State Farm v. Gonzalez – Personal Injury Protection Coverage Dispute


Florida follows a “no-fault” model with regard to auto insurance claims following a collision. What that means is everyone in Florida is required to carry a minimum level of insurance in order to cover their own injuries and property damages – up to a certain amount – that will be paid by their own insurance company in the event of a crash.

The law requires $10,000 in personal injury protection benefits, $10,000 in property damage liability benefits. Only those with serious injuries will receive more than $2,500 and medical treatment must be sought within 14 days. It’s only if one’s injury-related costs exceed $10,000 that the insured can step outside the no-fault system and take action against third parties, such as the at-fault driver.

In the recent case of State Farm v. Gonzalez, the parties had already settled out-of-court for $80,000 in underinsured motorist benefits after insured was struck by an underinsured driver, sustaining injuries. The question before Florida’s Third District Court of Appeal was whether the insurer was responsible to pay $685 in personal injury protection (PIP) benefits and a medical payment for emergency treatment rendered at a local hospital after the crash.

Because plaintiff failed to comply with F.S. 672.736(5)(d) of state law, the court ruled the insurance company was not required to pay these costs. That provision of the law indicates all statements and bills for medical services rendered by a physician, hospital, clinic or other person or institution have to be submitted to the insurer on forms that are properly and timely completed.

This is one example of why it’s so imperative to speak with an experienced Naples personal injury lawyer as soon as possible after a crash. There is only a brief period of time to act in order to claim these benefits, and knowing the proper way to do that can be critical when time is off the essence.

According to court records in this case, insured was struck by another vehicle in May 2001 and received treatment at a local emergency room. The hospital in turn billed the injured woman’s health insurance company $685 for care. The health insurer paid the bill.

The following year, plaintiff’s attorney sent a letter of representation to the insurer, indicating plaintiff was injured, attaching the police accident report, indicating plaintiff had been transported to the hospital and requiring her policy number. However, counsel did not include a bill or statement from the hospital, nor any specific demand of payment for certain services.

Following that, insurer sent a number of letters and made several phone calls to the attorney, requesting that information. However, no information was received. After two years of not hearing anything back, the insurance company closed the claim.

Plaintiff then filed her action for UIM benefits, and she was ultimately able to collect on that – $80,000. However, less than a month after settling that claim, plaintiff’s attorney requested an additional $10,000 each for PIP and medical pay benefits. Insurance company denied this claim, asserting plaintiff failed to adhere to Florida statute in making the claim.

Plaintiff then filed a lawsuit, alleging she was entitled to $31,000 in compensation for neurological treatment, $685 for the emergency hospital treatment and $350 for orthopedic care. Claim to the orthopedic care was abandoned when it was learned those services were rendered prior to the crash. The claim for neurological treatment was abandoned when the insurance company learned the lien for those services was dropped to $1,000.

Insurer then filed motion for summary judgment, arguing it didn’t owe PIP or Med-Pay benefits because it never received notification or statement of those charges, as per the law.

Although trial court denied this motion, the appeals court reversed and remanded, with instruction for trial court to find in insurance company’s favor.

If you have been injured in an accident, contact the Hollander Law Firm at (561) 347-7770 for a free and confidential consultation. There is no fee unless we win.

Additional Resources:

State Farm v. Gonzalez,  Oct. 14, 2015, Florida’s Third District Court of Appeal

More Blog Entries:

Riley v. Ford Motor Co. – Defective Vehicle Lawsuit Results in Increased Damage Award, Oct. 6, 2015, Fort Myers Car Accident Lawyer Blog