accident in question. The Defendant relies on Michigan case law to support its position. The Defendant did not cite any binding Florida cases directly on point.
CONCLUSIONS OF LAW
3. Florida’s No-Fault Statute §627.736 requires a personal injury protection insurance carrier to pay the insured all reasonable expenses within 30 days of receipt of the claim unless other provisions of the No-Fault Statute are satisfied. These payments are first party benefits, and under Florida Law the insured is not obligated to submit the payment to the provider.
4. Florida law does not require an insured to be sued by a medical provider prior to filing suit against a personal injury protection insurer.
5. If Defendant’s arguments were adopted, insurance companies could circumvent the dictates of Florida Statute 627.736 by simply placing an indemnification clause in their policies. They would then have no incentive to promptly pay claims, because the risk would not be a suit by the insured, but only the risk of being sued by an insured after the provider has sued, or a suit by the provider directly through an assignment. The statutory purpose to encourage prompt payment of claims would be defeated.
6. Notwithstanding the existence of an indemnification clause in the policy, the insured who is entitled to the payment of the bills, and who could be liable for the balance of the bill, properly states a claim for damages under both Florida Statute 627.736 and the contract.
7. There are genuine issues of material fact in dispute as to whether the medical bills in question were reasonable and necessary which must be determined by the jury. It is, therefore,
ORDERED AND ADJUDGED that Defendant’s Motion is denied.
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