COMPREHENSIVE HEALTH CENTER, LLC, A/A/O ANGELA COOPER v. STAR CASUALTY INSURANCE COMPANY ( 2023 )

Third District Court of Appeal
State of Florida
Opinion filed February 22, 2023.
Not final until disposition of timely filed motion for rehearing.
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No. 3D21-1612
Lower Tribunal No. 16-5737 CC
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Comprehensive Health Center, LLC,
a/a/o Angela Cooper,
Appellant,
vs.
Star Casualty Insurance Company,
Appellee.
An Appeal from the County Court for Miami-Dade County, Gina
Beovides and Luis Perez-Medina, Judges.
Douglas H. Stein, P.A., and Douglas H. Stein, for appellant.
Hunker Appeals, Sarah Hafeez and Thomas L. Hunker (Fort
Lauderdale), for appellee.
Before EMAS, GORDO and BOKOR, JJ.
GORDO, J.
Comprehensive Health Center, LLC a/a/o Angela Cooper (“CHC”)
appeals the entry of final judgment and summary judgment in favor of Star
Casualty Insurance Company (“Star”). We have jurisdiction. Fla. R. App. P.
9.030(b)(1)(A). Because no genuine issue of material fact exists that
exhaustion occurred as a matter of law after the issuance of checks totaling
$10,000, we affirm.
FACTUAL AND PROCEDURAL BACKGROUND
In December 2013, Angela Cooper, a Star insured, was injured in a
motor vehicle accident. CHC provided medical treatment to Cooper. In
exchange, Cooper assigned her right to receive personal injury protection
(PIP) benefits to CHC. CHC submitted bills to Star for services rendered to
Cooper. Between March 2014 and April 2015, Star mailed four checks to
CHC in fulfillment of its payment of the bills submitted.
In July 2015, CHC sent a pre-suit demand letter to Star seeking full
reimbursement of the amounts billed. Star responded and advised CHC that
the PIP benefits under the policy were exhausted when it made a final
payment to another provider. In late January 2016, CHC returned two of the
previously issued checks to Star notifying Star it never deposited or cashed
the checks. CHC took issue with language printed on the checks and
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demanded Star reissue the checks to them without the contested language.
Star did not reissue the checks.
Three months later, CHC filed a complaint against Star for breach of
the insurance policy. Star filed its answer and affirmative defenses asserting
exhaustion of benefits pursuant to section 627.736(1), Florida Statutes.1
CHC filed a reply arguing exhaustion had not occurred because it had not
deposited two of the checks mailed by Star and therefore their value could
not be considered paid under the PIP statute. CHC and Star filed cross-
motions for summary judgment on the exhaustion defense. The trial court
held a hearing and concluded that exhaustion occurred as a matter of law
when Star made payment to CHC and issued checks totaling $10,000. This
appeal followed.
STANDARD OF REVIEW
The appellate standard of review on an order of summary judgment is
de novo. See Volusia Cnty. v. Aberdeen at Ormond Beach, L.P., 760 So. 2d
126, 130 (Fla. 2000). Because the hearing and order on summary judgment
were entered prior to May 1, 2021, the amended summary judgment rule
does not apply. See In re Amends. to Fla. R. of Civ. P. 1.510, 317 So. 3d
1For purposes of this opinion, section 627.736 shall be referred to as the
PIP statute.
3
72, 77 (Fla. 2021). Additionally, the interpretation of a statute is subject to a
de novo standard of review. See Gomez v. Vill. of Pinecrest, 17 So. 3d 322,
325 (Fla. 3d DCA 2009).
LEGAL ANALYSIS
“The purpose of PIP benefits is to provide up to $10,000 for medical
bills and lost wages without regard to fault.” Flores v. Allstate Ins. Co., 819
So. 2d 740, 744 (Fla. 2002). Pursuant to section 627.736(1), Florida
Statutes, PIP benefits are due to an insured, limited to $10,000 for injuries
arising out of ownership, maintenance or use of a motor vehicle. 2 Once the
full $10,000 of PIP benefits are “exhausted through the payment of valid
claims, an insurer has no further liability on unresolved, pending claims,
absent bad faith in the handling of the claim by the insurance company.”
Northwoods Sports Med. & Physical Rehab., Inc. v. State Farm Mut. Auto.
Ins. Co., 137 So. 3d 1049, 1057 (Fla. 4th DCA 2014).
The sole issue presented here is whether exhaustion of benefits can
be found where an insurer sent checks as payment and the provider chose
not to cash them. CHC argues benefits were not exhausted because
2
As an assignee, CHC was only entitled to the same benefits Cooper had at
the time of the assignment. See Union Indemnity Co. v. City of New Smyrna,
130 So. 453, 455 (1930) (finding an assignment conveys no greater right
than the assignor had at the time of the assignment).
