5 Fla. L. Weekly Supp. 489a
Insurance — Personal injury protection — Miscalculation of wage loss claim — Failure to pay medical bills within thirty days — Interest — Insured correctly contended that wage benefit calculation should have included amount earned for overtime or extra work — Insured clearly made claim for regular gross income as well as other earning capacity composed of overtime and extra hours by submitting wage and salary verification form with those figures provided, and insurer had affirmative duty to act if it had any question as to validity of overtime and extra hours — Failure to include overtime and extra hours in wage benefit calculations amounted to denial of that part of claim — Insurer liable for difference between wage benefit calculated at higher amount and wage benefit it paid insured, as well as interest on that amount after it became overdue — Medical service benefits — Mail properly addressed, stamped and mailed is presumed to have been received by addressee, and proof of general office practice satisfies requirement of showing due mailing — Insured established prima facie case that insurer received by mail each of disputed medical bills based on general office practices and various cross checks via office procedures, and insurer failed to present sufficient evidence to rebut presumption that it received bills — Attending physician’s report constituted reasonable notice of loss within meaning of statute — Insured entitled to interest on late paid claims
Additional ruling in this case at 5 Fla. L. Weekly Supp. 778a
DENNIS NENTWICK, Plaintiff, v. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 15th Judicial Circuit in and for Palm Beach County. Case No. MS-94-20497-RJ. February 20, 1998. Peter M. Evans, Judge.
FINAL JUDGMENT
This matter came before the court for nonjury trial. The Plaintiff was represented by, Diego Ascensio, Esq. The Defendant was represented by Patrick B. Flanagan, Esquire.
The plaintiff, Dennis Nentwick, was injured in an automobile accident on May 11, 1994. Under his insurance policy with the defendant, United Automobile Insurance Company (UAIC), he made a claim for lost wages and medical benefits emanating from that accident.
The parties stipulated that the defendant insured the plaintiff under an automobile insurance policy which provides no-fault benefits for the subject accident. The policy issued was in full force and effect at the time of the subject accident. All personal injury protection benefits for medical bills and lost wages are overdue if not paid within thirty (30) days after the defendant is furnished with written notice of the covered loss unless the defendant has reasonable proof to establish it is not responsible for the payment. The policy is subject to Chapter 627 of the Florida Statutes.
The plaintiff makes two claims. First, he claims his wage loss claim for three days was incorrectly calculated resulting in a $42.05 underpayment. Second, it is claimed that nine bills for treatment from three health care providers were received by the defendant and not paid within the thirty days required by statute. The plaintiff also claims interest on all late payments. Under the terms of the policy all overdue no-fault benefits must bear simple interest at the rate of ten (10%) per year.
The medical claims at issue concern nine bills from three health care providers that the plaintiff maintains were sent to the defendant. The defendant claims to have not received these bills until after the law suit was filed. The original complaint was filed on December 28, 1994. The plaintiff alleges that the defendant did not pay the following bills within 30 days of their receipt and, therefore, they are overdue pursuant to F.S. §627.736(4):
