13 Fla. L. Weekly Supp. 841a
Insurance — Personal injury protection — Declaratory judgment — Insurer’s obligation to provide policy, declarations page and/or PIP log on presuit request from assignee/medical provider — Provider that has valid assignment of benefits has right to copy of declarations page and PIP log on presuit request since claims and coverage information is essential to provider’s ability to determine status as PIP claimant — Further, insurer’s act of supplying documents after suit was filed is functional equivalent of confession of judgment
LEESBURG CHIROPRACTIC CENTER, INC., as assignee of Monique Mzhickteno, Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 18th Judicial Circuit in and for Seminole County. Case No. 04-SC-2271. May, 22, 2006. John R. Sloop, Judge. Counsel: Michael Tierney, Michael Tierney, P.A., Winter Park. Don Mathews, Don Mathews and Associates, P.A., Ft. Myers.
AMENDED ORDER GRANTING PLAINTIFF’S MOTION FOR FINAL SUMMARY JUDGMENT AS TO COUNT II, DECLARATORY JUDGMENT
THIS CAUSE having come before the Court, and the Court having reviewed the Motion(s) being otherwise duly advised in the premises, it is hereby
UNDISPUTED FACTS
1. Count II of the Plaintiff’s Amended Complaint is a claim for declaratory relief arising out of a motor vehicle collision.
2. The insured executed an assignment of benefits in favor of the Plaintiff.
3. The Plaintiff submitted their billing for payment; however the bill was not paid in full as numerous unilateral reductions were taken by the defendant.
4. Subsequently, the Plaintiff sent a Notice of Intent to Initiate Litigation, as well as a request to the Defendant to produce a copy of the declarations page, and PIP payout log pursuant to Florida Statutes 627.4137, 627.736(6)(d), and 627.7401.
5. The Defendant did not respond to the Plaintiff’s request for a copy of the declarations page, and PIP payout log.
6. The Plaintiff waited 22 days, but was left in doubt as to whether it had a claim for breach of contract, as the Defendant failed to provide the information.
7. Thereafter, the Plaintiff filed a Complaint requesting declaratory relief on 6/18/04.
8. On 12/16/04, the defendant provided the Dec sheet and PIP log, 181 days after suit was filed.
LAW AND ANALYSIS
The Plaintiff has a right to obtain the requested documentation in order to confirm whether benefits were exhausted in this claim. Furthermore, the Plaintiff needed to verify insurance coverage and available benefits, so they could determine, via a pre-suit investigation, whether to filing suit or not. This Court agrees that a health care provider, who has a valid assignment of benefits, has a right to determine, pre-suit, what claims have been made and when; how much PIP/med pay benefits remain. Thus, the Plaintiff has a right to a copy of the insurance policy and the declarations page. Even though this responsibility may not be explicit in F.S. 627.736, this Court finds that providing claims and coverage information, pre-suit, is essential to a health care provider’s ability to verify their status as a PIP claimant, and potentially avoid filing an unnecessary lawsuit. Furthermore, the Court finds that by disclosing this information from an insurer to an insured, or its assignee, is in conformity with the intent of the PIP statute. See Allstate v. Ivey Ins. Co., 774 So. 2d 679, 683-84 (Fla. 2000) (quoting Government Employees Ins. Co. v. Gonzalez, 512 So. 2d 269, 271 (Fla. 3d DCA 1987)). To rule otherwise places providers in a position of solely believing the insurer without a method of confirming their assertions regarding remaining PIP benefits, and putting the Plaintiff is a position of facing sanctions under 57.105 should they file suit and later discover that there were in fact no benefits to recover.
Moreover, since the Plaintiff obtained an assignment of benefits from the insured, this Court finds that the Plaintiff was entitled to the information and documentation requested pursuant to the assignment of benefits. Thus, since the insured had a contractual right to receive a copy of their PIP log and declarations page, so too did the Plaintiff. Furthermore the Plaintiff also had the right to know what claims were paid, and the amount of benefits remaining, if any. By obtaining the assignment of benefits, the Plaintiff obtained all of the rights and benefits of the insured under the policy, which included the right to obtain the requested documentation. See State Fire and Cas. Co., v. Ray, 556 So. 2d 811, 812 (Fla. 5th DCA 1990). Lastly, the defendant’s act of supplying the documents as issue, after suit was filed, is a functional equivalent of a confession of judgment under current case law.
This Court finds persuasive the following county court cases: INTEGRA DIAGNOSTICS (Shawn Umstead) v. RELIANCE NATIONAL INDEMNITY, 8 Fla. L. Weekly Supp. 349c, 17th Judicial Circuit, Judge William Herring (2001), and followed by ROM DIAGNOSTICS v. SECURITY NATIONAL INSURANCE COMPANY (Rafael Cruz), 9 Fla. L. Weekly Supp 323b, 9th Judicial Circuit, Judge Jeffery Arnold (2002); RURAL METRO AMBULANCE (Aletha Bryant) v. LIBERTY MUTUAL INSURANCE COMPANY, 11 Fla. L. Weekly Supp. 583a, 9th Judicial Circuit, Judge Leon Cheek III (2004); TALLAHASSEE MRI, P.A. (Jacques Amilcar) v. PROGRESSIVE AUTO PRO INSURANCE CO., 11 Fla. L. Weekly Supp. 69a, 17th Judicial Circuit, Judge Steven Deluca (2003); PALM BEACH REGIONAL MRI, INC. (Cynthia Jackman) v. SOUTHERN GROUP INDEMNITY INC., 11 Fla. L. Weekly Supp. 742a, 15th Judicial Circuit, Judge Joseph Marx (2004); FLORIDA EMERGENCY PHYSICIANS (Marvene Jones) v. PROGRESSIVE EXPRESS INSURANCE COMPANY, 12 Fla. L. Weekly Supp. 805b, 18th Judicial Circuit, Judge John Sloop (2005); FLORIDA EMERGENCY PHYSICIANS (Sharna Adderly) v. UNITED AUTOMOBILE INSURANCE COMPANY, 12 Fla. L. Weekly Supp. 774c, 9th Judicial Circuit, Judge Leon B. Cheek, III, (2005); FLORIDA EMERGENCY PHYSICIANS (Stephanie Carrico) v. AMERICAN VEHICLE INSURANCE COMPANY, 12 Fla. L. Weekly Supp. 478b, 9th Judicial Circuit, Judge Jerry L. Brewer (2005).
This Court also finds as persuasive the Fourth District’s opinion in UNITED AUTOMOBILE INSURANCE COMPANY v. ROUSSEAU, 21 Fla. L. Weekly D2477a, (4th DCA 1996). Lastly, this opinion is also consistent with the holding in New Hampshire Indemnity Ins. Co. v. Rural Metro Ambulance, a/a/o William Zaniboni, 04-72-AP (Seminole Cty. Ct., November 18, 2005).
For the reasons cited above, this Court GRANTS Plaintiff’s Motion for Summary Judgment and FINDS:
1. The Declaratory Judgment is a proper vehicle for the relief requested in this case.
2. The Defendant was required to provide, pre-suit, claims information, including a copy of the PIP log and declarations page.
3. The defendant’s act of supplying the documents, at issue, after suit was filed, was a functional equivalent of confession of judgment.
4. The failure to provide, pre-suit, claims information, which was necessary to determine the whether or not benefits existed in order to file suit, entitles Plaintiff to an award of attorney fees and costs. The Court reserves jurisdiction to determination of amount of fees and costs.
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