13 Fla. L. Weekly Supp. 1019b
Insurance — Personal injury protection — Explanation of benefits — Medical provider/assignee was entitled to EOB even where EOB had been furnished to insured and insurer had informed insured that it would not honor further bills for treatment rendered by provider in light of independent medical examination findings
R.J. TRAPANA, M.D., P.A., (a/a/o Elizabeth Alba), Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 06-02845 COSO 62. August 9, 2006. Julio E. Gonzalez, Jr., Judge. Counsel: Russel Lazega, Law Office of Russel Lazega, North Miami, for Plaintiff. Jared Dichek, for Defendant.
ORDER ON PLAINTIFF’S MOTION FOR PARTIAL SUMMARY JUDGMENTAS TO COUNT I OF PLAINTIFF’S COMPLAINT
This action came before the Court on Plaintiff’s Motion for Summary Judgment as to Count I of Plaintiff’s Complaint, and the Court having heard argument of counsel, and being otherwise advised in the premises, it is hereupon ordered and adjudged as follows:
Factual Findings
1. This is a P.I.P. Suit.
2. Count I of Plaintiff’s Suit alleges that Defendant failed to furnish Plaintiff with an itemized specification of unpaid charges (EOB) pursuant to F.S. s. 627.736(4)(b).
3. In support of the motion Plaintiff furnished discovery responses showing that Defendant furnished correspondence to the patient and other parties who were not the Plaintiff/assignee.
4. Defendant contends that it is not required to furnish the Plaintiff with an itemized specification/explanation of benefits in compliance with FS § 627.736(4)(b) due to the fact that it provided a letter to the insured informing him of United’s decision not to honor further bills for treatment rendered by an MD in light of the independent medical examination findings.
6. Defendant did not provide an itemized specification/explanation of benefits to the Plaintiff in response to the Demand Letter or make any response at all.
Conclusions of Law
This Court finds no merit in the Defendant’s argument that it is relieved of a continuing obligation to provide an itemized specification/explanation of benefits where an independent medical examination was performed and the report was furnished to the insured along with a letter informing the insured after which date they intended to refuse to honor bills from a similarly licensed doctor. Quite simply, an assignee medical provider is entitled to an itemized specification/explanation of benefits as to that provider’s services, even if one has been furnished to the insured, as the provider, by virtue of its assignment, has a stake in the claim and the same right as to the insured to the information.
This Court finds guidance in Judge Richard Eade’s decision in United Automobile Insurance Company vs. R.J. Trapana, M.D., P.A. (a/a/o Dudley Mabout), Circuit Court, 17th Judicial Circuit (Appellate) in and for Broward County, Case No. 03-222360 CACE 05 (February 14, 2005) reported at 12 Fla. L. Weekly Supp. 452a, where, as in this case, the Plaintiff brought an action for breach of contract where the insurer failed to provide an itemized specification pursuant to FS §627.736(4)(b) in response to a pre-suit demand for same. Judge Eade ruled “United Automobile’s failure to provide the required specification resulted in a breach of its obligation, entitling Trapana to attorney’s fees and costs.”
Accordingly, Partial Summary Judgment is entered for the Plaintiff, and Plaintiff is entitled to fees and costs pursuant to FS §627.428 to be determined at a later date.
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