1. Kastein’s bill for 8/29 to 8/31 ($150)
Date plaintiff claims it was mailed: September 9, 1994
Date defendant claims they received notice of charge: January 30, 1995
Date defendant paid claim: February 3, 1995
2. Warsett’s bill for 9/12 ($1395).
Date plaintiff claims it was mailed: September 17, 1994
Date defendant claims they received notice of charge: January 30, 1995
Date defendant paid claim: February 3, 1995
3. Kastein’s bill for 9/7 to 9/14 ($225)
Date plaintiff claims it was mailed: October 4, 1994
Date defendant claims they received notice or charge: January 30, 1995
Date defendant paid claim: February 3, 1995
4. Kastein’s bill for 9/21 to 9/26 ($150)
Date plaintiff claims it was mailed: October 4, 1994
Date defendant claims they received notice of charge: January 30, 1995
Date defendant paid claim: February 3, 1995
5. Gold Coast bill for 11/2 ($170)
Date plaintiff claims it was mailed: November 10, 1994
Date defendant claims they received notice of charge: May 18, 1995
Date defendant paid claim: June 12, 1995
6. Kastein’s bill for 10/3 to 10/19 ($225)
Date plaintiff claims it was mailed: November 4, 1994
Date defendant claims they received notice of charge: January 30, 1995
Date defendant paid claim: February 3, 1995
7. Kastein’s bill for 10/26 ($75)
Date plaintiff claims it was mailed: October 26, 1994
Date defendant claims they received notice of charge: January 30, 1995
Date defendant paid claim: February 3, 1995
8. Kastein’s bill for 11/2 ($75)
Date plaintiff claims it was mailed: December 7, 1994
Date defendant claims they received notice of charge: January 30, 1995
Date defendant paid claim: February 3, 1995
9. Golf Coast bill for 12/14 ($170) (D Ex #8, Pl Ex #33)
Date plaintiff claims it was mailed: December 21, 1994
Date defendant claims they received notice of charge: May 18, 1995
Date Defendant paid claim: June 12, 1995
A nonjury trial was conducted before the court. Both the plaintiff and defendant put on witnesses and provided other evidence. The witnesses included: Evelyn Gonzalez, who works for Dr. Kastein, one of the Plaintiff’s medical service providers; Dwayne Warsett, one of the plaintiff’s medical service providers; Joseph Costello, representing another of the plaintiff’s medical service providers; Scott Armand, General Manager, Hulett Environmental Services, the plaintiff’s employer; the plaintiff; Tara Davies, employee of Cooksey & Cooksey, P.A., the law firm representing the plaintiff in this matter; James Cooksey, attorney from Cooksey & Cooksey; and Antonio Martin, an adjuster with UAIC.
Issues
A. Was the wage loss benefit calculated correctly by the defendant?
B. Given the facts of this case and the legal presumptions regarding receipt of mail, when did the defendant receive sufficient notice of the nine contested medical charges?
C. Was Dr. Kastein’s Attending Physician’s Report “written notice of the fact of a covered loss” within the meaning of F.S. §627.736(4)(b)?
Wage Loss Benefit
The defendant requested that the plaintiff’s employer provide sworn proof of any lost time from work and the plaintiff’s average weekly wage by forwarding a Wage and Salary Verification Form (WSVF) to the plaintiff in its PIP package. The form was completed by an employee of Hulett Environmental Services, the plaintiff’s employer. Plaintiff’s Exhibit #41. It is undisputed that the defendant received this form. It is also undisputed that the plaintiff is entitled to benefits for three days of lost wages.
The WSVF contains two columns of figures, to wit: “Amount Earned Including Overtime or Extra Work” and “Gross Earnings.” The defendant used the “Gross Earnings” figures to calculate the plaintiff’s wage benefit. The plaintiff maintains that the defendant should have used the “Amount Earned Including Overtime or Extra Work” figures, which are for larger amounts.
Chapter 627.736(1)(b), Florida Statutes states that the disability benefits shall be “sixty percent of any loss of gross income and loss of earning capacity.” The relevant Insurance Rules state:
1. Gross income shall be determined as provided in the Worker’s Compensation Law (Sec. 44.14). In the typical case, this means taking an average of the prior thirteen weeks’ earnings to establish an average weekly wage.
2. “Loss of earnings capacity” means loss of income which the injured person may reasonably show would have been earned except for the injury.
Fl. Admin Code, r.4-176.010.
The defendant maintains, via testimony by the adjuster, that it did not know what the larger numbers represented and that is why the adjuster did not use those figures when calculating the lost wage benefit. According to the unrefuted testimony at trial the adjuster never made any inquiry regarding the figures in that column. The adjuster calculated the benefit based on the “Gross Income” column alone and a draft in the amount of $134.01 was issued in the plaintiff’s favor on November 8, 1994.
The plaintiff maintains that the wage benefit should be based on the column that includes overtime and extra hours, as this represents the plaintiff’s gross income and earning capacity.
