22 Fla. L. Weekly Supp. 131a

Online Reference: FLWSUPP 2201FONTInsurance — Personal injury protection — Where insurer partially paid medical provider’s bill and requested additional information concerning emergency medical condition, insurer’s obligation to pay claim did not arise until after provider complied with request for additional information — Claim paid within thirty days of receipt of requested information, albeit after suit was filed, was timely paid

ORTHOPEDIC SPECIALISTS LLP AS ASSIGNEE OF COLLEEN FONTANA, Plaintiff(s), v. USAA CASUALTY INSURANCE COMPANY, Defendant(s). County Court, 15th Judicial Circuit in and for Palm Beach County, County Civil Division. Case No. 502013SC013901XXXXMB, Division RB. July 3, 2014. Final Judgment Filed August 8, 2014. Ted Booras, Judge.

ORDER GRANTING DEFENDANT’SSUMMARY JUDGEMENT

THIS CAUSE came before the Court upon Defendant’s Motion for Summary Judgment. This is a PIP action arising from an injury resulting in medical care. The following dates are relevant to the Court’s determination:

April 20, 2013, policy issue date;

July 7, 2013, date of loss;

October 16, 2013, date of treatment;

October 31, 2013, date Defendant sent provider a letter requesting additional information as to emergency medical condition (EMC) pursuant to section 627.736(6)(b);

November 20, 2013, date provider sent the pre-suit demand letter to Defendant, (which prompted a second a letter requesting additional information as to EMC pursuant to section 627.736(6)(b));

December 31, 2014, date instant action was filed;

January 16, 2014, date provider/Plaintiff complied with Defendant’s two written requests.

The relevant additional facts are as follows: Upon receipt of the provider’s bill in October, Defendant paid $2500.00 to provider contemporaneously making a written demand pursuant to section 627.736(6)(b). Upon receipt of the provider’s pre-suit demand letter, Defendant’s written response advised that $2500.00 has been paid and that they are again making a demand for information pursuant to section 627.736(6)(b). Within thirty (30) days of provider/Plaintiff’s January 16, 2014 response, Defendant paid the entire claim.

Defendant’s primary argument is that this action was prematurely filed. That Defendant’s obligation to pay the PIP claim did not arise until provider/Plaintiff complied with Defendant’s written requests pursuant to section 627.736(6)(b) concerning EMC. Basically, that until January 16, 2014, Defendant’s statutory obligation to pay the claim did not exist. Since Defendant paid the claim within the statutory thirty (30) days, this action is a nullity.

Plaintiff’s primary response to this Motion is that since Defendant paid the claim after the action was commenced; there is a confession of judgment.

These facts placed Defendant in an unattainable position; either pay the debt and face a confession of judgment argument or do not pay the debt and clearly be in violation of the PIP statute.

The Court finds that Defendant properly contested the provider’s bill and made two valid written requests to the provider pursuant to section 627.736(6)(b) for additional information concerning the EMC. That this written request tolled the time within which Defendant had to pay the claim. Even though the instant claim was initiated before Defendant paid the claim, Defendant’s obligation to pay did not arise until provider/Plaintiff complied with section 627.736(6)(b) demands which was after this action was filed. The claim was paid in full within thirty (30) days of the legally sufficient notice by provider/Plaintiff. The court finds that the claim was in fact timely paid by Defendant.

ORDERED AND ADJUDGED that the claim at issue herein was timely paid by Defendant; therefore, Defendant’s Motion for Summary Judgment is hereby GRANTED.

__________________FINAL JUDGMENT

THIS CAUSE came before the Court upon Defendant’s Motion for Summary Judgment. By Order dated July 3, 2014, this Court granted Defendant’s motion. There being no remaining issues of law or fact, it is therefore

ORDERED AND ADJUDGED that Plaintiff, Orthopedic Specialists, LLP as assignee of Colleen Fontana take nothing by this action and that Defendant, USAA Casualty Insurance Company, shall go hence without day. The Court retains jurisdiction to determine costs and the entitlement and amount of attorney’s fees.

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