Key Takeaway
Florida court case examining the English Rule of priority between competing assignees in no-fault insurance claims, distinguishing assignees from insureds in payment order disputes.
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UNITED SERVICES AUTOMOBILE ASSOCIATION, vs LESS INSTITUTE PHYSICIANS, D/B/A LESSPINE INSTITUTE, A/A/O AMELIA F. STRINGER-GOWD, No. 3D21-157 (Fla 3d DCA 2022)
We once heard of a thing called the New York Rule. Meet the English rule.
“At the time, USAA claimed that it never received the EMC determination from Less; while in fact, Less had sent the determination to USAA, but USAA had overlooked it. As a result, Less’s requests for payment went unpaid. Subsequently, USAA received a claim from the insured for lost wages and PIP transportation. USAA elected to pay insured’s personal claim. As the result of payment, the $10,000 in insurance benefits was exhausted. Less filed a breach of contract action against USAA. During suit, Less
presented the EMC determination it had timely submitted to USAA that USAA had overlooked.
Throughout trial, this error by USAA was generally classified as an inadvertent mistake, except on summary judgment.
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“Though the trial court did not make a determination of bad faith, it instead held that benefits had not been exhausted because USAA’s payment of the insured’s claim was gratuitous because it was paid out of order pursuant to the English Rule of priority adopted by Florida courts. We find that the trial court misapplied the English Rule as the rule only applies to assignees (insurance providers) and not to the insured (typically the assignor). See Reg’l MRI of Orlando, Inc. a/a/o Lorraine Gerena v. State Farm Mut. Auto. Ins. , 18 Fla. L. Weekly Supp. 563a (Fla. 9th Cir.
App. ”); see also Boulevard Nat. Bank of Miami v. , 176 So. 2d 94, 96 (Fla. 1965) (“he so-called ‘English’ rule or ‘American’ rule of priority between assignees of successive assignments . . ”); Northwoods,137 So. 3d at 1054 (“he English rule of priorities, which gives priority to an assignee first giving notice to the creditor . . ”).
Very interesting in the priority of payment realm.
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Legal Context
Why This Matters for Your Case
New York's no-fault insurance system, established under Insurance Law Article 51, is one of the most complex insurance frameworks in the country. Every motorist must carry Personal Injury Protection coverage that pays medical expenses and lost wages regardless of fault, up to $50,000 per person.
But insurers routinely deny valid claims using peer reviews, EUO scheduling tactics, fee schedule reductions, and coverage defenses. The Law Office of Jason Tenenbaum has handled over 100,000 no-fault cases since 2002 — from initial claim submissions through arbitration before the American Arbitration Association, trials in Civil Court and Supreme Court, and appeals to the Appellate Term and Appellate Division. Jason Tenenbaum is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
His 2,353+ published legal articles on no-fault practice are cited by attorneys throughout New York. Whether you are dealing with a medical necessity denial, an EUO no-show defense, a fee schedule dispute, or a coverage question, this article provides the kind of detailed case-law analysis that helps practitioners and claimants understand exactly where the law stands.
About This Topic
New York No-Fault Insurance Law
New York's no-fault insurance system requires every driver to carry Personal Injury Protection (PIP) coverage that pays medical expenses and lost wages regardless of who caused the accident. But insurers routinely deny, delay, and underpay valid claims — using peer reviews, IME no-shows, and fee schedule defenses to avoid paying providers and injured claimants. Attorney Jason Tenenbaum has litigated thousands of no-fault arbitrations and court cases since 2002.
271 published articles in No-Fault
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