The plaintiff has the stronger position. The statute and regulations clearly state that the benefit is not limited to “gross income.” The statute includes both gross income and loss of earning capacity. F.S. §627.736(1)(b). When read in conjunction with the definition of earning capacity provided in the insurance regulations it is clear that overtime and extra hours should be included in the benefit calculation. Fla. Admin. Code, r.4-176.010(1) & (2); see also, Stewart v. Allstate Insurance Company, 618 So.2d 771, 773 (Fla. 5th DCA 1993) (the statute’s use of the term “gross income” rather than “net income” or earnings indicates the Legislature intended a liberal rather than restrictive interpretation).
Further, a number of Florida decisions support this interpretation. In Davidson Lumber Co. v. Smith, 390 So.2d 1221, 1222 (Fla. 1st DCA 1980), the court held that the calculation of average weekly wage for a worker’s compensation claim should have been based on full-time weekly wages, including overtime. See, Stewart, 618 So.2d at 773 (courts frequently look to the analogous provisions of the workers compensation law for guidance in interpreting the no-fault provisions of Chapter 627). In Sphinx Enterprises, Inc. v. Santa Cruz, 561 So.2d 1348 (Fla. 1st DCA 1990), the court held that the calculation for average weekly wage should also include tips and unreported wages for a worker’s compensation claim. See also, Preferred Aircraft Painting and CNA v. Duarte, 532 So.2d 715, 716-17 (Fla. 1st DCA 1988) (painter’s tips should be included).
The plaintiff clearly made a claim for his regular gross income as well as other earning capacity composed of overtime and extra hours by submitting the WSVF with those figures provided. If the defendant had a question as to the validity of the overtime and extra hours or whether it was an amount that the plaintiff reasonably would have earned, the defendant had the duty to affirmatively act. See, Martinez v. Fortune Ins. Co., 684 So.2d 201, 203 (Fla. 4th DCA 1996) (the burden is clearly upon the insurer to authenticate a claim within the statutory time period). The defendant should have made an inquiry if there was a question or some confusion. However, the defendant did not, The defendant denied that part of the claim by excluding those amounts from the calculation.
The plaintiff proceeded with a claim under the contract of insurance and F.S. §627.736(4) for an improper denial of benefits. The defendant is responsible for the entire amount of the claim unless he has “reasonable proof” to establish that he is not responsible for all or a portion of the claim. See, Id. The defense that the adjuster did not understand the information on the WSVF does not appear to meet this standard. Therefore, the defendant is liable for $42.50, the difference between the wage benefit calculated at the higher amount and calculated at the lower amount, as well as 10% simple interest on that amount after it became overdue. F.S. §627.736(4)(c).
Normally, benefits become due thirty days after the insurer is furnished written notice. F.S. §627.736(4)(b). In this case, the insurer was notified in writing of the claim in June or July of 1994, however, pursuant to the plaintiff’s request the defendant withheld the wage loss payments until the plaintiff’s policy deductible was met with medical bills. Therefore, the $42.50 became due on the date that the incorrect amount was paid. The accrued interest on this amount to date is $13.70.
Any argument that the defendant could make regarding some duty of the plaintiff to attempt to clarify any confusion by the defendant regarding the figures on the form before filing a law suit for overdue payment is not persuasive. The defendant has maintained all along and continuing through trial that their calculation is based on the correct figures even when confronted with the plaintiff’s interpretation. Further, there is nothing in the statute that provides an exception to the defendant’s liability for an overdue payment based on an error in interpreting the information on a notice of claim. Accord, Crooks v. State Farm Mut. Auto. Ins. Co., 659 So.2d 1266, 1268 (Fla. 3d DCA 1995) (trial court cannot create an exception to 627.736(4)(b) that does not exist); Martinez, 684 So.2d at 203 (insurers duty to authenticate).
Medical Service Benefits
The plaintiff maintains that, pursuant to Chapter 627, he need only prove that the defendant was furnished with “written notice of the fact of a covered loss and the amount of the same” in order to prevail on his claim for overdue payment of benefits. See, F.S. §627.736(4)(b). There appears to be no dispute as to whether the bills are for necessary treatments or that the charges are reasonable, therefore, plaintiff’s characterization of the issue is correct. In fact, all of benefits based on those bills have been paid, the only remaining issue is whether the payments were overdue.
