13 Fla. L. Weekly Supp. 745a
Insurance — Personal injury protection — Declaratory judgment — Insurer’s obligation to produce 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 policy, PIP log and declarations page on presuit request since claims and coverage information is essential to provider’s ability to determine status as PIP claimant
THE STAND-UP MRI OF ORLANDO, P.A., as assignee of Francela Henry, Plaintiff, vs. OMNI INSURANCE COMPANY, Defendant. County Court, 18th Judicial Circuit in and for Seminole County. Case No. 04-SC-815. May 3, 2006. John R. Sloop, Judge. Counsel: Michael Tierney, Micheal Tierney, P.A., Winter Park. Penny Creech, Hengber, Goldstein & Ray, Orlando.
ORDER GRANTING PLAINTIFF’S MOTION FOR FINAL SUMMARY JUDGMENT ASTO 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, hereby notes the following:
UNDISPUTED FACTS
The insured received care and treatment from the Plaintiff. During the scope of said treatment, the insured executed an assignment of benefits to the Plaintiff. The Plaintiff subsequently submitted a bill for care and treatment of the insured to the Defendant, along with a copy of the assignment of benefits. This bill was not paid due to benefits being exhausted. In response to their bills being unpaid, on January 11, 2004, the Plaintiff sent a written request, with the assignment of benefits, to the defendant requesting a copy of the insured’s declaration sheet as part of their pre-suit investigation to confirm if benefits were properly exhausted. The Plaintiff waited 50 days to receive the dec sheet. However, after not receiving the dec sheet, on March 2, 2004, the Plaintiff filed suit.
The Plaintiff filed suit because they were left in doubt as to whether benefits remained, whether there was a deductible applicable and/or whether the policy paid at 80% or 100%, and whether there was any med-pay available under the policy. However, on March 22, 2004, the defendant provided the dec sheet to the Plaintiff, 20 days AFTER suit was filed.
Now the Plaintiff seeks Final Summary Judgment and a Declaratory Judgment on the following:
1. the Defendant insurer was required to provide pre-suit, a copy of the insurance policy, declarations page;
2. failure to provide the requested information is a proper question for Declaratory Judgment; and
3. the provision of the subject information after suit was filed constitutes a function equivalent of a confession of judgment, entitling Plaintiff to an award of attorney fees and costs.
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, and not merely be left blindly believing in the defendant’s assertion that benefits were exhausted. 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; and whether benefits have truly been exhausted. The Plaintiff has a right to a copy of the insurance policy and the declarations page. Even though this requirement may not be explicit in F.S. 627.736, this Court finds that providing claims and coverage information is essential to a health care provider’s ability to verify their status as a PIP claimant. 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, and putting the Plaintiff is a position of facing sanctions under 57.105.
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 his insurance policy 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).
This Court finds persuasive the county court cases across the state beginning with 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 information including a copy of the insurance policy and declarations page and PIP log.
3. The failure to provide pre-suit information necessary to determine the merits of the denial of claim 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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