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payment did not occur as CHC chose not to deposit two of the checks Star
issued to it in fulfillment of payment. Star contends benefits were exhausted
pursuant to the statute because it tendered payment to CHC by mailing the
checks.
Thus, to answer this question, we must determine when benefits are
considered “paid” under the PIP statute. “Our statutory analysis begins with
the plain meaning of the actual language of the statute, as we discern
legislative intent primarily from the text of the statute.” Diamond Aircraft
Indus., Inc. v. Horowitch, 107 So. 3d 362, 367 (Fla. 2013). “‘When the
language of the statute is clear and unambiguous and conveys a clear and
definite meaning . . . the statute must be given its plain and obvious
meaning.’” City of Bartow v. Flores, 301 So. 3d 1091, 1096 (Fla. 1st DCA
2020) (quoting Fla. Dep’t of Revenue v. New Sea Escape Cruises, Ltd., 894
So. 2d 954, 960 (Fla. 2005)).
As correctly noted by the trial court, the term “payment” itself is not
defined in the definitions section of the PIP statute. 3 See § 627.732, Fla.
3
We note the trial court conducted a proper analysis of the plain and ordinary
meaning of the term “payment.” The Oxford English Dictionary defines
“payment” as “[t]he action, or an act, of paying,” “[a] sum of money (or other
thing) paid,” “[t]he action, or an act, of rendering to a person anything due,
deserved, or befitting, or of discharging an obligation; the thing so rendered.”
PAYMENT, Oxford English Dictionary (3d ed. 1955). Payment is also
defined as “[p]erformance of an obligation by the delivery of money or some
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Stat. “In ascertaining the plain meaning of the statute, [however,] the court
must look to the particular statutory language at issue, as well as the
language and design of the statute as a whole.” K Mart Corp. v. Cartier, Inc.,
486 U.S. 281, 291 (1988); see also Antonin Scalia & Bryan A. Garner,
Reading Law: The Interpretation of Legal Texts at 167 (2012) (stating a
“judicial interpreter [should] consider the entire text, in view of its structure
and of the physical and logical relation of its many parts,” when interpreting
any particular part of the text). “A provision that may seem ambiguous in
isolation is often clarified by the remainder of the statutory scheme—
because the same terminology is used elsewhere in a context that makes its
meaning clear or because only one of the permissible meanings produces a
substantive effect that is compatible with the rest of the law.” United Sav.
Ass’n of Texas v. Timbers of Inwood Forest Assocs., Ltd., 484 U.S. 365, 371
(1988) (internal citations omitted).
other valuable thing accepted in partial or full discharge of the obligation” and
“[t]he money or other valuable thing so delivered in satisfaction of an
obligation.” PAYMENT, Black’s Law Dictionary (11th ed. 2019). These
definitions are consistent with the trial court’s finding—that Star made
payment by “delivering” or “rendering” the checks to CHC to discharge its
obligation.
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Upon review, we find the language and statutory scheme of the PIP
statute twice provides a definition of when benefits are considered paid.
First, in Section 627.736(4), entitled “Payment of Benefits:”
(b) Personal injury protection insurance benefits paid
pursuant to this section are 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.
However:
...
5. For the purpose of calculating the extent to which
benefits are overdue, payment shall be treated as
being made on the date a draft or other valid
instrument that is equivalent to payment was
placed in the United States mail in a properly
addressed, postpaid envelope or, if not so
posted, on the date of delivery.
§ 627.736(4)(b)5., Fla. Stat. (emphasis added).
Second, in Section 627.736(10), entitled “Demand Letter:”
(d) If, within 30 days after receipt of notice by the
insurer, the overdue claim specified in the notice is
paid by the insurer together with applicable interest
and a penalty of 10 percent of the overdue amount
paid by the insurer, subject to a maximum penalty of
$250, no action may be brought against the insurer.
If the demand involves an insurer’s withdrawal of
payment under paragraph (7)(a) for future treatment
not yet rendered, no action may be brought against
the insurer if, within 30 days after its receipt of the
notice, the insurer mails to the person filing the notice
a written statement of the insurer’s agreement to pay
for such treatment in accordance with the notice and
to pay a penalty of 10 percent, subject to a maximum
penalty of $250, when it pays for such future
treatment in accordance with the requirements of this
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section. To the extent the insurer determines not to
pay any amount demanded, the penalty is not
payable in any subsequent action. For purposes of
this subsection, payment or the insurer’s
agreement shall be treated as being made on the
date a draft or other valid instrument that is
equivalent to payment, or the insurer’s written
statement of agreement, is placed in the United
States mail in a properly addressed, postpaid
envelope, or if not so posted, on the date of
delivery. The insurer is not obligated to pay any
attorney fees if the insurer pays the claim or mails its
agreement to pay for future treatment within the time
prescribed by this subsection.
