28 Fla. L. Weekly Supp. 524b

Online Reference: FLWSUPP 2806MART

Insurance — Personal injury protection — Standing — Assignment — Insurer waived any right to contest medical provider’s standing based on provider’s failure to attach valid assignment of benefits to demand letter where insurer did not apprise provider of alleged deficiency in assignment when it received demand letter, but instead issued payment for additional benefits and interest — Assignment correctly identifies sole owner of medical provider

CENTRAL FLORIDA HEALTH, INC., d/b/a THE VILLAGES REGIONAL HOSPITAL, a/a/o Shawn Martin, Plaintiff, v. PROGRESSIVE SELECT INSURANCE COMPANY, Defendant. County Court, 7th Judicial Circuit in and for Volusia County. Case No. 2019 14712 CODL. August 12, 2020. Angela A. Dempsey, Judge. Counsel: William S. Barr, Chad Barr Law, Altamonte Springs, for Plaintiff. Rhamen Love-Lane, Orlando, for Defendant.

ORDER DENYING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AND MOTION FOR PROTECTIVE ORDER

THIS MATTER came before the Court on August 5, 2020 on Defendant’s Motion for Summary Judgment and Motion for Protective Order as to Plaintiff’s standing under the subject assignment and satisfaction of condition precedent, and being considered by the Court and otherwise being fully advised of the premises, the Court finds as follows:

1. This is a claim for PIP benefits arising out of a motor vehicle collision that occurred on or about 8/15/2014 involving Shawn C. Martin.

2. Defendant issued a policy of insurance which provided $10,000.00 in PIP coverage to Shawn C Martin for the above accident.

3. Defendant received Plaintiff’s bill for emergency services and reduced the charged amount of $2,155.32 by 75% ($1,616.49) prior to applying the alleged $1,000 deductible.¹ After application of the fee schedule amount to the alleged deductible, Defendant issued a check for $493.20 made payable to “VILLAGES REGIONAL HOSPITAL.”

4. On or about May 23, 2019, Plaintiff submitted a Demand Letter for benefits to Defendant and attached the Plaintiff’s bill, Plaintiff’s Assignment of Benefits, and a copy of the check for the prior payment.

5. On or about 6/26/2019, Defendant revisited the Plaintiff’s Demand Letter for additional benefits. Defendant advised that would issue additional benefits in order to comply with the mathematical calculation pursuant to Progressive Select Ins. Co. v. Florida Hospital Med. Ctr., 2018 WL 6816810 (Fla. 2018) [44 Fla. L. Weekly S59a]. Defendant’s response to Plaintiff’s Demand Letter does not appear on its face to raise any defect or deficiency in Plaintiff’s claim to benefits for the emergency services rendered to Shawn Martin on 8/15/2014.

6. Defendant tendered a second payment for the subject bill in response to Plaintiff’s Statutory Demand Letter under Section 627.736(10), in the amount of $245.81 ($200 benefits and $45.81 interest) with a check made payable to “VILLAGES REGIONAL HOSPITAL AND CENTRAL FLORIDA HEALTH, INC DBA THE VILLAHES REGIONAL HOSP.”

7. On or about 7/11/2019, Plaintiff filed suit as CENTRAL FLORIDA HEALTH, INC d/b/a THE VILLAGES REGIONAL HOSPITAL a/a/o Shawn Martin.

8. On or about 8/21/2019, Defendant filed an Answer and Affirmative Defenses, raising four defenses. The First Affirmative Defense and the Fourth Affirmative Defense are the subject of Defendant’s Motion for Summary Judgment before the Court, and they state, 1) The Villages Regional Hospital is a fictitious business name owned by The Villages Tri-County Medical Center, Inc. — not Central Florida Health, Inc. Accordingly Plaintiff does not possess the requisite standing to maintain the subject cause of action; and 2) Plaintiff failed to comply with Florida Statute §627.736(10), by submitting a pre-suit demand letter without a valid assignment of benefits included/attached.

9. The parties agree that the Assignment of Benefits at issue explicitly identifies Central Florida Health Alliance, Leesburg Regional Medical Center, Inc., and The Villages Health System and that the assignment was executed by Shawn C. Martin.