The defendant maintains that it did not receive notice of any of the nine bills until January 30, 1995, subsequent to the filing of the law suit. Further, that all of the bills, except the Gold Coast bill, were paid on February 3, 1995, which, as calculated by the defendant, is within the 30 days required by Chapter 627. Defendant’s Memorandum in Lieu of Closing Arguments, at 2-3. According to the defendant, the Gold Coast claim which included both bills 5 & 9 by Gold Coast was received on May 18, 1995, but was paid within 30 days of receipt.
The plaintiff maintains that all of the bills were sent at various dates prior to January 30, 1995. That in each case the defendant did not pay the benefit within 30 days as required by Chapter 627, but only after the law suit was filed. He relies on the presumption of receipt to establish the defendant’s liability.
It is settled law that mail properly addressed, stamped, and mailed is presumed to have been received by the addressee, and that proof of general office practice satisfies the requirement of showing due mailing in each specific instance. Borwn [Brown] v. Giffen Industries, Inc., 281 So.2d 897 (Fla. 1973); Eckert v. Allstate Insurance Co., 472 So.2d 807 (Fla. 4th DCA 1985). The proponent need not show that the routine practice was actually followed in the particular instance at issue for the presumption to arise. Since a requirement that there be proof that the practice was actually performed would place an impossible burden on any business, a general presumption has arisen in the courts that the ordinary course of business or conduct was followed in a particular case absent a contrary showing. 31A C.J.S. Evidence §139. Borwn [Brown], 281 So.2d 897; Progressive American Insurance Co. v. Kurtz, 518 So.2d 1339 (Fla. 5th DCA 1987); Fl. R. Evid. §90.406 (sponsor’s note specifically states that the routine practice of an organization is admissible to prove that the organization acted in conformity with that routine on the instance in controversy).
For the presumption to arise you must provide evidence that the mail was sent to the correct address. Star Lakes Estates Association, Inc. v. Auerbach, 656 So.2d 271 (Fla. 3d DCA 1995). If the prima facie elements of the presumption are met and no evidence is presented to contradict the presumption, the plaintiff is entitled to a finding of receipt. See, Borwn [Brown], 281 So.2d 897 (Fla. 1973). However, if evidence is presented to contradict any of the elements necessary to establish the presumption, the fact of receipt becomes a question of fact for the fact finder. Scutieri v. Miller, 584 So.2d 15, 16 (Fla. 3d DCA 1991).
To overcome the presumption, credible evidence sufficient to sustain a finding of the nonexistence of the presumed fact must be introduced. Eckert, 472 So.2d at 809. Failure to remember whether something is received is usually considered insufficient to overcome the presumption of receipt, as is also the impression that it was not received. Id. Denial by the alleged recipient is sufficient to create a question of fact, however, denial of receipt does not automatically overcome the presumption. It simply creates a question of fact that must then be resolved by the trial court. The defendant may then attempt to prove it was not received. W.T. Holding, Inc. v. State Agency for Health Care Administration, 682 So.2d 1224, 1225 (Fla. 4th DCA 1996); Scutieri, 584 So.2d at 16.
Analyzing each of the bills / claims at issue it appears that the plaintiff has established a prima facie case for the presumption of receipt as to each of the claims based on general office practices and various cross checks via office procedures. However, the defendant has also presented evidence that attempts to contradict the presumption. Therefore, the trier of fact must weigh all the circumstances of the case to determine if the bills and claims were actually received. See, Camerota v. Kaufman, 666 So.2d 1042, 1045 (Fla. 4th DCA 1996).
The defendant makes a general denial as to all of the claims and asserts that none of the items were received until after the law suit was filed. The evidence for this claim is that none of the contested bills are in the claim file therefore they must not have been received. However, the plaintiff has provided evidence, via testimony from the defendant’s employees, that there is no mail intake system utilized by the company that logs incoming mail or that tracks mail within the company. Therefore, if mail were lost or destroyed after receipt, there would be no record of such nor any way to discover this via an internal investigation by the company.
