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Ivey v. Allstate Insurance Co.12/7/2000
We have for review Allstate Insurance Co. v. Ivey, 728 So. 2d 282 (Fla. 3d DCA 1999), on the basis of express and direct conflict with Haines City Community Development v. Heggs, 658 So. 2d 523 (Fla. 1995); Wollard v. Lloyd's & Companies of Lloyd's, 439 So. 2d 217 (Fla. 1983); and Dunmore v. Interstate Fire Insurance Co., 301 So. 2d 502 (Fla. 1st DCA 1974). We have jurisdiction. Art. V, ยง 3(b)(3), Fla. Const. For the reasons detailed below, we quash the Third District's decision in Ivey.
FACTS
While standing on a sidewalk, Farren Ivey was struck by an automobile operated by an Allstate-insured motorist. She suffered injuries to both her lower left leg and right shoulder. After receiving treatment for her injuries, Ivey timely applied to Allstate for personal injury protection (PIP) benefits. A health insurance claim form (HICF), reflecting a total of $710 in charges for treatment, along with the physician's report, was timely and properly forwarded to Allstate. While the HICF itself did not specify with absolute clarity whether the charges related to treatment for one or two injuries, the physician's report very clearly and unambiguously stated that Ivey had received treatment for both injuries. Allstate, without conducting any investigation whatsoever and without even referring to the physician's report, decided to simply assume that the amount claimed represented treatment for only one injury. Thus, Allstate unilaterally decided to make a reduced PIP payment reflecting only eighty percent of what Allstate had itself estimated to be the proper cost of treatment for one injury.
Ivey filed the present action seeking payment of the proper PIP amount alleging that Allstate had not provided full payment within thirty days after receiving written notice of the covered loss, as required by section 627.736(4)(b), Florida Statutes (1995). Ivey sought recovery of the additional amount appearing on the HICF which Allstate had unilaterally reduced. During the deposition of the treating physician, Allstate realized that Ivey had received treatment for two injuries and, therefore, the doctor was actually entitled to the amount Allstate had unilaterally and without investigation withheld. It was only after the filing of the legal action and the completion of some discovery that Allstate finally paid the additional amount to which the doctor was actually entitled and for which Ivey had initially submitted a claim. Ivey then requested an award of attorney's fees pursuant to sections 627.736(8) and 627.428(1), Florida Statutes (1995), because Allstate had conceded and paid the additional amount actually due and owing.
The county court concluded that because Allstate had paid the balance owed within thirty days of learning of its own unilateral mistake, Ivey was not entitled to attorney's fees. The county court reasoned that Allstate was not required to look beyond the HICF to clarify any questions or alleged ambiguities. The circuit court, sitting in its appellate capacity, reversed the county court's decision and in a written opinion unanimously held that Ivey was entitled to attorney's fees because a simple investigation by Allstate, within the initial thirty-day statutory period, would have revealed that the amount listed for treatment in the HICF represented treatment for injuries to multiple body areas and was correct. Allstate, dissatisfied with the appellate decision of the circuit court, sought certiorari relief in the Third District Court of Appeal. The Third District granted certiorari and reversed the circuit court's appellate decision, reasoning that because Allstate did not pay the entire claim due to an error in the doctor's bill, Ivey was not entitled to attorney's
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