13 Fla. L. Weekly Supp. 1006a
Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — Disclosure and acknowledgment form with description of “services actually rendered” omitted failed to provide notice of fact of covered loss — Contemporaneous submission of bills and medical records does not constitute substantial compliance with requirement to submit properly completed form where one of main purposes of form is to identify and divulge services actually rendered
FT. LAUDERDALE PAIN CENTER, INC., As assignee of ULYSSE SAINTELENE, Plaintiff, vs. ALLSTATE INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 05-5279 CC 23 (02). July 17, 2006. Caryn C. Schwartz, Judge. Counsel: Sanford Topkin, for Plaintiff. Brian S. Tenzer, Hengber, Goldstein, & Ray, P.A., Fort Lauderdale, for Defendant.
ORDER GRANTING DEFENDANTS MOTION FOR FINAL SUMMARY JUDGMENT
THIS CAUSE having come before this Court on Defendant’s Motion for Final Summary Judgment heard on June 29, 2006, and after having reviewed the file, heard argument of counsel, reviewed the affidavits in support and in opposition of Defendant’s Motion, and having been sufficiently advised in the premises, the Court finds as follows:
Plaintiff submitted a Disclosure and Acknowledgment Form to Defendant using the standard form approved by The Financial Services Commission. The form submitted by the Plaintiff omitted the “services . . . actually rendered” by leaving blank the space provided to delineate these services on paragraph 1 of the Form.
Pursuant to Florida Statute §627.736(5)(e), Plaintiff is required to submit an original and properly completed Disclosure and Acknowledgment Form to an insurance company as part of the provider’s notice of the fact of a covered loss. Because the Disclosure and Acknowledgment Form submitted by the Plaintiff failed to set forth the services “actually rendered,” Plaintiff failed to provide notice of the fact of a covered loss.
Plaintiff argues that it has substantially complied with the requirements of Florida Statute §627.736(5)(e) by submitting bills and medical records contemporaneously with the Disclosure and Acknowledgment Form that specify the services that were “actually rendered.” This Court recognizes the application of a substantial compliance standard under certain circumstances however, even if applying a substantial compliance standard in this case, the Form supplied by the Plaintiff with the services “actually rendered” blank or omitted, does not meet the minimal standards set forth in the Statute. One of the main purposes of the Disclosure and Acknowledgment Form is to identify and divulge the services “actually rendered” to the claimant, to the insurance company. The omission of the “services. . . actually rendered” description goes to the heart and purpose of the Form and, therefore, there has been no substantial compliance with Florida Statute §627.736(5)(e).
Accordingly, it is hereby ORDERED and ADJUDGED that Defendant’s Motion for Final Summary Judgment is GRANTED. The Plaintiff, FT. LAUDERDALE PAIN RELIEF CENTER shall take nothing in this action and Plaintiff shall go hence without day. The Court reserves jurisdiction on the issue of attorney fees and costs.
