17 Fla. L. Weekly Supp. 207a
Online Reference: FLWSUPP 1703WROB
Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — PIP statute does not require that medical provider that is clinic or medical institution and has submitted D&A form for initial date of service submit new D&A form each time treatment is subsequently rendered by one of its medical professionals licensed under different chapter of Florida Statutes
PHYSICIANS GROUP, LLC a/a/o BRYAN WROBLEWSKI, Plaintiff, vs. UNITED SERVICES AUTOMOBILE ASSOCIATION, Defendant. County Court, 12th Judicial Circuit in and for Sarasota County. Case No. 2008 SC 001673 NC. December 16, 2009. Phyllis R. Galen, Judge. Counsel: Anthony D. Barak, Barak and Zitani, LLC, Sarasota, for Plaintiff. David B. Kampf, Ramey and Kampf, P.A., for Defendant.
ORDER GRANTING PLAINTIFF’S AMENDED MOTION FOR PARTIAL SUMMARY JUDGMENT
THIS CAUSE, having come to be heard on August 7, 2009 on Plaintiff’s Amended Motion for Partial Summary Judgment, and the Court, having examined the court file, including deposition transcripts, pleadings, and filed affidavits, and having heard argument of counsel, reviewed the transcript of the motion hearing, reviewed proposed orders from each counsel and being otherwise advised of the premises, the Court adopts the following findings and it is hereby Ordered and Adjudged as follows:
Undisputed Facts
This case is a breach of contract action regarding personal injury protection benefits. Plaintiff is a medical provider composed of a group of physicians and other medical professionals operating as a limited liability company that treats individuals who have been involved in accidents. Plaintiff employs medical doctors, osteopathic physicians, chiropractors, nurse practitioners, physician assistants, and massage therapists. Also, Plaintiff is accredited by the Joint Commission as an ambulatory care organization and bills all its services under the name of Physicians Group and has one tax identification number.
On November 6, 2007, Bryan Wroblewski (hereinafter referred to as “the patient”) was involved in a motor vehicle accident, for which Defendant provided personal injury protection (PIP) coverage. On November 9, 2007, the patient presented to Plaintiff for treatment of injuries sustained in the subject accident and was seen by Stephen Plummer, A.R.N.P, at his initial service. On the patient’s initial visit, he executed an assignment of benefits wherein he assigned his rights and benefits under the policy of insurance to Plaintiff. Also, at the patient’s initial treatment with Plaintiff, he executed a standard disclosure and acknowledgment form as required by Florida Statute §627.736(5)(e).
On November 14, 2007, Plaintiff submitted charges to Defendant for reimbursement of the costs incurred on the patient’s first date of service (11/9/07), and included a fully executed original disclosure and acknowledgment form, the medical bill, the medical report, and the assignment of benefits. Upon receipt of Plaintiff’s bill, Defendant sent Plaintiff an explanation of reimbursement, which indicated that the bill would be applied to the deductible. For all subsequent dates of service at issue in this lawsuit Defendant denied Plaintiff’s bills based upon its allegation that a separate disclosure and acknowledgement form was needed for each of the treating medical professionals, licensed under a different chapter of Florida Statutes, who were employed by Plaintiff who treated the patient after the first service.
Plaintiff filed a Motion for Partial Summary Judgment asserting that it complied with the disclosure and acknowledgment form requirements under F.S. 627.736(5)(e) by submitting a fully executed disclosure and acknowledgment form for the patient’s initial service. Defendant seeks to avoid payment of Plaintiff’s subsequent bills by arguing that a separate disclosure and acknowledgement form is required for each of Plaintiff’s medical professionals licensed under a separate Florida Statute who rendered treatment to the patient.Issue
Accordingly, the legal issue for the purpose of this Motion for Partial Summary Judgment is whether or not Plaintiff was required to send a separate disclosure and acknowledgment form for each medical professional who rendered care to the patient after the initial service under Florida Statute 627.736(5)(e).
Legal Analysis
The following are the relevant parts of Florida Statute Section 627.736 involved in this case:
627.736(5)(e)1 provides:
At the initial treatment or service provided, each physician, other licensed professional, clinic, or other medical institution providing medical services upon which a claim for personal injury protection benefits is based shall require an insured person, or his or her guardian, to execute a disclosure and acknowledgement form, which reflects at a minimum that (emphasis added):
627.736(5)(e)9 provides:
The requirements of this paragraph apply only with respect to the initial treatment or service of the insured by a provider. For subsequent treatments or service, the provider must maintain a patient log signed by the patient, in chronological order by date of service that is consistent with the services being rendered to the patient as claimed. The requirements of this subparagraph for maintaining a patient log signed by the patient may be met by a hospital that maintains medical records as required by s. 395.3025 and applicable rules and makes such records available to the insurer upon request.
