Geico General Auto Insurance PIP Payout Calculation Class Action

This class action, against Geico General Insurance Company is similar to another recently filed against a different automobile insurer, alleging that the company miscalculated what it owed under its personal injury protection (PIP) coverage to the provider of treatment for injuries sustained during an auto accident. 

The is all Florida healthcare providers who (1) are the assignees of covered insureds under an auto policy issued by Geico as described in Florida Statute § 627.736(1)(a) (2) who during the class period billed Gieco for payment of PIP benefits for medical services, where (3) Geico improperly processed their claims by applying the reimbursement limitations first and then subtracting the deductible from that amount.

In this case, driver Manuel St. Pierre was involved in an accident in Florida on April 19, 2015, while covered by a Geico policy. St. Pierre was treated by Coastal Wellness Centers, Inc. and executed an Assignment of Insurance Benefits so that Coastal could bill Geico for the treatment. 

The case relies on Florida laws on auto insurance and how it sets forth the calculations and payouts for PIP claims. 

The bill for St. Pierre’s treatment was $1,095. According to the complaint, Geico should have first applied the $1,000 deductible to the amount and then applied reimbursement limits to what was left. That would have given Coastal a PIP payment of $76. Instead, the complaint says, Geico first applied the limits, reducing the total bill, and then applied the deductible, which resulted in no payment to Coastal.

The complaint quotes Florida law as saying, “The deductible amount must be applied to 100 percent of the expenses and losses described in [Florida Statute Section] 627.736. After the deductible is met, each insured is eligible to receive up to $10,000 in total benefits described in 627.736(1).”

The complaint claims that though “[t]he plaint language of” the law “requires that the deductible be applied to 100% of the expenses before the application of any reduction methodologies” permitted under the law.

The complaint is asking for declaratory judgment and injunctive relief. It also claims that Geico has breached its contracts in not paying all the PIP benefits due to its insureds.  

Article Type: Lawsuit
Topic: Consumer
Tags: Auto Insurance, Insurance, Nonpayment of Benefits