28 Fla. L. Weekly Supp. 405a
Online Reference: FLWSUPP 2805BARR
Insurance — Personal injury protection — Notice of loss — Claim form that omits medical provider’s professional license number is substantially complete and provided insurer notice of covered loss — Insurer that made payment on claim without objecting to missing license number cannot argue that number was material element of claim
HECTOR C. PAGAN, M.D., P.A. as assignee for Clifford Barron , Plaintiff, v. STATE FARM FIRE AND CASUALTY COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 16-2019-SC-010541, Division CC-G. June 10, 2020. Scott Mitchell, Judge. Counsel: Adam Saben, Shuster & Saben, LLC, Jacksonville, for Plaintiff. Eric Shubow, Cole, Scott & Kissane, P.A., Jacksonville, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT and DENYINGDEFENDANT’S MOTION FOR PARTIALSUMMARY JUDGMENT AS TO BOX 31
THIS MATTER comes before this Court for hearing on June 4, 2020 on Cross-Motions for Summary Judgment. This Court, having reviewed the Court file and having heard argument of counsel and being otherwise advised in the premises GRANTS the Plaintiff’s Motion for Summary Judgment and DENIES the Defendant’s Motion for Summary Judgment and finds as follows:
The facts are not in dispute. Plaintiff, PAGAN, treated assignor, Clifford Barron, for injuries sustained in a motor vehicle accident on March 8, 2015. Plaintiff submitted its bill to Defendant, STATE FARM, for one date of service, July 10, 2015. Although the date of service was paid, STATE FARM now alleges that PAGAN’s failure place the treating physician’s license number in Box 31 of the submitted CMS-1500 form fails to place the insurer on written notice of a covered loss, pursuant to Florida Statute 627.736(5)(d)(2016).
Based on the binding precedent of three District Courts of Appeal in United Automobile Ins. Co. v. Professional Medical Group, Inc., 26 So.3d 21 (Fla. 3d DCA 2009) [34 Fla. L. Weekly D2500a] (“Professional Medical”), USAA Cas. Ins. Co. v. Pembroke Pines MRI, Inc., 31 So.3d 234 (Fla 4th DCA 2010) [35 Fla. L. Weekly D613b], and Geico General Ins. Co. v. Tarpon Total Health Care, 86 So.3d 585 (Fla. 2nd DCA 2012) [37 Fla. L. Weekly D1027a], this Court finds that the Plaintiff substantially complied with the requirements to submit a “properly completed” CMS-1500 form and, therefore, STATE FARM was placed on written notice of a covered loss of the bill at issue in this case.1
All three Districts focused on the words “properly completed”, referencing the pip statutes definition of same in section 627.732(13), Florida Statutes (2004):
“Properly completed” means providing truthful, substantially complete, and substantially accurate responses as 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. Id. at 24. (emphasis in original).
The Third District in Professional Medical concluded that “based on the statute’s plain language, a bill or statement need only be ‘substantially complete’ and ‘substantially accurate’ as to relevant information and material provisions in order to provide notice to an insurer.” Id. The Court found that the bills submitted to United Auto were “substantially complete” as to all relevant and material information as required by section 627.736(5)(d). Important to the Court’s decision were the additional facts that, at no time did United Auto object to the missing physician’s license number. In the case at bar, State Farm never took issue with the missing number in Box 31 until after suit was filed. Therefore, State Farm cannot argue that the missing number was a material provision since it in no way prevented the Defendant in its ability to adjust the claim. Therefore, the Defendant’s Motion for Partial Summary Judgment is DENIED and the Plaintiff’s Motion for Summary Judgment is GRANTED.
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1Also see, Hyde Park Medical Center a/a/o Kimberly Coleman v. State Farm Mut. Auto. Ins. Co., Duval Cty. Ct. Case No.: 16-2019-SC-012313-MA-L (Order of Duval County Court Judge Michelle Kalil of March 30, 2020) [28 Fla. L. Weekly Supp. 142a] on the exact same issue.
