FORTUNE INSURANCE COMPANY, APPELLANT,
v.
JOSEPH A. FIGUEROA, APPELLEE
AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.
Florida appellate court affirmed that a PIP insured is legally responsible for reasonable medical bills and entitled to PIP coverage even when workers' compensation benefits have been partially applied, rejecting the insurer's argument that workers' compensation liability shields the insured from further responsibility.
A PIP insured remains legally responsible for reasonable medical bills and is entitled to PIP coverage under his policy even when workers' compensation benefits have been accepted in partial payment, and the PIP carrier must make required medical payments with a credit for workers' compensation received.
[1] A PIP carrier must make required medical payments under its policy even when the insured is receiving workers' compensation benefits, and is entitled to a credit for work…
Previewing 1 of 1 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.
Join FLexlaw to unlock all legal intelligence“the acceptance of Figueroa's workers' compensation benefits by the medical care providers in this case in part payment for Figueroa's medical bills herein did not, as urged, preclude such providers from pursuing Figueroa for the reasonable amount still due and owing on such bills”
Court rejecting Fortune's argument that workers' compensation acceptance eliminated further liability
Joseph Figueroa received workers' compensation benefits that were accepted by medical care providers in partial payment of his medical bills. Fortune …
The full statement of facts, procedural history, and disposition for this case are member content.
Join FLexlaw to unlock all legal intelligence© FLexlaw, Inc. — AI-generated enrichments are proprietary. All rights reserved.
Explore caselaw by topic → Browse Coordination Of Benefits cases and more on FLexlaw
PER CURIAM.
Contrary to the contention of the PIP insurance carrier [Fortune Insurance Company], we conclude that the PIP insured [Joseph Figueroa] is legally responsible for the reasonable medical bills in this case, and, that, accordingly, he is entitled as the trial court found, to PIP coverage for such bills under his insurance policy with Fortune; we therefore affirm the orders under review.
We reject Fortune’s contention that there is no PIP coverage for such bills because Section 440.13(4)(a), Florida Statutes (1989) insulates Figueroa entirely from any further liability for such bills; plainly, the acceptance of Figueroa’s workers’ compensation benefits by the medical care providers in this case1 in part payment for Figueroa’s medical bills herein did not, as urged, preclude such providers from pursuing Figueroa for the reasonable amount still due and owing on such bills. Compare Long Grove Builders, Inc. v. Haun, 508 So. 2d 476 (Fla. 1st DCA 1987). Indeed, we have held that a PIP carrier, as here, is required to make otherwise required medical payments under its policy with its PIP insured even though the PIP insured is also receiving workers’ compensation benefits; and that such payments are not restricted, as urged, to those prescribed by the workers’ compensation schedule, although the PIP carrier is entitled to a credit for workers’ compensation received in payment for covered medical expenses. Charter Oak Fire Ins. Co. v. Regalado, 339 So. 2d 277 (Fla. 3d DCA 1976).
Affirmed.
. These providers were not under contract with the employer or the employer’s carrier to provide medical services to the insured herein.
Cases With Similar Vibessemantic neighbors from the corpus
Citator
Cited By
-
SUN Bank/South Fla., N.A. v. Baker, 632 So. 2d 669 (Fla. 4th DCA 1994)…asis of individual consideration" subject to administrative rules. R.E. Ledford Constr. Co. v. King, 381 So. 2d 330, 332 (Fla. 1st DCA 1980); Mt. Sinai Medical Ctr. v. Samuels, 453 So. 2d 81 (Fla. 1st DCA 1984). . Fortune Insurance Co. v. Figueroa, 597 So. 2d 435, 436 (Fla. 3d DCA), rev. denied, 605 So. 2d 1263 (Fla.1992), contains language indicating that a medical provider may accept workers' compensation benefits and still pursue the employee for that portion of a reasonable fee which exceeds the compensa…
-
M. Felix Freshwater, M.D., P.A. v. Baker, 707 So. 2d 937 (Fla. 3d DCA 1998)…se propositions would also prevent Freshwater from recovering from Baker based upon the August 18 letter.1 For the reasons stated above, we affirm the summary judgment for Mr. Baker, and recede from our opinion in Fortune Insurance Co. v. Figueroa, 597 So. 2d 435 (Fla. 3d DCA 1992). Affirmed. . Sun Bank involved a similar issue. The health care provider claimed that because the injured worker had signed an agreement promising to pay whatever workers’ compensation and/or insurance did not pay, the worker wa…
Authorities Cited
- Charter OAK Fire Ins. Co. v. Regalado, 339 So. 2d 277 (Fla. 3d DCA 1976)
- Long Grove Builders, Inc. v. Haun, 508 So. 2d 476 (Fla. 1st DCA 1987)