23 Fla. L. Weekly Supp. 343a
Online Reference: FLWSUPP 2304CWILInsurance — Personal injury protection — Coverage — Timeliness of claim — Claim originally submitted to wrong carrier — Medical provider’s actions and submittals fell within exception to 30-day billing requirement applicable when providers have been furnished incorrect insurance information by a patient where provider/assignee of uninsured passenger injured in rental car originally submitted claims to two PIP insurers, who denied coverage; provider instituted declaratory action to determine coverage and added rental car company as co-defendant in action when it also denied coverage; during litigation rental car company became aware of reasons why provider had not previously sent statement of charges to company and eventually admitted coverage; and provider sent claim forms to rental car company within 35 days of its admission of coverage
ATLANTIC COAST MEDICAL REHAB, LLC a/a/o CAROLYN WILLIAMS, Plaintiff, vs. ENTERPRISE LEASING COMPANY OF FLORIDA, LLC, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 2011-SC-4720 CC-B. July 30, 2015. Roberto A. Arias, Judge. Counsel: Vincent P. Gallagher, BeachLifeLaw, Neptune Beach, for Plaintiff. Michael Manning, McFarland and Dolan, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTIONFOR SUMMARY JUDGMENT
This cause came on to be heard upon both parties’ Motion for Summary Judgment. Present before the Court appeared Vincent Gallagher, Esquire, for the Plaintiff and Michael Manning, Esquire, for the Defendant, Enterprise Leasing Company of Florida (Enterprise). After having considered arguments of counsel, the filings in the Court file and the affidavits filed in this cause, the Court finds that the Plaintiff’s Motion for Summary Judgment should be Granted. The Court has already entered an order denying Defendant’s Motion for Summary Judgment.
This cause arose out of an accident wherein Carolyn Williams, the Assignor of personal injury protection benefits (PIP) to Plaintiff, suffered injuries as a result of being a passenger of a rental car owned by Enterprise Leasing Company of Florida, LLC, the Defendant. The automobile was being driven by Carolyn Williams’ sister. Her sister was insured by Hallmark Insurance Company. Geico Insurance Company insured the other vehicle involved in the accident. The Assignor, Carolyn Williams, was not required to have automobile insurance, nor did she have any insurance policy that covered her.
When Carolyn Williams went to the Plaintiff for medical treatment, she provided the name of two potential personal injury protection insurers. She provided Hallmark Insurance Company and Geico Insurance Company to the medical provider, Plaintiff herein. The Plaintiff, subsequent to treating the Assignor, submitted claims to both Hallmark and Geico Insurance Companies because it was unknown as to which would be the primary coverage. Geico Insurance Company denied coverage by letters dated April 18th and May 3rd of 2011. The other insurance company, Hallmark Insurance Company, did not respond to the claims made by the Plaintiff and failed to make any payments for the dates of medical treatment provided by the Plaintiff. The Plaintiff thereafter, pursuant to the PIP Statute, submitted pre-suit demand letters to Hallmark and, on December 14, 2011, filed a complaint seeking a declaratory judgment against Hallmark Insurance Company, asking the Court to determine that Hallmark should cover the medical claims subject to this lawsuit.
During the litigation against Hallmark, it became apparent that Hallmark’s Insurance Policy contained language which might exclude insurance coverage for Carolyn Williams. This information came by way of a letter from Hallmark dated September 30, 2011. Coincidentally on that same date, the Defendant, Enterprise, advised Carolyn Williams’ attorneys by letter that Enterprise “provides no insurance to its renters.” The Plaintiff, in March of 2012, added Enterprise as a Co-defendant to the declaratory action which Plaintiff had filed against Hallmark. Enterprise responded to the Complaint by denying that it was responsible for coverage. Eventually, during the litigation of this count for declaratory judgment, the Enterprise admitted the Defendant’s obligation to cover the medical expenses claim for the injuries received as a result of this accident. This notice came by way of an email sent on August 15, 2012 which provided, in part,
“Based on Hallmark’s denial of coverage and our own coverage investigation Enterprise is primary for $10K PIP coverage for passenger Carolyn Williams. Therefore, as we are providing PIP coverage we respectfully request that you dismiss the dec action filed against Enterprise in that it is now moot.”
The Plaintiff had previously, on August 1, 2012 provided to Defendant by way of email, the completed HICFs previously submitted to Hallmark Insurance Company. These HICFs contained all the necessary information which the Defendant could use to process the claims. Additionally, the Defendant had already received a copy of the assignment of benefits executed by Carolyn Williams, before sending its letter affirming coverage. Lastly, on September 13, 2012, well within the 35 days from the date in which the Defendant affirmed coverage to Carolyn Williams, the Plaintiff’s attorney sent the Defendant’s attorney a new set of HICFs specifically addressed to ELCO Administrative Services, Defendant’s claims administrator. The Defendant’s adjustor denied coverage of those claims because they were not timely received within 35 days from the date the provider obtained the correct information to furnish the insurer with a statement of the charges. Thereafter, the Plaintiff sent a pre-suit demand letter to the Defendant. The pre-suit letter was sent after 30 days had lapsed from the date Plaintiff furnished of the HICFs to Enterprise.
