22 Fla. L. Weekly Supp. 282a
Online Reference: FLWSUPP 2202JECRInsurance — Personal injury protection — Notice of loss — Claim form marked to indicate that MRI service was not related to automobile accident did not provide notice of covered loss — Insurer’s motion for summary judgment is granted
SOUTH FLORIDA IMAGING & DIAGNOSTIC CENTER, INC. (ASSIGNEE OF JECROIS, JEAN), Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 15th Judicial Circuit in and for Palm Beach County. Case No. 50 2013 SC 001486 SB RS. Claim No. 59-0T81-739. August 7, 2014. Edward A. Garrison, Judge. Counsel: Abraham Ovadia, Florida P.I.P. Law Firm, P.A., Boca Raton, for Plaintiff. Matthew N. Grosswald, Roig Lawyers, Deerfield Beach, for Defendant.
FINAL JUDGMENT FOR THE DEFENDANT
THIS CAUSE came forth before the Court for hearing on July 31, 2014 on Defendant, State Farm Mutual Automobile Insurance Company’s Motion for Final Summary Judgment, and after hearing argument of counsel, reviewing the pleadings and record presented, and otherwise being fully advised on the premises, the Court finds as follows:
1. This is an action by Plaintiff, South Florida Imaging & Diagnostic Center, Inc. (assignee of Jecrois, Jean) to recover alleged overdue Personal Injury Protection (PIP) benefits from the Defendant for alleged treatment rendered to Jean Jecrois.
2. On July 20, 2012, Defendant received a bill submitted by the Plaintiff on a CMS-1500 form for alleged MRI services rendered to Jean Jecrois on date of service July 6, 2012.
3. It is undisputed that at the time this CMS-1500 form was received by Defendant, the Plaintiff had indicated in Box 10(b) that the service was not related to an automobile accident. Additionally, the Plaintiff did not submit a corrected bill to Defendant within thirty-five (35) days from the date of service.
4. It is also undisputed that on January 30, 2014, Defendant took the deposition of Plaintiff’s Corporate Representative, Carol Andracchi who testified that the CMS-1500 form was not completed correctly as to all of its material provisions.
5. Florida Statute, §627.736(5)(d), requires that:
“All statements and bills for medical services rendered by any physician, hospital, clinic, or other person shall be submitted to the insurer on a properly completed Centers for Medicare and Medicaid (CMS 1500) form . . . . . For purposes of paragraph (4)(b), an insurer shall not be considered to have been furnished with notice of the amount of covered loss or medical bills due unless the statements or bills comply with this paragraph, and unless the statements or bills are properly completed in their entirety as to all material provisions, with all relevant information being provided therein.”
6. The term “properly completed” has been defined in Fla. Stat. §627.732 (13) as:
[p]roviding truthful, substantially completed and substantially accurate responses to all material elements to each applicable request for information or statement by a means that may lawfully be provided and that complies with this section, or as agreed by the parties.
7. Whether Box 10 of the CMS 1500 form is marked “YES” or “NO” to the question of whether the services are related to an automobile accident is relevant to the claim and therefore, a material provision of the CMS1500/HCFA form. See South Florida Chiropractic Rehab, Inc., d/b/a Boca Spine & Wellness Center, Inc. (Elizabeth K. Mabry) v. United Services Automobile Association, 16 Fla. L. Weekly Supp. 193a (Fla. 15th Jud. Cir., Cty Ct., Palm Beach Cty., November 4, 2008).
8. Plaintiff has failed to demonstrate the existence of a material issue of fact by failing to reveal any counter evidence that the service was related to a motor vehicle accident. Accordingly, the Court finds that Plaintiff failed to provide notice of a covered loss and as such, Defendant’s Motion for Final Summary Judgment is GRANTED and Final Judgment is entered on behalf of the Defendant, State Farm Mutual Automobile Insurance Company. The Plaintiff, South Florida Imaging & Diagnostic Center, Inc. shall take nothing from this action and the Defendant shall go hence without a day. The Court retains jurisdiction for the purpose of any Motion by the Defendant to tax attorney’s fees and costs in this matter.
