13 Fla. L. Weekly Supp. 344b
Insurance — Personal injury protection — Coverage — Medical expenses — Absence of reasonable proof of covered loss
MARILYN REESE, Plaintiff, v. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 16-2003-CC-016929, Division I. December 8, 2005. Pauline Drayton, Judge. Counsel: Kelly B. Hampton, The Gallagher Law Firm, Jacksonville, for Plaintiff. Christopher K. Leifer, James C. Rinaman, III & Associates, P.A., Jacksonville, for Defendant.
ORDER GRANTING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT RE: LACK OF REASONABLEPROOF OF A COVERED LOSS
THIS CAUSE, having come before the court on Defendant’s Motion for Summary Judgment, and it appearing that good and sufficient grounds were shown for Granting the Motion, and otherwise being fully advised in the premises, it is hereby:
ORDERED AND ADJUDGED that the Court makes the following findings:
1. On or about July 23, 1999 and August 28, 1999, Plaintiff was involved in motor vehicle accidents. Plaintiff has filed the case sub judice to recover medical bills for treatment rendered to her by Jaguar Chiropractic.
2. Plaintiff sustained injuries in the July 23, 1999 accident and received treatment from Timothy DeWitt, D.C., of Jaguar Chiropractic.
3. Jaguar Chiropractic submitted medical bills (“HCFA’s”) to Defendant for treatment rendered to Plaintiff for date of loss July 23, 1999, as indicated in Box 14 of said HCFA’s.
4. None of the HCFA’s submitted by Jaguar Chiropractic indicated the date of loss as August 28, 1999.
5. FLA. STAT. § 627.736(4) states, in pertinent part, that benefits “shall be due and payable as loss accrues, upon receipt of reasonable proof of such loss and the amount of expenses and loss incurred.”
6. Defendant never received a HCFA, from Jaguar Chiropractic, indicating a loss attributable to the August 28, 1999 motor vehicle accident; therefore, Defendant has not received “reasonable proof of such loss.” Because Defendant received no reasonable proof of a covered loss, there can be no medical bills, related to the August 28, 1999 motor vehicle accident, that are “due and payable” under FLA. STAT. § 627.736(4).
7. Even if Jaguar Chiropractic were now to submit medical bills and provide Defendant with reasonable proof of a covered loss, with respect to treatment rendered to Plaintiff as a result of the August 1999 accident, those medical bills would not comply with FLA. STAT. § 627.736(5); requiring submission of all charges for medical treatment to be postmarked not greater than 75 days after treatment was rendered; therefore, Defendant would not be required to pay for said charges.
8. Further, because the medical bills referred to in paragraph 7 would not be in compliance with FLA. STAT. § 627.736(5), Plaintiff would not be liable for the charges that were unpaid because of the provider’s failure to comply with FLA. STAT. § 627.736(5). See, State Farm Mut. Auto Ins. v. Warren, 805 So. 2d 1074 (Fla. 5th Dist. Ct. App. 2005), White v. Progressive Consumers Ins. Co., 12 Fla. L. Weekly Supp. 671a (Fla. Polk County Ct. 2004), and Leconte v. United Services Automobile Servs., 11 Fla. L. Weekly Supp. 791d (Fla. Palm Beach County Ct. 2004).
9. There remain no genuine issues as to any triable facts. The medical bills at issue in this did not provide Defendant with reasonable proof of a covered loss with respect to Plaintiff’s August 28, 1999 motor vehicle accident; therefore, neither Defendant nor Plaintiff can be required to pay for said medical bills.
IT IS THEREFORE ORDERED AND ADJUDGED that Plaintiff, MARILYN REESE, take nothing by this action and Defendant, PROGRESSIVE EXPRESS INSURANCE COMPANY, shall go hence without day and the Court retains jurisdiction for the purpose of determining any motion by Defendant to tax attorney’s fees and costs.
