Partner Keith Hernandez Wins Declaratory Judgment Against Provider Attempting to Collect Benefits Above PIP Policy Limits

Sea Spine Orthopedic Institute (Charriez, Carmen) vs. Liberty Mutual Insurance Company

Keith Hernandez, a partner in the Deerfield Beach office of ROIG Lawyers, succeeded in getting a Motion for Declaratory Judgment granted in favor of Liberty Mutual. Keith successfully argued that Liberty Mutual’s policy provides $2,500 in personal injury protection medical benefits, which is included into the total of $10,000 in Personal Injury Protection medical benefits when it has been determined that the injured person has sustained an emergency medical condition.

Prior to suit, Liberty Mutual exhausted Personal Injury Protection medical and disability benefits available under the subject policy in the amount of $10,000.00 where it was determined that the patient had sustained an emergency medical condition. The provider (Petitioner) then filed suit for declaratory judgment seeking a declaration that Liberty Mutual’s policy of insurance allows a maximum of $12,500.00 for personal injury protection benefits. The total amount available was alleged by Petitioner to be determined from the total of the amounts listed on the schedule of available benefits listed on the Personal Injury Protection Policy Endorsement. Petitioner alleged that the policy was ambiguous as to the total amount of available personal injury protection benefits and that the ambiguity should be interpreted to provide the greatest amount of coverage available.

Keith successfully argued that since the policy issued by Liberty Mutual is required to comply with the requirements of Florida Statute 627.736, then the only reasonable interpretation is that the coverage afforded for Personal Injury Protection medical and disability benefits is $10,000.00 when it has been determined that the injured person has sustained an emergency medical condition, consistent with the No-Fault Statute.

The Court agreed with Keith and found the policy to be legally sufficient and not ambiguous, denying Petitioner’s Motion for Summary Judgment Regarding Petitioner’s Petition for Declaratory Relief and granting Respondent’s Cross Motion for Declaratory Relief.