Tuesday, January 12, 2010

PIP Statement Of Charges Must Come From Provider-Not Insured-Under § 627.736(5)(c)1

In State Farm Mutual Automobile Insurance Company v. Pressley (1D09-1481), the First District reversed a grant of summary judgment against State Farm because pursuant to section 627.736(5)(c)1, Florida Statutes, the statement of charges for medical treatments and services must be furnished by a provider.  In this case, the statement was furnished by the insured and, therefore, did not comply with the statute.  The court stated:
State Farm was entitled to summary judgment as a matter of law because it owed no PIP benefits to Ms. Pressley due to her and her medical providers’ failure to comply with sections 627.736(5)(c)1 and 627.736(5)(d)....Additionally, section 627.736(5)(d) requires that “all statements and bills for medical services rendered by any physician, hospital, clinic, or other person or institution shall be submitted to the insurer on a properly completed [form].”....The language of section 627.736(5)(c)1 is clear and unambiguous and, therefore, should be accorded its plain meaning. In this section, the Legislature set forth the exclusive procedures for payment of PIP benefits from the no-fault insurer under a PIP policy....Pursuant to section 627.736(5)(c)1, the statement of charges for medical treatments and services “must be furnished to the insurer by the provider,” and the PIP insurer is only obligated to pay those bills submitted by the provider within the statutory time period. Id. The statute does not make any provision for the submission of medical bills by an insured or other third party.
Judge Wetherell wrote the opinion and was joined by Judge Lewis.  Judge Kahn wrote a dissent.


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