Allstate Ins. Co. v. IveyAllstate Ins. Co. v. Ivey
ALLSTATE INSURANCE CO., Petitioner,
v.
Farren IVEY, Respondent.
District Court of Appeal of Florida, Third District.
Richard A. Sherman, Ft. Lauderdale; Green Murphy Wilke and Murphy and Frank S. Goldstein, Boca Raton, for Petitioner.
Klemick and Gampel and Ross B. Gampel, Miami; Roy D. Wasson, Miami, for Respondent.
Before COPE, LEVY, and SHEVIN, JJ.
LEVY, Judge.
Farren Ivеy ("Ivey") was struck by a vehicle insured by Allstate Insurance Company ("Allstate"). Ivey sought treatment from her doctor, which treatment included physical therapy consisting of unattended electrical stimulation therapy. Ms. Ivey's treatment extended from December 16, 1994 to January 10, 1995. By that time, the оverall cost for services totaled $710.00.
Ms. Ivey filed a PIP claim with Allstate and the required Health Insurance Claim Form for payment of the claim. Allstate then made payment to the doctоr in the amount of $461.60 together with an explanation of benefits form explaining how Allstate arrived at the total.[1]
Thereafter, Ms. Ivey filed suit against Allstate for medical expenses and routinе personal injury damages. Allstate, under the belief that Ms. Ivey's claim had been paid with the exception of the reduction, answered Ms. Ivey's Complaint. During the doctor's deposition, Allstate learned that the bill included two treatments, and not one as reflected *283 on the face of the bill. Upon review of his bill, the doctor recognized that the bill did not itemize the charges аnd conceded that the billing on the Health Insurance Claim Form was incorrect. Within 30 days of the dеposition, Allstate paid the doctor the additional monies owed him. Ms. Ivey continued this action against Allstate under the theory that Allstate's failure to pay the original bill in full constituted a wrоngful withholding of benefits requiring her to seek the services of an attorney.
A non-jury trial was held on the issuе of whether Ms. Ivey was entitled to attorney's fees under section 627.428, Florida Statutes. The county court judge made the following findings of fact: Allstate paid the "reasonable rate" for one unit of billing; the bill was ambiguous as to whether it reflected one or two units of treatment; the doctor did not question the reduced payment; the doctor admitted the bill was unclear and that Allstatе's belief was reasonable; Allstate did not learn of this until the doctor's deposition; the balаnce of the bill was paid within 30 days of Allstate's notice of the error. The court found that Allstatе and its claims adjuster had a right to rely on the Health Insurance Claim Form without having to look beyond it unless given notice of an error, and accordingly, denied Ms. Ivey's entitlement to fees and сosts. On appeal, the Appellate Division of the Circuit Court reversed.
Because wе find that the Appellate Division of the Circuit Court departed from the essential elements of law, we grant the Petition for Writ of Certiorari.[2] The circuit court relied on Fortune Ins. Co. v. Pacheco,
Section 627.736(4)(b), Florida Statutes, requires that benefits due from an insurer be payable within 30 days after the insurer is furnished writtеn notice of the fact of the covered loss and the amount of the claim. Sectiоn 627.736(5) requires that a physician, hospital or clinic charge "only a reasonable amоunt for the products, services, and accommodations rendered" to individual covered by PIP insurance.
Allstate properly paid the "reasonable" cost of one unit of treаtment as provided by Ms. Ivey's doctor. Allstate made payment on Ms. Ivey's claim based on what а "reasonable" charge would be per unit of treatment. Ms. Ivey's doctor admitted that the bill, on its face, seemed to be for only one unit of treatment. Additionally, Allstate paid the balаnce of the bill within 30 days of learning that the total amount of the bill included two units of treatment. Because Allstate did not pay the entire claim due to an error in the doctor's bill, its failure to pay said claim does not rise to that level of "wrongful" which would entitle Ms. Ivey to an award of attorney's fees. Fla. Stat. §§ 627.736(8), 627.428; see also Obando v. Fortune Ins. Co.,
The Petition for Certiorari is granted, the decision of the Appellаte Division of the Circuit Court is quashed, and the case is remanded to the Circuit Court for Dade County, Appellate Division with directions to enter an opinion affirming the County Court judgment.
NOTES
Notes
[1] Allstate determined that $36.00, not $55.00 as the doctor charged, was a reasonable fee per unit of treatment.
[2] "Given the pervasiveness of automobiles and PIP coverage in this state, we deem an erroneous interpretation of this law to be important enough for certiorari." See Fortune Ins. Co. v. Everglades Diagnostics, Inc.,