§ 627.736(10)(d), Fla. Stat. (emphasis added). We find these sections
clearly provide that under the PIP statute payment shall be treated as being
made on the date a check or other valid instrument is placed in the mail. See
§§ 627.736(4)(b)5., 627.736(10)(d), Fla. Stat.
CHC asserts this Court should ignore this statutory language, arguing
it only applies to determinations of whether a payment is overdue. CHC,
instead asks this Court to define payment as being made when a check or
other valid instrument sent to an insured is deposited.
First, it is a “‘fundamental principle of statutory construction (and,
indeed, of language itself) that the meaning of a word cannot be determined
in isolation, but must be drawn from the context in which it is used.’” Lab.
Corp. of Am. v. Davis, 339 So. 3d 318, 323–24 (Fla. 2022) (quoting Deal v.
United States, 508 U.S. 129, 132, (1993)). Under the PIP statute, section
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627.736(4) outlines how and when an insurer makes payment of benefits
and section 627.736(10) details how an insurer receives notice of allegedly
overdue claims. Thus, in the context of the PIP statute, these sections
provide the procedure an insurer must follow in order to make proper
payment of PIP benefits. Application of this definition of when payment is
made to the PIP statute as a whole is appropriate—particularly as the PIP
statute itself imposes strict deadlines on insurers for making payments.
Importantly, this section of text in the PIP statute defines when
payment is overdue. Florida courts have long recognized the significance of
defining when payment of benefits is overdue because it triggers other
provisions contained in the PIP statute. See United Auto. Ins. Co. v.
Rodriguez, 808 So. 2d 82, 86–87 (Fla. 2001) (noting an insurer has thirty
days to verify a claim and becomes subject to specific penalties for an
overdue payment, which are “intended to promote the prompt resolution of
PIP claims”); Amador v. United Auto. Ins. Co., 748 So. 2d 307, 308 (Fla. 3d
DCA 1999) (“If the insurer does not pay by the statutory 30–day period, on
the 31st day, the insurer is itself in violation of the PIP statute and the insured
is free to initiate a lawsuit to have the case determined on the merits.”);
Dunmore v. Interstate Fire Ins. Co., 301 So. 2d 502, 502 (Fla. 1st DCA 1974)
(“The insurance company has thirty days in which to verify the claim after
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receipt of an application for benefits. There is no provision in the statute to
toll this time limitation.”). Given the significance of overdue payments as
delineated in the PIP statute, the plain language of this section should guide
our analysis in defining when payment is considered made.
Second, this is further supported by the explicit legislative directive of
the PIP statute. “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.” §
627.731, Fla. Stat. The Florida Supreme Court has stated “[w]ithout a doubt,
the purpose of the no-fault statutory scheme is to ‘provide swift and virtually
automatic payment so that the injured insured may get on with his [or her]
life without undue financial interruption.’” Ivey v. Allstate Ins. Co., 774 So.
2d 679, 683–84 (Fla. 2000) (quoting Gov’t Emps. Ins. Co. v. Gonzalez, 512
So. 2d 269, 271 (Fla. 3d DCA 1987)). CHC’s construction of the term
“payment” would undermine this explicit directive as it would prevent “swift
and virtually automatic payment.” It would place insurers in a no-win
situation. An insurer would be forced to either: (1) continue issuing checks—
even while some previously issued checks remained undeposited—and risk
paying more than the $10,000 statutory limit; or (2) wait to issue checks until
all prior checks have been deposited and thereby risk violating the statutory
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requirement to make payment within thirty days. 4 We reject such a
construction as absurd. To adopt it would violate the plain language of the
statute and render much of its remaining language superfluous.
CONCLUSION
We find pursuant to the PIP statute, payment is “made on the date a
draft or other valid instrument that is equivalent to payment was placed in
the United States mail in a properly addressed, postpaid envelope.” §§
627.736(4)(b)5., 627.736(10)(d), Fla. Stat. No genuine issue of material fact
exists in the record before us that benefits were exhausted by Star through
its payment of valid claims. Thus, the trial court properly awarded final
summary judgment in Star’s favor.
Affirmed.
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We further note that utilizing CHC’s proposed definition of payment would
render an insurer’s ability to satisfy its obligation to make timely payment
entirely reliant on actions over which it has no control—namely, the provider
or insured’s acceptance or deposit of payment.
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