14 Fla. L. Weekly Supp. 179a
Insurance — Personal injury protection — PIP log — Explanation of benefits — Cross motions for summary judgment in action alleging that insurer breached contract by failing to provide insured with PIP log and itemized specification of each item reduced or denied — Where it is undisputed that insurer did not reduce or deny any medical bills submitted, insurer did not violate PIP statute by failing to provide itemized specification of items reduced or denied — Where insurer did not attempt to invoke section 627.736(6), whereby insurer can petition court to seek discovery measures and insured has right to request copies of any discovery so obtained, insured cannot rely on statute to assert right to PIP log — Summary judgment granted in favor of insurer
KAREN AJOY, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court,15th Judicial Circuit in and for Palm Beach County. Case No. 502005SC011668XXXXMB, Division RL. November 16, 2006. Janis Brustares Keyser, Judge. Counsel: Joseph G. Murasko, Vernis & Bowling of Palm Beach, P.A., North Palm Beach. Gary Russo, West Palm Beach.
ORDER ON PLAINTIFF’S AND DEFENDANT’S CROSS MOTIONS FOR SUMMARY JUDGMENT
THIS CAUSE having come before the Court for review upon Plaintiff and Defendant’s Cross Motion for Summary Judgment and the Court having heard argument of counsel on Monday, September 25, 2006, and being otherwise fully advised in the premises, hereby finds as follows:
The Plaintiff sued the Defendant for alleged breach of contract for failure to provide a personal injury protection payout summary upon demand. The operative amended complaint included an exhibit which was a letter dated March 14, 2005 from the Plaintiff’s attorney to the Defendant demanding the “PIP payout log” and “an itemized specification of each item that the insurer had reduced, omitted or declined to pay.” The exhibit to the amended complaint alleged a right to the PIP payout summary pursuant to Florida Statute Sections 627.736(4)(b) and 627.736(6)(d).
According to the deposition testimony of Defendant’s claim representative Joffer Faria, it is undisputed that the Defendant did not provide the payout log. According to the same testimony, it is undisputed that the insurer had not reduced bills, nor omitted bills nor declined to pay bills.
Section 627.736(4)(b), Florida Statutes provides in pertinent part “[w]hen an insurer pays only a portion of a claim or rejects a claim, the insurer shall provide at the time of partial payment or rejection, an itemized specification of each item that the insurer had reduced, omitted, or declined to pay.”
The undisputed facts indicate that there was no such reduction nor denial of medical bills submitted. See the deposition testimony of Joffer Faria page 29, lines 14 through 19. Accordingly, there is no record evidence that Florida Statute Section 627.736(4)(b) comes into play in this situation because this particular provision requires an itemized specification only in the event of a bill reduction, omission or failure to pay.
Florida Statute Section 627.736(6) is a statutory scheme whereby the insurer can petition a Court in order to seek discovery measures. Once that provision is invoked, the insured has a right to request copies of any discovery so obtained. There is no record evidence that the carrier attempted to invoke this statutory provision and therefore this statutory provision is not applicable to the facts of this case. Accordingly, it is;
ORDERED AND ADJUDGED that the Plaintiff’s Motion for Summary Judgment is hereby denied and the Defendant’s Cross Motion for Summary Judgment is granted.
