United Auto. Ins. Co. v. Rodriguez

• Citation: 808 So.2d 82
• Decision Date: 08 November 2001
• Docket Number: No. SC00-112., No. SC00-111
• Parties: UNITED AUTOMOBILE INSURANCE COMPANY, Petitioner, v. Marisol RODRIGUEZ, Respondent. State Farm Fire and Casualty Company, Petitioner, v. Juana Maria Perez, Respondent.
• Court: United States State Supreme Court of Florida

808 So.2d 82

UNITED AUTOMOBILE INSURANCE COMPANY, Petitioner, v. Marisol RODRIGUEZ, Respondent.

State Farm Fire and Casualty Company, Petitioner, v. Juana Maria Perez, Respondent.

Nos. SC00-111, SC00-112.

Supreme Court of Florida.

November 8, 2001.

Rehearing Denied February 12, 2002.

Steven E. Stark of Fowler, White, Burnett, Hurley, Banick & Strickroot, P.A., for United Automobile Insurance Company, Petitioner.

James K. Clark of Clark, Robb, Mason & Coulombe, and Frances F. Guasch of Kevin W. Korth & Associates, Miami, FL, for State Farm Mutual Automobile Insurance Company, Petitioner.

John H. Ruiz, Luisa M. Linares, and Maloy Castro Morales of John H. Ruiz, P.A., and Amado Alan Alvarez of Alvarez & Alvarez Zane, Miami, FL, for Marisol Rodriguez and Juana Maria Perez, Respondents.

David B. Shelton of Rumberger, Kirk & Caldwell, Orlando, FL; and Peter J. Valeta of Ross & Hardies, Chicago, IL, for Allstate Insurance Company and Florida Insurance Council, Amici Curiae.

Vincent F. Iacono of the Law Offices of Howard W. Weber, Tampa, FL, for GEICO Casualty Company, GEICO Indemnity Company, GEICO General Insurance Company, and Government Employees Insurance Company, Amici Curiae.

Edward H. Zebersky of Zebersky, Payne & Kushner, LLP, Hollywood, FL; and Philip M. Burlington of Caruso, Burlington, Bohn & Compiani, P.A., West Palm Beach, FL, for Academy of Florida Trial Lawyers, Amicus Curiae.

Robert A. Robbins of Robbins & Reynolds, P.A., Miami, FL; and Arthur Joel Berger, Miami, FL, Amicus Curiae.

SHAW, J.

We have for review Perez v. State Farm Fire & Casualty Co., 746 So.2d 1123 (Fla. 3d DCA 1999), based on conflict with Jones v. State Farm Mutual Automobile Insurance Co., 694 So.2d 165 (Fla. 5th DCA 1997). We have jurisdiction. Art. V, § 3(b)(3), Fla. Const. We quash Perez.

I. FACTS

The relevant facts in the Rodriguez case are set forth in the district court opinion below:

Marisol Rodriguez sustained injuries in an automobile accident and made a PIP claim to her insurer, United Auto, on October 1, 1997. United Auto admitted coverage and waived all defenses except as to the reasonableness, relationship, and medical necessity of the bills incurred.

On October 17, Ms. Rodriguez submitted her claimed medical bills to United Auto. As of November 26, United Auto had not received a report indicating that these claimed medical bills were unreasonable, unrelated, or unnecessary.

On December 17, Ms. Rodriguez submitted more medical bills for payment. On January 16, United Auto submitted Ms. Rodriguez's medical bills for review to a doctor who issued a report to United Auto on January 19, 1998, outside the thirty-day statutory time period.

Ms. Rodriguez sued [in county court] to recover the amount of the unpaid medical bills plus interest. § 627.736(4)(b), (c), Fla. Stat. (1997). She moved for summary judgment on the grounds that the insurer had only thirty days from the date of receipt of the medical bills to obtain a report constituting "reasonable proof" that the treatments were not reasonable, related, or necessary and that absent same, the insurer could not defend on that basis, thereby entitling her to final summary judgment.

United Auto conceded that it did not obtain reasonable proof within the thirty-day period and did not raise any coverage defense. However, United Auto argued that the failure to obtain the report did not compel payment of the bills, but only subjected it to paying interest and attorney's fees should liability be established. The trial court entered final summary judgment in favor of Ms. Rodriguez for the amount of the medical bills plus accrued interest....

Perez v. State Farm Fire and Casualty Co., 746 So.2d 1123, 1124 (Fla. 3d DCA 1999) (emphasis omitted). The county court certified the issue to the district court as a question of great public importance.¹

The relevant facts in the Perez case also are set forth in the district court opinion below:

On March 24, 1996, Ms. Perez sustained personal injuries as a result of an automobile accident. She sought treatment for her injuries and submitted medical bills to State Farm under the PIP coverage of her automobile insurance policy. State Farm failed to pay the bills; Ms. Perez filed a lawsuit [in county court] against State Farm for payment of these bills.

