FLORIDA INJURY
v.
UNITED AUTO INS.
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Florida Injury East, a medical provider, appealed summary judgment denying its claim for PIP benefits from United Auto Insurance. The court reversed, holding that the trial court improperly imposed an additional burden on the provider to identify the correct insurer beyond what the PIP statute requires.
The PIP statute does not require a medical provider to investigate or 'explore every reasonable avenue' to identify the correct insurer. The 35-day deadline for submitting a claim begins when the provider obtains the correct insurer information, and Florida Injury East timely submitted its claim within 35 days of learning United Auto was the correct carrier.
[1] A statute governing personal injury protection (PIP) benefits should not be interpreted to impose burdens on medical providers that are not explicitly contained within th…
[2] When an insured fails to provide a medical provider with the correct information regarding their personal injury protection (PIP) insurer, the provider is granted an exte…
Previewing 2 of 4 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.
Join FLexlaw to unlock all legal intelligence“If, however, the insured fails to furnish the provider with the correct name and address of the insured's personal injury protection insurer, the provider has 35 days from the date the provider obtains the correct information to furnish the insurer with a statement of the charges.”
The statutory provision defining when the 35-day deadline for submitting PIP claims begins when incorrect insurer information was provided.
Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceFlorida Injury East treated patient Charna Dovalus from January through April 2011 for car accident injuries. Dovalus assigned her PIP benefits to Flo…
The full statement of facts, procedural history, and disposition for this case are member content.
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Before WEISS, BARBOUR, and SHEPARD, J.J.
PER CURIAM.
Appellant, Florida Injury East, Inc., seeks review of the final summary judgment entered in favor of United Automobile Insurance Company. This Court has jurisdiction. § 26.012(1), Fla. Stat. (2015); Fla. R. App. P. 9.030(c)(1)(A). Because the trial court imposed an additional burden upon Florida Injury East in determining whether it timely submitted its claim for PIP benefits that is not contained in the PIP statute, we reverse. From January 15 through April 18, 2011, Florida Injury East provided medical treatments to Charna Dovalus for injuries she sustained in a car accident. Dovalus assigned her PIP benefits to Florida Injury East and informed it that State Farm was her insurer. State Farm denied Florida Injury East’s claims, and on May 10, 2011, told Florida Injury East that the checks it previously sent regarding Dovalus’s treatment were a mistake. On this same date, State Farm told Florida Injury East that it should get coverage through Dovalus’s mother’s PIP insurer.
On June 29, 2011, Dovalus’s mother’s PIP insurer, United Auto, called Florida Injury East and informed it that United Auto was the correct PIP carrier for claims for treatment to Dovalus. In early July 2011, Florida Injury East submitted its bills to United Auto along with an affidavit pursuant to the procedures in Florida Statute section 627.736(5)(c)(2) (2010).
United Auto denied coverage, stating that the bills were untimely. Florida Injury East filed suit to recover the PIP benefits, but the trial court agreed with United Auto that the claim was untimely and entered summary judgment against Florida Injury East. Florida Injury East now seeks review of that judgment. “The standard of review of a trial court's entry of summary final judgment is de novo.” Evans v. McCabe 415, Inc., 168 So. 3d 238, 240 (Fla. 5th DCA 2015).
Florida Injury East argues that the trial court imposed a burden upon it not contemplated by the PIP statute. For support, Florida Injury East points to the phrase in the trial court’s order stating that it is reasonable for Florida Injury East to “explore every reasonable avenue to avoid jeopardizing payment . . . .” (R. 268.) To receive PIP benefits, a medical provider must submit its statement of charges to the insurer within thirty-five days of treatment. § 627.736(5)(c)1., Fla. Stat. (2010).
The PIP statute provides a medical provider with an extension of time if the insured gave the provider inaccurate information regarding the PIP insurer, as happened in this case. Specifically, the statute states: If, however, the insured fails to furnish the provider with the correct name and address of the insured’s personal injury protection insurer, the provider has 35 days from the date the provider obtains the correct information to furnish the insurer with a statement of the charges. The insurer is not required to pay for such charges unless the provider includes with the statement documentary evidence that was provided by the insured during the 35-day period demonstrating that the provider reasonably relied on erroneous information from the insured and either: a. A denial letter from the incorrect insurer; or b. Proof of mailing, which may include an affidavit under penalty of perjury, reflecting timely mailing to the incorrect address or insurer. § 627.736(5)(c)2. (emphasis added).1 The trial court found that Florida Injury East knew United Auto was the pertinent PIP carrier on May 10, 2011, when State Farm told Florida Injury East that the mother’s insurer was the correct carrier. Because Florida Injury East submitted its bill in early July 2011, more than thirty-five days after May 10, 2011, Florida Injury East’s submission was untimely.
On May 10, 2011, however, Florida Injury East knew only that the correct PIP carrier was Dovalus’s mother’s PIP insurer.
The trial court placed a burden on Florida Injury East to track down the correct coverage information. But neither the PIP statute nor case law contains this burden. Inserting this additional requirement in an otherwise unambiguous statute is improper.
The trial court’s order stating that the provider should “explore every avenue” is not contemplated in the statute and imposes a requirement on the provider that does not exist. The PIP statute only requires the medical provider to act within thirty-five days of obtaining the correct information. Florida Injury East did this when it submitted its claim to United Auto on July1, 2011, two days after learning that United Auto was the correct PIP insurer.
Thus, Florida Injury East’s claim was timely submitted to United Auto. Based on the foregoing, it is hereby ORDERED AND ADJUDGED as follows: 1. The “Final Judgment,” entered on September 21, 2015, is REVERSED and this matter is REMANDED for proceedings consistent with this opinion.
18 day of August, 2016.
/S/
KEVIN B. WEISS Presiding Circuit Judge
BARBOUR and SHEPARD, J.J., concur. CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing Order has been furnished to: The Honorable Stefania C. Jancewicz, Osceola County Judge, Osceola County Courthouse, 2 Courthouse Square, Kissimmee, FL 34741; Jonathan D. Wilson, Esq., and Peter A. Shapiro, Esq., The Law Offices of Peter A. Shapiro & Jonathan D. Wilson, 211 E. Livingston St., Orlando, FL 32801; and Michael J. Neimand, Esq., House Counsel for United Automobile Insurance Co., P.O. Box 694260, Miami, FL 33269-9854; on this 18th day of August, 2016.
/S/
Judicial Assistant