15 Fla. L. Weekly Supp. 472a
Insurance — Personal injury protection — Claims — Timeliness — Medical provider that submitted bills to insurer more than 35 days after dates of service forfeited any claim for payment from PIP carrier or insured — Even if bills had been timely submitted, insurer properly applied bills to deductible
NORTHEAST FLORIDA NEUROLOGY CLINICS a/a/o Nakeay Riley, Plaintiff(s), vs. NATIONWIDE MUTUAL INSURANCE CO., Defendant(s). County Court, 4th Judicial Circuit in and for Duval County. Case No. 16-2006-SC-3844-XXXX, Division C. March 14, 2008. Brent D. Shore, Judge. Counsel: Vincent P. Gallagher, Jacksonville. James J. Dye, Conroy, Simberg, Ganon, Krevans, Abel, Lurvey, Morrow & Schefer, P.A., Orlando.
ORDER ON DEFENDANT’S AMENDED MOTION FOR FINAL SUMMARY JUDGMENT
This cause came before the Court for Hearing on the Defendant’s Amended Motion For Final Summary Judgment and the Court having considered the argument of Counsel as well as the Affidavits and attachments filed in this cause, finds:
(a) Nakeay Riley was involved in an automobile accident on July 6, 2005. The Plaintiff is the wife of Ralphalon W. Riley, the named insured under a policy of insurance issued by the Defendant, Nationwide Mutual Insurance Company. On the date of the motor vehicle accident, Nakeay Riles, was named as an insured driver and was covered for Personal Injury Protection benefits pursuant to the policy issued by the Defendant.
(b) As a direct result of the motor vehicle accident, Nakeay Riley, received medical treatment at Northeast Florida Neurology Clinics. Nakeay Riley received medical treatment on July 8, 2005; July 11, 2005; and July 27, 2005.
(c) According to the terms and conditions of the Defendant’s policy, $10,000.00 in PIP benefits were available, after a $1,000.00 deductible had been met. The Plaintiff mailed requests for payment for the dates of service at issue. The bills were received by the Defendant on October 28, 2005. The bills totaled $514.00 and were applied to Nakeay Riley’s deductible on November 8, 2005, in the order they were received.
APPLICABLE LAW
Medical Service Providers must submit their bills directly to a PIP insurer within thirty-five (35) days of the date of service, in accord with Florida Statute Section 627.736(5)(c). The penalty for failing to comply with the Statute is the forfeiture of any claim for payment from either the PIP carrier or the patient. The medical services provided by the Plaintiff took place in July, 2005, however, the Plaintiff did not submit the bills to the Defendant until October 27, 2005.
The Court finds that Nakeay Riley was a named insured pursuant to Florida Statute Section 627.739(1) and that the policy deductible applies to her. Pappagallo v. New Hampshire Indemnity Company, (7 Fla. L. Weekly Supp. 805a, County Court, 12th Judicial Circuit, September, 2000) and Sturgis v. Fortune Insurance Company, 475 So.2d 1272 (Fla. 2nd DCA 1985). Even if the bills had been timely submitted by the Plaintiff, the insurance carrier properly applied the bills to Nakeay Riley’s deductible. Physicians Injury Care Center, Inc. a/a/o Gail Scott v. Progressive Express Insurance Company, 12 Fla. L. Weekly Supp. 693a (Cir. Ct. 9th Judicial Circuit, May 13, 2005). Therefore, it is
ORDERED AND ADJUDGED:
The Defendant’s Amended Motion For Final Summary Judgment is Granted. The Court reserves jurisdiction to award taxable costs, if any, to the Defendant.
