824 F.3d 1311
11th Cir.2014Background
- PICC fraudulently billed State Farm for personal injury protection (PIP) benefits via a sham treatment scheme.
- State Farm began paying, then stopped, challenging PICC’s fraudulent bills.
- Intervenors—Williams, Byers, and Reed—had assigned PIP rights to PICC and intervened after State Farm’s challenge.
- Florida lawNo-Fault law governs withdrawals of benefits and requires a valid medical report before withdrawing payment under 627.736(7)(a).
- This court previously held State Farm violated 7(a) by withdrawing payments without a proper report, but later confronted an intervening Florida authority undermining that reasoning; the panel reinstates the jury verdict in favor of State Farm.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the law-of-the-case doctrine bars revisiting the 7(a) report rule. | Intervenors rely on law-of-the-case to resist reconsideration. | State Farm argues new Florida authority requires reconsideration. | Intervenors fail to show applicable exceptions; law-of-the-case not revisited. |
| Whether State Farm was required to obtain a medical report before withdrawing PIP in a fraudulent-claims context. | PICC fraud precludes withdrawal without proper report under 7(a). | Chiropractic One and subsequent authority permit denial without report due to fraud. | Florida law allows denial without a 7(a) report when fraud invalidates claims; no report required. |
| Whether the denial of PIP benefits can arise from fraud and how damages are computed. | Intervenors seek recovery based on what State Farm paid before fraud; need damages computed. | Damages limited by fraud; initial payments were voided by fraud. | Claims are invalid due to fraud; damages and fees are reversed and remanded for entry of judgment for State Farm. |
| Whether Intervenors have standing to pursue PIP benefits after revoking assignment. | Intervenors’ rights arise from Florida law protecting insureds’ PIP benefits. | Standing not affected by revocation; injury remains under state law. | Standing resolved in prior decision; state-law injuries confirmed; no reversal. |
Key Cases Cited
- Chiropractic One, Inc. v. State Farm Mut. Auto. Ins. Co., 92 So. 3d 871 (Fla. 5th Dist. Ct. App. 2012) (fraud invalidates claims; 5(b) permits denial of fraudulent charges)
- Viles v. United Auto. Ins. Co., 726 So. 2d 320 (Fla. 3d Dist. Ct. App. 1998) (medical report prerequisite to withdrawal; fraud context affects obligation)
- Charioting One, Inc. v. State Farm Mut. Auto. Ins. Co., 92 So. 3d 871 (Fla. 5th Dist. Ct. App. 2012) (read into 5(b)/5(c) changes; fraud taxes enforcement of 4(b) vs 7(a))
- Hyma Med. Ctr., Inc. v. State Farm Mut. Auto. Ins. Co., 22 So. 3d 699 (Fla. 3d Dist. Ct. App. 2009) (withdrawal vs denial; No-Fault distinctions; report requirement varies by posture)
- Schiavo ex rel. Schindler v. Schiavo, 403 F.3d 1289 (11th Cir. 2005) (law-of-the-case doctrine governs subsequent proceedings; exceptions apply)