Roig Lawyers Attorney Sets Precedent in Personal Injury Protection (PIP) Case

January 29, 2015

Roig Lawyers managing partner of the West Palm Beach office, Drew A. Stoller, obtained a favorable ruling from the Honorable Robert A. Farrance of the Twelfth Judicial Circuit in and for Manatee County on behalf of Roig Lawyers’ client/insurer in a case of first impression of the insurer’s policy language and whether it complied with the holding in GEICO Indemnity Co. v. Virtual Imaging Services, Inc., 2013 WL 333285 (Fla. 2013) in electing to reimburse PIP benefits pursuant to the schedule of maximum charges.

The Plaintiff filed suit seeking breach of contract damages for PIP benefits under a policy of insurance issued by Defendant/Insurer to the Insured, and further purporting to be the assignee of said benefits. The Plaintiff timely submitted charges to the Defendant for services rendered and the Defendant applied the schedule of maximum charges (F.S. §627.736(5)(a)2) to the Plaintiff’s bill and capped the charges.

Stoller argued that the Plaintiff is precluded from recovery of breach of contract damages due to the insurer’s application of the schedule of maximum charges (fee schedule) to the Plaintiff’s bills; also that the policy not only defines “reasonable medical expenses,” and how they will be reimbursed, but its policy language mirrors the permissive reimbursement methodology found in section (5)(a)2.

Florida’s Motor Vehicle No–Fault statute mandates that PIP insurers “shall provide personal injury protection to the named insured … [for] eighty percent of all reasonable expenses for medically necessary … services,” up to $10,000. § 627.736 (1) (a), Fla. Stat. (2008).

The Court did not find any ambiguity in the Defendant’s policy language when read in its entirety and granted summary judgment in favor of the Defendant.

“We are pleased with the outcome of this case as this is the first time a legal decision has been entered regarding the client’s policy language and sets the precedent for similar cases,” said Stoller.