12 Fla. L. Weekly Supp. 262a
Insurance — Personal injury protection — Demand letter — Motion for summary judgment on ground that demand letter was sent to wrong insurer is denied — Original claims were received and acted on without denial of coverage by incorrect insurer having similar name and same address, same registered agent, and the same person authorized to receive demand letters as correct insurer — Insurer cannot thwart intent of statute allowing resubmission of claim by not sending denial and then using failure to notice proper insurer as defense — Insurer’s motion for summary judgment on whether billing for separate CPT codes constituted unlawful unbundling is denied where no evidence was presented to dispute affidavit swearing services were properly coded — Bills were overdue when demand letter and suit were filed given fact that insurer’s written request for documentation was not dated until 51 days after notice of covered loss
STEVEN D. GELBARD, M.D., P.A., (a/a/o LARRY WHEATON), Plaintiff, vs. PROGRESSIVE CONSUMERS INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. COCE 04-7456 (49). December 15, 2004. Kathleen D. Ireland, Judge. Counsel: Justin G. Morgan, Justin G. Morgan, P.A., Weston, for Plaintiff. Lee Colombo, Matt Hellman, P.A., Plantation, for Defendant.
ORDER DENYING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS CAUSE having come on to be heard on Defendant’s Motion for Summary Judgment, and the Court having heard argument of counsel, reviewed the motion and the evidence, makes the following findings and ruling:
The issues of law presented were:
I. Whether Plaintiff properly submitted demand letter and whether Plaintiff sent its demand letter to the wrong insurer?
In this instance, “Progressive Express” was noticed when it should have been “Progressive Consumers Insurance Company”.
Both companies have the same mailing address, same principle address, same registered agent, and the person authorized to receive demand letter notices is TARA FEENEY for both entities.
The original HCFAs were received and acted upon by EXPRESS without denial of coverage but rather by the submission of an Explanation of Benefits refusing payment for reasons other than incorrect coverage.
Florida Statute 627.736(5)(c)(2) allows a provider 35 days from the date the provider obtains the correct information to resubmit the statement, if the insured provided an incorrect name, and/or the resubmission is accompanied by a denial letter from the incorrect insurer.
An insurer cannot thwart the intent of the statute by not sending a denial as an incorrect insurer and then use failure to notice the proper insurer as a defense.
Motion for Summary Judgment on grounds of wrong insurer is DENIED.
II. Whether Plaintiff’s act of billing for CPT Codes 99214, 72141, and 72148 constitutes unbundling in violation of Florida Statute 627.736(5)(b)?
The Defendant having presented no conflicting testimony to Plaintiff’s sworn affidavit by a physician that the services were properly coded, the Defendant’s Motion for Summary Judgment on issue II is DENIED.
III. Whether Plaintiff properly filed a demand letter and properly filed suit over bills that Defendant alleges were not yet overdue?
The HCFAs were submitted on February 17, 2004, and the written request for documentation was dated April 8, 2004, or 5l days after notice of the covered loss. Therefore, the Plaintiff’s bills were overdue and the insurer had defaulted when Plaintiff filed the demand letter. Accordingly, the suit was properly filed.
Motion for Summary Judgment on grounds of improperly filed demand letter is DENIED.
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