10. The parties submitted numerous Requests for Judicial Notice of the corporate records maintained by the Florida Division of Corporations and this Court takes notice of same pursuant to Florida Statutes 90.202 and 90.203.

11. After reviewing the facts, argument and evidence in the record, this Court concludes that Central Florida Health, Inc. is the sole owner of The Villages Tri-County Medical Center, Inc., Central Florida Health Alliance, The Villages Health System and The Villages Regional Hospital at all times material hereto and Plaintiff has standing to pursue the benefits claimed due in this matter.

12. The Court concludes that Defendant issued payment to Central Florida Health, Inc. d/b/a The Villages Regional Hospital after receipt of the subject Assignment of Benefits.

13. This Court adopts the reasoning and conclusions set forth in Emergency Physicians, Inc. d/b/a Emergency Resources Group a/a/o Judith Rainwater v. USAA Casualty Insurance Company, 24 Fla. L. Weekly Supp. 64a (Judge Green March 14, 2016) affirmed by USAA Casualty Insurance Company v. Emergency Physicians, Inc. d/b/a Emergency Resources Group a/a/o Judith Rainwater, 25 Fla. L. Weekly Supp. 410a (Volusia County Circuit Appellate July 20, 2017); Emergency Physicians, Inc. d/b/a Emergency Resources Group a/a/o Brianna Spath v. USAA Casualty Insurance Company, Volusia County Case Number 2015 21118 CONS (Judge Green March 14, 2016) affirmed by USAA Casualty Insurance Company v. Emergency Physicians, Inc. d/b/a Emergency Resources Group a/a/o Brianna Spath, 25 Fla. L. Weekly Supp. 410b (Volusia County Circuit Appellate July 20, 2017); Emergency Physicians, Inc. d/b/a Emergency Resources Group a/a/o Bradley Roseberry v. USAA General Indemnity Company, Volusia County Case Number 2015 21218 CONS (Judge Green July 6, 2016) affirmed by USAA General Indemnity Company v. Emergency Physicians, Inc. d/b/a Emergency Resources Group a/a/o Bradley Roseberry, 25 Fla. L. Weekly Supp. 411a (Volusia County Circuit Appellate July 20, 2017); Emergency Physicians, Inc. d/b/a Emergency Resources Group a/a/o Danielle Strong-Robinson v. Garrison Property and Casualty Insurance Company, Volusia County Case Number 2015 21117 CONS (Judge Green March 14, 2016) affirmed by Garrison Property and Casualty Insurance Company v. Emergency Physicians, Inc. d/b/a Emergency Resources Group a/a/o Danielle Strong-Robinson, Volusia County Case No. 2016-10010-APCC (Volusia County Circuit Appellate July 20, 2017); Emergency Physicians, Inc. d/b/a Emergency Resources Group a/a/o Jerry Solich v. United Service Automobile Association, 25 Fla. L. Weekly Supp. 54b (Judge Green January 5, 2017) affirmed by United Services Automobile Association v Emergency Physicians, Inc. d/b/a Emergency Resources Group a/a/o Jerry Solich, Case Number 2017-10006 APCC (Volusia County Circuit Appellate December 6, 2017); Emergency Physicians, Inc. d/b/a Emergency Resources Group a/a/o Florence Freemnan v. USAA Casualty Insurance Company, 24 Fla. L. Weekly Supp. 546a (Judge Green September 9, 2016) affirmed by USAA Casualty Insurance Company v. Emergency Physicians, Inc. d/b/a Emergency Resources Group a/a/o Judith Rainwater, Case Number 2016-10044-APCC (Volusia County Circuit Appellate November 2, 2017). The Court concludes that the Plaintiff hospital is controlled and governed by EMTALA and FAEC and the supremacy clause and waiver analysis of the aforementioned cases is likewise adopted by this Court.

It is hereby ORDERED AND ADJUDGED that:

1. Defendant’s Motion for Summary Judgment regarding the First and Fourth Affirmative Defenses is hereby DENIED.

__________________

¹The Plaintiff disputes whether the deductible applies to the patient, Shawn C. Martin.