8 Fla. L. Weekly Supp. 250a
Insurance — Personal injury protection — Coverage — Denial — Reasonable and necessary expenses — Medical provider/assignee is entitled to be paid for medical bill submitted to insurer prior to exhaustion of benefits under policy if the charges were reasonable and necessary, even though all benefits under the policy were subsequently exhausted — Insurer may seek to recover against medical provider that insurer wrongfully paid
MED+PLUS MEDICAL CLINICS, INC., As Assignee of Roshunti Edwards, Plaintiff vs. ALLSTATE INSURANCE COMPANY, Defendant. County Court, 12th Judicial Circuit in and for Manatee County, Civil Division. Case No. 2000-SC-2241. January 19, 2001. Matthew E. McMillan, Judge. Counsel: Gary R. Jodat, Jodat & Luhrsen, P.A., Sarasota, for Plaintiff. Dale Parker, for Defendant.
ORDER ON DEFENDANT’S MOTIONFOR SUMMARY JUDGMENT
THIS CAUSE having come on to be heard on the Defendant’s Motion for Summary Judgment, and the Court, having been duly advised in the premises, hereby finds as follows;
The facts of this case are relatively simple and are agreed to for purposes of this motion. Roshunti Edwards was injured in an automobile accident and sought medical treatment at Med+Plus Medical Clinic. Edwards executed an assignment of benefits under her insurance policy with Allstate. For purposes of this motion, Allstate has stipulated that this was a valid assignment of benefits. At some point, Edwards was advised to have a nerve conductivity test performed. She did so and a bill for $2200.00 was submitted to Allstate for payment.
Allstate declined to pay the bill on the basis that it was not reasonable or necessary.1 Meanwhile, Allstate continued to pay bills as they came in and eventually, all the benefits under the policy were exhausted. At the time of the submission of the bill for the nerve testing, there were still benefits available to pay the medical provider, Med+Plus for the tests. The issues presented to the Court are what damages are now available to the Plaintiffs.
TheDefendant contends that once the policy limits are paid and benefits exhausted, even if the Plaintiff should prevail, the Plaintiff is only entitled to payment of attorney fees, costs and interest. But, the insurance carrier would not be liable for payment of the original bill since under the policy, the benefits were exhausted paying for other medical bills. The Defendant asserts that the Court cannot make them pay more than what the contract requires in the form of additional benefits.
The Plaintiff suggests that the failure to pay the nerve testing, if found to be reasonable by the trier of fact, would necessarily mean that Allstate had misapplied benefits. Therefore, they would be responsible for the payment ofthe medical tests to the Plaintiff. The Defendant argues that the “English Rule”, as enunciated in Boulevard National Bank of Miami v. Metal Industries, Inc., 176 So.2d 94 (Fla. 1965) requires that the bills be paid in the order in which they are received. The Defendant asserts that Allstate’s remedy is to seek reimbursement from the insured or the providers paid in lieu of Med+Plus being paid. However, the English gives preference to the first assignee who gives notice to the debtor. Med+Plus gave first notice and therefore was first in line for the distribution of the benefits.
The “American Rule”, as enunciated in Boulevard National Bank, was squarely rejected by the Florida Supreme Court. Accordingly, the insurer paid the wrong medical provider. This would be no different than the insurer paying the wrong insured for a lost wage claim. The assignment, which the parties have stipulated to, vestsMed+Plus with all the rights and obligations of the insured. Med+Plus is entitled to be paid if the charges were reasonable and necessary. The insurer may seek to recover against the medical provider that the insurer wrongfully paid, but the assignee stands in the shoes of the assignor.
ORDERED AND ADJUDGED that the Defendant’s Motion for Summary Judgment is denied.
__________________
1Allstate also admits, for purposes of this motion that they were wrong to withhold payment and should have paid the bill.
* * *
