2 Lawsuits Against 21st Century for Failing to Pay Medical Payments Coverage
My clients were injured in a motor vehicle accident. Before the accident, they wisely took out substantial automobile insurance to protect them, including coverages for bodily injury liability, uninsured motorists coverage, personal injury protection, and medical payments.
As a result of the accident, they incurred medical expenses. These medical expenses were properly submitted to their car insurer, 21st Century, under their PIP and Med Pay coverages. The auto insurer paid 80% of the medical charges under PIP, but refused to use the Medical Payments coverage to pay the remaining 20%. (PIP in Florida pays the first 80% of medical charges, typically up to a limit of $10,000. Med Pay is intended to pay any amounts not paid by PIP).
The insurance company says that, based on its insurance policy, it doesn't have to pay anything under the Medical Payments coverage until the PIP is totally exhausted. In reality, the insurance policy states that the Medical Payments coverage is "excess" over the PIP. This means that the insurer is required to pay any amounts that are in excess of the 80% paid by PIP.
Today, I filed a declaratory judgment action against 21st Century insurance to have a judge determine if my interpretation is correct, or if the insurer's interpretation is correct.
As with most of my insurance cases, if I win, the insurance company will be required to pay my fees and costs, and if I lose, I'll work for free.
