12 Fla. L. Weekly Supp. 1107a
Insurance — Personal injury protection — Explanation of benefits — Insurer breached contract with medical provider by failing to provide EOB when it failed to make payment on medical bills received from provider
MIAMI CHIROPRACTIC ASSOCIATES, INC. a Florida Corporation (assignee of Jean-Gilles, Fritznel), Plaintiff, v. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 05-04835 COCE 53. August 15, 2005. Robert W. Lee, Judge. Counsel: Russel Lazega, The Law Office of Russel Lazega, North Miami.
ORDER GRANTING PLAINTIFF’S MOTION FOR PARTIAL SUMMARY JUDGMENT AS TO COUNT I OF COMPLAINT (BREACH OF CONTRACT FAILURE TO PROVIDE ITEMIZED SPECIFICATION/EOB)
THIS CAUSE came before the Court on August 12, 2005 for hearing of the Plaintiff’s Motion for Summary Judgment as to Count I of the Complaint, and the Court having reviewed the Motion, Court file, and relevant legal authorities; having heard argument; and having been sufficiently advised in the premises, hereby finds as follows:
Background. Onor about September 7, 2004, the Plaintiff filed this 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 pay 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 in response to Plaintiff’s Second Interrogatories and Second Request to Produce acknowledges that no response was sent directly to Plaintiff, that would explain Defendant’s failure to make payment on the medical billing received from Plaintiff.
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. Plaintiff shall be entitled to recover from Defendant at a minimum nominal damages, plus attorney’s fees and costs related to Count I of Plaintiff’s Complaint in an amount to be determined at a later hearing. See Florida Statute s. 627.428.
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