16 Fla. L. Weekly Supp. 114b
Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form that failed to identify services actually rendered did not provide notice of covered loss — No merit to argument that failure to provide properly completed D&A form impacts only initial date of service and not entire claim
FLORIDA MEDICAL & INJURY CENTER INC., as assignee of Adrian Escobeda, Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 18th Judicial Circuit in and for Seminole County. Case No. 06-SC-2225. September 12, 2007. Donald L. Marblestone, Judge. Counsel: Michael Tierney, Winter Park. Eric Biernacki, Adams & Diaco, P.A., Orlando.
ORDER GRANTING 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 Adrian Escobeda, against Defendant for reduced medical bills for services allegedly rendered to Adrian Escobeda, as a result of injuries he sustained in an automobile accident which occurred on January 28, 2005.
2. Pursuant to §627.736(5)(e)(1) 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), Florida Statutes (2005). (emphasis added)
3. Plaintiff submitted a document alleged to be a disclosure and acknowledgment form to Defendant regarding the treatment it rendered to Adrian Escobeda for the January 28, 2005 accident.
4. However, Plaintiff failed to list the services allegedly rendered to Adrian Escobeda on Line 1 of the disclosure and acknowledgment form as required. Instead, Plaintiff left Line 1 of said form blank.
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. 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, Case No. 06-SC-4820 (Seminole County, 18th Jud. Cir., 2007) [14 Fla. L. Weekly Supp. 789a]; Robert’s Orthopaedic Clinic, a/a/o Gene Glaser, v. Progressive Auto Pro Insurance Company, Case No. 05-SC-2738 (Seminole County, 18th Jud. Cir., 2007).
8. 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.
9. 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 Plaintiff’s PIP claim.
Accordingly, it is hereby
ORDERED and ADJUDGED that Defendant’s Motion for Summary Final Judgment is GRANTED; it is further
ORDERED and ADJUDGED that Plaintiff shall take nothing by this action and Defendant shall go hence without day; it is further
ORDERED and ADJUDGED that the Court shall reserve jurisdiction as to Defendant’s attorney’s fees and taxable costs.
