13 Fla. L. Weekly Supp. 1212a
Insurance — Personal injury protection — Claims — HCFA form — Provision of signature in box 31 of HCFA form is not requirement under Florida law and, therefore, failure to provide signature is not valid defense — Standing — Assignment — No merit to defense that medical provider lacks standing because insured executed assignments to more than one provider
AFO IMAGING, INC., (as assignee of Maritza Donoso), Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 13th Judicial Circuit in and for Hillsborough County, Civil Division. Case No. 05-3813, Division H. October 3, 2006. Eric R. Myers, Judge. Counsel: Timothy A. Patrick and Helen Stratigakos, Nicholas, Lipscomb & Patrick, P.A., Tampa, for Plaintiff. Heather Harwell, for Defendant.
[Editor’s note: See 14 Fla. L. Weekly Supp. 895b.]
ORDER GRANTING PLAINTIFF’S MOTION FOR FINAL SUMMARY JUDGMENT
THIS CAUSE, having come before the Court on September 7, 2006 for hearing regarding Plaintiff’s Motion for Final Summary Judgment with Helen Stratigakos, Esquire appearing on behalf of Timothy A. Patrick, Esquire for Plaintiff and Heather Harwell, Esquire appearing on behalf of Defendant, UNITED AUTOMOBILE INSURANCE COMPANY and the Court having heard argument of counsel and the Court being otherwise fully advised in this matter does hereby make the following Findings of Fact and Conclusions of Law:
FINDINGS OF FACT
1. That Patient Maritza Donoso was involved in a motor vehicle accident on September 24, 2004.
2. That Ms. Donoso treated with the Plaintiff, AFO IMAGING, INC. on October 5, 2004. The Defendant United Automobile Insurance Company received reasonable notice of a covered loss on November 4, 2004, pursuant to the deposition testimony of Richard Threlkeld, as filed with the Court. The Defendant, United Automobile Insurance Company did not provide reasonable proof for non-payment within thirty (30) days after receipt of this bill.
3. That Defendant, United Automobile Insurance Company received a properly executed demand letter by the Plaintiff on December 28, 2004, pursuant to the deposition testimony of Richard Threlkeld as filed with the Court. The Defendant did not respond to this demand letter.
4. That the Plaintiff filed suit on this matter in February, 2005. Subsequent to the filing of the lawsuit a motion for default was entered on April 20, 2005.
5. That on January 6, 2006 an Answer and Affirmative Defenses was finally filed by Defendant, United Automobile Insurance Company. Between November 4, 2004 and the filing of the Answer and Affirmative Defenses on January 5, 2006, the Defendant did not produce and/or forward any explanation of benefits and/or documentation as to the reasonable proof for the non-payment by the Defendant as to the bill submitted.
CONCLUSIONS OF LAW
Pursuant to Florida Statute Section 627.736(4)(b) a bill received by the Defendant is due and owing within thirty (30) days of receipt. The Defendant’s penalty for failing to pay the bill in this thirty day window is that it starts to accrue interest on the thirty-first day. Furthermore, the Defendant does not lose its right to contest the bill after the thirty day window if it contests it on the grounds of reasonableness, necessity, and relatedness to the automobile accident in question. The Defendant in the instant case proffered only two defenses as to the failure to pay the bill on a timely basis. The Court finds neither of these defenses as compliant with Florida Statute Section 627.736(4)(b). Specifically the Defendant raised the defense that the HCFA claim form failed to provide a signature on box “31” and as such was an invalid HCFA pursuant to Florida Statute Section 626.736(4)(b) subsection (5)(d). Citing the cases of Florida MRI, Inc. (Raza) v. Progressive Express Insurance Company, 13 Fla. L. Weekly Supp. 190b and Miami Medical Group (Castillo) v. Progressive Southeastern Insurance Company, 12 Fla. L. Weekly Supp. 115b, the Court finds that the failure to provide a signature in box “31” is not a requirement under Florida law and more specifically, Florida Statute section 627.736 and therefore is not a valid defense in this action. The second defense proffered by the Defendant is the fact the patient had executed more than one assignment of benefits in her treatment and therefore, the Plaintiff has no standing to pursue the instant case. The Court finds, as a matter of law that there is no precedent that an assignment needs to be unilateral to only one medical provider. Instead, the Court finds that an assignment to a provider is specific as to that provider and cannot transfer any and all rights to any other providers seeking reimbursement under the PIP policy. The Court finds that a carrier must provide reasonable proof for non-payment as required by Florida Statute 627.736(4)(b). The Defendant in this action has failed to provide this proof.
For the foregoing reasons, therefore it is
ORDER AND ADJUDGED:
1. That Plaintiff’s Motion for Final Summary Judgment is hereby GRANTED.
2. The Court retains jurisdiction on the issues of pre-judgment interest, attorney’s fees and costs. [See 14 Fla. L. Weekly 895b]
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