Comprehensive Health Center, LLC v. Star Casualty Insurance Company

Third DCA

Comprehensive Health Center, LLC v. Star Casualty Insurance Company—(J. Gordo; 3DCA; 2/22/23).

In December 2013, Angela Cooper, a Star insured, was injured in a motor vehicle accident. CHC provided medical treatment to Cooper. In exchange, Cooper assigned her right to receive personal injury protection (PIP) benefits to CHC. CHC submitted bills to Star for services rendered to Cooper. Between March 2014 and April 2015, Star mailed four checks to CHC in fulfillment of its payment of the bills submitted.

There were two issues that cropped up. In 2015, CHC demanded more money to pay the amounts in full, but Star told CHC that the full policy limits had been exhausted. Then, in 2016, CHC returned two checks to Star because they objected to some language on the checks (perhaps because the checks stated they were payment in full and CHC thought that acceptance of the checks would be taken as a stipulation that it was payment in full). Star did not reissue the checks.

CHC sued for breach of the insurance policy, and Star answered and asserted an affirmative defense that it had fully exhausted the policy limits. CHC disagreed that the benefits were exhausted because it had never cashed the two checks that it had returned.

The trial court agreed with Star and granted summary judgment. CHC appealed.

“The purpose of PIP benefits is to provide up to $10,000 for medical bills and lost wages without regard to fault.” Pursuant to section 627.736(1), Florida Statutes, PIP benefits are due to an insured, limited to $10,000 for injuries arising out of ownership, maintenance or use of a motor vehicle. Once the full $10,000 of PIP benefits are “exhausted through the payment of valid claims, an insurer has no further liability on unresolved, pending claims, absent bad faith in the handling of the claim by the insurance company.”

“Payment” is not defined under the PIP statute, but two statutes within Chapter 627 state that payment is made when the insurer places the check in the mail. Thus, all benefits were exhausted because Star mailed them, and the fact that the checks were returned does not matter. The policy was exhausted. (NOTE: Uhhh…can they get those two “paid” checks back??). Affirmed. 5909_i.pdf

Terry P. Roberts
Director of Appellate Practice Fischer Redavid PLLC
PDF Version

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