12 Fla. L. Weekly Supp. 803c
Insurance — Personal injury protection — Demand letter — Sufficiency — Patient ledger that does not indicate which services had been reduced or denied fails to meet specificity requirement for attachment to demand letter — Standing — Assignment — Where assignment of benefits is in name different than provider’s registered corporate name, provider was unlawfully conducting business as unregistered fictitious entity and is precluded from maintaining cause of action or claiming entitlement to PIP benefits since services were not lawfully rendered — Provider does not fall within exception to fictitious name registration for business formed by person practicing licensed profession unless name under which business is to be conducted differed from name as licensed or registered where name on assignment relied upon for standing differs from provider’s registered corporate name — Further, assignment naming unregistered fictitious entity cannot confer standing on provider
SUN COAST HEALTH CARE CENTER #1, INC. (Pamela Segal), Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 04-011064 COCE 54. May 3, 2005. Lisa G. Trachman, Judge. Counsel: Jose Pete Font. Laura Rodgers.
FINAL SUMMARY JUDGMENT FOR DEFENDANT PROGRESSIVE EXPRESS INSURANCE COMPANY
THIS CAUSE having come before the Court for hearing on April 19, 2005 on Defendant’s Motion for Final Summary Judgment, and the Court having reviewed the file, the Defendant’s motion, heard arguments of counsel, and being otherwise fully advised in the premises, it is hereby
ORDERED AND ADJUDGED:
Nature of the Case
1. The Plaintiff, Sun Coast Health Center #1, Inc., brought this action on behalf of Progressive Express Insurance Company’s (“Progressive”) Insured, Pamela Segal, seeking recovery of personal injury protection (“PIP”) benefits.
2. Plaintiff’s complaint alleges standing to file suit on behalf of the Defendant’s Insured pursuant to an assignment that the Defendant’s Insured was said to have executed in favor of the Plaintiff.
3. Progressive moved forward on a motion for final summary on the following issues:
(a.) Whether an insurer is entitled to final summary judgment when a medical care provider, prior to filing suit for PIP benefits, fails to provide the insurer a Demand Letter that adheres to all the material requirements set forth under Fla. Stat. § 627.736(11)?
(b.) Whether a medical care provider who conducts business as an unregistered fictitious entity and alleges standing based on an assignment that names the unregistered fictitious entity is precluded from maintaining a cause of action against an insurer?
Findings of Fact
4. The facts material to Progressive’s motion for final summary judgment are undisputed and established by the pleadings and discovery on record. The material facts are set forth below.
5. The assignment of benefits that the Plaintiff relies on for standing names Sun Coast Health Center, rather than the named Plaintiff in this suit, Sun Coast Health Center #1, Inc.
6. Sun Coast Health Center #1, Inc. is a registered Florida Corporation. Also registered as a distinct Florida Corporation is Sun Coast Health Center #2, Inc.
7. The Demand Letter that the Plaintiff submitted to Progressive used a patient ledger as an itemized statement.
8. The patient ledger listed all services that were rendered to Progressive’s Insured, the date that the services were rendered, the nature of the services, and the total amount that was being claimed as due.
9. Although Progressive had paid in part or in whole a number of the services listed on the patient ledger, there was no indication given by the Plaintiff as to which services had been reduced or which services had been paid in full.
Conclusions of Law
10. The Court hereby adopts the foregoing findings of fact to the extent they encompass conclusions of law or mixed findings of fact and conclusions of law.
11. By failing to indicate on the patient ledger which services had been reduced or denied, the Plaintiff failed to meet the specificity requirement set forth under Fla. Stat. § 627.736(11)(b)(3) which provides in pertinent part that “[t]o the extent applicable,” the Demand Letter must have attached an “itemized statement specifying each exact amount . . . .
12. Since the patient ledger attached to the Plaintiff’s Demand Letter listed all service charges previously submitted by the Plaintiff, including those that had been paid in part or in whole, it was impossible for the Defendant to make a determination as to specifically which service charges were at issue and the amount that was being claimed as due for that particular service charge.
13. If a medical provider is going to use a patient ledger as an itemized statement they must clearly mark the services in a manner that the Insurer will be able to determine which services were paid, which services were reduced, and if reduced, by how much.
14. Legislative intent would be frustrated if a medical care provider was not required to provide an insurer with the statutorily mandated specificity in their itemized statement.
15. Accordingly, the Court finds that since the Plaintiff did not satisfy the Demand Letter condition precedent set for under Fla. Stat. 627.736(11) the Defendant is entitled to final summary judgment.
16. The court also finds in favor of the Defendant on the second issue presented.
17. Based on all the evidence on record it is concluded that the Plaintiff was unlawfully conducting business as an unregistered fictitious entity.
18. As such under Fla. Stat. 865.09(9) the Plaintiff is not entitled to maintain this cause of action against the Defendant, and is precluded from claiming entitlement to PIP benefits under Fla. Stat. § 627.736(5)(a) since the services were not lawfully rendered.
19. The Court took into consideration the exception to the fictitious name registration that is set forth under Fla. Stat. § 865.09(7), and concludes that the Plaintiff does not fall under the exception, since the name on the assignment that the Plaintiff’s relies upon for standing differed from Plaintiff’s registered corporate name. Further, being that the assignment names an unregistered fictitious entity rather than the Plaintiff, it cannot be said that the Plaintiff has standing to maintain this cause of action.Final Judgment
IT IS HEREBY ADJUDGED that Plaintiff, Sun Coast Health Center #1, Inc., take nothing by this action and the Defendant, Progressive Express Insurance Company, shall go hence without day. The Court retains jurisdiction for the purpose of determining any motion by Defendant to tax fees and costs.
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