DR. KASTEIN’S FOUR (4) CLAIMS
(Bills 1, 3, 4, 6, 7, 8)
Evelyn Gonzalez testified that she has worked for Dr. Kastein for 7 years and 8 months and that her duties include personally and physically making sure that claims are properly sent to insurance companies and that accurate records are maintained of sending claims to insurance companies. Gonzalez described a methodical and well-organized procedure with checks and cross-checks. She testified that it is her general and routine office procedure to maintain a written and contemporaneous log sheet that shows the patient’s name, the name and address or the patient’s insurance company, the date on which she mailed the claim to the insurance company, and the corresponding treatment dates. (Plaintiff’s exhibit #35).
Gonzalez testified that she personally and carefully put the envelopes together for Mr. Nentwick’s claims and that she is certain that she mailed each and every claim form. Gonzalez duly recorded the amount and date of mailing in her log for each and every claim submitted to Defendant. All of the claims submitted by Ms. Gonzalez, including the four claims at issue listed in the Facts section above, each mailed on a different date, appear on Ms. Gonzalez’s log (Plaintiff’s Exhibit #35).
In addition to her patient log, Gonzalez testified that she wrote the date of the mailing of claims to insurance companies on the claims forms themselves when they were mailed out (Plaintiff’s exhibit 37). All of the claims forms submitted by Ms. Gonzalez, including the four “missing” claims each mailed on a different date, have the notation of the date of mailing upon them.
Defendant admitted receiving Dr. Kastein’s claims for medical services rendered to Mr. Nentwick in June, 1994, which were applied to Mr. Nentwick’s deductible. This fact supports Ms. Gonzalez’s testimony that she indeed, early on, had possession of the correct claim information and address. There was no evidence that Ms. Gonzalez at some point modified the address.
Evelyn Gonzalez’s testimony established a prima facie case that she followed her normal and ordinary procedure with respect to the submittal of Mr. Nentwick’s claims and that the four claims at issue were mailed.
The defendant attempts to rebut this presumption with several arguments. First, there was a computer problem around the time of the relevant billing, therefore, one could argue that normal office procedures were not followed. As evidence of this Ms. Gonzalez did testify that some bills were manually typed rather than printed on the computer. This was the reason she gave for not having multiple copies of some bills in the file. Further, the fact that Ms. Gonzalez did not follow up with the insurer when payment on the bills became overdue implies that normal office policies were not followed. Ms. Gonzalez, testified however, that although she calls insurance companies after claims have become overdue as part of her normal procedure, and she did not remember calling the defendant for Mr. Nentwick’s claim, she would have no need to call the insurance company and complain because she was cognizant that Mr. Nentwick’s PIP coverage was subject to a $2,000.00 deductible and therefore no benefits would have otherwise been due.
DR. WARSETT’S CLAIM (Bill 2)
Dr. Warsett testified that on September 17, 1994, his claim form (Plaintiff’s Exhibit 38) and reports were mailed to Defendant in accordance with his office’s normal and customary procedures. Dr. Warsett testified that his office obtained the name, address and claim number from the referring physician, Dr. Kastein. This information was noted in Dr. Warsett’s appointment book. This information is also noted in Dr. Warsett’s ledger notes (Plaintiff’s Exhibit “40”). Dr. Warsett testified that the claim forms were prepared by his wife, Gwenn Warsett, and mailed to Defendant by her on September 17, 1994 (at trial, defense counsel stipulated that Mrs. Warsett’s testimony would support Dr. Warsett’s testimony that she mailed the claim forms on September 17, 1994).
Dr. Warsett also testified that it is his office’s customary practice to maintain a contemporaneous dated ledger card (see Plaintiff’s exhibit #40) for each patient to memorialize, among other pertinent information, the date that claims are mailed to insurance companies. The notation “ins” is written after the date the claim is mailed to denote that on that date the claims were mailed to the insurance company. Dr. Warsett’s testimony established a prima facie case that his office followed its normal and ordinary procedure with respect to the submittal of Mr. Nentwick’s claims.
