21 Fla. L. Weekly Supp. 567a
Online Reference: FLWSUPP 2106BERRInsurance — Personal injury protection — Disclosure and acknowledgment form — Where medical provider did not opt out of class action regarding bills denied by insurer based on noncompliant D&A forms, final judgment in class action extinguished and released provider’s claims for bills that were denied due to noncompliant D&A forms
STELLER LIFE CARE, INC. D/B/A SPINAL CORRECTION CENTERS, (A/A/O GILBERT BERRY), Plaintiff, vs. USAA CASUALTY INSURANCE COMPANY, Defendant. County Court, 6th Judicial Circuit in and for Pinellas County, Civil Division. Case No. 12 004420 CO, Division 039. March 17, 2014. Honorable Walt Fullerton, Judge. Counsel: William Foman, for Plaintiff. David Hwalek, for Defendant.
ORDER GRANTING DEFENDANT’S MOTIONFOR PARTIAL SUMMARY JUDGMENT
THIS CAUSE came before this Honorable Court on March 6, 2014 upon Defendant’s Motion for Partial Summary Judgment. The Court, having heard arguments of both Plaintiff’s and Defendant’s counsel; after a review the record evidence, memoranda, and submitted case law; and being otherwise fully advised in the premises, finds as follows:
FINDINGS OF FACT
1. This is a Personal Injury Protection (PIP) case arising out of an accident that occurred on August 3, 2007 involving USAA CASUALTY INSURANCE COMPANY’S [hereinafter “USAA CIC] insured, Gilbert Berry.
2. The dates of service at issue for this Partial Summary Judgment are August 30, 2007 through October 22, 2007; February 13, 2008; and February 20, 2008.
3. All CPT codes [codes used by medical provider to describe the services rendered] billed for the dates of service described in the prior paragraph were denied using reason coded “FL_DIS&ACK” or “FL_DIS&ACK1”. The affidavit of USAA CIC’s Lisa Crowell confirms this.
4. Reason codes “FL_DIS&ACK” or “FL_DIS&ACK1” were codes that USAA CIC used to deny payment based on a non-compliant Standard Disclosure and Acknowledgment form [said form is part of the PIP statute, specifically described in F.S. 627.736(5)(e)].
5. Reason codes “FL_DIS&ACK” or “FL_DIS&ACK1” were encompassed with the class action lawsuit of Steven B. Goodwiller, M.D., P.A. v. United Services Automobile Association and USAA Casualty Insurance Company (Case no. 08-015594- CACE- 12) (Fla. 17th Jud’l Cir) [19 Fla. L. Weekly Supp. 1069b] (hereinafter “Goodwiller”).
6. The Goodwiller class action was resolved via Judge Peter Weinstein’s [presiding judge in the Goodwiller class action] Final Judgment and Order of Final Approval [previously filed with this Court], executed by Judge Peter Weinstein on December 1, 2009.
7. Said Final Judgment extinguished and released the claims of class members whose bills were denied by USAA CIC based on reason codes “FL_DIS&ACK” or “FL_DIS&ACK1”.
8. USAA CIC also filed the affidavit of Rust Consulting’s Amy Lake. Amy Lake is the Senior Project Administrator for Rust Consulting, Inc. [Rust Consulting was chosen by both plaintiff’s and defendant’s counsel in the Goodwiller class action, and approved by the Goodwiller court, to serve as the Goodwiller class action administrator]. Amy Lake stated in her affidavit that notice of the Goodwiller class action was provided to the Plaintiff on August 14, 2009, that the notice was not returned as undeliverable, and that at no time did Rust Consulting receive any claim or request to opt out of the Goodwiller class action.
5. The Court finds that the Plaintiff was a member of the Goodwiller class action. Furthermore, based on the class action case law of In Re Prudential, 177 F.R.D. 216 (U.S. Dist. 1997), and Greene v. Metropolitan Insurance, Case No. 07-2903 (U.S. Dist. N.J. 2009), the affidavits of USAA’s Lisa Crowell, and Rust Consulting’s Amy Lake, this Court finds that the Plaintiff did receive notice of the Goodwiller class action, and did not opt out.
CONCLUSIONS OF LAW
6. Because the Plaintiff did not opt out of the Goodwiller class action, it is bound by the terms of the class action pursuant to the Settlement Agreement and Stipulation, which states that any class member that does not opt out will be bound by terms and provisions of the Settlement Agreement [said Settlement Agreement is attached to the affidavit of Amy Lake, and is specifically incorporated into Judge Weinstein’s Final Judgment]. Therefore, pursuant to the Final Judgment, the Plaintiffs claims for dates of service 8-30-07 through 10-22-07, 2-13-08, and 2-20-08 are extinguished and released.
Wherefore, for the foregoing reasons, the Court hereby orders and adjudges that:
1. Defendant’s Motion for Partial Summary Judgment as to dates of service 8-30-07 through 10-22-07, 2-13-08, and 2-20-08 is hereby GRANTED;
2. As to dates of service 8-30-07 through 10-22-07, 2-13-08, and 2-20-08, USAA CIC is the prevailing party, and shall go henceforth without day as to dates of service 8-30-07 through 10-22-07, 2-13-08, and 2-20-08. The Court reserves jurisdiction to entertain any timely served motions to tax attorney’s fees and costs.
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