Insurance Prompt Pay Problems With PIP

Lake Worth insurance lawyers handling Personal Injury Protection (PIP) coverage may find this Texas Supreme Court case interesting. The opinion was issued in 2001, and the style of the case is, Allstate Insurance Company v. Bonner. Here is some of the relevant information from the case.
Rhonda Bonner was covered by an auto insurance policy issued by Allstate. Bonner was injured in an accident caused by an uninsured motorist. This policy included a non-duplication-of-benefits provision. Bonner reported a claim for medical costs resulting from her injury to Allstate, and received $1,619 in personal injury protection benefits. After receiving this, Bonner filed an uninsured motorist claim, which Allstate received on December 15, 1997. Allstate did not acknowledge receipt of the claim until, January 16, 1998, and eventually rejected the claim.
Bonner filed suit against Allstate seeking payment of uninsured motorist benefits. Bonner also sought attorneys’ fees and costs, relying to the Prompt Payment of Claims statute, which requires insurance companies to acknowledge receipt of claims within 15 days. The jury awarded compensatory damages to Bonner of $1,000 and fees and costs totaling $7,500. The trial judge however, rendered a take-nothing judgment after trial. The court of appeals upheld the take-nothing judgment with respect to compensatory damages, as Bonner had already been compensated under the personal injury benefit, but assessed costs and fees against Allstate. The court of appeals held that an insurance company must comply with the Prompt Payment of Claims Act every time the insured presents a claim. Allstate sought review from the Supreme Court of Texas, asserting that Bonner did not present a claim for which it was liable (because of the no-nduplication of benefits provision). Allstate distinguished this case from earlier cases in which insureds had valid claims above and beyond what they had already been paid by Allstate.
In the final holding, the Texas Supreme Court affirmed the court of appeals with respect to the take-nothing judgment on compensatory damages and reversed with respect to the court of appeals assessment of fees and costs under the Prompt Payment Act. In order to receive fees and costs under the Prompt Payment Act, the insured must show that the insurance company was presented with a claim for which the insurance company was liable under the terms of the policy. The insured must also show a violation of one or more provisions of the Prompt Payment Act. Because the jury found Allstate’s liability ($1,000) to be less than what it had already paid out to Bonner ($1,619), and because of the non-duplication-of-benefits provision in the policy, Allstate’s payouts offset its liabilities and owed nothing. Because Bonner was entitled to neither additional benefits from Allstate nor fees and costs under the Prompt Payment of Claims Act, the Texas Supreme Court rendered a take-nothing judgment.