15 Fla. L. Weekly Supp. 750b
Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — Where medical provider failed to list services provided on D&A form, insurer did not have notice of covered loss — Summary final judgment entered for insurer
ROBERTS ORTHOPAEDIC CLINIC, P.A., as assignee of Caleb Cooper, Plaintiff, v. PROGRESSIVE AMERICAN INSURANCE COMPANY, Defendant. County Court, 18th Judicial Circuit in and for Seminole County. Case No. 06-SC-3818. March 19, 2008. Donald L. Marblestone, Judge. Counsel: Mark Cederberg, Rutledge Bradford, Orlando. Wendy L. Pepper, Rissman, Barrett, Hurt, Donahue & McLain, P.A., Tampa.
AMENDED SUMMARY FINAL JUDGMENT
THIS CAUSE having come to be heard upon Defendant’s Motion for Summary Final Judgment, and this Court having carefully considered the motion, the cases cited, case law presented by opposing counsel, heard argument of counsel, and being otherwise fully advised in the premises, finds as follows:
1. Plaintiff filed a PIP suit, as assignee of Caleb Cooper, against Defendant for reduced medical bills for services allegedly rendered to Caleb Cooper, as a result of injuries he allegedly sustained in an automobile accident which occurred on October 24, 2005.
2. Pursuant to §627.736(5)(e)(1), Florida Statutes, 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 Caleb Cooper, signed on February 10, 2006.
4. However, Plaintiff failed to list the services allegedly rendered to Caleb Cooper on Line 1 of the disclosure and acknowledgment form as required.
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. 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).
7. 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.
This Amended Summary Final Judgment supersedes the Summary Final Judgment entered by this Court on February 22, 2008.
