16 Fla. L. Weekly Supp. 103b
Insurance — Personal injury protection — Explanation of benefits — Duty to provide — Question certified: When an insurer does not pay a portion of a claim or reject a claim within 30 days, does it, pursuant to Florida Statute §627.736(4)(b), have to provide an itemized specification of each item that the insurer had reduced, omitted, or declined to pay and any information that the insurer desires the claimant to consider related to the medical necessity of the denied treatment or explain the reasonableness of the related charge?
TAMPA TRAUMA MEDICAL CENTER, INC., a/a/o Carlos O. Gonzalez, Plaintiff, v. STATE FARM FIRE AND CASUALTY COMPANY, Defendant. County Court, 13th Judicial Circuit in and for Hillsborough County, General Civil Division. Case No. 05-27646-J. October 13, 2008. Gaston J. Fernandez, Judge. Counsel: Thomas J. Dandar. Steven D. Manno, Andrews & Manno, P.A., Tampa.
AFFIRMED at 17 Fla. L. Weekly Supp. 10b
FINAL SUMMARY JUDGMENT
THIS CAUSE came before the court on Motions for Summary Judgment, and the court having heard arguments of counsel and evidence presented, and otherwise being fully advised in the premises, it is
ORDERED AND ADJUDGED that judgment is entered in favor of the Defendant, STATE FARM FIRE AND CASUALTY COMPANY, and against the Plaintiff, TAMPA TRAUMA MEDICAL CENTER, INC., due to an exhaustion of benefits, and the court finding that the Defendant did not have to furnish the Plaintiff with itemized specifications as required under § 627.736(4)(b), Fla. Stat., because there was no rejection of benefits, termination or reduction of benefits. The court declines to make a ruling as to whether or not the payment to Dr. Robert Martinez was a proper or improper payment. It is further
ORDERED AND ADJUDGED that the court certifies as a matter of great public importance the following question:
WHEN AN INSURER DOES NOT PAY A PORTION OF A CLAIM OR REJECT A CLAIM WITHIN 30 DAYS, DOES IT, PURSUANT TO FLORIDA STATUTE §627.736(4)(b), HAVE TO PROVIDE AN ITEMIZED SPECIFICATION OF EACH ITEM THAT THE INSURER HAD REDUCED, OMITTED, OR DECLINED TO PAY AND ANY INFORMATION THAT THE INSURER DESIRES THE CLAIMANT TO CONSIDER RELATED TO THE MEDICAL NECESSITY OF THE DENIED TREATMENT OR EXPLAIN THE REASONABLENESS OF THE RELATED CHARGE?
It is further
ORDERED AND ADJUDGED that the court certifies this order as a matter of great public importance pursuant to Rule 9.030(b)(4), Fla. R. App. P.
ORDERED AND ADJUDGED that the court retains jurisdiction on the issue of attorney fees and costs.
