12 Fla. L. Weekly Supp. 493a
Insurance — Personal injury protection — Coverage — Denial — Explanation of benefits — Declaratory judgments — Insurer that failed to comply with statutory requirement to furnish medical provider with itemized specification of unpaid charges breached insurance contract with insured — Summary judgment entered in favor of provider as to liability and at minimum nominal damages on count for declaratory relief seeking EOB and on count for breach of contract — Attorney’s fees and costs awarded to provider
PRIMARY CARE MEDICAL GROUP, INC., a Florida Corporation (assignee of Bermudez, Eliczer), Plaintiff, v. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 03-01226 COCE 54. March 1, 2005. Lisa Trachman, Judge. Counsel: Russel Lazega, The Law Office of Russel Lazega, North Miami. Yvette Blackwell.
ORDER GRANTING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT AS TO COUNT I OF AMENDED COMPLAINT (DECLARATORY RELIEF SEEKING ITEMIZED SPECIFICATIONOF UNPAID CHARGES/EOB) AND COUNT II OF PLAINTIFF’S AMENDED COMPLAINT (BREACH OF CONTRACT SEEKING ITEMIZED SPECIFICATION OF UNPAID CHARGES/EOB)
THIS CAUSE came before the Court on February 10, 2005 for hearing on Plaintiff’s Motion for Summary Judgment (Count I — Declaratory Relief seeking itemized specification of unpaid charges/EOB) and Count II (Breach of Contract — seeking itemized specification of unpaid charges), and the Court’s having reviewed the Motion and entire Court file; reviewed the relevant legal authorities; heard argument, and been sufficiently advised in the premises the Court finds as follows:
Background: On January 21, 2003, having not received from Defendant the required statement of the reasons for non-payment of its charges, the Plaintiff filed its Complaint against Defendant for Declaratory Relief and Breach of Contract seeking an itemized specification of unpaid charges/Explanation of Benefits itemizing the charges received by Defendant from Plaintiff and detailing the reasons for non-payment. The complaint was later amended to add a third count for breach of contract seeking payment of the unpaid charges once Plaintiff discovered the reasons for non-payment and elected to pursue the claim for benefits. The gist of the two Counts at issue (Counts I and II) is that the Defendant failed to provide the explanation of benefits required by Florida Statute §627.736(4)(b).
Defendant has presented no proper record evidence showing that it furnished the required itemized specification. In fact, in response to Plaintiff’s Supplemental Interrogatory dated March 17, 2004 (which tracked the language of Florida Statute 627.736(4)(b) pertaining to itemized specifications of unpaid charges and specifically asked the Defendant to identify every itemized specification that it sent to the Plaintiff pursuant to this statute), the Defendant identified only the Plaintiff’s own HCFA Forms (medical bills) that Plaintiff had submitted to the Defendant.
Conclusions of Law. The Plaintiff is correct that the provisions of the Florida Statutes governing insurance become part of the insurance contract between the parties, Grant v. State Farm Fire & Casualty Co., 638 So.2d 936, 938 (Fla. 1994); Mia A. Higginbotham D.C., P.A. v. United Automobile Ins. Co., 11 Fla. L. Weekly Supp. 748 (Broward Cty. Ct. 2004), and that accordingly, the provision of Florida Statute s. 627.736(4)(b) requiring the insurer to furnish the claimant with an itemized specification of unpaid charges became part of the contract and a breach of contract action is proper. See Goldson v. United Auto. Ins. Co. (Decision of Judge Robert Lee, Broward County case #03-7459 COSO 62) [12 Fla. L. Weekly Supp 161b]; STAT Technologies, Inc. v. United Auto. Ins., Co. (Decision of Judge Lee Jay Seidman Broward County Case 02-01929 COSO 62; All Care Health & Wellness (Decision of Judge Sharon Zeller Broward County Case 03-3115 COSO 60). Additionally, the Plaintiff is entitled to declaratory relief to determine its rights and obligations under the statute and contract. See R.J. Trapana M.D., P.A. v. United Auto. Ins. Co. (Decision of Judge Linda Pratt Broward County Case 02-020836 COCE 56); R.J. Trapana, M.D., P.A. v. United Auto. Ins. Co. (Decision of Judge Sharon Zeller Broward County Case 02-0303 COSO 60); and R.J. Trapana, M.D., P.A. v. United Auto. Ins. Co. (Decision of Judge Martin Dishowitz Broward County Case 02-12623 COCE 51). As a result, when the Defendant failed to comply with the mandatory provisions of Fla. Stat. §627.736(4)(b), it breached its insurance contract with the insured. Additionally, Plaintiff is entitled to have its dispute with the Defendant regarding Plaintiff’s rights to this information determined by this court pursuant to a claim for Declaratory Relief. Accordingly, it is hereby
ORDERED AND ADJUDGED the Plaintiff’s Motion for Summary Judgment is GRANTED. Summary judgment is entered in favor of Plaintiff as to liability and at a minimum nominal damages on Count I of the Complaint. As to Count II, Summary Judgment is entered in favor of Plaintiff as this court finds Plaintiff is entitled to Declaratory Relief regarding the dispute over Plaintiff’s entitlement to the itemized specification. Moreover, as Defendant failed to provide the information until well after suit was filed, the Plaintiff is the prevailing party as to this count as well. Pursuant to Florida Statute 627.428. Plaintiff is entitled to recover from Defendant attorney’s fees and costs as to both Count I and Count II in an amount to be determined at a later hearing, for which, the court reserves jurisdiction.
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