The ledger maintained by Dr. Warsett for Mr. Nentwick shows that on September 17, 1994, claims were mailed to Defendant, in accordance with Dr. Warsett’s testimony. After having received no payment or any other inquiry from Defendant, Dr. Warsett personally telephoned Tony Martin on November 2, 1994 to inquire about his claim. Dr. Warsett testified that Martin told him that he (Martin) would check to see our bill was received and will call back. Dr. Warsett noted a summary of his conversation with Martin in the ledger he maintained for Mr. Nentwick (See Plaintiff’s Exhibit 40). After receiving no call back from Martin or any other inquiry, Dr. Warsett called Defendant again on November 9, 1994 and left a message, however, no one called him back or otherwise communicated with him. Likewise, Dr. Warsett made a note of his November 9, 1994 telephone call to Defendant in the ledger he maintained for Mr. Nentwick (See Plaintiff’s Exhibit 40).
The plaintiff has established a prima facie case for the presumption of receipt.
The defense attempts to rebut the presumption with the following evidence. First, Martin, the adjuster, testified that he does not recall Dr. Warsett’s telephone calls. Second, Dr. Warsett’s wife is the office manager, however, Dr. Warsett monitored and followed up on the plaintiff’s bills. Therefore, according to the defendant, this is evidence that the normal office procedures were not followed. However, there is no evidence regarding how often Dr. Warsett does the billing and if in fact this is not normal. The defendant also maintains that because Dr. Warsett did not log the mailing of the duplicate bill that he sent to the attorney Cooksey’s office this is additional evidence that indicates that normal office procedures were not followed. Again, however, there is no evidence that logging duplicates sent to the attorney is normal office procedure. The Dr.’s testimony was that duplicates sent to insurer’s were logged.
GOLD COAST ORTHOPEDIC’S TWO CLAIMS
(Bills 5 and 9)
Linda Shankowitz’s deposition was entered into evidence. She had worked for Gold Coast Orthopedics for one and a half years as a trained billing clerk. Ms. Shankowitz testified that Mr. Nentwick’s file was handled in accordance with standard and customary office procedure. Ms. Shankowitz testified that a claim form for Mr. Nentwick’s November 2, 1994 office consultation with Dr. Arlosoroff was printed out on November 4, 1994 and was mailed to Defendant within two days thereafter together with Dr. Arlosoroff’s office notes (SHAN 14, 16, 17). Ms. Shankowitz testified that a claim form for Mr. Nentwick’s December 14, 1994 office consultation with Dr. Arlosoroff and medical reports were mailed to Defendant on December 21, 1994 (SHAN 17). Defendant maintains that he did not receive either of these original claim submittals.
The defendant did, however, admit receiving Gold Coast Orthopedics’ claims for medical services rendered to Mr. Nentwick on September 30, 1994, which pre-dated the two “missing” claims. In fact, Defendant paid the PIP benefits for this claim. This supports the fact that Ms. Shankowitz had possession of all of the pertinent information necessary to correctly mail the subsequent “missing” claims to Defendant.
Ms. Shankowitz’ testimony established prima facie evidence for the presumption of receipt.
The defendant attempts to rebut this presumption by an apparent anomaly in the billing. Apparently it is the normal office procedure to identify a resubmission with an “x” on the form. The bill generated March 28, 1995 does not have an “X” which is some evidence that it is not a resubmission, but rather, the first billing. The defendant maintains that this is the first notice of that claim received and that it was not received until May 18, 1995.
The court feels that the evidence looked at in its entirety, shows by a preponderance of the evidence that the bills were mailed in the normal course of business by the three different medical care providers and subsequently received by the defendant.
Dr. Kastein’s Attending Physician’s Report (APR).
The plaintiff maintains that the defendant was in receipt of reasonable “notice” of the covered loss, within the meaning of F.S. §627.736(4), when it received Dr. Kastein’s September 12, 1994 APR. Plaintiff’s Exhibit #16. The plaintiff contends that the defendant should have considered the form’s $1,335.00 “total charge to date” figure as an actual billing by Dr. Kastein. Therefore, the defendant should have either paid on it or applied it to the deductible. The defendant, on the other hand, maintains that it acted properly by not considering the document as “proof of claim” and, therefore, not applying the $1,335.00 of reported charges to the deductible or paying on it. The defendant waited for future submissions before doing either.
