7 Fla. L. Weekly Supp. 807a
Insurance — Personal injury protection — Insurer, who refused to pay total amounts contained in bills submitted by healthcare providers and only paid what it deemed to be reasonable charges for medically necessary services, is entitled to summary judgment on claim seeking payment of PIP benefits as there is complete absence of any material issues of fact — Insurer does not breach its insurance contract by refusing to pay for all, as opposed to only reasonable health care services provided to insured — Insured is removed from jeopardy and cannot suffer damages as matter of law where enforceable contractual obligation upon insurer is created by correspondences from insurer to insured agreeing to defend and indemnify insured in event any cause of action is brought by healthcare provider against insured for outstanding bills
JEFF KOCHINSKI, Plaintiff, v. STATE FARM FIRE AND CASUALTY COMPANY, Defendant. County Court, 13th Judicial Circuit in and for Hillsborough County, Civil Division. Case No. 98-18714 SC. Divison H. September 20, 2000. Frank A. Gomez, Judge. Counsel: Gale L. Young, St. Petersburg. Leslie L. Longshore, Tampa.
ORDER ON DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS CAUSE came before the Court March 9, 2000, on Defendant’s Motion for Summary Judgment, and the Court, after considering the Motion, argument of Counsel, review of the file, and being otherwise fully informed in the premises, it is hereby:
ORDERED AND ADJUDGED:
That based upon the pleadings, correspondences, affidavits, there is a complete absence of any material issues of fact and accordingly, as a matter of law, STATE FARM FIRE AND CASUALTY COMPANY is entitled to a summary judgment pursuant to Florida Rule of Civil Procedure 1.510.
FINDINGS OF FACT
1. Plaintiff entered into a contract of insurance with STATE FARM FIRE AND CASUALTY COMPANY and was insured under the subject policy.
2. Plaintiff has brought this cause of action, seeking payment of personal injury protection (PIP) benefits relating to injuries suffered as a result of an accident that occurred on or about October 8, 1997.
3. Plaintiff alleges that certain medical treatment was necessary and reasonable as related to the accident. Plaintiff was treated by Dr. William E. Gatlin, M.D., EMSA, and NU-BEST DIAGNOSTIC LABS, INC.
4. Each submitted bills to STATE FARM FIRE AND CASUALTY COMPANY for payment for the services rendered to the Plaintiff.
5. Although STATE FARM FIRE AND CASUALTY COMPANY did not pay the total amounts contained in the bills submitted, they paid what they deemed to be reasonable charges for medically necessary services.
6. Correspondences to the Plaintiff from Defendant informed the Plaintiff that should any of the health care providers pursue any type of legal action against the Plaintiff, STATE FARM FIRE AND CASUALTY COMPANY agreed and stood ready to defend and indemnify the Plaintiff at its expense.
7. The afore-recited material facts are undisputed.
LAW
1. This Court holds that an insurer does not breach its insurance contract by refusing to pay for all, as opposed to only the reasonable health care services provided to the insured.
2 . Correspondences, from an insurer to an insured, agreeing to defend and indemnify the insured in the event any cause of action is brought by the healthcare provider against the insured for the outstanding bills creates an enforceable contractual obligation upon the insurer.
3. Based upon the above mentioned enforceable contractual obligation, Plaintiff is removed from jeopardy and cannot suffer damages as a matter of law.
4. This Court finds the cases of LaMothe v. Auto Club Insurance Association, 543 N.W. 2d 42 (Mich. App. 1995); McGill v. Automobile Association of Michigan, 526 N.W. 2d 12 (Mich. App. 1994) and McQueen v. Allstate Indemnity Company, 6 Fla. L. Weekly Supp. 185 (17th Jud. Cir. Broward County, December 7, 1998) to be persuasive, finding the facts of this case analogous to those cases and GRANTS STATE FARM FIRE AND CASUALTY COMPANY’s Motion for Summary Judgment.
WHEREFORE it is:
FURTHER ORDERED AND ADJUDGED:
1. That Plaintiff shall take nothing and go hence without day.
2. That this Court reserves jurisdiction to tax any applicable fees and costs.
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