Ms. Perez moved for summary judgment on the grounds that the defendant had no reasonable proof to establish that it was not responsible for the payment of her claimed medical bills within the thirty-day statutory period. She argued "that failure to obtain such proof within the statutory period means the insurer must pay the bills, in their entirety, at the expiration of the 30 day period."

The trial court entered summary judgment in Ms. Perez's favor, ruling that it is the "responsibility on the part of an insurer to pay within 30 days absent reasonable proof within that time that they are not responsible for payment." On appeal, the circuit court appellate division reversed the trial court in a two-to-one decision although State Farm conceded "that it failed to obtain reasonable proof that it is not responsible within the 30-day period."

Perez, 746 So.2d at 1124-25 (emphasis omitted). Perez sought certiorari review of the circuit court decision, and the district court consolidated the Rodriguez and Perez cases and rendered a single decision.

The district court affirmed the county court decision in the Rodriguez case, quashed the circuit court decision in the Perez case, and held that because the insurers failed to pay the claims within the thirty-day statutory period they now must pay the claims, i.e., they cannot contest the claims. The court also held that the insurers must pay statutory interest. This Court granted review based on conflict with Jones v. State Farm Mutual Automobile Insurance Co., 694 So.2d 165 (Fla. 5th DCA 1997), wherein the court noted that failure to pay within the thirty-day period exposes an insurer to the statutory penalties but does not bar the insurer from contesting the claim.²

The instant cases present the following issue: If the payment of benefits for a PIP claim is "overdue" under section 627.736, Florida Statutes (1997), are the penalties set forth in Florida Statutes the only penalties that may be levied against the insurer, or is the insurer also forever barred from contesting the claim. Both United Automobile Insurance Company and State Farm Fire and Casualty Company contend that the statutory sanctions are the only penalties approved by the Legislature. We agree.

II. "OVERDUE" PAYMENT OF BENEFITS

Legislative intent, as always, is the polestar that guides a court's inquiry under the Florida No-Fault Law ("the Law").³ Where the wording of the Law is clear and amenable to a logical and reasonable interpretation, a court is without power to diverge from the intent of the Legislature as expressed in the plain language of the Law. The Law, which was enacted in 1971, was intended to provide a minimum level of insurance benefits without regard to fault:

627.730 Florida Motor Vehicle No-Fault Law.—Sections 627.730-627.7405 may be cited and known as the "Florida Motor Vehicle No-Fault Law."

627.731 Purpose.—The purpose of ss. 627.730-627.7405 is to provide for medical, surgical, funeral, and disability insurance benefits without regard to fault, and to require motor vehicle insurance securing such benefits, for motor vehicles required to be registered in the state and, with respect to motor vehicle accidents, a limitation on the right to claim damages for pain, suffering, mental anguish, and inconvenience.

§§ 627.730, 627.731, Fla. Stat. (1997). Section 627.736 sets forth the benefits that are required for personal injury protection (PIP) and mandates coverage if the loss is sufficiently related, reasonable, and necessary:

627.736 Required personal injury protection benefits; exclusions; priority. —

(1) REQUIRED BENEFITS.—Every insurance policy complying with the security requirements of s. 627.733 shall provide personal injury protection to the named insured, relatives residing in the same household, persons operating the insured motor vehicle, passengers in such motor vehicle, and other persons struck by such motor vehicle and suffering bodily injury ... to a limit of $10,000 for loss sustained by any such person as a result of bodily injury, sickness, disease, or death arising out of the ownership, maintenance, or use of a motor vehicle as follows:

(a) Medical benefits.—Eighty percent of all reasonable expenses for necessary medical, surgical, X-ray, dental, and rehabilitative services....

§ 627.736(1)(a), Fla. Stat. (1997) (emphasis added).

Section 627.736 also defines an "overdue" payment of benefits and sets forth the penalties that may be levied:

(4) BENEFITS; WHEN DUE.— Benefits due from an insurer under ss. 627.730-627.405 shall be primary, except that benefits received under any workers' compensation law shall be credited against the benefits provided by subsection (1) and shall be due and payable as loss accrues, upon receipt of reasonable proof of such loss and the amount of expenses and loss incurred which are covered by the policy issued under ss. 627.730-627.7405....

. . . .

(b) Personal injury protection insurance benefits paid pursuant to this section shall be overdue if not paid within 30 days after the insurer is furnished written notice of the fact of a covered loss and of the amount of same. If such written notice is not furnished to the insurer as to the entire claim, any partial amount supported by written notice is overdue if not paid within 30 days after such written notice is furnished to the insurer. Any part or all of the remainder of the claim that is subsequently supported by written notice is overdue if not paid within 30 days after such written notice is furnished to the insurer. However, any payment shall not be deemed overdue when the insurer has reasonable proof to establish that the insurer is not

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