CENTRAL MAGNETIC IMAGING, ETC., APPELLANT,
v.
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, 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.
A medical provider who accepts an assignment of PIP benefits is entitled to statutory attorney fees as a prevailing party when the insurer pays the full benefits after receiving a demand for arbitration.
[1] A medical provider who accepts an assignment of PIP insurance benefits is entitled to statutory attorneys' fees as a prevailing party at arbitration when the insurer tend…
[2] An insurer's payment of PIP benefits after receiving a demand for arbitration is the functional equivalent of a confession of judgment, entitling the medical provider to…
Previewing 2 of 4 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.
Join FLexlaw to unlock all legal intelligenceTwo insureds assigned their rights to PIP benefits to a medical provider. The insurer failed to pay within the statutory time, prompting the provider …
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 Demand For Arbitration cases and more on FLexlaw
JORGENSON, J.
A medical provider appeals an order dismissing its complaint for statutory attorneys’ fees. The trial court dismissed the complaint with prejudice relying on USAA Casualty Insurance v. Romm, 712 So. 2d 405 (Fla. 4th DCA 1998). Due to the conflict among judges within the Eleventh Circuit, the trial court also certified the following question as one of great public importance:
Is a medical provider who has accepted assignment of PIP insurance benefits entitled to an award of statutory attorneys fees as a prevailing party at arbitration pursuant to Section 627.736(5) Florida Statutes, where the medical provider, through its attorney, serves a demand for arbitration by way of certified mail upon the insurer and where the insurer thereafter tenders full payment of benefits together with statutory interest subsequent to receipt of the demand for arbitration?
For the following reasons, we reverse and answer the certified question in the affirmative.
This is a consolidation of two cases. Marcos Santiago and Antonio Suarez were injured in two unrelated automobile accidents. The insurer, State Farm, provided personal injury protection coverage for Santiago and the driver of the vehicle in which Suarez was riding. Both Santiago and Suarez received medical services from Central Magnetic, the medical provider. In return for these medical services, both insureds assigned their rights to PIP benefits to the medical provider. Because the insurer failed to pay the medical provider within the statutory prescribed time, the medical provider demanded arbitration pursuant to section 627.736(5), Florida Statutes (1997).
When the insurer received the arbitration demand, it paid the PIP benefits but refused to include attor neys’ fees in the amount. The medical provider then filed suit to compel payment of attorneys’ fees. The insurer moved to dismiss the complaint because there had not been an arbitration and, therefore, no prevailing party was entitled to attorneys’ fees.
The trial court erred in relying on Romm. In Romm, the medical provider admitted that he did not accept an assignment of benefits from the insured. Id. at 406.
Therefore, section 627.736(5) was not invoked. Also, no arbitration appears to have been initiated; the trial court did not order arbitration. Id. Here, the medical provider initiated the arbitration process by sending the insured an arbitration demand letter. It is well settled in Florida that “[w]hen the insurance company has agreed to settle a disputed case, it has, in effect, declined to defend its position in the pending suit.
Thus the payment of the claim is, indeed, the functional equivalent of a confession of judgment or a verdict in favor of the insured.” Wollard v. Lloyd’s and Cos. of Lloyd’s, 439 So. 2d 217, 218 (Fla.1983); see also Avila v. Latin American Property & Cas. Ins. Co., 548 So. 2d 894 (Fla. 3d DCA 1989); Brown v. Vermont Mut. Ins. Co., 614 So. 2d 574, 579 (Fla. 1st DCA 1993).
Cf. Allstate Ins. Co. v. Ivey, 728 So. 2d 282, 283 (Fla. 3d DCA 1999) (failing to pay entire claim due to an error in doctor’s bill “does not rise to that level of ‘wrongness’ which would entitle [the insured] to an award of attorney’s fees.”).
A dispute arose when the insurer failed to pay the medical bills within the statutory period and the medical provider sent an overdue bill to the insurer for these medical expenses. The medical provider’s arbitration demand letter commenced this action. The insurer’s subsequent payment of the PIP benefits acted as a settlement of the action.
Therefore, the insured’s payment is equivalent to a confession of judgment, and the medical provider is the prevailing party under section 627.736(5), Florida Statutes.
An insurer cannot escape the penalty of attorney’s fees simply by ignoring an outstanding medical bill, paying it when an arbitration demand is made and then arguing that arbitration was not held because full payment of benefits was subsequently made. See Cincinnati Ins. Co. v. Palmer, 297 So. 2d 96, 99 (Fla. 4th DCA 1974) (“It is neither reasonable nor just that an insurer can avoid liability for statutory attorney’s fees by the simple expedient of paying the insurance proceeds to the insured or the beneficiary at some point after suit is filed but before final judgment is entered, thereby making unnecessary the entry of a judgment.”). This, in effect, would toll the insurer’s obligation to pay benefits within the statutory time period.
We answer the certified question in the affirmative and reverse the trial court’s dismissal of the medical provider’s complaint with prejudice.
REVERSED.
Cases With Similar Vibessemantic neighbors from the corpus
Citator
Cited By
-
Palm Springs Mile Assocs., Ltd. v. Ross Dress for Less, Inc. (S.D. Fla. 2020)
Authorities Cited
- Wollard v. Lloyd's & Cos. OF Lloyd's, 439 So. 2d 217 (Fla. 1983)
- The Cincinnati Ins. Co. v. Palmer, 297 So. 2d 96 (Fla. 4th DCA 1974)
- Brown v. Vt. Mut. Ins. Co., 614 So. 2d 574 (Fla. 1st DCA 1993)
- Lucio Avila v. Latin Am. Prop. & Cas. Ins. Co., 548 So. 2d 894 (Fla. 3d DCA 1989)
- Allstate Ins. Co. v. Farren Ivey, 728 So. 2d 282 (Fla. 3d DCA 1999)
- USAA Cas. Ins. Co. v. Michael R. Romm, Richard Keller, M.D., P.A., 712 So. 2d 405 (Fla. 4th DCA 1998)