11 Fla. L. Weekly Supp. 128b
Insurance — Personal injury protection — Claims — Timeliness — Where medical provider timely submitted notice of initiation of treatment to insurer, time for submission of all charges, not just charges for first treatment, was extended from 30 days to 60 days — Summary judgment granted in favor of provider
HANDS FOR HEALTH, INC., as assignee of Mamerto Marte, Plaintiff, vs. ALLSTATE INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. CCO 01-11437. December 12, 2003. C. Jeffery Arnold, Judge. Counsel: Amanda N. Gifford, Payas, Payas & Payas, LLP, Orlando, for Plaintiff. Julie Walbroel-Pardy, Julie Warbroel-Pardy, P.A., Ocoee, for Defendant.
ORDER DENYING DEFENDANT’S MOTION FOR FINAL SUMMARY JUDGMENT AND DEFENDANT’S MOTION TO STRIKE PLEADING AND FOR SANCTIONS PURSUANT TO F.S. 57.105 AND GRANTING PLAINTIFF’S CROSS MOTION FOR SUMMARY JUDGMENT
THIS CAUSE having come before this Honorable Court on December 3, 2003 upon Defendant’s Motion for Final Summary Judgment, Defendant’s Motion to Strike Pleading and for Sanctions Pursuant to F.S. 57.105 and Plaintiff’s Cross Motion for Summary Judgment, and the Court having reviewed the file, having heard argument of counsel and being fully advised in the premises, the Court makes the following findings of fact and conclusions of law:
FACTS
1. There is no dispute as to any material fact and the issue in this case is sufficiently crystallized to permit this Court to rule on the issue of Defendant’s liability for the medical benefits at issue as a matter of law. The undisputed facts are as follows:
A. On or about April 30, 2001, Mamerto Marte was involved in a motor vehicle accident in which he sustained personal injuries and for which Defendant provided personal injury protection coverage.
B. As a result of his injuries from the motor vehicle accident, Mamerto Marte sought medical treatment from Plaintiff and executed an Assignment of Benefits in favor of Plaintiff with regard to his rights and benefits under his insurance policy with Defendant.
C. Mamerto Marte treated with Plaintiff on various dates of service beginning on May 10, 2001.
D. On May 23, 2001, within 21 days of initiating treatment to Mamerto Marte, Plaintiff sent a notice pursuant to Section 627.736(5)(b), Florida Statutes (2000) advising that Plaintiff had begun treatment to Mamerto Marte. Defendant stipulated to timely receipt of said notice.
E. Subsequently, Plaintiff submitted charges for treatment rendered to Mamerto Marte on May 29, 2001, May 31, 2001, June 5, 2001, June 14, 2001, June 19, 2001, and June 21, 2001 in the amount of $750.00. None of Plaintiff’s charges at issue were submitted to Defendant within 30 days from the date treatment was rendered all were submitted within 60 days.
F. Defendant denied Plaintiff’s charges on the basis that the same were not submitted within 30 days from the date treatment was rendered and, therefore, as untimely and in violation of Section 627.736(5)(b), Florida Statutes (2000).
G. The only issue to be determined by the Court is whether Plaintiff’s timely submission to Defendant of its Notice of Initiation of Treatment regarding Mamerto Marte and made pursuant to Section 627.736(5)(b), Florida Statute (2000) extended the time within which Plaintiff had to submit all of its charges or whether the 60 day extension only applied to Plaintiff’s charges for its initial or “first treatment” to Mamerto Marte.
H. All procedural requirements have either been satisfied or waived and determination of this issue is dispositive of all matters involved and this entire case.
LAW AND ANALYSIS
2. Section 627.736(5)(b), Florida Statutes (2000), is clear and unambiguous and there is no need for the Court to look beyond the plain language of the statute and/or to resort to rules of statutory construction and legislative intent.
3. Plaintiff is a healthcare provider required to submit its charges for treatment rendered to Defendant’s insured within 30 days. However, Plaintiff has availed itself of the explicit exception set forth in Section 627.736(5)(b), Florida Statutes (2000), by having timely submitted a Notice of Initiation of Treatment to Defendant, thereby extending the time for submission of all charges from 30 days to 60 days.
4. Section 627.736(5)(b), Florida Statutes (2000), does not limit the 30 day extension to Plaintiff’s initial treatment of the insured. The clear language of the statute begins with the phrase “With respect to any treatment or services. . .”. The statute then goes on to set forth the time limitations and exceptions thereto regarding the statement of charges for any treatment or services.
5. The statute does not distinguish the first date of treatment from any other date of treatment or services and, therefore, Section 627.736(5)(b) Florida Statutes (2000) applies to charges for all dates of treatment related to the date of loss and patient for which the provider makes a claim.
6. Reference to the “first examination or treatment” in Section 627.736(5)(b), Florida Statutes (2000), merely provides a point from which to measure the 21 days within which healthcare providers must submit a notice of initiating treatment to obtain the 30 day extension.
7. Further, the Court is aware of and has reviewed the opinion set forth in Premier Plus Healthcare as assignee of Torres Claudia v. United Services Automobile Association, 8 Fla. L. Weekly Supp. 868 (17th Cir. Broward County, Sept. 10, 2001), and finds the same unpersuasive. The Premier Plus opinion is not binding on this Court and does not provide any guidance or reasoning as to why that Court deviated from the plain language of the statute. The Court and both counsels are unaware of any other decision on point and this is a matter of first impression to this Court.
8. Based on the foregoing, the Court does hereby ORDER and ADJUDGE as follows:
Defendant’s Motion for Final Summary Judgment is hereby DENIED.
Defendant’s Motion to Strike Pleading and Motion for Sanctions Pursuant to 57.105, F.S. is hereby DENIED.
Plaintiff’s Cross Motion for Summary Judgment is hereby GRANTED.
9. Final Summary Judgment is hereby entered in favor of Plaintiff and against Defendant for $600.00 (80% of $750.00), plus statutory interest, and reasonable attorney’s fees and costs incurred in the prosecution of this matter.
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