14 Fla. L. Weekly Supp. 238a
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 — No error in entering summary judgment in favor of provider on claim for declaratory relief based on insurer’s failure to furnish PIP log where insurer furnished some documents to provider whose claim was allegedly applied to deductible but, because documents did not contain information regarding total amount of bills applied to deductible or indicate that provider’s bill was only bill received, provider was unable to determine its status as claimant with respect to whether or not deductible had been met
GEICO CASUALTY COMPANY, Appellant, vs. FLORIDA EMERGENCY PHYSICIANS KANG & ASSOCIATES, M.D., P.A., a/a/o Camille Davila, Appellee. Circuit Court, 18th Judicial Circuit (Appellate) in and for Seminole County. Case No. 06-59-AP. December 18, 2006. Appeal from the County Court for Seminole County, Honorable John R. Sloop. Counsel: Jennings L. Hurt and Karissa L. Owens, for Appellant. Kevin B. Weiss, Weiss Legal Group, P.A., Maitland, for Appellee.
[Lower court order at 13 Fla. L. Weekly Supp. 737a.]
Rehearing denied. 14 Fla. L. Weekly Supp. 239a
(NELSON, D., J.) Florida Emergency Physicians Kang & Associates (“Florida Emergency Physicians”) submitted a bill to Geico Casualty Company (“Geico”) for $279.00 for emergency medical services rendered as a result of an automobile accident that occurred on January 2, 2003. Geico forwarded an Explanation of Benefits to Florida Emergency Physicians stating that its bill was not paid because the deductible on the policy of its insured had not been satisfied.
On June 25, 2004, Florida Emergency Physicians sent its Notice of Intent to Initiate Litigation to Geico’s PIP Claims Office. Geico treated the letter as a15-day demand letter, pursuant to the statutory requirements of section 627.736(11), Florida Statutes. Enclosed with this “demand letter” was a document that requested policy information in the form of a copy of the insurance policy, a declarations page, and a “PIP payout sheet.”
Geico provided six items in response to this request: 1) correspondence explaining that Florida Emergency Physicians’ bill had been applied to the deductible; 2) a copy of the applicable insurance policy; 3) a declarations sheet; 4) numerous underwriting pages; 5) a “PIP-Med Register — Payment Record” and 6) an affidavit of coverage. It is undisputed that this information was provided within 30 days of Geico’s receipt of the demand letter.
The PIP/Med Register — Payment Record provided by Geico listed no payments made on Carmen Davila’s account because all bills received in relation to the accident were applied to the $2000.00 deductible. On August 3, 2004, Florida Emergency Physicians faxed a follow-up letter advising Geico that it still needed a PIP payout log to verify amounts applied to the deductible.
In its claim for declaratory relief, Florida Emergency Physicians alleged that Geico had failed to respond to Florida Emergency Physicians’ pre-suit request for a copy of the PIP/Med-Pay payout log as well as a copy of the policy and declarations page showing coverages in effect. Florida Emergency Physicians’ Motion for Summary Judgment on Count II was based upon the contention that Geico failed to provide a PIP log that would have shown whether Florida Emergency Physicians’ bill was correctly applied to the deductible. On April 25, 2006, the trial court entered an Order Granting Plaintiff’s Motion for Final Summary Judgment on Count II and Denying Defendant’s Motion for Summary Judgment. Geico’s Motion for Rehearing was denied. Geico appeals from these Orders.
The applicable standard of review on appeal of a trial court’s order granting or denying a summary judgment motion is de novo. Volusia County v. Aberdeen at Ormond Beach, L.P., 760 So.2d 126 (Fla. 2000). The standard of review on appeal of a denial of a motion for rehearing is whether the trial court abused its discretion. See Trammell v. Ward, 667 So.2d 223, 226 (Fla. 1st DCA 1995); Cem-A-Care of Fla. Inc. v. Automated Planning Sys., 442 So.2d 1048 (Fla. 4th DCA 1983); and Monarch Cruise Line, Inc. v. Leisure Time Tours, Inc., 456 So.2d 1278 (Fla. 3d DCA 1984).
Sections 627.736 and 627.4137, Florida Statutes, do not require an insurer to provide a copy of the declarations page or PIP log to a medical provider upon request. This Court held in New Hampshire Indemnity Insurance Co. v. Rural Metro Ambulance, a/a/o William Zaniboni, Appeal No. 04-72-AP (Cir. Ct. 18th Jud. Cir., Nov. 18, 2005) [13 Fla. L. Weekly Supp. 573a] on rehearing that this does not mean that the medical care provider is not entitled to that information. “Although a requirement to provide such information may not be expressly stated in section 627.736, Florida Statutes, this Court finds that the provision of such information is essential to [Rural Metro Ambulance’s] ability to determine its status as a claimant and makes eminently good common sense.” Id. at 4.
The trial court in this case found that Geico “failed to furnish the [Plaintiff] with a copy of the information that would otherwise be compiled in a ‘pip log,’ as the document that [Geico] chose to produce does not contain any information regarding . . . the total amount of bills applied to the deductible, and does not even reference the receipt and application of [Florida Emergency Physicians’] bill.” R. 138. The trial court further found that “[Geico] failed to furnish [Florida Emergency Physicians] with the information that would allow [Florida Emergency Physicians] to determine, ‘if any claims have been paid or denied, whether the deductible has been met, and if not, how much remains.”
While the facts which gave rise to this cause of action took place before this Court’s ruling in New Hampshire Indemnity Insurance Co. v. Rural Metro Ambulance, a/a/o William Zaniboni, Appeal No. 04-72-AP (Cir. Ct. 18th Jud. Cir., Nov. 18, 2005) [13 Fla. L. Weekly Supp. 573a] on rehearing, this case is subject to its now-established precedent. Florida Emergency Physicians was unable, without this information, to determine its status as a claimant with respect to whether or not the deductible had been met.
The evidence presented in the deposition testimony of Rebecca Schatzow indicates that Geico did not provide Florida Emergency Physicians with any information indicating that Florida Emergency Physicians’ bill was the only bill received for treatment related to this accident. R. 57, 60-62. Florida Emergency Physicians therefore had no way of determining its status as a claimant, or confirming that the deductible had indeed not been met.
As such, the trial court’s ruling is not inconsistent with the undisputed facts of the case and not contrary to the evidence presented. The trial court did not err in entering Final Summary Judgment on Count II in favor of Florida Emergency Physicians, and did not err in denying Geico’s Motion for Final Summary Judgment.
Further, the trial court’s order was not inconsistent with the record evidence. As the standard of review on a Motion for Rehearing is an abuse of discretion, this Court cannot say that the trial court’s denial of the Motion for Rehearing was an abuse of discretion.
ACCORDINGLY the Order Granting Plaintiff’s Motion for Final Summary Judgment on Count II and Denying Defendant’s Motion for Final Summary Judgment is AFFIRMED. The Order Regarding Defendant’s Motion for Rehearing on Order Granting Plaintiff’s Motion for Summary Judgment on Count II and Denying Defendant’s Motion for Final Summary Judgment is AFFIRMED.
