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January v. State Farm Mutal Insurance Co.2/14/2003
ays does not lose right to contest claim, but is exposed to the statutory penalties attendant to overdue claim).
The PIP insurer is given thirty days to investigate and to either pay the claim or discover the facts that warrant a refusal to pay. If it does not do so then the claim is overdue and the statutory penalties for failing to pay the claim timely (interest and fees) are due. If the insurer fails to pay the claim, electing either to refuse the claim or to continue investigating, it is not barred from contesting the claims, but must pay the penalties once its duty to pay the claim is established. Clearly, if there is no coverage for the claim, the insurer's failure to act within thirty days is not fatal to the insurer's right to refuse the claim. In that sense, the county court was correct that the thirty-day limit is not applicable. But it is simply incorrect to conclude that where the insurer's reason for non- payment is a doubt about coverage, that the insurer is free to ignore the thirty-day claim deadline and investigate at its leisure with no limitation or consequences.
Thus, as to those claims under the policy made by January that were not paid by State Farm within thirty days, January's claim was mature and he was entitled to seek a judicial determination of his rights. See State Farm Mut. Auto. Ins. Co. v. Jenkins, 767 So. 2d 622 (Fla. 4th DCA 2000). There is no arguable breach of contract by him that we can identify prior to March 23 that would excuse payment of the claim and statutory penalties once coverage is established. Obviously, if there is no coverage, there is no amount due, but if there is coverage, then payment of the claim plus the statutory penalties is due. It does appear that coverage existed in this case, although we do not declare it. We only say that the trial court and the circuit court were wrong in concluding that January's subsequent refusals to be examined pursuant to State Farm's request cannot justify refusal to pay those claims.
So what is the effect of January's refusal to be examined? We have no basis to gainsay the lower court's conclusion that this was a material breach of the policy and would bar recovery for any claim that was not thirty days old when the policy was breached by January's refusal to comply with State Farm's request. Certainly, by May 3, 1999, January's letter to State Farm clearly communicated his refusal to comply with the request. Whether this breach of the policy occurred as early as the March 23 non-appearance is a question that may or may not matter and may or may not require judicial determination based on the surrounding facts and circumstances.
We accordingly vacate the decision of the circuit court and remand.
PETITION GRANTED, DECISION VACATED and REMANDED.
SHARP, W., and SAWAYA, JJ., concur.
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