15 Fla. L. Weekly Supp. 372a
Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — Sufficiency — D&A form that does not list services allegedly rendered failed to place insurer on notice of covered loss — Deficient D&A form is fatal to provider’s entire claim, not just claim for initial date of service, and deprives provider of standing to bring action for declaratory relief
R & C FIRST MEDICAL CENTER, a Florida Corporation (assignee of Rodriguez, Jose), Plaintiff, v. PROGRESSIVE AMERICAN INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 07-SC-1669-0. December 13, 2007. Antoinette Plogstedt, Judge. Counsel: Russel Lazega, Law Offices of Russel Lazega, P.A., Miami. Eric Biernacki, Adams & Diaco, P.A., Orlando.
SUMMARY FINAL JUDGMENT
This CAUSE having come before this Court on Defendant’s Motion for Summary Final Judgment and Motion for Protective Order, and the Court having carefully considered the motion, supporting affidavit, Plaintiff’s response, the cases cited, and arguments of counsel and being otherwise fully advised in the premises, finds as follows:
1. Plaintiff filed a PIP suit, as assignee of Jose Rodriguez, against Defendant for reduced and denied medical bills for services allegedly rendered to Jose Rodriguez, as a result of injuries he allegedly sustained in an automobile accident which occurred on September 23, 2006.
2. Pursuant to §627.736(5)(e)(1), Florida Statutes (2006), each clinic providing medical services upon which a claim for personal injury benefits is based shall require the insured “to execute a disclosure and acknowledgment form” at the initial treatment or service provided. In addition, the “insured . . . must countersign the form attesting to the fact that the services set forth therein were actually rendered,” according to §627.736(5)(e)(1)(a). (emphasis added)
3. Plaintiff submitted a document alleged to be a disclosure and acknowledgment form to Defendant regarding the treatment it rendered to Jose Rodriguez for the September 23, 2006 accident.
4. However, Plaintiff failed to list the services allegedly rendered to Jose Rodriguez on Line 1 of the disclosure and acknowledgment form as required. Instead, Plaintiff listed the following: “R & C First Medical Center.”
5. Pursuant to §627.736(5)(e)(5), Plaintiff is required to provide the completed, original disclosure and acknowledgment form to the insurance company in order to provide written notice of the fact of a covered loss.
6. When the language of the statute is clear and unambiguous, and conveys a clear and definite meaning, the statute must be given its plain and obvious meaning. State of Florida v. Warren, 796 So. 2d 489 (Fla. 2001).
7. It is undisputed that Plaintiff failed to list the services allegedly rendered to Jose Rodriguez on Line 1 of the disclosure and acknowledgment form it submitted to Defendant.
8. Thus, Plaintiff failed to comply with §627.736(5)(e), Florida Statutes (2006), and, in turn, failed to place Defendant on notice of a covered loss for purposes of §627.736(4)(b). In addition, §627.736(4)(b) expressly provides that an insurer may raise this defense any time.
9. §627.736(4)(b), Florida Statutes (2006), in its pertinent part states:
“Personal injury protection benefits paid pursuant to this section shall be overdue if not paid within 30 days after the insurer is furnished with written notice of the fact of a covered loss . . . . This paragraph does not preclude or limit the ability of the insurer to assert that the claim was . . . in violation of, subsection (5). Such assertion by the insurer may be made at any time, including after payment of the claim or after the 30-day time period for payment set forth in this paragraph.” (emphasis added)
10. This Court finds that Defendant has not waived its defense raised pursuant to subsection (5) of §627.736 because of the express terms contained in the above-referenced subsection 4(b).
11. Thus, a disclosure and acknowledgment form that does not identify the services actually rendered, violates the statutory requirements and is fatal to Plaintiff’s PIP claim. Preziosi West/East Chiropractic Clinic, P.A., a/a/o Federico Vega, v. Progressive American Insurance Company, 14 Fla. L. Weekly Supp. 789a (Seminole County Court, 18th Jud. Cir., May 11, 2007).
12. If this Court were to accept Plaintiff’s argument that failure to provide a properly completed disclosure and acknowledgment form only impacts the initial date of service and not the entire claim, it would render the statutory provision useless.
13. Moreover, since Plaintiff failed to comply with a statutory condition precedent by not providing Defendant with a properly completed disclosure and acknowledgment form, Plaintiff does not have standing to bring an action for declaratory relief.
14. As such, Plaintiff’s failure to list the services actually provided on Line 1 of the disclosure and acknowledgment form, as required by §627.736(5)(e)(1), is fatal to all of Plaintiff’s causes of action.
Accordingly, it is hereby
ORDERED and ADJUDGED that a Summary Final Judgment is hereby entered for Defendant; it is further
ORDERED and ADJUDGED that Plaintiff shall take nothing by this action and Defendant shall go hence without day.
