Casualty

The trial court granted the defendant’s motion to dismiss the plaintiff’s amended complaint. The plaintiff sought a declaration regarding whether the insurer had a duty to process and pay reimbursement for his mileage when traveling for treatment without the insured making a reimbursement request. 

The plaintiff’s amended complaint contained a single count for declaratory relief in which the plaintiff sought the following declaration: (a) when the defendant was presented with a claim for medical expenses in connection with a motor vehicle accident under a policy for no-fault benefits, the defendant was placed on actual and/or constructive notice of a claim for transportation costs; (b) after receiving a claim for these medical expenses, the defendant owed a duty to its insureds to have standards adopted and ready for implementation to properly investigate the concurrent obligation towards transportation costs; (c) after receiving a claim for medical expenses, the defendant owed a duty to its insureds to promptly acknowledge and act upon the transportation reimbursement portion of the claim; (d) after receiving a claim for medical expenses, the defendant owed a duty to its insureds to promptly notify them of any additional information necessary for the processing of a claim for transportation costs; and (e) the defendant, after being placed on actual and/or constructive notice of its insured’s claim for transportation costs, failed to undertake any of the actions specified in b, c and d. 

To summarize, the plaintiff’s request for declaratory relief sought judicial interpretation of both the Florida PIP statute (§ 627.736) as well as the Florida Unfair Insurance Trade Practices Act (§ 626.9541). The court noted that the PIP statute and controlling case law do establish that reasonable transportation expenses may be recoverable pursuant to a PIP policy if associated with reasonable and medically necessary treatment (citing Malu v. Security Nat’l Ins. Co., 898 So. 2d 69, 76 (Fla. 2005) [30 Fla. L. Weekly S145a]. The court concluded that any request for a declaration that the controlling policy or the Florida PIP statute includes transportation costs was moot. 

Regarding the plaintiff’s assertion that the insurer had a “duty to investigate” transportation costs absent a reimbursement request from the insured, the court cited United Automobile Insurance Company v. Buchalter, 344 So. 3d 474, 477 (Fla. 4th DCA 2002) [47 Fla. L. Weekly D 629a] as well as United Auto. Ins. Co. v. A 1st Choice Healthcare Sys., 21 So. 3d 124, 128 (Fla. 3d DCA 2009) [34 Fla. L. Weekly D2268a] to conclude that the plaintiff’s complaint was an improper attempt to maintain a private action, which neither statute supports. 

The implications of this ruling confirm that an insurer does not have a duty to investigate potential transportation costs unless its insured notifies the insurer that they are seeking a claim for same.
 

_{Case Law Alerts, 3rd Quarter, July 2023 is prepared by Marshall Dennehey to provide information on recent developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. Copyright © 2023 Marshall Dennehey, all rights reserved. This article may not be reprinted without the express written permission of our firm.}