United Services Automobile Association v. Less Institute Physicians, d/b/a Lesspine Institute, a/a/o Amelia F. Stringer-Gowdy
A PIP medical provider/assignee sued USAA for breach of contract after USAA overlooked an EMC determination and later exhausted the $10,000 in PIP benefits by paying the insured's own lost wage and transportation claim. The county court granted summary judgment for the provider, holding the payment to the insured was 'gratuitous' because it was made out of order under the English Rule of priority. The Third DCA reversed, holding the English Rule applies only to competing assignees and not to the insured/assignor, so benefits were validly exhausted and, absent pleaded and adjudicated bad faith, USAA had no further liability.
Key facts
- USAA, an auto insurer, and Less Institute Physicians, a PIP medical provider and benefits assignee, disputed PIP benefit allocation after USAA paid the insured's own lost wage and transportation claim while a provider claim remained pending.
- The insured had $10,000 in available PIP benefits; USAA paid the insured's valid claims first, exhausting benefits before resolving the provider's submitted claim, which the provider argued should have been prioritized under the English Rule.
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Why it matters
This opinion clarifies the limits of the English Rule of priority in the PIP context — it protects insurers who pay the insured's own valid claims even after an assignee provider has submitted competing claims. It also… — full analysis with a trial
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