PIP Benefits Not Due When Insurer Lacked Notice in Florida Pedestrian Injury Case

DSC00503 morguefil DMedinaIn State Farm Mutual Automobile Insurance Company v. Gonzalez, a pedestrian was apparently struck by a car in Florida in May 2001. Following the incident, the injured woman was treated at a local emergency room. The woman’s health care insurer later paid the hospital $685 for the woman’s treatment. The hospital did not send a bill to the woman’s auto insurer.

More than six months later, the pedestrian’s attorney sent a letter of representation and a copy of the accident report to the woman’s liability insurer. The lawyer also requested certain insurance information from the company. Despite the correspondence, the woman’s counsel failed to include a hospital bill or request payment from the auto insurer. After that, the insurance company allegedly made numerous unsuccessful attempts to contact the injured pedestrian’s lawyer regarding her harm. The insurer ultimately closed the woman’s claim in August 2004.

About five years after the pedestrian accident, the hurt woman filed a lawsuit, seeking uninsured motorist benefits from her auto insurer in a Florida court. The parties settled that case, and the woman then demanded additional personal injury protection (“PIP”) and medical payment benefits from the insurance company. When the insurer refused the woman’s demands, she filed another lawsuit against the company, seeking PIP benefits under Section 627.736 of the Florida Statutes.

In response, the insurance company filed a motion for summary judgment. According to the insurer, it was not required to pay the woman PIP benefits because the pedestrian failed to provide the company with a statement of the emergency room charges as required by the Florida statute. The trial court denied the company’s motion and instead ordered it to pay the injured woman $685.

On appeal to Florida’s Third District, the auto insurer claimed the trial court committed error when it entered judgment in favor of the injured pedestrian, since she did not provide the company with notice regarding the hospital charges. The insurance company also stated the requested PIP benefits did not become due as a result of this lack of notice.

The appellate court first examined the language of the statute before stating PIP benefits are not due until an insurance company receives written notice regarding a covered loss, such as a copy of a hospital bill. Next, the Third District ruled that PIP benefits never became due in the case because the insurance company did not receive appropriate notice of the pedestrian’s PIP claim. Since the insurer had no obligation to pay PIP benefits in the case, Florida’s Third District Court of Appeal reversed the trial court’s order in favor of the hurt pedestrian and remanded the case.

If you were hurt in a South Florida car or pedestrian accident, you are advised to discuss your rights with a skilled attorney as soon as you are able. To schedule a free consultation with a knowledgeable Miami personal injury lawyer, contact Friedman, Rodman & Frank, P.A. online or call us today at (305) 448-8585.

Additional Resources:

State Farm Mutual Automobile Insurance Company v. Gonzalez, Fla: Dist. Court of Appeals, 3rd Dist. 2015

More Blog Posts:

Florida Liability Insurer Held Jointly and Severally Liable for Costs in Car Accident Case, October 15, 2015, South Florida Personal Injury Lawyers Blog

Appeals Court Elaborates on Definition of Compensable Injury Under Florida Workers’ Compensation Law, October 15, 2015, South Florida Personal Injury Lawyers Blog

Photo Credit: DMedina, MorgueFile

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