12 Fla. L. Weekly Supp. 1180a
Insurance — Personal injury protection — Notice of claim — Disclosure and acknowledgment form — Medical provider which sent self-generated PIP disclosure and acknowledgment form rather than standard disclosure and acknowledgment form authored by Office of Insurance Regulation provided sufficient notice to insurer
HOLLYWOOD DIAGNOSTICS CENTER, INC a/a/o JOSEPH THOMPSON, Plaintiff, vs SOUTHERN GROUP INDEMNITY, INC., a Florida corporation, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 04-18074 SP 05. June 16, 2005. Roger A. Silver, Judge. Counsel: Peter G. DePrimo, Spencer G. Morgan, P.A., Miami. Jesus Cabarcos.
ORDER DENYING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS CAUSE, having come to be heard on Defendant’s, Southern Group Indemnity, Motion for Summary Judgment, the Court having heard arguments of counsel on May 31, 2005, and being otherwise fully advised in the premises, it is:
ORDERED AND ADJUDGED:
1. Defendant’s Motion for Summary Judgment is DENIED. After reviewing the Court file, including the pleadings, affidavits, and hearing argument of counsel, Defendant was provided proper notice of a covered loss even though Plaintiff, Hollywood Diagnostics Center failed to furnish the “Standard Disclosure and Acknowledgment Form” authored by the Office of Insurance Regulation.
2. The Court recognizes both the insurer’s right to investigate to ensure against payment of potentially fraudulent claims, and to pay only for treatment rendered, the Court also recognizes contemplation of prompt payment of PIP claims.
FINDINGS OF FACT
3. The Plaintiff sued the Defendant on October 29, 2004, alleging violations of Florida Stat., §627.736 and breach of contract, seeking to enforce the payment of PIP benefits arising out of a motor vehicle accident that occurred on June 9, 2004.
4. Plaintiff sued Defendant for medical expenses for date of service June 14, 2004, wherein Plaintiff provided the insured with the technical component of multiple radiological examinations.
5. On or about August 10, 2004, Defendant received the bill along with a form titled “PIP Disclosure and Acknowledgment” generated by Plaintiff, and not the form authored by the Office of Insurance Regulation titled, “Standard Disclosure and Acknowledgment Form.” The form generated by Plaintiff did not include the declarations of the provider which are included in the version authored by the Office of Insurance Regulation.
6. The time for Defendant to issue payment expired without a response and Plaintiff issued a demand letter.
7. On or about September 24, 2004, Defendant responded with an explanation of benefits indicating only that payment of the bill was pending an examination under oath.
CONCLUSION
8. O.P. Diagnostic Center a/a/o Osvel Cancio v. U.S. Security Insurance Company, (11th Judicial Circuit), 12 Fla. L. Weekly Supp. 483b, is distinguished from the case at bar in that Hollywood Diagnostic Center did in fact provide a form, albeit one self generated and not including the declarations of the provider included on the form authored by the Office of Insurance Regulations.
9. This Court concludes Plaintiff, Hollywood Diagnostics Center, provided sufficient notice to Defendant, Southern Group Indemnity, whereby a form titled PIP Disclosure and Acknowledgment was provided, which provides substantial compliance.
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