16 Fla. L. Weekly Supp. 351a
Online Reference: FLWSUPP 164MITIA
Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form is legally sufficient where form lists service as “physical therapy” and attached HCFA form and medical records list actual CPT codes rendered
ATLANTIC ACU-MEDICAL CENTER CORP., (Kerlie Mitiale, Patient), Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 08-1699CONO(70). February 17, 2009. Steven P. Deluca, Judge. Counsel: Ana Cohen, Matt Hellman, P.A., Plantation. Cindy A. Goldstein, Cindy A. Goldstein, P.A., Coral Springs.
ORDER ON DEFENDANT’S MOTION FOR FINAL SUMMARY JUDGMENT
THIS CAUSE having come before this Honorable Court on Defendant’s Motion for Final Summary Judgment, and based upon the argument of counsel and the Court being otherwise advised in the premise, it is hereby
ORDERED AND ADJUDGED:
1. This is an action for unpaid PIP benefits filed by Plaintiff on March 19, 2008, for dates of service 10/31/07 to 12/19/07 in the amount of $3,808.00.
2. A Standard Disclosure and Acknowledgement Form was timely submitted to the Defendant for the initial date of service, October 31, 2007. Line 1 of the Standard Disclosure and Acknowledgement Form read that the services rendered were: “History, Exam, Physical Therapy, X-rays.” The HCFA form and medical records pertaining to this date of service were also attached to the Standard Disclosure and Acknowledgement Form.
3. Defendant filed its Motion for Summary Judgment contending that Plaintiff failed to provide a proper Standard Disclosure and Acknowledgement Form under Florida Statute 627.736(5)(e) in that the words hot/cold packs, electrical stimulation, ultrasound were not listed on line 1 of the form. The HCFA form attached to the Standard Disclosure and Acknowledgement Form actually listed the CPT codes: CPT codes 97010 (hot/cold packs), 97014 (electrical stimulation), 97035 (ultrasound), CPT code 99204 (office visit and management of new patient) CPT codes 72050 (x-ray cervical, 4 views) and 72100 (x-ray lumbar spine, 2-3 views). Plaintiff filed its Notice of Filing Affidavit of Dr. Thomas Hupp in Opposition to Defendant’s Motion for Summary Judgment in that the patient was informed at the time of executing the Standard Disclosure and Acknowledgement Form of the services rendered for which would be sent to the Defendant and that there was insufficient space on the form to provide an extensive list of all medical services rendered to the patient.
4. Plaintiff argued at the hearing that the description of “physical therapy” was sufficient to describe hot/cold packs, electrical stimulation, and ultrasound and the actual CPT codes rendered; that there was not enough room on the Standard Disclosure and Acknowledgement Form to list every single procedure rendered; that the Plaintiff, albeit unnecessary, attached the HCFA forms/medical records to the Standard Disclosure and Acknowledgement Form; that the Standard Disclosure and Acknowledgement Form requirement only applies to the first date of service; and that Defendant waived this defense by failing to provide Plaintiff with an Explanation of Benefits to correct any defect.
5. The Standard Disclosure and Acknowledgement Form requirement only applies to the first date of service. Reese King v. United Automobile Insurance Company, 15 Fla. L. Weekly Supp. 430a (Miami-Dade Cty. 2008 Appellate).
6. This Court finds that the Standard Disclosure and Acknowledgement Form in this case meets the statutory requirement of Florida Statute 627.736(5)(e)(1). This Court finds that United Automobile was clearly placed on proper notice of a covered loss and that the general description of “physical therapy” was sufficient to cover hot/cold packs, electrical stimulation, and ultrasound modalities as the HCFA form and medical records were attached to the Standard Disclosure and Acknowledgment Form.
7. Since this Court has found that the Standard Disclosure and Acknowledgement Form was legally sufficient, it does not need to rule on the issue of waiver.
8. Defendant’s Motion for Summary Judgment is DENIED.
