6 Fla. L. Weekly Supp. 573c
Insurance — Error to terminate no fault insurance benefits based on insured’s refusal to submit to independent medical examination — With regard to first scheduled examination, insured was never notified by insurer of its decision to utilize a particular entity to perform an independent medical examination and did not inform insured that she was required to comply with the request made by that entity for an IME — First IME was not scheduled in municipality where insured resided or where insured was receiving treatment — With regard to second scheduled examination, it was not unreasonable for insured to become confused as to where and when she was to submit to IME in view of conflicting communications — Medical bills, penalties, and interest awarded to assignee
SOUTHEAST HEALTH CARE As assignee of MELISSSA MOSES, Plaintiff, vs. OCEAN HARBOR CASUALTY INSURANCE COMPANY, Defendant. County Court of 15th Judicial Circuit in and for Palm Beach County. Case No. MS 97-8006 RF. March 29, 1999. Jeffrey J. Colbath, Judge.
FINAL JUDGMENT
This action was tried before the court. On the evidence presented
FINDINGS OF FACT:
1. The Defendant, OCEAN HARBOR CASUALTY INSURANCE COMPANY, never notified its insured, Melissa Moses, of their decision to utilize JBA Medical to perform Independent Medical Examinations and of her obligation to comply with their requests for Independent Medical Examinations.
2. The Defendant, OCEAN HARBOR CASUALTY INSURANCE COMPANY, scheduled an independent Medical Examination, through JBA Medical by way of letter to Melissa Moses dated March 12, 1997, for an examination to be conducted on April 3, 1997, in Coral Springs, Florida. Melissa Moses is charged with knowledge of this examination. However, Melissa Moses did not unreasonably refuse to attend this examination in that Melissa Moses was never notified by the Defendant, OCEAN HARBOR CASUALTY INSURANCE COMPANY, that she must comply with the request of JBA Medical for an Independent Medical Examination and the location of the examination violated Florida Statute Section 627.736(7)(a), in that it was not scheduled in a municipality of residence, Coconut Creek, Florida, or where Melissa Moses was receiving treatment, Fort Lauderdale, Florida.
3. The Defendant, OCEAN HARBOR CASUALTY INSURANCE COMPANY, scheduled a second Independent Medical Examination for April 10, 1997, once again through JBA Medical and without notifying Melissa Moses of her obligation to comply with the request of JBA Medical. The examination was scheduled in a proper municipality, Fort Lauderdale, Florida. However, this examination was rescheduled by mutual agreement pursuant to a telephone conversation of April 8, 1997, for April 14, 1997.
4. JBA Medical had mailed a letter notifying Melissa Moses that she was to submit to an Independent Medical Examination on April 22, 1997. Melissa Moses received notification of this examination on April 9, 1997, one day after agreeing to be examined on April 14,1997. The Defendant, Ocean Harbor Casualty Insurance Company, once again failed to notify Melissa Moses of her obligation to comply with the Request of JBA Medical for an Independent Medical Examination. It was not unreasonable for Melissa Moses to become confused as to where and when she was to submit to an Independent Medical Examination. This court finds that Melissa Moses did not unreasonably refuse to submit to the examination scheduled for April 14, 1997.
5. The Defendant, cut off the No-Fault Benefits of Melissa Moses for her failure to submit to the Independent Medical Examination which was scheduled for April 14,1997. This court finds that Melissa Moses was not obligated to attend an Independent Medical Examination scheduled for April 22, 1997, when the No-Fault Benefits had already been cut off.
6. There was a proper assignment of benefits executed between Melissa Moses and the Plaintiff, SOUTHEAST HEALTH CARE.
7. That the total amount of No-Fault insurance benefits for the medical bills of Melissa Moses owed by the Defendant, OCEAN HARBOR CASUALTY INSURANCE COMPANY, to the Plaintiff, SOUTHEAST HEALTH CARE, is $4,144.00.
8. That the total amount of penalties owed is $801.05.
IT IS ADJUDGED that the Plaintiff, SOUTHEAST HEALTH CARE, recover from the Defendant, OCEAN HARBOR CASUALTY INSURANCE COMPANY, the sum of $4,945.05, that shall bear interest at the rate of 10% per year for which let execution issue. This court reserves jurisdiction to award attorney fees and costs.
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