15 Fla. L. Weekly Supp. 749a
Insurance — Personal injury protection — Coverage — Denial — Failure to maintain patient logs does not permit insurer to deny responsibility to pay claims for lawfully rendered treatment
DR. CLIFTON OKMAN, D.C., P.A., a/a/o Patrick Rowe, Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 06-13042 COCE (50). April 2, 2008. Peter B. Skolnick, Judge. Counsel: Steven N. Ainbinder, Law Offices of Steven N. Ainbinder, P.A., Boca Raton, for Plaintiff. Heather A. Burns, Houck Anderson, P.A., Ft. Lauderdale.
AFFIRMED at 16 Fla. L. Weekly Supp. 1028c
ORDER DENYING DEFENDANT’S MOTION FOR FINAL SUMMARY JUDGMENT AS TO PLAINTIFF’S FAILURE TO MAINTAIN PATIENT LOGS
The above captioned case came on to be heard by the Court, pursuant to the Motion of the Defendant, UNITED AUTOMOBILE INSURANCE COMPANY, for Final Summary Judgment, against the Plaintiff, DR. CLIFTON OKMAN, D.C. P.A., for Plaintiff’s failure to maintain patient logs, pursuant to Section 627.736(5)(e)(9). The Court, having heard argument by counsel for the respective parties involved herein, having considered the statutory and case law, the various memoranda of law submitted by the parties, and having examined the record evidence, finds that the Plaintiff’s failure to maintain patient logs, as required, pursuant to Section 627.736(5)(e)(9), is not a legal basis for the Defendant to deny payment of the medical bills submitted by the Plaintiff in the instant case.
The Court finds that:
1. This lawsuit stems from the nonpayment of Personal Injury Protection (P.I.P.), medical benefits. As a result of a November 10, 2003 motor vehicle collision, Patrick Rowe sought medical treatment from the Plaintiff, from November 15, 2003 through May 19, 2003. The Plaintiff, DR. CLIFTON OKMAN, D.C., P.A., obtained an assignment of benefits from his patient, Patrick Rowe, who is an insured under an automobile insurance policy with the Defendant, UNITED AUTOMOBILE INSURANCE COMPANY.
2. On February 5, 2008, the Defendant took the deposition of DR. CLIFTON OKMAN, who was the treating physician, billing clerk and records custodian.
3. DR. OKMAN testified that he failed to maintain a patient log for his patient, Patrick Rowe, as required, pursuant to Section 627.736(5)(e)(9), Florida Statutes.
4. Based upon DR. OKMAN’s testimony, it was the position of the Defendant that it possessed a legal basis to deny payment of the medical bills submitted by DR. OKMAN.
5. Section 627.736(4)(b), Florida Statutes (2003), states that, “[p]ersonal 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 and of the amount of same.
6. Section 627.736(4)(b), Florida Statutes (2003) also states that, “[t]his paragraph does not preclude or limit the ability of the insurer to assert that the claim was unrelated, was not medically necessary, or was unreasonable or that the amount of the charge was in excess of that permitted under, or in violation of, subsection (5). Such assertion may be made at any time, including after payment of the claim or after the 30-day time period set forth in this paragraph.
7. Section 627.736(5)(e)(1) states in pertinent part that, 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.
8. The legislature further required in Section 627.736(5)(e)(5) that the “original completed disclosure and acknowledgment form shall be furnished to the insurer pursuant to paragraph (4)(b) and may not be electronically furnished. Therefore, the Court finds that the legislature required that the “original completed disclosure and acknowledgment form shall be furnished to the insurer. . . ,” in order to place the insurer on notice of a covered claim.
9. Section 627.736(5)(e)(9) states that the requirements of this paragraph apply only with respect to the initial treatment or service of the insured by a provider.
10. Section 627.736(5)(c)(9) further states that, “[f]or subsequent treatments or service, the provider must maintain a patient log signed by the patient, in chronological order by date of service, that is consistent with the services being rendered to the patient as claimed.” However, the Court finds that this subsection does not require the submission of patient logs to place the insurance carrier on notice of a covered claim.
11. The language of Section 627.736, Florida Statutes must be liberally construed in order to effect the legislative purpose of providing broad PIP coverage for Florida Motorists. See, Blish v. Atlanta Casualty Company, 736 So.2d 1151 (Fla. 1999).
12. When the language of the statute is clear and unambiguous, and conveys a clear and unambiguous meaning, there is no occasion for resorting to the rules of statutory construction; the statute must be given its plain and obvious meaning.” See, State Farm Mutual Automobile Insurance Company v. Nichols, 932 So.2d 1067 (Fla. 2006).
13. The court finds that had the legislature desired to have a notice or penalty provision in connection with the maintenance of patient logs, as it has done with the disclosure and acknowledgment form, it would have included language setting forth that requirement in Section 627.736(5)(e)(9).
14. Also, the Legislature did not require the provider to submit patient logs to the insurer as part of the claims process. See, Total Care Chiropractic VII, Inc. v. United Automobile Insurance Company, 15 Fla. L. Weekly Supp 190, (17th Judicial Circuit December 17, 2007).
15. Lastly, the Court finds that compliance with Section 627.736(5)(e)(9) is but one way for the medical provider to prove, if accused of insurance fraud, that the medical treatment was lawfully rendered. However, the failure to maintain patient logs does not permit the Defendant to deny its responsibility to pay lawfully rendered claims.
The Court being otherwise fully advised in the premises, it is therefore,
ORDERED AND ADJUDGED that:
1. Based upon the arguments set forth in Defendant’s Motion for Final Summary Judgment and Plaintiff’s Memorandum of Law in Opposition to same, the Motion of the Defendant, UNITED AUTOMOBILE INSURANCE COMPANY, for Final Summary Judgment, against the Plaintiff, DR. CLIFTON OKMAN, D.C. P.A., for Plaintiff’s failure to maintain patient logs, pursuant to Section 627.736(5)(e)(9), is hereby DENIED.
2. All other affirmative defenses being asserted by the Defendant, UNITED AUTOMOBILE INSURANCE COMPANY, are not affected by the entry of this Order.
