10 Fla. L. Weekly Supp. 1034a
Insurance — Personal injury protection — Claim forms — Where medical provider originally filed suit under name of one of his six corporations other than the corporation to which assignment of benefits was directed and filed HCFAs indicating treatment was completed by the plaintiff corporation rather than assignee corporation and containing other information that was false or misleading, HCFAs do not establish compliance with section 627.736, and plaintiff has failed to lawfully render treatment and provide insurer of notice of loss and amount thereof — Insurer’s motion for summary judgment granted
ATWOOD NEUROSPINAL CLINIC, P.A. (a/a/o Irma Paul), Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 20th Judicial Circuit in and for Collier County. Case No. 01002133 SP-LDM. October 2, 2003. Eugene C. Turner, Judge. Counsel: Matt Hellman, Matt Hellman, P.A., Plantation. Michael McQuagge.
FINAL JUDGMENT FOR DEFENDANT
This action came before the Court on August 29, 2003 on Defendant’s Motion for Summary Judgment. On the evidence presented, the Court makes the following findings:
1. Dr. Atwood had six corporations formed, one of which the assignment of benefits was directed to, Atwood Neurospinal. Other corporations formed by Dr. Atwood, which are separate legal entities, were Unity Medical, Faith Medical, Atwood Chiropractic and Pain Clinic, A & C Medical, and New Visions Chiropractic.
2. Plaintiff originally filed suit as Atwood Chiro and submitted HCFAs that contained the following:
a. Box 11.c. of the submitted HCFAs identified the insurance plan name as Progressive Insurance.
b. Box 11.d. of the submitted HCFAs checked “no” for the question of whether there was another health plan.
c. Box l2 of the submitted HCFAs, used for patient’s authorization to release medical or other information necessary to process claim, contained the date 12/31/99.
d. Box 13 of the submitted HCFAs, used for the insured’s authorization for payment of medical payments to the undersigned physician or supplier for medical treatment, contained the phrase “Benefits assigned” after the word “signed”.
e. Box 14 of the submitted HCFAs, used to identify the date of injury, contained the date 9/29/01.
f. The tax identification number in Box 25 was that of Atwood Neurospinal.
g. Box 31 of the submitted HCFAs, is contained an entity identified as Michael S. Atwood, P.A. Additionally, Box 31 did not contain a handwritten signature, but did contain the date 12/31/99.
h. Box 32 identified Atwood Chiro as the entity that rendered the medical service to the insured.
i. Box 33 identified the physician/supplier’s billing name as Atwood Chiro.
3. Atwood Neurospinal is a separate and distinct entity from Atwood Chiro.
4. The insured, Irma Paul, assigned her benefits of the insurance policy at issue to Atwood Neurospinal.
5. Defendant filed its Motion for Summary Disposition based upon the fact that said HCFAs submitted indicated treatment was completed by Atwood Chiro, yet the assignment of benefits was to Atwood Neurospinal.
6. In opposition to Defendant’s Motion for Summary Disposition, Plaintiff filed a legally insufficient affidavit of Atwood Neurospinal’s billing office manager, Angela Huber. Specifically, said affidavit was not based on personal knowledge and contained legal conclusions. Furthermore, said affidavit asserted that Atwood Neurospinal and Atwood Chiropractic are the same company, in contradiction of the sworn deposition testimony of Dr. Atwood who stated that Atwood Chiropractic and Atwood Neurospinal were separate companies.
7. Subsequent to Defendant’s filing its Motion for Summary Judgment, Plaintiff re-submitted the above HCFAs for the same dates of service, cpt codes, and charges. However, the re-submitted HCFAs contained were revised in the following boxes:
a. Box 11.c. identified “THE GERAGHTY LAW FIRM”.
b. Box 11.d identified “yes” for another insurance plan.
c. Box 31 contained the typewritten name Michael S. Atwood, D.C.
d. Box 32 was empty.
e. Box 33 contained the name Atwood Neurospinal.
8. Said re-submitted HCFAs were voluntarily withdrawn by the Plaintiff during the hearing for Defendant’s Motion for Summary Judgment and were not considered by the Court.
9. This Court agrees with Judge Gridley in New Hampshire v. Equinox, 10Fla. L. Weekly Supp. 172 (9th Judicial Circuit, Circuit Court, 2002) that “a medical provider/supplier cannot recover direct payment from an insurer under Florida Statutes, Section 627.736 when the medical provider/supplier knew or should have known that the information contained within the HCFA is false, misleading, incomplete or patently deceptive; or when it acts in deliberate ignorance of the truth, falsity or completeness of the information contained within the HCFA. Furthermore, a health care provider/supplier who negligently provides incorrect information material to the nature of the services, location of the services, charge for the services, the amount of services or identity of the provider does not provide the insurer with notice of the loss or amount of same.”
10. Further, the HCFAs submitted and records do not establish compliance with F.S. 627.736. More particularly, Plaintiff failed to lawfully render treatment and failed to provide Defendant with written notice of a covered loss and the amount of same.
Based upon the record evidence presented, Defendant’s Motion for Summary Judgment is granted.
IT IS ADJUDGED that Plaintiff, ATWOOD NEUROSPINAL CLINIC, P.A. (a/a/o Irma Paul), take nothing by this action and Defendant, PROGRESSIVE EXPRESS INSURANCE COMPANY, shall go hence without day and the Court retains jurisdiction for the purpose of determining attorney’s fees and costs upon proper Motion from Defendant.
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