In Martinez, 684 So.2d at 202, the court carefully analyzed the language of F.S. §627.736 and found that under this provision the insurer is obligated to pay based on receipt of “written notice” of a loss rather than “proof” of a loss.
… . The insurance company has thirty days in which to verify the claim after receipt of an application for benefits. There is no provision in the statute to toll the time limitation. The burden is clearly upon the insurer to authenticate the claim within the statutory time period. …
Id., citing, Dunmore v. Interstate Fire Insurance Co., 301 So.2d 502 (Fla. 1st DCA 1974). Therefore, if the APR provides sufficient information to put the insurer on notice of the claim, it should have been applied to the deductible or paid upon within 30 days.
New Hampshire Indemnity Company v. Pinnacle Medical Inc., 4 Fla. L. Weekly Supp. 753a (Fla. 9th Circ. 1997) is instructive as to what constitutes “sufficient notice.” In that case a Health Insurance Claim Form was scrutinized to identify if it contained sufficient information to put the insurer on notice of the claim. The document contained: 1) an indication that the insured’s condition was related to an auto accident; 2) a date that was either the date of injury or date of accident; 3) identifying information of the insured; 4) the claim number that the insurer assigned to the claim and 5) the amount of the loss. See also, Crooks, 659 So.2d at 1268 (letter sent to insurer listing the itemized bills for three medical providers was sufficient to satisfy notice of claim pursuant to F.S. §627.736(4)(b), even though insurer required the use of specific in-house claim form). The bottom line is whether the insurer was notified in writing of the relevant charges.
By applying these decisions to the facts of this case it appears that the APR was sufficient to constitute “reasonable notice” of loss within the meaning of F.S. §627.736(4). It provides the plaintiff’s name in the box “our policyholder” and provides identifying information about the plaintiff. It describes the accident, lists the plaintiff’s condition and provides the date that symptoms appeared. It states the dates that the patient was disabled and states the total amount of the “charge to date.” The $1,335 should therefore have been applied to the deductible or paid pursuant to the terms of the contract and Chapter 627 within 30 days of receipt. It was the defendant’s responsibility to authenticate or verify the document during that time. Martinez, 684 So.2d at 202; Crooks, 659 So.2d at 1268.
Based upon the foregoing The Court makes the following findings:
1. The Court finds for the plaintiff on the wage loss benefit claim and orders the defendant to pay the difference in the amount, $42.50, plus simple interest at 10% annually since November 11, 1994. Therefore, the $42.50 became due on the date that the incorrect amount was paid. The accrued interest on this amount to date is $13.94.
2. Dr. Kastein’s Attending Physician’s Report received by the defendant in May of 1994 is sufficient as “written notice of the covered loss” within the meaning of F.S. §627.736(4)(b). Therefore, the $1,335 “total charge” on that document should have been applied to the plaintiff’s deductible or paid out within 30 days of receipt. Dr. Kastein’s covered charges became overdue on November 27, 1994 (date deductible met) and interest is due on the covered losses in the amount of $19.40.
3. As to the medical benefit claims, the evidence supports a finding for the plaintiff that the bills and claims in question were received by the defendant shortly after the dates that the plaintiff claimed that they were mailed. Therefore, the payments were overdue and the court shall order the payment of interest. The total interest due on those late paid claims is $63.72.
Based upon the foregoing it is thereupon:
ORDERED AND ADJUDGED as follows:
1. Plaintiff, DENNIS NENTWICK, recover from defendant, UNITED AUTOMOBILE INSURANCE COMPANY, the sum of $97.06, which shall bear interest at the rate of 10% for the current year and thereafter at the prevailing rate per year as provided for by Florida Statutes, for all of which let execution issue.
2. The Court retains jurisdiction for the taxing of attorneys fees and costs pursuant to F.S. §627.736(8) and F.S. §627.428.
* * *
