11 Fla. L. Weekly Supp. 673b
Insurance — Personal injury protection — Explanation of benefits — Where insurer concedes that it failed to provide insured with statutorily-mandated explanation of benefits for unpaid claim, summary judgment is granted in favor of provider on count alleging breach of contract for failure to provide explanation of benefits
MIA A. HIGGINBOTHAM, D.C., P.A., Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 03-08008 COSO (62). May 17, 2004. Robert W. Lee, Judge. Counsel: Russel Lazega, North Miami, for Plaintiff. Thomas A. Freehling, Fort Lauderdale, for Defendants.
ORDER GRANTING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT (COUNT I)
THIS CAUSE came before the Court on May 12, 2004 for hearing of the Plaintiff’s Motion for Summary Judgment as to Count I of the Complaint, and the Court’s having reviewed the Motion, Court file, and relevant legal authorities; having heard argument; and having been sufficiently advised in the premises, the Court hereby finds as follows:
Background. On November 6, 2003, the Plaintiff filed her action for breach of contract against the Defendant. The Complaint sets forth two counts: (1) breach of contract for failure to provide an explanation of benefits; and (2) breach of contract for failure to payment amounts owed. The Plaintiff has moved for summary judgment as to Count I. The basis of the complaint is an alleged violation of Florida law which requires a “PIP” insurer to provide an explanation of benefits to its insured when the insurer reduces, omits or declines to pay a benefit. Fla. Stat. §627.736(4)(b). The Defendant concedes that it has failed to pay the amount in question, and it further concedes that it did not provide the insured with the statutorily-mandated explanation of benefits.
Conclusions of Law. Under Florida law, the provisions of the Florida Statutes governing insurance become part of the insurance contract between the parties. Grant v. State Farm Fire & Casualty Company, 638 So.2d 936, 938 (Fla. 1994). As a result, Florida Statute §627.736(4)(b) has become part of the PIP insurance contract in the case. When the insurer failed to provide the required explanation of benefits, it was subjecting itself to an action for breach of contract.
The record evidence establishes that no material dispute of fact exists as pertains to Count I of the Complaint. Therefore, the Plaintiff is entitled to the relief it is seeking as to Count I. The Court finds that the Defendant has breached its contract with the Plaintiff by failing to provide an explanation of benefits. Accordingly, it is hereby
ORDERED and ADJUDGED that the Plaintiff’s Motion for Summary Judgment is GRANTED as to Count I only.
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