16 Fla. L. Weekly Supp. 347a
Online Reference: FLWSUPP 164BISTL
Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form on which medical provider wrote “Consult/Procedure” and to which provider attached bills did not set forth services actually rendered and, therefore, did not provide insurer with notice of loss
JANE E. BISTLINE, MD PA, Plaintiff, vs. USAA CASUALTY INSURANCE COMPANY, Defendant. County Court, 15th Judicial Circuit in and for Palm Beach County, Civil Division. Case No. 502008CC005852, Division RB. January 28, 2009. Ted Booras, Judge.
REVERSED at 17 Fla. L. Weekly Supp. 1001a
FINAL ORDER FOR SUMMARY JUDGMENT FOR DEFENDANT
THIS CAUSE having come before the Court upon Defendant’s Motion for Summary Judgment as to Plaintiff’s (healthcare provider) failure to comply with the “Disclosure and Acknowledgment” requirement of section 627.736(5)(e). On the Disclosure and Acknowledgment Form1, Plaintiff wrote “Consult/Procedure”. Plaintiff attached to the Disclosure and Acknowledgment Form a four (4) page bill2 with fourteen (14) line item charges for the initial date of service. The sub-totals on the bills were $6,800.00 (page one), $3,750.00 (page two), $1,024.20 (page 3), and $200.00 (page 4).
The Court first rejects Plaintiff’s argument that the disclosure and acknowledgment form need not be filled out as a statutory requirement. The Court finds that where the disclosure and acknowledgment form does not set forth services actually rendered, an insurer is not provided with a notice of loss as mandated by statute. See, North Florida Medical Clinic v. Progressive, 14 Fla. L. Weekly Supp. 689 (Fla. Duval Cty.Ct. 2007) (“The form submitted by the Plaintiff omitted the services . . . actually rendered by leaving blank the space provided to delineate these services . . .”); R & C First Medical Center v. Progressive, Case No: 07-SC-1669-0 (Fla. Orange Cty.Ct. 2007) [15 Fla. L. Weekly Supp. 372a] (“Plaintiff failed to list the services allegedly rendered . . .”); and, Roberts Orthopaedic Clinic v. Progressive, 15 Fla. L. Weekly Supp. 750 (Fla. Seminole Cty.Ct. 2008) (Where medical provider failed to list services provided on disclosure and acknowledgment form, insurer did not have notice of covered loss).
Plaintiff next argues that the verbiage “Consult/Procedure” either satisfies the statutory requirement or creates a material disputed fact for the trier of fact to determine. The Court finds that this is a question of law. Based on the facts of this case, the Disclosure and Acknowledgment Form herein did not set forth the services actually rendered, thus Defendant (insurer) was not provided with a notice of loss as required by section 627.736(5)(e).
IT IS THEREFORE ORDERED AND ADJUDGED that Defendant’s Motion for Summary Judgment as to Plaintiff’s (healthcare provider) failure to comply with the “Disclosure and Acknowledgment” requirement of section 627.736(5)(e) is hereby GRANTED.
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1The Disclosure and Acknowledgment Form is attached to Defendant’s Motion for Summary Judgment as Exhibit A.
2This bill is attached to Defendant’s Motion for Summary Judgment as Exhibit B.
