11 Fla. L. Weekly Supp. 649b
Insurance — Personal injury protection — Coverage — Medical expenses — Premature suit — Where insurer receiving claims for TENS unit and related supplies sent provider/assignee Explanation of Benefits requesting invoice from supplier to determine proper payment unit and supplies, and provider did not send invoice prior to filing suit, claims were not overdue at time of filing suit since EOB tolled time for payment of claims — Summary judgment is granted in favor insurer
PHYSICIANS EXTENDED SERVICES, a/a/o CHRISTINA L. NELSON, Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County, Civil Division. Case No. 2003-SC-14544. April 21, 2004. Leon B. Cheek, III, Judge. Counsel: Steven C. Blinn, for Plaintiff. Anthony J. Parrino, for Defendant.
ORDER GRANTING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT/JUDGMENT FOR DEFENDANT
THIS CAUSE having come on for hearing on Defendant’s Motion for Summary Judgment, on April 14, 2004, and being fully advised in the premises, the Court makes the following findings:
1. Christina Nelson was involved in a motor vehicle accident on June 4, 2003.
2. Plaintiff, theassignee of Christina Nelson, sold a TENS unit to Ms. Nelson on August 7, 2003.
3. Defendant received the HCFA bill from Plaintiff for said TENS unit on August 21, 2003.
4. On August 26, 2003, Defendant sent to Plaintiff an Explanation of Benefits (“EOB”) regarding said claim for the TENS unit in which Defendant requested that Plaintiff “submit an invoice from the supplier to determine proper payment for medical appliances/equipment.”
5. Plaintiff did not send an invoice to Defendant or otherwise respond to the EOB of August 26, 2003, prior to filing the instant action.
6. Plaintiff, likewise, sold TENS unit supplies to Ms. Nelson on September 18, 2003.
7. Defendant received the HCFA bill from Plaintiff for said TENS unit supplies on September 22, 2003.
8. On October 2, 2003, Defendant sent to Plaintiff an EOB regarding said claim for the TENS unit supplies in which Defendant requested that Plaintiff “submit an invoice from the supplier to determine proper payment for medical appliances/equipment.”
9. Plaintiff did not send an invoice to Defendant or otherwise respond to the EOB of October 2, 2003, prior to filing the instant action.
10. The only claims that are the subject of the instant action are for the TENS unit on August 3, 2003, and the TENS unit supplies on September 18, 2003.
11. Defendant made timely requests for information pursuant to Section 627.736(6)(b), Florida Statutes, thus tolling the time for payment of the claims that are thesubject of the instant action.
12. Having received no responses from Plaintiff prior to the filing of the instant action, the claims that are the subject of the instant action were not “overdue” at the time of filing.
Based on the foregoing findings, it is hereby ORDERED and ADJUDGED that Defendant’s Motion for Summary Judgment is GRANTED and judgment is hereby entered in favor of Defendant with the Court retaining jurisdiction over any claim for attorney’s fees and costs by Defendant.
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