## Facts

- Emond was injured in a 1979 automobile collision and sought benefits under her State Farm auto policy.
- State Farm paid $5,000 in basic personal injury protection (PIP) benefits.
- The policy also provided $5,000 in medical payments coverage for medical services furnished within one year of the accident, described as excess over PIP.
- After Emond tendered premium for $50,000 optional PIP coverage recognized under Georgia law, State Farm accepted it and paid an additional $40,000.
- Emond later submitted medical expenses incurred more than one year after the accident; State Farm denied payment.
- Emond sued, contending she had received only $45,000 in PIP because the earlier $5,000 medical-payments payment should not count toward the $50,000 PIP limit.
- The trial court granted summary judgment to State Farm, and Emond appealed.

## Issues

1. Whether, after the insured elected $50,000 optional PIP, the insurer could treat a prior $5,000 payment made under the policy’s medical-payments provision as part of the insured’s PIP recovery.
2. Whether the insured was entitled to an additional $5,000 in PIP benefits beyond amounts already paid, based on the claim that medical-payments benefits were separate from PIP.

## Decision

- The Court of Appeals of Georgia affirmed summary judgment for State Farm.
- The court held that the previously paid $5,000 under medical payments could be credited toward the $50,000 optional PIP benefits.
- Because State Farm had paid a total of $50,000 ($5,000 basic PIP + $5,000 medical payments + $40,000 additional PIP), no further PIP benefits were owed.
- The insured could not obtain additional recovery for post–one-year medical expenses where medical-payments coverage was time-limited and the PIP obligation was fully satisfied.

## Legal Principles

- When optional PIP coverage is elected post-accident upon tender of premium and proof of loss, the insurer must provide PIP benefits up to the elected limit.
- An insurer may credit previously paid policy benefits toward satisfaction of the elected PIP limit when doing so avoids exceeding the contractual and statutory PIP maximum.
- Medical-payments coverage limited to services furnished within one year does not extend to later-incurred expenses, and it does not create an additional recovery beyond the satisfied PIP limit when credited against PIP.

## Conclusion

The court upheld State Farm’s position that the $5,000 paid under medical payments could be applied toward the $50,000 optional PIP limit, leaving the insured fully paid and not entitled to an additional $5,000 or further recovery for later medical expenses.


Emond v. State Farm Mut. Auto. Ins. Co., 175 Ga. App. 548, 333 S.E.2d 656 (1985)