8 Fla. L. Weekly Supp. 411b
Insurance — Personal injury protection — No error in granting summary judgment in favor of insurer in action by insured for payment of PIP benefits for charges which insurer had denied as not reasonable or necessary where insurer had advised insured that it would defend and indemnify insured should any legal action be brought to recover the unpaid charges — Insurer complied with its contractual obligation when it denied payment of benefits it deemed unreasonable or unnecessary — Record contained no evidence of damage to insured, who has not been pursued for unpaid charges or suffered related adverse consequences, and there was no evidence that insurer has breached promise to defend and indemnify insured
LYNN GRIFFITH, KIMBERLY GRIFFITH, and BRADLEY GRIFFITH, by and through his next friend, natural guardian, and father, KIMBERLY GRIFFITH, Appellants, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Appellee. Circuit Court, 6th Judicial Circuit (Appellate) in and for Pinellas County. Case No. 00-4430-CI-88A. Opinion filed January 31, 2001. W. Douglas Baird, Judge. Appeals from Final Judgment, County Court, Civil Division, Pinellas County. The Honorable Karl B. Grube. Counsel: Jorge Leon Chalela, St. Petersburg, for Appellants. David B. Kampf and Sonya S. Hammac, Tampa, for Appellee.
ORDER AND OPINION
THIS CAUSE came before the Court on appeal, filed by Lyn Griffith, Kimberly Griffith and Bradley Griffith (Appellants), from an Order Granting Defendant’s Motion For Summary Judgment in favor of State Farm Mutual Automobile Insurance Company (Appellee), entered March 28, 2000. Upon review of the record and the briefs and being otherwise fully advised in the premises, the Order entered by the lower court is affirmed.
Although a party moving for summary judgment has a high burden, the Appellee met that burden in this case. See Tamm v. Bradley, 696 So.2d 816 (Fla. 2d DCA 1997). The record shows that the Appellants were involved in an automobile accident and sought payment of personal injury protection (PIP) benefits pursuant to their policy of insurance. The Appellee denied payment of various charges submitted by the Appellants’ medical providers, finding that the level or amount of treatment received by the Appellants was not reasonable or necessary. The Appellee advised the Appellants that it would defend and indemnify them should any type of legal action be brought to recover such unpaid charges. The Appellants then filed the underlying cause of action seeking payment of PIP benefits. These facts are undisputed.
In granting the Appellee’s Motion for Summary Judgment, the lower court cited authority that holds an insurance company does not breach its contract, and the insured suffers no damages, when the insurer pays the amount it determines to be reasonable for a submitted expense and further agrees to defend and indemnify the insured if he or she is pursued for any remaining balance. See Dominquez v. State Farm Mutual Auto. Ins. Co., No. 99-2376 (Fla. Pinellas Cty. Ct. July 22, 1999), affirmed, No. 99-7195 (Fla. 6th Cir. Ct. Aug. 24, 2000); McQueen v. Allstate Indemnity Co., 6 Fla. L. Weekly Supp. 185 (Fla. 17th Cir. Ct. 1998); LaMothe v. Auto Club Ins. Assoc., 543 N.W.2d 42 (Mich. App. 1995).
This Court agrees with this conclusion. See Caravakis v. Allstate Indemnity Company, No. 00-0028 (Fla. 6th Cir. Ct. August 31, 2000) (citations omitted) [7 Fla. L. Weekly Supp. 760].Further,this Court finds that the Appellee complied with its statutory and contractual obligations when it denied payment of benefits it deemed to be unreasonable or unnecessary. See Fla. Stat. § 627.736(1)(a), (5)(a) (2000) (providing that an insurer need not pay more than a reasonable charge and that a health care provider may charge no more than what is reasonable).
There is also nothing in the record to demonstrate that the Appellants have suffered damages from the Appellee’s denial of payment to the medical providers in question; the Appellants have not been pursued for the unpaid charges nor suffered related adverse consequences. See Heard v. Mathis, 344 So.2d 651 (Fla. 1st DCA 1977) (holding that an essential element of a cause of action in contract is a violation of a duty that results in damage to the plaintiff); see also Mostoufi v. Presto Food Stores, Inc., 618 So.2d 1372, 1377 (Fla. 2d DCA 1993) (finding that a cause of action consists of two parts, a wrong and resulting demonstrable damage). Additionally, there is no evidence that the Appellee has breached its promise to defend and indemnify should the Appellants be pursued for the unpaid balance. Therefore, this Court finds that the lower court did not err in entering summary judgment in favor of the Appellee.
Therefore, it is,
ORDERED AND ADJUDGED that the Order Granting Defendant’s Motion For Summary Judgment is hereby affirmed. The Appellant’s request for oral argument is denied. It is further
ORDERED AND ADJUDGED that the Appellee is entitled to reasonable attorney’s fees and costs expended on this appeal. The trial court shall determine the amount of these fees and costs.
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