14 Fla. L. Weekly Supp. 580b
Insurance -- Personal injury protection -- Motion to dismiss and motion for summary judgment in action brought by medical provider against insured's employer's commercial carrier for benefits and for presuit information are denied as premature where, although commercial carrier was wrong insurer and insured's PIP carrier covered provider's claim, commercial carrier did not inform provider that it was the wrong insurer presuit
EMERGENCY PHYSICIANS OF CENTRAL FLORIDA, as assignee of Martin Collins, Plaintiff, v. AUTO-OWNERS INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 05-SC-11640-0, Division 73. April 12, 2007. Deb Sammons Blechman, Judge. Counsel: Cameron E. Shackelford, Meier, Bonner, Muszynski, O'Dell & Harvey, P.A., Orlando. Rutledge Bradford, Rutledge Bradford Attorneys at Law, Orlando.
ORDER DENYING DEFENDANT'S MOTION TO
DISMISS AND DENYING DEFENDANT'S
MOTION FOR SUMMARY JUDGMENT
THIS CAUSE has been argued upon Motion to Dismiss and Motion for Summary Judgment. Mr. Collins was injured while driving his employer's work vehicle. He presented the name of the insurance company for his employer's commercial carrier when he went to the emergency room. That carrier is the Defendant in this case. Subsequent to emergency room treatment, Mr. Collins and Defendant carrier agreed that Mr. Collins would seek primary coverage through his personal injury insurance carrier, State Farm. Meanwhile, the emergency room physicians, having been presented the insurance card for the commercial carrier, submitted their bill and subsequent demand letters to Defendant. Thinking that a response was not required to the medical provider because State Farm would cover the claim, Defendant's claims adjuster did not reply to the requests for payment by the emergency room treatment provider. The medical provider filed suit for benefits and for pre-suit information. Subsequently State Farm paid the 80% PIP benefits and 20% Med Pay benefits. Now the commercial carrier has moved to dismiss Plaintiff's claim and also for summary judgment on the basis that Plaintiff sued the wrong insurer. Plaintiff argues that the suit would not have had to have been filed if the adjuster had simply replied to the medical provider, or that there still may have been needed some pre-suit discovery in relation to the Med Pay claim. Much argument has been made in regard to the merits of both parties' positions. The following findings are entered.
Recently a 9th Circuit Court appellate panel decided the case of American Vehicle Insurance Company v. Florida Emergency Physicians Kang & Associates, P.A., as assignees of Stephenie Carrico, CVA05-17 (Jan. 2007) [14 Fla. L. Weekly Supp. 352a]. That decision upheld a county court decision which held that pre-suit information is to be provided to a medical provider as assignee of an insured, notwithstanding the insurance company's position that the medical bill had been applied to the insured's deductible. The Carrico decision is instructive in regard to the nature of information discoverable by a provider from a PIP carrier, and also the scope of the carrier's obligation to furnish information. Citing Florida Statute, Section 627.4137, the court said that under Section 627.4137, a carrier must provide information to any claimant, not merely to the named insured. The Court also stated that this statutory provision reflects a legislative recognition of the importance of a claimant's access to insurance information in making settlement decisions, and that if pre-suit information was not required to be provided, that carriers would ignore discovery requests thereby spawning litigation.
This Court is mindful that the instant case presents an additional factual element, in that there was no question in the Carrico casethat the insurance company was the primary insurer for the insured party. However, given the trend for courts to read the statute as requiring insurance companies to give sufficient information to a claimant to put them on notice of claim defenses so that they can evaluate if suit should be filed or not, it would seem premature to grant either of Defendant's motions. See also Gelbard, M.D. a/a/o Larry Wheaton v. Progressive Consumers Insurance Company, 12 Fla. L. Weekly Supp. 262a (County Court, 17th Judicial Cir., 2004) which stated that an insurer cannot thwart the intent of the statute by not sending a denial as an incorrect insurer and then use failure to notice the proper insurer as a defense.
WHEREFORE, Defendant's Motion to Dismiss and Motion For Summary Judgment are hereby DENIED.
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14 Fla. L. Weekly Supp. 305a
Insurance -- Personal injury protection -- Hospital lien -- Timeliness -- Medical provider is entitled to full payment of bill where hospital lien was untimely
EMERGENCY PHYSICIANS OF CENTRAL FLORIDA, LLP as assignee of Carlos Lopez, Plaintiff, v. GEICO GENERAL INSURANCE COMPANY, Defendant. County Court, 18th Judicial Circuit in and for Seminole County. Case No. 05-SC-002145. December 6, 2006. John R. Sloop, Judge. Counsel: Rutledge M. Bradford, Rutledge Bradford, Attorneys At Law, Orlando. Thomas Player, Weiss Legal Group, P.A., Maitland. Robert D. Bartels, Rissman, Barrett, Hurt, Donahue & McLain, P.A., Orlando.