The language of Florida Statute 627.736(5)(e)(9) makes it clear that 627.736(5)(e) only requires the disclosure and acknowledgment form to be executed “with respect to the initial treatment or service of the insured by a provider.” Since 627.736(5)(e)1 states at the initial treatment or service provided “each physician, other licensed professional, clinic, or other medical institution” shall require the disclosure form, it should be interpreted to mean the disclosure form is required at the initial treatment/service with any physician, or at the initial treatment/service with a licensed medical professional, or at the initial treatment/service with a clinic, or at the initial treatment service with a medical institution. This section cannot be construed to mean, as Defendant urges, that each physician licensed under a separate chapter of Florida Statutes must submit a new disclosure form when subsequent services are rendered at the same facility.
Under Florida Statute 627.736 Plaintiff is considered a “clinic” or “other medical institution.” See MRI Services, Inc. v. State Farm Mutual Automobile Ins. Co., 807 So.2d 783 (Fla. 2nd DCA 2002) (Wherein the Court concluded that MRI Services, Inc. is a “clinic” or “other medical institution” and comes within the ambit of section 627.736(6)(b), as MRI Services, Inc. is the entity that actually rendered the MRI services). Accordingly, if an MRI entity, as the entity actually rendering its MRI services, is considered a “clinic” or “other medical institution” under F. S. 627.736, Plaintiff, as the entity actually rendering treatment to ambulatory patients, clearly falls into these categories as well.
The statute does not contemplate the same “clinic” or “other medical institution” having to repeatedly provide a separate disclosure and acknowledgment form at each of the patient’s subsequent treatment or service at that entity, even if the subsequent treatment is by a different type of physician. It is only required at the initial treatment or service. Because it is this Court’s opinion that Plaintiff falls into the “clinic” or “other medical institution” category as intended under Florida Statute §627.736(5)(e), the disclosure and acknowledgement form was only required on the patient’s initial treatment/service with Plaintiff.
Even if this Court were to determine that the initial disclosure form failed to comply with Florida Statute §627.736(5)(e) in some way (although not a question before this Court currently), such a failure does not excuse an insurer from paying subsequently filed bills. See Reese King v. United Automobile Insurance Company, 15 Fla. L. Weekly Supp. 430a (Miami-Dade Appellate Court, February 28, 2008); Dr. Martin A. Grossman, D.C. a/a/o Jean-Charles Jemimi v. United Automobile Insurance Company, 15 Fla. L. Weekly Supp. 923b (Dade County Court, July 17, 2008) (The statute is clear on its facethat the disclosure form requirement only applies to the first date of service); and Lake Worth Emergency Chiropractic Center, P.A. a/a/o Clifford Riley v. Progressive American Insurance Company, 15 Fla. L. Weekly Supp. 1227a (Broward County Court, June 26, 2008) (Requirement of the disclosure form only applies with respect to the initial treatment or service of the insured by a provider); also see Bayou Chiropractic Center, P.A. d/b/a Art of Chiropractic a/a/o Allen Morgenstern v. USAA Casualty Insurance Company,15 Fla. L. Weekly Supp. 502a (Escambia County Court decision, March 11, 2008)(Because the intent of this section of the statute is to prevent fraud, it is logical that the form only be required at the time of the initial treatment. Further confirming the legislature’s purpose of avoiding concern over improper solicitation or fraud is that the disclosure and acknowledgment form is not required in emergency situations).
Defendant’s position is based upon its notion that if subsequent treatment is rendered by a physician licensed under a different chapter of Florida Statutes, another disclosure form needs to be submitted because treatment by an alternately-licensed physician is not consistent with the initial care rendered. This Court finds that the clear language of Florida Statute §627.736(5)(e) does not support Defendant’s position. Also, Defendant asserts that even though Plaintiff is the “provider” billing for all the services in this case, the various medical professionals employed by Plaintiff who saw the patient after the initial treatment are required to execute yet another disclosure and acknowledgement form. Based upon the clear language in the statute and the Court’s interpretation of Florida Statute 627.736(5)(e) this Court does not agree with Defendant’s position that multiple disclosure forms are required for subsequent services rendered by a “clinic” or “other medical institution.”
Conclusion
Based upon the foregoing, this Court grants Plaintiff’s Amended Motion for Partial Summary Judgment as Plaintiff complied with the requirements of Florida Statute 627.736(5)(e). Since Plaintiff falls into the category of “clinic” or “medical institution,” the disclosure and acknowledgment form requirement only applies with respect to the initial service or treatment with Plaintiff, not for any subsequent services. This holds true regardless of the number of different medical professionals at Plaintiff’s facility who render care after the initial service/treatment. The Court reserves jurisdiction to award Plaintiff reasonable attorney’s fees and costs.
