14 Fla. L. Weekly Supp. 689b
Insurance — Personal injury protection — Disclosure and acknowledgment form — Where disclosure and acknowledgment form did not set forth services actually rendered, insurer was not provided with notice of loss, and neither insurer nor insured is responsible for payment of bills — Submission of medical bills and records contemporaneously with disclosure and acknowledgment form does not constitute substantial compliance with statutory requirement to disclose services rendered on form — No merit to arguments that non-compliant form only impacts initial date of service and that insurer should be estopped from defending on basis of non-compliant form
NORTH FLORIDA MEDICAL CLINIC, INC., (as assignee of Margaret Pryor), Plaintiff, v. PROGRESSIVE SELECT INSURANCE COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 16-2006-SC-8650, Division E. May 1, 2007. John A. Moran, Judge. Counsel: Vincent P. Gallagher, Gallagher Law Firm, for Plaintiff. Lindsay A. Cole, Rinaman & Associates, Jacksonville, for Defendant.
AMENDED ORDER GRANTING DEFENDANT’S MOTION FOR SUMMARY DISPOSITION
THIS CAUSE, came before the Court on April 10, 2007, for hearing of the Defendant’s Motion for Summary Disposition Re: Improper Completion of Disclosure and Acknowledgment Form. Present before the Court appeared counsel for Plaintiff, Vincent P. Gallagher, Esquire, and counsel for Defendant, Lindsay A. Cole, Esquire. Having heard arguments of counsel, reviewed the pleadings, motions and evidence before the Court and being otherwise fully advised in the premises, the Court finds as follows:
1. On or about October 13, 2006, the Plaintiff, North Florida Medical Clinic, Inc., filed suit alleging non-payment of No-Fault/Personal Injury Protection (“PIP”) benefits for medical services rendered to Margaret Pryor, related to injuries sustained in a motor vehicle accident that occurred on January 27, 2006. Specifically at issue in this matter are reductions for the services provided on June 9, 2006 and September 1, 2006.
2. The Plaintiff provided medical services to Margaret Pryor beginning on February 3, 2006, in exchange for an assignment of benefits under the policy of insurance issued by Defendant. On February 27, 2006, the Defendant received billing documentation from the Plaintiff related to the service provided on February 3, 2006. Included, was the standardized disclosure and acknowledgment form approved by the Financial Services Commission executed by the Plaintiff and Margaret Pryor, dated February 3, 2006. The form submitted by the Plaintiff omitted the “services . . . actually rendered” by leaving blank the space provided to delineate these services on paragraph 1 of the form. Both the statute and the form itself provide that the services rendered must be divulged in the space provided.
3. Pursuant to Florida Statute § 627.736(5)(e), Plaintiff is required to submit an original and properly completed disclosure and acknowledgment to an insurance company as part of the provider’s notice of the fact of a covered loss. Because the disclosure and acknowledgment form failed to set forth the services “actually rendered,” Plaintiff failed to provide notice of the fact of a covered loss.
4. Florida Statute § 627.736(4)(b) states, in pertinent part: “Personal injury protection insurance benefits paid pursuant to this section shall be overdue if not paid within 30 days after the insurer is furnished written notice of the fact of a covered loss.”
5. Florida Statute § 627.736(5)(e)(1) requires,
“At the initial treatment or service provided, each physician . . . providing medical services upon which a claim for personal injury protection benefits is based shall require an insured person . . . to execute a disclosure and acknowledgment form . . .”
Florida Statute § 627.736(5)(e)(1)(a) states,
“The insured . . . must countersign the from attesting to the fact that the services set forth therein were actually rendered.”
Florida Statute § 627.736(5)(e)(l)(d) states,
That the physician . . . rendering services for which payment is being claimed explained the services to the insured . . .”
Florida Statute § 627.736(5)(e)(5) states,
“The original completed disclosure and acknowledgment form shall be furnished to the insurer pursuant to paragraph (4)(b) . . .”
6. Florida Statute § 627.736(4)(b), states in pertinent part that an insurer can assert that a claim is in violation of Florida Statute § 627.736(5), at any time. The Defendant asserted its statutory right to assert that the claim was in violation of Florida Statute § 627.736(5).
7. In addition, the Florida Supreme Court stated in United Auto. Ins. Co. v. Rodriguez, 808 So.2d 82 (Fla. 2001), that “Legislative intent, as always, is the polestar that guides a court’s inquiry under the Florida No Fault Law (“the Law”). Where the wording of the Law is clear and amenable to a logical and reasonable interpretation, a court is without power to diverge from the intent of the Legislature as expressed in the plain language of the Law.”
8. Plaintiff argues that it has substantially complied with the requirements of Florida Statute § 627.736(5)(e) by submitting bills and medical records contemporaneously with the disclosure and acknowledgment form that specify the services that were “actually rendered.” This Court recognizes the application of a substantial compliance standard under certain circumstances; however, even if applying a substantial compliance standard in this case, the form supplied by the Plaintiff with the services “actually rendered” blank or omitted, does not meet the minimal standards set forth in the Statute. This Court recognizes that the purpose of the form is to prevent insurance fraud and as such, one of the main purposes of the form is to identify and divulge the services “actually rendered” to the claimant, to the insurance company. Consequently, the omission of the “services . . . actually rendered” description goes to the heart and purpose of the form and; therefore, there has been no substantial compliance with Florida Statute § 627.736(5)(e). Ft. Lauderdale Pain Center, Inc. v. Allstate Ins. Co., 13 Fla. L. Weekly Supp. 1006a (11th Judicial Cir., Miami-Dade Cty., July 17, 2006).
9. Further, the Plaintiff cites the Court to Florida Statute § 627.736(5)(e)(9), in an attempt to argue that the failure to provide the original and properly completed disclosure and acknowledgment form would only affect payment of the initial date of service and not the entire claim. The Court is not persuaded. Florida Statute § 627.736(5)(e)(9), specifically provides that the requirement to complete the form only applies to the initial treatment or service provided to the insured. Where the disclosure and acknowledgment form is not properly completed when submitted, no subsequent dates of service are payable.
10. The Court finds that there is no prejudice to the insured, because where the medical provider has not complied with the legal requirements to submit the bill, neither the insurer, nor the insured are responsible for payment. Florida Statute § 627.736(5)(b)(1)(b).
11. This Court finds that there remain no genuine issues as to any material fact, the evidence is clear that Plaintiff submitted a non-compliant disclosure and acknowledgment form in violation of Florida Statute § 627.736(5). The Defendant was not provided with written notice of the fact of a covered loss pursuant to Florida Statute § 627.736(4)(b). The Defendant is entitled to an order granting its motion for summary disposition as a matter of law.
IT IS THEREFORE ORDERED AND ADJUDGED that Plaintiff, NORTH FLORIDA MEDICAL CLINIC, take nothing by this action and Defendant PROGRESSIVE SELECT INSURANCE COMPANY, shall go hence without day and the Court retains jurisdiction for the purpose of determining any motion by Defendant to tax attorney’s fees and costs.
