14 Fla. L. Weekly Supp. 299a
Insurance — Personal injury protection — Coverage — Medical expenses — Failure to pay or investigate within 30 days — Tolling of period — Where insurer timely requested that medical provider submit invoice from supplier of electrical stimulation pads to determine proper payment, and provider did not submit invoice prior to filing suit, request for invoice tolled time for payment of charge for pads, and charge was not overdue at time provider filed suit
PHYSIATRIC PAIN & MEDICAL REHABILITATION CLINIC, as assignee of KUNTA K. BRASWELL, Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 05-CC-2060. January 29, 2007. Antoinette D. Plogstedt, Judge. Counsel: George Milev, Adams & Diaco, P.A., Tampa. Kim Driggers.
ORDER GRANTING DEFENDANT’S MOTION FOR PARTIAL SUMMARY JUDGMENT
THIS CAUSE having come before the Court on Defendant’s Motion for Partial Summary Judgment regarding CPT Code 99070, date of service 11/18/03, and Defendant’s Motion to Deem Matters Admitted on January 22, 2007, the Court having heard arguments by counsels for Plaintiff and Defendant, upon stipulation by Plaintiff and otherwise being fully advised in the premises, hereby
FINDS, ORDERS AND ADJUDGES as follows:
1. Plaintiff filed the above styled PIP lawsuit against Defendant alleging breach of automobile insurance contract.
2. Plaintiff claimed in its Complaint that Defendant has failed to reimburse Plaintiff amongst other things for electrical stimulation pads, CPT code 99070, provided to Kunta Braswell for date of service November 18, 2003.
3. Plaintiff is a medical provider which filed the above styled lawsuit as an assignee of Kunta Braswell who was involved in an auto accident on or about October 1, 2003.
4. Defendant received the HCFA/bill from Plaintiff containing the charge for said electrical stimulation pads on January 12, 2004.
5. Upon receipt of that bill, Defendant generated an Explanation of Benefits (EOB) in which Defendant requested that Plaintiff “please submit an invoice from the supplier to determine proper payment for medical appliances/equipment” (the electrical stimulation pads).
6. Defendant made timely request for documentation pursuant to §627.736(6)(b), Fla. Stat. (2003), thus tolling the time for payment of the electrical stimulation pads charge.
7. The claim for the electrical stimulation pads charge was not overdue at the time the current lawsuit was filed as Plaintiff did not respond to Defendant’s request prior to filing of lawsuit.
WHEREFORE, Defendant’s Motion for Partial Summary Judgment regarding CPT Code 99070, date of service 11/18/03, is hereby GRANTED and Defendant’s Motion to Deem Matters Admitted is hereby DENIED.
