Opinion ID: 1860983
Heading Depth: 1
Heading Rank: 2

Heading: overdue payment of benefits

Text: 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 responsible for the payment, notwithstanding that written notice has been furnished to the insurer.... (c) All overdue payments shall bear simple interest at the rate of 10 percent per year. . . . . (8) APPLICABILITY OF PROVISION REGULATING ATTORNEY'S FEES.With respect to any dispute under the provisions of ss. 627.730-627.7405 between the insured and the insurer, the [attorneys' fees] provisions ofs. 627.428 shall apply. [ [4] ] § 627.736, Fla. Stat. (1997) (emphasis added). The legislative intent evinced in the penalty provisions is clear: The provisions were intended to promote the prompt resolution of PIP claims by imposing several reasonable penalties on insurers who pay late. In sum, the criteria governing payment of benefits and penalties are as follows: (1) an insured may seek the payment of benefits for a covered loss by submitting reasonable proof of such loss to the insurer; [5] (2) if the benefits are not paid within thirty days and the insurer does not have reasonable proof that it is not responsible for the payment, the payment is overdue; [6] (3) all overdue payments shall bear simple interest at a rate of ten percent per year; [7] and (4) whenever an insured files an action for payment of PIP benefits and prevails, the insured is entitled to attorneys' fees. [8]