In Florida, the personal injury protection (PIP) benefits are the primary compensation of reasonable and necessary medical expenses for a motor vehicle accident. § 627.736(4), Fla. Stat. The PIP statute is the source that guarantee payments of medical expenses from a motor vehicle accident. State Farm Mut. Auto. Ins. Co. v. Pressley, 28 So. 3d 105, 106 (Fla. 1st DCA 2010) [35 Fla. L. Weekly D150b]. The legislature intended through § 627.736(5)(c)(1), Fla. Stat., to impose time limits on the submission of medical bills. The statute also contemplates recovery of payment by medical providers directly from the personal injury protection (PIP) insurer which in turn guarantees injured parties quick payment of medical bills. However an exception to this rule arises when a medical provider does not know the name of the correct insurer, or the patient provides no insurance information at all. In part, the statute states that “the provider has 35 days from the date the provider obtains the correct information to furnish the insurer with the statement of the charges.” It further provides that “the insurer is not required to pay unless the provider includes with the statement documentary evidence that was provided by the insured during the 35 day period demonstrating that the [medical] provider reasonably relied on erroneous information from the insured.” § 627.736(5)(c)(1), Fla. Stat. To fulfill the requirements of the cited section the provider either can submit a denial letter from the incorrect insurer, or proof of mailing reflecting timely mailing to the incorrect address or insurer.
Generally, the provisions of the Florida No-Fault Act are construed liberally in favor of the insured. Farmer v. Protective Casualty Ins. Co., 530 So.2d 356 (Fla. 2d DCA 1988); Florida Med. & Injury Ctr., Inc. v. Progressive Exp. Ins. Co., 29 So. 3d 329 (Fla. 5th DCA 2010) [35 Fla. L. Weekly D215b]. “Legislative intent, as always, is the polestar that guides a court’s inquiry under the Florida No-Fault Law.” United Auto. Ins. Co. v. Rodriguez, 808 So.2d 82, 85 (Fla. 2001) [26 Fla. L. Weekly S747a]. The Legislature’s intent must be determined primarily from the statutory language. Rollins v. Pizzarelli, 761 So.2d 294, 297 (Fla. 2000) [24 Fla. L. Weekly S69a]. If the statutory language is clear and unambiguous, the statute must be given its plain and obvious meaning. Id.
The language of section 627.736(5)(c)1 is clear and unambiguous and, therefore, should be accorded its plain meaning. In this section, the Legislature set forth the exclusive procedures for payment of PIP benefits from the no-fault insurer under a PIP policy. State Farm Mutual Insurance Company v. Pressley, supra at 108.
In Peachtree Cas. Ins. Co. v. Prof’l Massage Servs., 923 So. 2d 548, 549 (Fla. 1st DCA 2006) [31 Fla. L. Weekly D708a] the insured patient was covered by a policy of insurance. The patient obtained treatment from a provider to whom she gave an incorrect name of a different insurance company. The provider timely billed that other insurance company, instead of the correct insurer, for the services. When the healthcare provider discovered the error, and billed the correct insurer, the insurer denied the claims as untimely. The lower courts ruled in favor of the provider under the old version of Fla. Stat. § 627.736(5)(b) (1998). In ruling on the certiorari petition, the court found in favor of the insurer. However the 2001 amendment renumbered section 627.736(5)(b) (1998) to section 627.736(5)(c) and provided an exception to the 30-day billing requirement directly addressing the situation at bar. The exception allows medical providers 35 additional days to submit a claim when they are furnished incorrect insurance information by a patient.
The undisputed facts show that on September 30, 2011 the Defendant, through ELCO Administrative Services, initially denied coverage to Carolyn Williams. Thereafter, the Defendant finally, on August 15, 2012 during the pendency of the declaratory action against the Defendant, notified the Plaintiff that it was providing PIP coverage to Carolyn Williams. It is apparent that the Plaintiff and Carolyn Williams, the Assignor, timely notified all insurance companies and entities including the Defendant, to alert them of her needs for medical treatment and seeking coverage for those expenses. Thereafter, the Plaintiff had no other choice but to engage in litigation after the Insurance Companies and Defendant did nothing more than to claim that someone, other than themselves, was responsible for providing coverage.
The facts are clear and not in dispute that August 15, 2012 was the first time that Enterprise affirmed and communicated they were responsible for the PIP coverage to Carolyn Williams. After Plaintiff had knowledge of the correct insurer, on September 13, 2012, they submitted a set of HICFs addressed to ELCO Administrative Services, Enterprise Claim Administrator, well within the 35 days required by the statute. Furthermore, Enterprise, through this litigation, was made aware of the reasons why the Plaintiff had not previously sent the statement of the charges to Enterprise. Therefore, the Plaintiff’s actions and submittals to Enterprise complied with the requirements of §627.736(5)(c)(1). Desaussure v. Direct General Ins. Co., 18 Fla. L. Weekly Supp. 335a (Fla. 7th Circuit 2011); Bigley and Associates, P.A., v. First Floridian Auto and Home Ins. Co., 22 Fla. L. Weekly Supp. 611a (Fla. 9th Circuit 2014).
For the above stated reasons the Plaintiff’s Motion for Summary Judgment is hereby GRANTED.
