921 F.3d 1273
11th Cir.2019Background
- March 18, 2015 car accident: insured Conor Carruthers sought treatment from A&M Gerber Chiropractic; his GEICO PIP policy provided up to $10,000 but full PIP requires an EMC (emergency medical condition) diagnosis; without EMC statutory cap is $2,500.
- At filing, Carruthers had not been diagnosed with an EMC, but GEICO pre-suit paid $7,311 to Carruthers/Gerber (exceeding the $2,500 cap).
- Dispute centered on interpretation of GEICO endorsements: FLPIP (01-13) (fee-schedule based payments and a sentence stating insurer will pay a submitted charge if it is less than amounts otherwise allowed) vs. M608 (01-13) notice stating insurer will pay no more than 80% (GEICO treated it as part of the policy; Gerber called it a non-policy notice).
- Gerber (assignee of Carruthers) filed a class-action declaratory-judgment complaint in state court seeking a declaration that GEICO must pay 100% of certain billed charges; complaint disclaimed any claim for monetary relief. Case was removed to federal court under CAFA.
- District Court held Gerber had standing, treated M608 as a non-policy notice, and entered declaratory judgment for Gerber interpreting FLPIP to require payment of the billed charge when it is less than 200% of the fee schedule. GEICO appealed.
- Eleventh Circuit reversed for lack of Article III standing and instructed dismissal; the court declined to reach the merits.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standing to seek declaratory relief | Gerber (assignee) can pursue declaratory relief about policy interpretation; future injury exists because uncertainty will recur and providers may be harmed | No standing: at the time of filing Carruthers had received $7,311 (more than statutory cap), so there was no injury-in-fact or likelihood of future injury to Carruthers and thus no Article III case or controversy | Held: No standing. As of filing Carruthers suffered no cognizable present or likely future injury; Gerber (assignee) cannot have greater rights than Carruthers, so suit must be dismissed |
| Justiciability given pre-suit full payment | Gerber argued declaratory relief is appropriate regardless of pre-suit payments; emphasizing policy uncertainties and possible future effects on providers | GEICO argued full pre-suit payment left no redressable controversy; courts must examine standing at filing and Gerber cannot obtain relief for already-exhausted benefits | Held: Pre-suit full payment is dispositive for Article III standing in this posture; absence of money owed and lack of substantial likelihood of future harm defeats declaratory claim |
| Policy scope: whether M608 (01-13) is part of the policy | Gerber: M608 is only a notice, not an endorsement; FLPIP’s sentence governs and requires payment of billed charges under 200% of fee schedule | GEICO: M608 is an endorsement/part of the policy and caps insurer payment at 80% | Held: Court did not reach merits on this issue because of lack of jurisdiction (District Court had ruled M608 was not part of the policy; Eleventh Circuit reversed on standing and vacated merits) |
| Class certification / representative standing | Gerber sought class certification; argued representative could represent providers assigned benefits | GEICO: A class cannot be certified if the named plaintiff lacks personal Article III standing at filing | Held: Because the named plaintiff lacked standing, class action could not proceed; at least one named plaintiff must have had an Article III case or controversy at filing |
Key Cases Cited
- Robbins v. Garrison Prop. & Cas. Ins. Co., 809 F.3d 583 (11th Cir. 2015) (interpreting Florida PIP EMC requirements and PIP benefit limits)
- Mills v. Foremost Ins. Co., 511 F.3d 1300 (11th Cir. 2008) (coverage dispute and damages claim distinguished standing from merits; plaintiffs there sought damages)
- Harrison v. United Mine Workers of Am. 1974 Ben. Plan & Trust, 941 F.2d 1190 (11th Cir. 1991) (if insurer pays all benefits, no case or controversy exists)
- Malowney v. Federal Collection Deposit Grp., 193 F.3d 1342 (11th Cir. 1999) (to obtain declaratory relief plaintiff must allege substantial likelihood of future injury)
- Warth v. Seldin, 422 U.S. 490 (1975) (standing requires plaintiff to have personally suffered injury that the court can remedy)
- O’Shea v. Littleton, 414 U.S. 488 (1974) (no class relief if named plaintiffs lack Article III standing)