13 Fla. L. Weekly Supp. 732c
Insurance — Personal injury protection — Explanation of benefits — Medical provider is entitled to maintain cause of action for breach of contract and declaratory relief based on insurer’s failure to provide explanation of benefits upon presuit request by provider — Motion to dismiss denied
R. J. TRAPANA, M.D., P.A., a Florida Corporation (assignee of Reynoso, Franklyn), Plaintiff, v. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 05-10502 COSO 60. May, 8, 2006. Sharon Zeller, Judge. Counsel: Russ Lazega, Law Office of Russel M. Lazega, P.A., North Miami. Jon Sorenson.ORDER
This cause came upon Defendant’s Motion to Dismiss Count I and II of Plaintiff’s Complaint (Breach of Contract regarding Explanation of Benefits and Declaratory Relief regarding Explanation of Benefits). The Court having consider the matter, having heard argument and being otherwise advised, finds as follows:
Factual Background
This is a P.I.P. case. Count I of Plaintiff’s Complaint alleges that Plaintiff requested from Defendant an itemized specification of Plaintiff’s unpaid charges and the reasons for nonpayment (commonly known as an Explanation of Benefits or EOB). Plaintiff contends that despite pre-suit request, Defendant refused to furnish Plaintiff with an EOB. Defendant asserts that it is not legally obligated to do so and that this Count of the Complaint should be dismissed accordingly. Plaintiff also raises an alternative Count for declaratory relief along these same lines asserting that Defendant, through its position, has created an issue of law to be resolved by this Court regarding Plaintiff’s legal right to this information pursuant F.S. 627.736(4)(b) and the insurance policy. The Court now considers the arguments raised by Defendant in its Motion to Dismiss these two (2) Counts.
Conclusions of Law
Plaintiff’s entitlement to maintain this cause of action under both theories set forth by Plaintiff (Breach of Contract and Declaratory Relief) have been established by binding appellate authority in this circuit. See R.J. Trapana, M.D., P.A. (a/a/o Dudley Mabout) v. United Auto Ins. Co. (Broward County Circuit Appellate Case # 03-22360 — Decision of the Honorable Richard Eade 2005) [12 Fla. L. Weekly Supp. 452a]; see also R.J. Trapana, M.D., P.A. (a/a/o Marcia Hoglo) v. United Auto. Ins. Co. (Broward County Circuit Appellate Case — Decision of the Honorable Richard Eade 2005). The Court is aware of at least twenty (20) County decisions following this reasoning and NONE to the contrary. Interestingly, Defendant did not raise to the Court the existence of these two (2) binding appellate decisions. Accordingly, Defendant’s Motion to Dismiss Counts I and II of Plaintiff’s Complaint are DENIED. Defendant shall answer these Counts within twenty (20) days. The Court reserves jurisdiction to determine Plaintiff’s Motion for Sanctions pursuant to F.S. 57.105.
