Thanks for visiting! Welcome to a new way to research case law. You are viewing a free summary from Descrybe.ai. For citation and good law / bad law checking, legal issue analysis, and other advanced tools, explore our Legal Research Toolkit — not free, but close.
Sheldon v. United Services Automobile Ass'n
Citations: 55 So. 3d 593; 2010 Fla. App. LEXIS 20245Docket: No. 1D10-0777
Court: District Court of Appeal of Florida; December 27, 2010; Florida; State Appellate Court
The County Court for the First Judicial Circuit in Okaloosa County granted summary judgment in favor of United States Automobile Association (USAA) regarding a personal injury protection (PIP) insurance claim by Dr. Richard A. Sheldon, who treated Travis Baliel after an automobile accident. Baliel had a $10,000 PIP policy with USAA, which paid some of Sheldon's charges but reduced others based on usual and customary rates. Sheldon filed a lawsuit against USAA for unpaid benefits, interest, penalties, and attorney’s fees. USAA argued that the benefits were exhausted when it paid out the policy limits on January 14, 2008, shortly after the complaint was filed, and moved for summary judgment. The county court initially denied this motion but later granted it upon reconsideration, certifying a question of great public importance regarding the ability to pursue claims for penalties and fees after PIP benefits are exhausted. Dr. Sheldon contended that he should still be able to seek penalties and fees for the reduced or denied benefits, which he argued were overdue under Florida law. However, established case law indicates that once an insurer pays the policy limits, it is not liable for additional benefits, even if disputed. If benefits are exhausted after a lawsuit is filed but before service to the insurer, the lawsuit for benefits cannot proceed, as the insurer has fulfilled its contractual obligation. Dr. Sheldon acknowledges that he cannot continue his suit for denied benefits based on prior case law (Simon and Stand-Up MRI). Instead, he seeks to pursue claims for interest, penalties, and attorney fees under specific statutory provisions. However, the statute does not allow recovery of these claims unless benefits are first deemed overdue, which is not possible when benefits are exhausted prior to the suit being served. An insurer that has paid the policy limits cannot be held liable for additional disputed benefits, and therefore, there can be no overdue benefits to justify claims for interest or attorney fees. Justice Pariente's commentary confirms that penalties for overdue payments apply only if the insurer is ultimately found liable for the claim. Since USAA will not be required to pay the disputed benefits, Dr. Sheldon cannot claim interest or attorney fees related to those benefits. The court affirmed the summary judgment in favor of USAA, concluding that Dr. Sheldon is not entitled to any further claims based on the exhaustion of benefits. Dr. Sheldon had billed $1,865.00, of which USAA paid only $310.75.