16 Fla. L. Weekly Supp. 114a
Insurance — Personal injury protection — Notice of loss — Claim form contained sufficient information to put insurer on notice of loss — Notice requirements in policy do not supersede statutory notice requirements
EMERGENCY PHYSICIANS OF CENTRAL FLORIDA, LLP, as assignee of Jennifer Adams, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 18th Judicial Circuit in and for Seminole County. Case No. 05-SC-2631. November 6, 2008. Donald L. Marblestone, Judge. Counsel: Mark A. Cederberg, Rutledge Bradford Attorneys at Law, Orlando. Valencia Percy Flakes, Maitland.
ORDER DENYING DEFENDANT’S MOTION FOR FINAL SUMMARY JUDGMENT
THIS MATTER having come before this Court on Defendant’s Motion for Final Summary Judgment (certificate of service date September 28, 2006), and this Court having reviewed the file, having heard argument of counsel, having considered relevant Florida law, finds as follows:
1. This is a claim for PIP benefits arising out of a motor vehicle related injury that occurred on, or about, February 20, 2005 involving the assignee, Jennifer Adams.
2. The Plaintiff rendered emergency medical services to Ms. Adams, in the emergency room, on February 21, 2005 for injuries Ms. Adams sustained in the above-referenced incident. Ms. Adams executed an Assignment of Benefits in favor of the Plaintiff.
3. The Defendant issued an automobile insurance policy to Ms. Adams, which provided for PIP benefits and was in full force and effect when the above-referenced loss occurred.
4. On, or about, March 21, 2005, the Plaintiff submitted its bill for care and treatment rendered to Ms. Adams in the emergency room on February 21, 2005 and the bill was received by the Defendant on March 28, 2005. The CMS 1500 form (bill) included, amongst other things, the insured’s name, the insured’s home address, the insured’s telephone number, the insured’s date of birth, the name of the other “named insured” on the subject policy of insurance and the policy number taken directly from Ms. Adams’ State Farm insurance card in the emergency room. The bill went unpaid.
5. On July 26, 2005, the Plaintiff filed suit against the Defendant for breach of contract.
6. The Defendant’s failure to timely investigate the claim and pay the subject bill or deny the bill within thirty (30) days of receipt necessitated the filing of the instant lawsuit.
7. It is the Defendant’s position that Ms. Adams failed to comply with the “notice” provisions of her policy of insurance with State Farm.
It is hereby ORDERED AND ADJUDGED that:
1. Defendant’s Motion for Final Summary Judgment is DENIED.
2. The Court finds that the CMS 1500 form at issue in this case contained sufficient information to put the Defendant on notice of the claim, and therefore, the Defendant was required to pay the claim within thirty (30) days of receipt of the CMS 1500 form. Upon receipt of the CMS 1500 form, which constituted sufficient “written notice” of the claim, the burden was on the Defendant to authenticate the claim within (30) days; if the Defendant could not prove it was not responsible for the payment, it should have paid the claim within thirty (30) days of the date of receipt of the CMS 1500 form. See Palmer v. Fortune Insurance Company, 776 So.2d 1019 (Fla. 5th DCA 2001), Superior Insurance Company v. David A. Libert, M.D., 776 So.2d 360 (Fla. 5th DCA 2001) and New Hampshire Indemnity Company v. Pinnacle Medical, Inc. d/b/a ISO Data Diagnostics, 9th Judicial Circuit in and for Orange County, Appellate Case No. CVA 196-53 (June 10, 1997). See also Fl. Stat. §627.736(4)(b) (2005).
3. Additionally, the Court finds that the “notice” requirements as set forth in the assignor’s policy of insurance with the Defendant do not supercede the statutory requirements as set forth in Fl. Stat. §627.736(4)(b).