AFFIRMED at 15 Fla. L. Weekly Supp. 682b
FINAL SUMMARY JUDGMENT
THIS CAUSE having come to be heard upon Plaintiff's Motion for Final Summary Judgment on January 9, 2006, and by Order of the Appellate Court to enter a Final Judgment, this Court, having heard argument of counsel, and being otherwise fully advised in the premises,
IT IS HEREBY ORDERED and ADJUDGED that
1. Plaintiff's Motion for Final Summary Judgment on Count I is GRANTED. Plaintiff was entitled to payment in full of its bill due to the untimely hospital lien. Plaintiff's bill was for $420. Plaintiff was entitled to payment in full at 80%, or $336, plus interest from December 22, 2004 for which let execution issue forthwith.
2. Defendant's Motion for Final Summary Judgment is Denied.
3. Jurisdiction is retained by this Court to determine Plaintiff's entitlement to and the amount of attorney's fees and costs associated with the filing of this lawsuit.
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13 Fla. L. Weekly Supp. 1112a
Insurance -- Personal injury protection -- Standing -- Assignment -- Consent to treatment and authorizations and guarantee agreement given to hospital which references "my physicians" is assignment of benefits to emergency room doctors -- Even if emergency room doctors were not included in written assignment, equitable assignment exists where insured intended to give and doctors intended to receive assignment, and insurer would be justified in paying doctors who rendered treatment to insured -- Insurer had notice of medical bill where insurer's corporate representative testified that nothing further was needed for insurer to consider bill, and insurer paid 80% of approved amount
FLORIDA EMERGENCY PHYSICIANS KANG & ASSOCIATES, MD, PA, as assignee of Ronald Cefarelli, Plaintiff, vs. DAIRYLAND INSURANCE COMPANY, Defendant. County Court, 18th Judicial Circuit in and for Seminole County. Case No. 06-SC-000155. August 7, 2006. John R. Sloop, Judge. Counsel: Mark A. Cederberg, Rutledge Bradford, Orlando. Aaron E. Leviten, Winter Park.
ORDER DENYING DEFENDANT'S MOTION
FOR FINAL SUMMARY JUDGMENT
THIS MATTER having come before this Court on Defendant's Motion for Final Summary Judgment and this Court having heard arguments of counsel and being otherwise fully advised in the premises, finds as follows:
1. This is a claim for breach of contract arising out of a motor vehicle collision that occurred on or about 9/1/05.
2. The Plaintiff in this matter is FLORIDA EMERGENCY PHYSICIANS, as assignee of Ronald Cefarelli.
3. On or about 9/1/05, Ronald Cefarelli was involved in a motor vehicle collision which required emergency treatment at Florida Hospital East. The emergency treatment was rendered to Ronald Cefarelli by the Plaintiff, FLORIDA EMERGENCY PHYSICIANS.
4. On or about 9/30/05, the Defendant received the bill that the Plaintiff submitted to the Defendant for payment. The bill was not paid in full.
5. Thereafter, the Plaintiff sent a Notice of Intent to Initiate Litigation, on December 20, 2005, as well as a demand for a declarations page, copy of the policy and a PIP log, pursuant to Florida Statutes 627.4137 and 627.736(6)(d) that was received by the Defendant on December 23, 2005.
6. In response to the December 20, 2005 demand, the Defendant responded that the bill at issue had been paid at a reduced amount "based on the 90th percentile of the Ingenix fee schedule for usual and customary charges in your geographical area. Payment for 80% of the approved amount has been paid timely, thus we respectfully deny your demand for this date of service at this time."
7. Along with the Notice of Intent to Initiate Litigation, the Plaintiff also sent a document entitled "Consent to Treatment and Authorizations and Guarantee Agreement," upon which it relied as an assignment of benefits.
It is therefore ORDERED AND ADJUDGED as follows:
1. The Defendant's Motion for Final Summary Judgment is hereby denied.
2. The Court finds, as a matter of law, that the document entitled "Consent to Treatment and Authorizations and Guarantee Agreement," is an assignment of benefits.
3. The Court finds that the Plaintiff is included in the Assignment of Benefits given to Florida Hospital East and is clearly referenced by the words "and my physicians."
4. Further, even if the assignment were not sufficient or the Plaintiff was not included, the Plaintiff has provided un-controverted evidence of its intent to receive an assignment.
5. Under Florida law, no particular words of art are necessary to create an assignment and the same can be made in writing; orally or partially of each.
6. An assignment can be expressed or implied under the circumstances. Assignments can be equitable, where no words or form of instrument is necessary to effect an equitable assignment, and any language, however informal, which shows an intention on one side to assign a right or chose in action and an intention on the other to receive, will operate as an effective equitable assignment.
7. As set forth by the Florida Supreme Court, the true test of an assignment is whether the debtor would, however be justified in paying the debt to the person claiming to be the assignee. Here, clearly that is the case. The Defendant would be quite justified in paying the emergency room doctors who rendered treatment to their insured at Florida Hospital East.
8. The Court further finds that the Defendant was put on proper notice of the Plaintiff's bill as the Defendant's Corporate Representative testified that nothing further was needed from the Plaintiff to consider the bill for payment and, indeed, the Defendant paid 80% of the "approved amount" pursuant to the Ingenix fee schedule.
9. The Court reserves jurisdiction as to the issue of attorney's fees and costs.
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