16 Fla. L. Weekly Supp. 958a
Online Reference: FLWSUPP 1610MORA
Insurance — Personal injury protection — Coverage — Medical expenses — Overdue bills — Request for documentation — Where insurer made timely request for additional documentation regarding claims and received no response from medical provider, claims were not overdue at time of filing suit and lawsuit is premature
HIALEAH MEDICAL CORP. A/A/O SUNRIDE MORA, Plaintiff, vs. MERCURY INSURANCE COMPANY OF FLORIDA, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County, Civil Division. Case No. 08-12702 SP 25. July 17, 2009. Andrew S. Hague, Judge. Counsel: Ana D’Costa, Shirejian & O’Hara, Mercury Ins. Group, Aventura. Munir Barakat.
ORDER GRANTING DEFENDANT’S MOTION FOR FINAL SUMMARY JUDGMENT PURSUANT TO F.S. §627.736(6)(b)
THIS MATTER having come on to be heard on June 10, 2009, on Mercury Insurance Company’s (“Mercury”) Motion for Final Summary Judgment based on its request for additional documentation, pursuant to F.S. § 627.736(6)(b), and the Court being otherwise fully advised in the premises, it is hereby:
ORDERED AND ADJUDGED that:
Defendant’s Motion is hereby granted.
THIS COURT FURTHER FINDS that:
FINDINGS OF FACT:
1. Hialeah Medical Corp. (hereinafter “Plaintiff”) billed for and sought reimbursement for treatment ordered by Carlos A. Blanco, M.D., for dates of service of January 21, 2008 through May 6, 2008, for injuries the insured allegedly sustained in an automobile accident that occurred on January 17, 2008.
2. Plaintiff submitted five bills. The total billed for these dates of service was $14,405.00.
3. Mercury sent numerous (6)(b) letters to the Plaintiff (within 30 days of receipt of the bills, on March 27th, April 1st, May 5th, May 14th, and June 19th, 2008) and requested that the Plaintiff complete the OIR-B1-1809 form and demonstrate how it is eligible to receive payment for PIP benefits under the recently enacted provision of the PIP statute, §627.736(1)(a).
4. Plaintiff never responded to the (6)(b) letters.
5. The Plaintiff submitted three demand letters to Mercury on April 8th, June 12th, and June 17th, 2008; and Mercury responded to all of them, explaining to Plaintiff that the bills were not overdue since the Plaintiff had not complied with the (6)(b) letters.
6. Plaintiff then filed a one count complaint for breach of contract for failure to pay PIP benefits.
CONCLUSION OF LAW:
7. The pertinent part of F.S. § 627.736(6)(b), states:
Every physician, hospital, clinic, or other medical institution providing, before or after bodily injury upon which a claim for personal injury protection insurance benefits is based, any products, services, or accommodations in relation to that or any other injury, or in relation to a condition claimed to be connected with that or any other injury, shall, if requested to do so by the insurer against whom the claim has been made, furnish forthwith a written report of the history, condition, treatment, dates, and costs of such treatment of the injured person. . .If an insurer makes a written request for documentation or information under this paragraph within 30 days after having received notice of the amount of a covered loss under paragraph (4)(a), the amount of the partial amount which is the subject of the insurer’s inquiry shall become overdue if the insurer does not pay in accordance with paragraph (4)(b) or within 10 days after the insurer’s receip of the requested documentation or information, whichever occurs later.
8. Pursuant to F.S. § 627.736(6)(b), Mercury was entitled to request additional information regarding the Plaintiff’s eligibility requirements under the new PIP statute [§627.736(1)(a)], as such information went to costs, one of the enumerated categories contained in (6)(b).
9. As stated in Kaminester v. State Farm Mutual Insurance Company, 775 So. 2d 981 (Fla. 4th DCA 2000), State Farm Mutual Automobile Insurance Company v. Dr. Elias Goldstein, et al., 798 So. 2d 807 (Fla. 4th DCA 2001), and MRI Services, Inc. v. State Farm Mutual Automobile Insurance Company, 807 So. 2d 783 (Fla. 2nd DCA 2002), §627.736(6)(b) is designed to enable the insurer to make inquiry of certain facts so that it can better investigate its claims. F.S. §627.736(6)(b) can move things faster because it can accelerate discovery. Specifically, (6)(b) can accelerate the insurer’s investigation of the particular claim by allowing it to make a determination as to whether or not it has sufficient information to pay or deny the claim based on the information the insurer learns from the inquiry. Further, this part of the PIP statute may have the power to eliminate litigation as well as eliminate post suit discovery.
10. However, if the medical provider fails to respond to (6)(b) requests, then its claims do not become overdue. In fact, where an insurer has made a timely request for additional information, such in a case like this, “and having received no responses from the plaintiff, the claims that were the subject of the suit were not ‘overdue’ at the time of the complaint and are not collectible as the law suit is premature.” Professional Medical Group, Inc. a/a/o Jurgen Ugalde v. Progressive Express Insurance Company, 13 Fla. L. Weekly Supp. 1000b (Fla. 11th Judicial Circuit July 2006).
11. In fact, numerous cases stand for the proposition that when a (6)(b) request has been made and the medical provider does not respond, the law suit is premature. See, e.g., Drew Medical Inc. a/a/o Belen Vazquez) v. Progressive Express Insurance Company, 12 Fla. L. Weekly Supp. 403b (Fla. 18th Judicial Circuit January 2005), Physicians Extended Services a/a/o Christina L. Nelson) vs. Progressive Express Insurance Company, 11 Fla. L. Weekly Supp. 649b (Fla. 9th Judicial Circuit April 2004), Doctors Pain Management (a/a/o Dalon Finley) v. Progressive Auto Pro Insurance Company, 11 Fla. L. Weekly Supp. 1071b (Fla. 9th Judicial Circuit August 2004).
12. Moreover, even if there is a dispute regarding whether or not the medical provider is required to respond to the insurer’s request for additional information, the medical provider is obliged to at least advise the insurer of same pursuant to F.S. § 627.736(6)(c), which provides:
In the event of any dispute regarding an insurer’s right to discovery of facts under this section, the insurer may petition a court of competent jurisdiction to enter an order permitting such discovery. . .
It follows, then, that a medical provider respond and advise the insurer that it is disputing the insurer’s request for information.
13. Here, as Plaintiff failed to respond to Mercury’s timely request for additional information pursuant to F.S. §627.736(6)(b), the claims pertaining to this lawsuit are not overdue; and therefore, this lawsuit is premature.
WHEREFORE, it is ordered and adjudged:
That Mercury’s Motion for Final Summary Judgment is hereby GRANTED.
