Progressive American Ins. Co. v. Rural/Metro Corp.

994 So. 2d 1202, 2008 WL 4889128
CourtDistrict Court of Appeal of Florida
DecidedNovember 14, 2008
Docket5D07-1176
StatusPublished
Cited by5 cases

This text of 994 So. 2d 1202 (Progressive American Ins. Co. v. Rural/Metro Corp.) is published on Counsel Stack Legal Research, covering District Court of Appeal of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Progressive American Ins. Co. v. Rural/Metro Corp., 994 So. 2d 1202, 2008 WL 4889128 (Fla. Ct. App. 2008).

Opinion

994 So.2d 1202 (2008)

PROGRESSIVE AMERICAN INSURANCE COMPANY, et al., Appellants/Cross-Appellees,
v.
RURAL/METRO CORPORATION OF FLORIDA, Appellee/Cross-Appellant.

No. 5D07-1176.

District Court of Appeal of Florida, Fifth District.

November 14, 2008.

*1204 Kenneth P. Hazouri, Dale T. Gobel and Valencia Percy Flakes, of deBeaubien, Knight, Simmons, Mantzaris & Neal, L.L.P., Orlando, for Appellants/Cross-Appellees.

Maria Elena Abate and Krista S. Kovalcin, of Colodny, Fass, Talenfeld, Karlinsky & Abate, P.A., Fort Lauderdale, Amicus Curiae, Florida Property and Casualty Association.

Dean A. Mitchell, Ocala, for Appellee/Cross-Appellant.

PLEUS, J.

Progressive appeals a judgment in favor of Rural Metro ("RMA"), an ambulance service, which dismissed Progressive's complaint for declaratory relief. The trial court concluded that RMA was entitled to pre-suit disclosure of insurance information from Progressive. Because we find that Progressive has no legal duty under Florida law to provide the requested documentation to the assignee medical provider, we reverse.

When a Progressive insured is in an accident and RMA provides emergency ambulance services, RMA routinely accepts assignments from the insured for personal injury protection ("PIP") benefits. Armed with the assignments, RMA requests payment from Progressive. If payment is not promptly made, and prior to filing suit, RMA sends demand letters requesting payment and the following insurance information: (1) "a PIP payout sheet," (2) the name of the insurer, (3) the name of each insured, (4) the limits of liability coverage, (5) a statement of any available policy or coverage defense, and (6) a copy of the policy." A PIP payout sheet, also known as a PIP log, is a document prepared by the insurance company which lists claims against the account, bills that have been paid, deductible amounts, etc., and would allow a medical provider to *1205 assess the chances of recovering money from PIP benefits.

Progressive sought a declaratory judgment that it did not have a legal duty to respond to these demands. The only issue was whether Progressive had a duty to provide the requested insurance information as a matter of law.

The trial court dismissed Progressive's suit for declaratory judgment based on a Florida Ninth Circuit appellate decision, Am. Vehicle Ins. Co. v. Fla. Emergency Physicians Kang & Assoc., M.D., P.A., as assignee of Stephanie Carrico, 14 Fla. L. Weekly Supp. 352 (Fla. 9th Cir.Ct.2007). As discussed below, the trial court should have determined that Progressive was entitled to judgment as a matter of law.

Subsection 627.736(6), Florida Statutes

RMA relies on sections 627.736(6), 627.7401, 627.4137, and 626.9541, Florida Statutes. Subsection 627.736(6) is inapplicable. Section 627.736 requires that all automobile insurance policies include PIP coverage. Subsection (6) allows an insurance company to investigate PIP claims and request documents from the insured's employers and medical providers to substantiate the claim. It provides, in pertinent part:

(6) Discovery of facts about an injured person; disputes.—
(a) Every employer shall, if a request is made by an insurer providing personal injury protection benefits under ss. 627.730-627.7405 against whom a claim has been made, furnish forthwith, in a form approved by the office, a sworn statement of the earnings, since the time of the bodily injury and for a reasonable period before the injury, of the person upon whose injury the claim is based.
(b) Every physician, hospital, clinic, or other medical institution providing, before or after bodily injury upon which a claim for personal injury protection insurance benefits is based, any products, services, or accommodations in relation to that or any other injury, or in relation to a condition claimed to be connected with that or any other injury, shall, if requested to do so by the insurer against whom the claim has been made, furnish forthwith a written report of the history, condition, treatment, dates, and costs of such treatment of the injured person and why the items identified by the insurer were reasonable in amount and medically necessary....
. . . .
(d) The injured person shall be furnished, upon request, a copy of all information obtained by the insurer under the provisions of this section, and shall pay a reasonable charge, if required by the insurer.

Simply stated, subsection 627.736(6) allows an insurer to investigate a PIP claim and paragraph (d) provides that the insured is entitled to copies of any documents obtained by the insurer.

The Third District has previously addressed this issue and properly determined that subsection 627.736(6) does not require pre-suit disclosure to an assignee medical provider. Southern Group Indem., Inc. v. Humanitary Health Care, Inc., 975 So.2d 1247 (Fla. 3d DCA 2008). In Southern Group, a health care provider sued an insurer for PIP benefits and a declaration that it was entitled to receive pre-suit disclosure of the insurer's PIP logs pursuant to subsection 627.736(6). The county court held that the insurer was required to provide such information and the circuit court affirmed. Id. at 1249. The Third District disagreed, finding that "[s]ubsection (6) of the statute pertains to the obligation of the various entities to provide discovery to the insurer." Id. (emphasis in original). In other words, the court recognized that the entire purpose of subsection (6) is to require medical *1206 providers and employers to give information to the insurance company and paragraph (d) simply "allows the insured to obtain a copy of all information obtained by the insurer through this process." Id. at 1250. We agree with the Third District.

Regarding PIP logs, this Court has previously recognized:

No provision of section 627.736, Florida Statutes, dictates that an insurer must provide a PIP log to an insured, or his/her assignee. In fact, there is no provision under section 627.736, Florida Statutes, which requires that an insurer must create a PIP log at all. Thus, the trial court erred when it determined that the provider was entitled to a copy of the PIP log.

GEICO Gen. Ins. Co. v. Fla. Emergency Physicians, 972 So.2d 966, 969 (Fla. 5th DCA 2007) (quoting New Hampshire Indem. Ins. Co. v. Rural Metro Ambulance as assignee of William Zaniboni, 13 Fla. L. Weekly 573 (Fla. 18th Cir.Ct.2005)). As we recognized in GEICO, nothing in Florida Statutes requires even the creation of, much less a legal duty to produce, a PIP log. Moreover, as the Third District properly determined, subsection 627.736(6) creates discovery rights in an insurance company investigating a PIP claim but does not create any discovery rights for a medical provider who is assigned an insured's PIP benefits. The plain language of subsection (6) does not create any pre-suit discovery right for any insurance information in an assignee medical provider.

Section 627.7401, Florida Statutes

RMA also claims entitlement to the insurance information under section 627.7401, Florida Statutes (2006). This statute requires an insurance company to provide form notice of an insured's right to collect PIP benefits under Florida law. Under the statute, all that is required is form notification of PIP benefits and how they work under Florida's No-Fault laws.

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Cite This Page — Counsel Stack

Bluebook (online)
994 So. 2d 1202, 2008 WL 4889128, Counsel Stack Legal Research, https://law.counselstack.com/opinion/progressive-american-ins-co-v-ruralmetro-corp-fladistctapp-2008.