Florida Appellate Court Reverses Award of PIP Benefits for Lack of Notice to Insurer

Florida is one of the states that require drivers to obtain personal injury protection, or PIP, insurance to cover medical payments that may arise from an accident. Unsurprisingly, many issues arise regarding whether an insurance company must make payments through a PIP policy when someone gets injured.

In State Farm Mutual Automobile Insurance Company v. Gonzalez, a Florida pedestrian suffered injuries when she was struck by a car during May 2001. The injured pedestrian received treatment for her injuries at the emergency room immediately following the incident, and the pedestrian’s health insurance company paid $685 to the emergency room for her treatment. At no time did the emergency room provide a bill to the pedestrian’s auto insurance carrier.

Over six months later, the injured pedestrian’s lawyer sent a letter of representation to the motor vehicle insurance company along with an accident report. The letter also sought specific information regarding the insurance policy. The letter did not include, however, a copy of the hospital bills associated with the woman’s treatment, or a request that the auto insurer provide payments for the hospital bills.

The insurance company alleged that it made several attempts to contact the injured pedestrian’s attorney but had no success. In August 2004, the insurance company closed the pedestrian’s claim.

Five years later, the pedestrian filed a lawsuit seeking uninsured driver benefits from her motor vehicle insurance company. The parties eventually entered into a settlement agreement, and the woman made a demand for PIP payments and medical payment benefits from the insurer. The insurance company denied these requests, and the woman initiated a second lawsuit, claiming that she was entitled to the PIP benefits pursuant to Florida Statutes Section 627.736.

The insurer moved for summary judgment, contending that it was not required to provide PIP benefits because she failed to provide the insurance company with any ledger or receipt for the medical costs incurred at the emergency room pursuant to Florida’s PIP laws. The court rejected this argument, denied the motion for summary judgment, and entered an order requiring the insurer to pay the woman $685.

On appeal, Florida’s Third District Court of Appeals first turned to the PIP statutes’ language regarding when benefit payments are due. According to the court, the benefits are due when the insurer is provided with notice in writing regarding the loss. The appellate court also concluded that the PIP benefits in this case never became due because the motor vehicle insurance company never received any written notice from the pedestrian regarding her claim for PIP payments. Ultimately, the appellate court reversed the lower court’s award of damages and remanded the case.

If you or someone you love suffered injuries in a car accident, you may be entitled to compensation. At Lusk, Drasites & Tolisano, we have helped many car accident victims throughout Southwest Florida, including in Naples, Fort Myers, and Cape Coral. We offer a free consultation and fight aggressively for our clients along each step of the way. Call us now at 1-800-283-7442 or contact us online to set up your appointment.

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