15 Fla. L. Weekly Supp. 633a
Insurance — Personal injury protection — Declaratory judgment — Recoding CPT codes — Complaint states cause of action for declaratory relief for improper recoding of charges — Court ruling on motion to dismiss will not go outside four corners of complaint to consider explanation of benefits offered by insurer to show that it did not change CPT codes
FIDEL S. GOLDSON, D.C., P.A., Florida Corporation (assignee of Malaugh-Washington, Maureen), Plaintiff, v. PROGRESSIVE AMERICAN INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 07-18134 COCE 54. April 9, 2008. Lisa Trachman, Judge. Counsel: Jonathan J. Warrick, The Law Office of Russel Lazega, P.A., Miami, for Plaintiff. Erich Von Unrich, for Defendant.
ORDER DENYING DEFENDANT’S MOTION TO DISMISS COUNT I (DECLARATORY RELIEF RE:DEFENDANT’S RECODING OF CPT CODE 97014)
THIS CAUSE, came before the court for hearing on April 4, 2008, and the court, having reviewed the Motion, the court file, legal authorities and having heard argument of counsel, finds as follows:
Factual Background:This is a multi-count P.I.P. case. Count I claims declaratory relief (regarding whether Defendant may recode CPT Code 97014 to G0283). Defendant argued that there was no ambiguity in F.S. s. 627.736(5)(b)(1)(e) and offered an explanation of benefits (“EOB”) to the Court to evidence that Defendant did not change CPT code 97014 to G0283. Plaintiff replied that the six elements required to be plead in an action for declaratory relief are clearly plead in Plaintiff’s complaint and that for the purposes of a motion to dismiss, all well-plead allegations are taken as true. Plaintiff further replied that any discussion of documents that are not incorporated into Plaintiff’s complaint, e.g., an EOB, are outside the four-corners of the complaint and are an improper subject for a motion to dismiss.
Conclusions of Law:Plaintiff may state a cause of action for declaratory relief for improper re-coding of charges. Actions for declaratory relief are to be liberally allowed. See Higgins v. State Farm Fire & Cas. Co., 894 So. 2d 5 (Fla. 2004). Based on the four-corners of the complaint, Plaintiff has stated a viable cause of action for declaratory relief. Barbado v. Green & Murphy, P.A., 758 So. 2d 1173 (Fla. 4th DCA 2000) (holding “[a] motion to dismiss tests the legal sufficiency of the complaint” and “[a] court may not go beyond the four corners of the complaint in considering the legal sufficiency of the allegations).
Accordingly, it is hereby,
ORDERED AND ADJUDGED that Defendant’s Motion to Dismiss is DENIED. Defendant shall respond to the complaint within 20 days.
