Marjorie HOWELL-DEMAREST, Appellant,
v.
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Appellee.
District Court of Appeal of Florida, Fourth District.
*527 Arnold R. Ginsberg of Perse, P.A. & Ginsberg, P.A. and Hoppe, Backmeyer & Stokes, Miami, for appellant.
Richard A. Sherman and Rosemary B. Wilder of the Law Offices of Richard A. Sherman, P.A., and Charles B. Green, Jr. of Green, Murphy & Wilke, P.A., Fort Lauderdale, for appellee.
KLEIN, Judge.
The insured's State Farm policy provided $100,000 in medical payment coverage and $10,000 in personal injury protection coverage (PIP). PIP coverage pays 80% of medical expenses and 60% of loss of income up to its limits. After an accident, the insured, as she was entitled to do, requested State Farm to pay her medical bills from her mediсal pay coverage, not her PIP coverage, in order to maximize her benefits for lost wages under the PIP coverage. State Farm did not comply, and she sued for the PIP benefits, also alleging that State Farm's refusal is a general business practice which will *528 give rise to a statutory punitive damage claim.[1]
The insured's claim is based on Holloway v. State Farm Mutual Automobile Insurance Co.,
The statutory basis alleged in the insured's complaint is section 626.9541(1)(i) 2 and 3, Florida Statutes (1991)[2], which subsection is titled "Unfair Claims Settlement Practices." Section 624.155 authorizes civil actions for violations of section 626.9541(1), but provides in subsection 624.155(4), with regard to punitive damages:
No punitive damages shall be аwarded under this section unless the acts giving rise to the violation occur with such frequency as to indicate a general business practice and thеse acts are:
(a) Willful, wanton, and malicious;
(b) In reckless disregard for the rights of any insured;
The insured alleges that notwithstanding Holloway, State Farm, after being requested by the insureds to allocate, has refused to do so "with such frequency as to indicate a general business practice ... in reckless disregard for the rights of ... [insureds]." § 624.155(4).[3] As evidence of a general business practice, the insured cited in her complaint three other reported decisions in which State Farm had failed to follow Holloway; State Farm Mutual Automobile Insurance Co. v. Chacon,
The trial court granted State Farm's motion for summary judgment, and although the court did not set forth its reasoning, it appears, based on the arguments made at the hearing, that the court concluded that the allegations agаinst State Farm were not sufficiently egregious to give rise to a punitive damage claim under section 624.155(4). We disagree.
In Home Insurance Co. v. Owens,
In Bennett, State Farm refused to allocate pursuant to Holloway because the insured had not made the request to allocate prior to some payments having already been made which exhausted the PIP benefits for medical expenses, leaving nothing for lost wages. In rejecting that contention, Judge Ryder stated:
Few insureds can foresee exactly how an accident will affect their lives. Here, Bennett initially had lost wages and medical expеnses, then sometime after the accident she had additional lost wages, no further PIP coverage, and unused medical payments coveragе. We do not feel that it is right to deny insured's benefits for which they have clearly paid, because they did not have the insight to determine how their payments should be apportioned.
State Farm chose to exhaust the PIP benefits first, despite the fact that the majority of the claims submitted were for medicаl expenses. State Farm should have been more concerned about their obligation to provide their insured with the maximum benefits allowable under their contract. Instead, State Farm unfairly argues that it should be allowed to keep the benefit of the $1,000.00 that Bennett paid for inasmuch as she did not foresee the need to allocate prior to submitting her first claim. The fact remains, however, that Bennett has approximately $1,000.00 worth of benefits remaining under the medical payment provision, and by not allowing her to reapportion her claim she is not receiving the full value of the contract for which she bargained and paid premiums.
Bennett,
Notwithstanding the fact that an insured pays a separate premium for PIP and medical pay coverage, this court did not, in Holloway, require that benefits automatically be paid by the insurer in a manner which would give the insured full benefit of the PIP coverage. We hеld that the insurer was required to allocate only after being requested to do so. If in fact State Farm has a "general business practice" of nоt allocating, i.e., not paying out benefits as they are clearly required to do under the law, that, in our opinion, would be the type of conduct fоr which the insured could recover punitive damages.
The insured has yet to establish in the record that State Farm has engaged in this practice morе often than in the present case and the cited cases. To survive a motion for directed verdict, the insured would have to demonstrate that Stаte Farm engaged in this practice far more frequently than that. But we are reviewing a summary judgment, and State Farm has not met its burden of establishing the non-existence of a genuine issue of material fact. Holl v. Talcott,
PARIENTE and GROSS, JJ., concur.
NOTES
Notes
[1] State Farm paid the cоmpensatory damages after suit was filed and argues that there can be no claim for punitive damages in the absence of a claim for сompensatory damages. That argument is unavailing where, as here, there is a settlement of the compensatory damage claim, but no settlеment of the punitive damage claim. Stephenson v. Collins,
[2] Subsections 1(i)(2) and (3) provide:
2. A material misrepresentation made to an insured or any other person having an interest in the procеeds payable under such contract or policy, for the purpose and with the intent of effecting settlement of such claims, loss, or damagе under such contract or policy on less favorable terms than those provided in, and contemplated by, such contract or policy; or
3. Committing or performing with such frequency as to indicate a general business practice any of the following:
* * * * * *
b. Misrepresenting pertinent facts or insurance policy provisions relating to coverage at issue;
c. Failing to acknowledge and act promptly upon communications with respect to claims.
[3] Holloway was not merely binding on State Farm in the fourth district. In the absence of a conflicting decision from another district court of appeal, it was appliсable statewide. Pardo v. State,
[4] We do not agree with the insured's allegations in the complaint that State Farm also was under a duty to automatically allocate, in the absence of a request by the insured, since the case law does not require that. Those allegations should be stricken after remand.
