13 Fla. L. Weekly Supp. 124a
Insurance — Personal injury protection — Claims — Timeliness — Where medical provider never submitted MRI bill to insurer, and bill was submitted by insured’s attorney five months after treatment was rendered, trial court correctly concluded that medical provider lost right to be paid for MRI — Med pay — Error to enter summary final judgment in favor of insurer where, in absence of statutory or contractual restriction, insured may be entitled to recover from med pay coverage the 20% of MRI bill that would have remained unpaid by PIP had claim been properly submitted
ELIZABETH UNKEL-ANDERSON, Appellant, vs. AMERICAN INTERNATIONAL INSURANCE COMPANY, Appellee. Circuit Court, 7th Judicial Circuit (Appellate) in and for Volusia County. Case No. 2004-00027-CAAP. L.C. Case No. 02-31614-CICO. August 17, 2005. Appeal from County Court, Judge Steven N. deLaroche. Counsel: Keith C. Warnock, Daytona Beach, for Appellant. Hinda Klein, Hollywood; and Jerona Maiyo, Orlando, for Appellee.
[Original Opinion at 13 Fla. L. Weekly Supp. 10a]
[Editor’s note: Case republished with corrected headnote.]
The appellant, Elizabeth Unkel-Anderson, was injured in an automobile accident on January 8, 2000 and sustained a dislocated left elbow. She was treated by Dr. Charles Williamson, an orthopedist, who referred her to Ormond Radiology Partnership, LLC, who performed an MRI of the elbow on December 1, 2000.
The appellant purchased a motor vehicle insurance policy from American International Insurance Company which is a member of the AIG Group. The policy contained the usual provisions including personal injury protection benefits as well as medical payments coverage.
Ormond Radiology never submitted its bill for its services to AIG but instead the appellant’s attorney forwarded the bill totaling $1,155 to AIG on April 30, 2001 which was thereafter received on May 3, 2001, some five months after the treatment was rendered.
The trial court entered its Final Summary Judgment having concluded that based on the undisputed facts Ormond Radiology had lost its right to be paid by failing to directly submit its bill within 30 days contrary to Florida Statutes, Section 627.736(5)(b). This statute has recently been found to be constitutional. Warren v. State Farm Mutual Automobile Insurance Company, 30 Fla. L. Weekly S197 (Fla. March 31, 2005). The statute also relieves the insured from liability to the provider when non-compliance occurs. The trial court’s conclusion that AIG is not responsible for the PIP is well supported by the record and the appellant cannot recover the 80% of the Ormond Radiology bill that would have been due if the bill had been properly submitted.
The coverage for medical payments is not as easy an issue to resolve. The policy itself obligates AIG to cover medical payments rendered within three years from the date of the accident. The coverage is excess over any sums due under the PIP coverage. AIG argues that Florida Statutes, Section 627.736(4)(f), limits its exposure to medical benefits which are otherwise payable due to co-insurance provided in paragraph (1)(a). That particular section deals with workers compensation coverage and other co-insurance but makes no reference to PIP. Without a statute or contractual restriction, there is no factual or legal reason that the appellant should not receive the medical payments coverage provided by the policy that would have been paid had the PIP claim been properly submitted by Ormond Radiology. The insured did not have a deductible under PIP and since the PIP would have paid 80% of the Ormond Radiology bill, the appellant may be entitled to recover from her medical payments coverage the 20% of that bill that would have remained unpaid by PIP.
Accordingly, the appellant may be entitled to recover 20% of the Ormond Radiology bill of $1,155 or $231. Therefore, the Summary Final Judgment of the trial court is affirmed as to the PIP claim and reversed for further proceedings consistent with this opinion.
AFFIRMED IN PART AND REVERSED IN PART. (WILLIAM A. PARSONS and ROBERT K. ROUSE, JR., JJ.)
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