6 Fla. L. Weekly Supp. 779a
Insurance — Personal injury protection — Insurer entitled to summary judgment on claim alleging insurer wrongfully refused to pay medical bills insured incurred for treatment rendered by health care provider — Section 627.736(5)(b) (1998) is clear and unambiguous in requiring that PIP bills be furnished only by provider directly to carrier within thirty (30) days of date of service, which date is measured by postmark on envelope in which bills are transmitted — Health care provider did not submit “Notice of Initiation” to insurer which would extend time within which insurer might be responsible for payment of bills for services rendered — Medical bills, which were not sent to insurer within 30 days of date services were rendered, were untimely pursuant to statute and insurer is relieved of its obligation to pay these bills
CONSUELO S. HOO-MARTINEZ, Plaintiff, vs. STATE FARM FIRE AND CASUALTY COMPANY, Defendant. County Court, 11th Judicial Circuit, in and for Miami-Dade County, General Jurisdiction Division. Case No. 99-2100 CC25 (03). August 18, 1999. Phillip Cook, Senior Judge.
ORDER GRANTING MOTION FOR SUMMARY JUDGMENT AND ENTERING FINAL SUMMARY JUDGMENT IN FAVOR OF DEFENDANT
THIS CAUSE having come before the Court on August 10, 1999 on Defendant STATE FARM FIRE AND CASUALTY’S (“STATE FARM”) Motion for Final Summary Judgment and the Court having considered the pleadings, evidence of record and argument of counsel:
1. The Court finds the following facts:
(a) Plaintiff CONSUELO S. HOO-MARTINEZ (HOO-MARTINEZ) was involved in an automobile accident on November 8, 1998. At the time of her accident, HOO-MARTINEZ was insured by STATE FARM.
(b) HOO-MARTINEZ brought this Personal Injury Protection suit alleging that STATE FARM wrongfully refused to pay medical bills she incurred for treatment rendered by Ralph Martinez, D.C. HOO-MARTINEZ treated with Dr. Martinez from November 10, 1998 to March 1, 1999.
(c) STATE FARM received Dr. Martinez’ bills in a letter from HOO-MARTINEZ’ counsel Mitchell J. Panter. The letter was dated February 8, 1999 but was not postmarked until February 11, 1999. The dates of service for the bills sent by Panter were November 10, 1998 through December 7, 1998 and December 9, 1998 through January 11, 1999.
(d) STATE FARM also received Dr. Martinez’ bills directly from Martinez’ office via facsimile on February 16, 1999. These bills were for services rendered on November 10, 1998 through December 7, 1998.
(e) On February 19, 1999 and February 24, 1999, STATE FARM denied payment for bills dated November 10, 1998 through December 7, 1998, and December 9, 1998 through January 11, 1999 on the grounds that the bills were not submitted to STATE FARM in accordance with Florida Statute 627.736(5)(b), as amended on October 1, 1998.
(f) STATE FARM timely paid Martinez’ bills for services rendered February 8, 1999 through March 11, 1999.
2. The Court makes the following conclusions of law based on the foregoing undisputed facts:
(a) Florida Statute 627.736(5)(b) (1998) provides that:
With respect to any treatment or service . . . the statement of charges must be furnished to the insurer by the providers and may not include, and the insurer is not required to pay, charges for treatment or services rendered more than thirty days before the postmarked date of the statement, except for past due amounts previously billed on a timely basis under this paragraph, and except that, if the provider submits to the insurer a notice of initiation of treatment 21 days after its first examination or treatment of the claimant, the statement may include charges for treatment or services rendered up to, but not more than, 60 days before the postmarked date of the statement. The injured party is not liable for, and the provider should not bill the injured party for, charges that are unpaid because of the provider’s failure to comply with this paragraph.
(Emphasis added).
(b) The Court finds that the foregoing statute is clear and unambiguous in requiring that PIP bills be furnished only by the provider directly to the carrier within thirty (30) days of the date of service, which date is measured by the postmark on the envelope in which the bills are transmitted.
(c) The Court further finds that Dr. Martinez did not submit a “Notice of Initiation” to STATE FARM which would extend the time within which the insurer might be responsible for payment of bills for services rendered.
(d) The Court finds that since it is undisputed that Dr. Martinez did not mail STATE FARM bills for service dates of November 10, 1998 through December 7, 1998 and December 9, 1998 through January 11, 1998 and that neither Dr. Martinez nor Attorney Panter sent STATE FARM these bills within thirty (30) days of the date services were rendered, the bills were untimely pursuant to the statute and STATE FARM is relieved of its obligation to pay these bills.
(e) The Court further finds that because the provider failed to comply with its obligations under the statute, the insured, HOO-MARTINEZ, is likewise relieved of any liability on the unpaid bills. It is therefore
ORDERED AND ADJUDGED that:
(A) STATE FARM’S Motion for Summary Judgment is granted in all respects.
(B) Judgment is hereby rendered in favor of Defendant STATE FARM FIRE & CASUALTY COMPANY and against Plaintiff CONSUELO S. HOO-MARTINEZ.
(C) Plaintiff CONSUELO S. HOO-MARTINEZ shall take nothing by this action and Defendant STATE FARM FIRE & CASUALTY COMPANY shall go hence without day.
(D) This Court reserves jurisdiction to tax attorneys’ fees and costs, if authorized by law.
* * *
