14 Fla. L. Weekly Supp. 84a
Insurance — Personal injury protection — Coverage — Summary judgment is entered in favor of insurer where insured denied that he was involved in accident on alleged date of loss or that he was treated by medical provider — Examination under oath attached to motion for summary judgment was sufficient to support motion without necessity of affidavit from insured
MILLENNIUM DIAGNOSTIC IMAGING CENTER a/a/o ALEJANDRO GONZALEZ, Plaintiff, vs. ALLSTATE PROPERTY & CASUALTY INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 05-1236 SP 24 1. October 12, 2006. Darrin P. Gayles, Judge. Counsel: Scott E. Danner, Law Offices of Kirwan & Spellacy, P.A., Fort Lauderdale. Lewis Mertz.
ORDER ON DEFENDANT’S MOTION FOR SUMMARY JUDGMENT WITH INCORPORATED MEMORANDUM OF LAW
THIS CAUSE having come on to be heard on Defendant’s Motion for Summary Judgment and the Court having considered the Motion and being otherwise duly advised in the premises, finds as follows:FACTS
The Plaintiff in this matter, MILLENNIUM DIAGNOSTIC IMAGING CENTER (as assignee of Alejandro Gonzalez) is a healthcare provider, who allegedly rendered treatment to Alejandro Gonzalez for injuries allegedly sustained in a motor vehicle accident, which purportedly occurred on or about July 18, 2001.
On or about June 22, 2005 the Defendant, ALLSTATE, was served with a copy of the summons and complaint. The Plaintiff, MILLENNIUM DIAGNOSTIC, was seeking payment of outstanding medical bills for services allegedly rendered on October 19, 2001. ALLSTATE received and declined to make payment to MILLENNIUM DIAGNOSTIC until the claim had been thoroughly investigated. Mr. Gonzalez had reportedly been treated at Abdon Medical Services, Sun State Diagnostics and Med Services Group, Inc. Mario LaPlume M.D. of Med Services Group, Inc. purportedly sent Mr. Gonzalez to the Plaintiff, Millennium Diagnostic for an MRI of the Cervical Spine. Allstate was billed $2060.00 for that service.
Allstate learned that Abdon Medical Services, Sun State Diagnostics, Med Services Group, Inc. and Mario LaPlume were no longer operating in the State of Florida.
Moreover, when Allstate contacted Alejandro Gonzalez, he indicated that he was not involved in the accident. Mr. Gonzalez attended an Examination Under Oath and provided sworn testimony to counsel for Allstate on February 20, 2006. The transcript was attached to the motion as an exhibit.
During the Examination Under Oath, Mr. Gonzalez denied being in an automobile accident on July 18, 2001, denied treating with the Plaintiff and asserted that he had only been in one accident in his life and the accident caused him to be airlifted and admitted to the hospital for four days. Mr. Gonzalez denied signing the HCFAs or any SOAP notes from any provider related to an accident on July 18, 2001. Moreover, he alleged that the signatures on the HCFAs and medical records were forgeries. Mr. Gonzalez stated that he did not know any of the parties to the accident, was not listed on the police report and provided his driver’s license which had a signature distinctly different from the signature on the medical records.
LEGAL ANALYSIS
Defendant moved for Final Summary Judgment attaching the Examination Under Oath as one of its exhibits and argued that a provider may not recover Personal Injury Protection Benefits when no treatment has been rendered. This is the clear and logical result of a plain and straightforward reading of the Florida “No-Fault” Statute. The express language of § 627.736 of the Florida Statutes establishes that the protection provided applies only to the:
[N]amed insured, relatives residing in the same household, persons operating the insured motor vehicle, passengers in such motor vehicle, and other persons struck by such motor vehicle and suffering bodily injury while not an occupant of a self-propelled vehicle.” Fla. Stat. § 627.736(1).
It is clear that Mr. Alejandro Gonzalez, based upon his testimony, did not fall into the category of covered persons as specified by § 627.736 of the Florida Statutes because be was not in an accident on the date of loss nor did he treat with the Plaintiff provider. Furthermore, it is a well established principle that a provider should only be paid by the insurer for services it provided to the insured or other person covered by Fla. Stat. § 627.736.
Plaintiff argued that Defendant had failed to attach an affidavit from the insured declaring the facts laid out in the sworn statement and having the insured swear to same. Defendant argued that the examination under oath was a sworn statement provided before a court reporter while the insured was under oath. The court agreed as a matter of law.
In light of the above stated facts, it is therefore a proper contention that since the Plaintiff provider did not provide services to the Defendant’s covered person or other person covered by Fla. Stat. § 627.736(1) that the Defendant is not responsible for the charges billed by the Plaintiff.
CONCLUSION
This action was brought based on breach of contract. There can be no breach of contract when the insured or another covered person did not receive treatment from the Plaintiff provider and the Defendant’s subsequent refusal to pay for an unidentified third party. Therefore, the Defendant, ALLSTATE, is under no duty to pay medical bills for services that were not rendered to their insured or other person covered by the subject policy of insurance.
The Defendant, ALLSTATE, is entitled to Final Summary Judgment as a matter of law because there are no genuine issues of material fact.JUDGMENT
IT IS HEREBY ADJUDGED that Defendant’s Motion for Summary Judgment be and same is GRANTED. Plaintiff MILLENNIUM DIAGNOSTIC IMAGING CENTER (as assignee of Alejandro Gonzalez) shall take nothing by this action and Defendant, ALLSTATE PROPERTY AND CASUALTY COMPANY, shall go hence without day and the Court will retain jurisdiction for the purposes of determining any motion by Defendant to tax fees and costs.
