8 Fla. L. Weekly Supp. 736c
Insurance — Personal injury protection — Action against insurer for denying full payment of medical bill — Insurer complied with requirements of statute in reducing amount bill by obtaining reasonable proof that it was not responsible for the amount billed — Where insurer complied with statute, no payment was overdue and insured could not be entitled to statutory interest on unpaid portion of bill — Final judgment entered in favor of insurer
PAMELA J. COBB, Plaintiff, v. METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. SCO 00-3338. July 23, 2001. C. Jeffrey Arnold, Judge. Counsel: Norman A. Monroe, Winter Park. J. Tracy Wilkenson, Orlando.
FINAL SUMMARY JUDGMENT IN FAVOR OF DEFENDANT
THIS CAUSE came before the Court on Defendant’s Motion for Final Summary Judgment, and the Court having reviewed the Court file, heard argument of counsel and being otherwise fully advised in the premises, hereby finds as follows:
1. This is a suit for breach of contract alleging the Defendant denied full payment of a billing statement from Headache Institute in the amount of $300.00 for services rendered on November 17, 1999.
2. Defendant issued a policy of automobile insurance including PIP and Med-Pay coverage to the Plaintiff. Policy limits were $10,000.00 for PIP coverage and $2,500.00 for medical payments coverage.
3. Headache Institute submitted its billing directly to Metropolitan. Metropolitan processed this billing through the Mitchell Medical Decision Point Database. The Database recommended payment in the amount of $222.00. Metropolitan timely made this payment to Headache Institute.
4. On May 23, 2000, the PIP benefits were exhausted by payment. On October 16, 2000, the Medical Payments coverage was exhausted by payment. The Plaintiff has no further no-fault benefits available to her through Metropolitan.
5. Defendant filed a Motion for Final Summary Judgment alleging that the Plaintiff had received the full benefit of her bargain, the suit was moot and the Plaintiff could gain nothing further by the continuation of this suit.
6. Plaintiff asserts that although benefits were indeed exhausted, she could nevertheless go to trial and prove the reasonableness of the amount charged, and therefore be entitled to interest pursuant to Florida Statute 627.736(4).
7. Defendant counters that Plaintiff cannot be entitled to statutory interest because it has complied with Florida Statute 627.736(4)(b) in that it has obtained reasonable proof to establish that it is not responsible for the disputed amounts. Because it obtained reasonable proof, the bill is not overdue and the Plaintiff could not be entitled to interest.
It is therefore ORDERED AND ADJUDGED that Defendant’s Motion for Final Summary Judgment is hereby GRANTED.
Florida Statute 627.736(1)(a) requires that personal injury protection insurance policies provide benefits for reasonable expenses for necessary medical services. Florida Statute 627.736(4)(c) provides that interest is required to be paid on overdue payments. Florida Statute 627.736(4)(b) provides, “However, any payment shall not be deemed overdue when the Insurer has reasonable proof to establish that the Insurer is not responsible for the payment, …”.
Metropolitan had reasonable proof that it was not responsible for the payment of the amount billed by Headache Institute at issue. This reasonable proof is based upon the Decision Point Medical Analysis Database used by Metropolitan. Metropolitan complied with the Florida Statutes by obtaining reasonable proof that it was not responsible for the amount billed. Even if the case continued to trial and the Plaintiff proved that the amount billed was reasonable, the Defendant still would have complied with the requirements of the No-Fault Statute in reducing the amount billed. Since Metropolitan has obtained reasonable proof that it was not responsible for the amount billed, it has complied with the Statute, no payment is overdue and Plaintiff cannot be entitled to statutory interest.
Accordingly, the Final Summary Judgment is hereby entered in favor of the Defendant, Metropolitan Property and Casualty Insurance Company and against the Plaintiff, Pamela J. Cobb and Defendants shall go hence without day. The Court retains jurisdiction to award taxable costs.
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