Roig Lawyers Attorneys Victorious in Health Care Clinic Licensure Case

March 10, 2015

Roig Lawyers litigators won a stunning victory on behalf of their client/Insurer in a mandatory licensing (House Bill 119) case in the County Court in and for Miami-Dade County. Michael A. Rosenberg, firm managing partner, and Danielle R. Parry, associate, secured final judgment against the Defendant ultimately resulting in the Plaintiff not having any legal obligation to pay the pending claim.

The Plaintiff issued a policy of automobile insurance to the Insured under which the Defendant sought payment. The Defendant operated as a medical clinic and allegedly rendered medical treatment to the Insured who was injured in an automobile accident. Subsequently, the Defendant submitted charges for payment of Personal Injury Protection (PIP) benefits to the Plaintiff. The Defendant was advised that the claim submitted for PIP benefits was not payable because the clinic was not properly licensed pursuant to Section 627.736, Florida Statutes (2013).

Roig Lawyers attorneys argued that the Defendant was required to obtain a Health Care Clinic License as a condition precedent to submitting charges for reimbursement and failure to obtain the Health Care Clinic License rendered the charges noncompensable.

In 2012, the Legislature required mandatory licensing for all clinics holding an exempt status, whether by issuance of Certificate of Exemption or self-determined, in order for clinics to receive reimbursement pursuant to the “PIP Statute.” Hence, a clinic must be licensed under Part X, Chapter 400 to receive reimbursement for PIP benefits, unless it qualifies for an exception listed in Section 627.736(5)(h).

The Court found that the Defendant being wholly owned by a license massage therapist does not qualify for any of the exceptions delineated in §627.736(5)(h)(1)-(6) and was required to obtain a Health Care Clinic license as a condition precedent to receiving reimbursement of PIP benefits.
As a result of the Defendant’s failure to obtain a Health Care Clinic License, Roig Lawyers prevailed for their client and the Court found that the charges submitted by Defendant were unlawful and thus, noncompensable pursuant to Florida’s Motor Vehicle No-Fault Law.