9 Fla. L. Weekly Supp. 323b
Insurance — Personal injury protection — Dispute between medical provider and insurer — Where insurer denied medical provider’s presuit request for a copy of PIP log, which provider sought to verify insurer’s claim that provider’s bill was applied to insured’s deductible, provider properly sought declaratory relief on issue of whether insurer was required to provide log — Motion to dismiss because suit was moot after log was provided during discovery is denied — Jurisdiction to award attorney’s fees to medical provider reserved
ROM DIAGNOSTICS, on behalf of Rafael Cruz, Plaintiff, vs. SECURITY NATIONAL INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. CCO 01-9327. March 18, 2002. C. Jeffery Arnold, Judge. Counsel: Armando R. Payas, Michael Tierney, J.D., Payas, Payas & Payas, P.A., Orlando, for Plaintiff. Paul Tipton, Rissman, Weisberg, Barrett, Hurt, Donahue & McLain, P.A., Orlando.
ORDER DENYING DEFENDANT’S MOTION TO DISMISS
This cause having been heard on January 4th, 2002, on Defendant’s Motion to Dismiss Plaintiff’s Complaint, the Court having heard argument counsel and being otherwise fully advised in the premises, the Court finds as follows:
FACTS AND PROCEDURAL BACKGROUND
On November 22nd, 2000, Plaintiff performed an objective range of motion diagnostic test on the insured (Rafael Cruz). Subsequent to rendering the service, the Plaintiff submitted their bill to the Defendant. However, Plaintiff did not receive payment; rather, ROM Diagnostics was informed by the Defendant that their bill for date of service 11/22/00 would not be paid because it was applied to the claimant’s $2,000.00 deductible. This in turn prompted ROM Diagnostics to submit a written request to Security National to provide them with a copy of the Pip Log so that ROM could verify this information.
Even though ROM’s written request for a copy of the PIP log contained the proper authorization from the policy holder, Security National refused to cooperate by honoring their policy holder’s authorization to release the PIP Log. Security National said that the PIP Log was internal work product which allowed them to ignore their policy holder’s instructions. (Defendant’s Motion to Dismiss filed on August 7th, 2001, avers the foregoing facts.)
After Security National’s refusal to release the PIP Log, ROM Diagnostics then filed this law suit. On July 5th, 2001, the Plaintiff filed the complaint seeking judicial declaratory relief regarding its right of access to the PIP Log. On July 18th, 2001, the Defendant was served with the instant law suit. On August 3rd, 2001, Security National contacted Plaintiff’s counsel and then provided a copy of the insured’s PIP Log. They also requested the law suit be dismissed. Security National believed the suit was moot since they produced the pay-out sheet after Plaintiff propounded discovery. Additionally, the PIP log confirmed their position that the bill in question was applied to the claimant’s deductible.
LAW AND ANALYSIS
Defendant argued that neither contract law nor statute permitted ROM Diagnostics to bring such a cause of action. However, Plaintiff’s counsel contended that statute(s) §§627.736(6)(d), 627.7401, and 627.4137, F. S., as well as the assignable rights (which do not impair the integrity of the risks undertaken at the inception of the insurance contract) require that an insurer provide a copy of their PIP log, pre-suit, to its insured, or a provider. It is a basic principle under contract law, i.e assignments, that the health care provider (assignee), who, by virtue of an proper assignment from the insured (assignor), completely “stands in the shoes” of its insured. (INTEGRA DIAGNOSTICS (a/a/o Shawn Umstead) vs. RELIANCE NATIONAL INDEMNITY COMPANY, 8 Fla. L. Weekly Supp. 394c) The insurer is, therefore, equitably estopped from refusing to provide a health care provider with a Pip log. Id. To rule otherwise would permit a PIP carrier to selectively honor applicable case law.
Plaintiff’s declaratory relief claim is granted on the merits. Failure of insurers to recognize and comply with proper assignments only serve to increase litigation and thwart public policy, as well as to impugn the intent of No-Fault Statute. When a health care provider is provided a PIP log pre-suit, this allows them to know their respective position as it relates to the insured’s deductible. Id. To hold otherwise would encourage unnecessary litigation, and potentially subject the health care provider to sanction under Section 57.105(1). INTEGRA DIAGNOSTICS (a/a/o Shawn Umstead) vs. RELIANCE NATIONAL INDEMNITY COMPANY, 8 Fla. L. Weekly Supp. 394c.
Furthermore, the health care provider is also entitled to a pip-log so that the provider may also verify that their bill was correctly applied, or, if applicable, properly paid under an apportionment of satisfying the remaining portion of the deductible which their bill satisfied.
Based on the foregoing, it is
ORDERED AND ADJUDGED that:
1. Defendant’s Motion to Dismiss is DENIED.
2. Plaintiff properly sought declaratory relief on the issue of whether the Defendant insurer is required, on pre-suit request from a health care provider, to produce a current PIP payout sheet/log to the health care provider so that the provider may know its position as it pertains to the deductible.
3. This Court reserves jurisdiction as to awarding Plaintiff’s attorney’s fees.
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