11 Fla. L. Weekly Supp. 508a

Insurance — Personal injury protection — Claim form — Signature of physician — Countersignature — Assigned claim — Statute does not require signature or credential of provider on HCFA-1500 form, nor does it require insured’s countersignature on form where there is valid assignment of benefits — Order granting summary judgment in favor of provider/assignee is affirmed where insurer’s sole basis for nonpayment of bills was absence of signature and countersignature on claim forms

UNITED AUTOMOBILE INSURANCE COMPANY, a Florida Corporation, Appellant, v. MEDICAL SPECIALISTS & DIAGNOSTIC SERVICES, a/a/o Richard Navas, Appellee. Circuit Court, 9th Judicial Circuit (Appellate) in and for Orange County. Case No. CVA1 02-58. L.C. Case No. 01-8264-CC. March 1, 2004. Appeal from the County Court for Orange County, C. Jeffery Arnold, Judge. Counsel: Mark A. Gatica, for Appellant. Morgan, Colling & Gilbert, P.A., for Appellee.

(Before KIRKWOOD, KOMANSKI, and STRICKLAND, JJ.)

FINAL ORDER AND OPINION AFFIRMING TRIAL COURT

[Lower court order published at 9 Fla. L. Weekly Supp. 708a.]

(PER CURIAM.)Appellant, United Automobile Insurance Company (“United”), appeals the trial court’s Final Order Granting Plaintiff’s Motion for Summary Judgment in favor of Appellee, Medical Specialists & Diagnostic Services (“Provider”), as assignee of Richard Navas (“Navas”). This Court has jurisdiction pursuant to Florida Rule of Appellate Procedure 9.030(c)(1)(A). We dispense with oral argument pursuant to Florida Rule of Appellate Procedure 9.320.

Navas was involved in an automobile accident and received medical treatment from the Provider for his injuries. At the time of the accident, he was insured by United, and his policy included personal injury protection (“PIP”). Navas executed an assignment of his PIP benefits to the Provider, which was provided to United. The Provider timely submitted the medical bills to United on approved health insurance claim forms, HCFA-1500 (the “Form”), for payment.

Box 13 of the Form contains a signature line for Navas, which provides an authorization for payment of his medical benefits to the Provider. Navas did not sign the authorization on the Forms; rather, the Forms contained the typed notation “Signature on File” on the signature line. Box 31 of the Form contains a signature line for the physician or supplier, including degrees or credentials. Some of the Forms submitted by the Provider contained the typed name of the physician; however, they did not include the physician’s signature or his degree. United denied the claims because Navas and the Provider failed to sign the Forms, and the Provider subsequently filed suit.

The Provider moved for summary judgment, claiming that Navas’ signature on the Forms was not required because he executed a valid assignment of benefits. United also moved for summary judgment, contending that Navas’ signature was required notwithstanding the existence of an assignment of benefits. United further contended that the Forms lacked the signature of the physician or the supplier, including medical degrees or credentials; therefore, the Forms failed to comply with the statutory requirements.

The trial court entered an order granting the Provider’s motion for summary judgment and denying United’s motion for summary judgment. The trial court found that Section 627.736(5)(a), Florida Statutes, does not contain language requiring the insured to sign the Form and that Section 627.736(5)(d), Florida Statutes, does not contain language requiring a provider to sign the Form. Nevertheless, the trial court held that it would prefer it if the provider or its representative signed the Form because it would aid the insurance adjuster who receives it, thereby potentially decreasing the litigation on the issue. On September 18, 2002, the trial court entered a Final Order Granting Plaintiff’s Motion for Summary Judgment, from which United now appeals. The standard of review for a summary judgment is de novo. Volusia County v. Aberdeen at Ormond Beach, L.P., 760 So. 2d 126, 130 (Fla. 2000).

United contends that the trial court abused its discretion in entering summary judgment in favor of the Provider because the insured’s signature on the Form is a condition precedent to the Provider’s entitlement to payment. It relies on Section 627.736(5)(a), Florida Statutes, in claiming that where the bills are not countersigned by the insured, the insurer may not pay the provider directly, and that inserting the phrase “Signature on File” in lieu of an actual signature does not satisfy the countersignature requirement. United maintains that even where there is a valid assignment of benefits, a countersignature by the insured is required to attest that the services were actually provided.

United also contends that the Provider did not comply with the requirements of the Form itself by failing to include the Provider’s signature; therefore, it was not furnished with adequate notice of a covered loss. It maintains the signature requirements under the PIP statute were required by the Florida Legislature in order to prevent insurance fraud and misrepresentation by professionals by insuring that legitimate claims are submitted under the PIP statutory scheme.

Section 627.736(5)(a), Florida Statutes, provides that any provider rendering treatment to an injured person for an injury covered by PIP insurance may charge only a reasonable amount. It further provides in pertinent part as follows:

[T]he insurer providing such coverage may pay for such charges directly to such person or institution lawfully rendering such treatment, if the insured receiving such treatment or his or her guardian has countersigned the invoice, bill, or claim form approved by the Department of Insurance upon which such charges are to be paid for as having actually been rendered, to the best knowledge of the insured or his or her guardian.

§ 627.736(5)(a), Fla. Stat. (2000).

Section 627.736(5)(d), Florida Statutes, requires that all statements and bills for medical services rendered by a provider be submitted to the insurer on the Form, that all billings must follow the Physicians’ Current Procedural Terminology, and that no charges may be included for services performed by a person or entity that does not possess a valid license to perform such services. An insurer shall not be considered to have notice of the covered loss or bills due if the statements or bills fail to meet these requirements. § 627.736(5)(d), Fla. Stat. (2000).

This issue has been repeatedly addressed by county courts throughout the state. The overwhelming majority of those decisions hold that the insured’s countersignature is not required on the Form when there has been a valid assignment of benefits. It is noteworthy that the majority of these cases involved United. See South Florida Open MRI v. United Automobile Ins. Co., 9 Fla. L. Weekly Supp. 397a (Fla. Dade Cty. Ct. 2002); Health Care Assoc. of South Florida, Inc. v. United Automobile Ins. Co., 9 Fla. L. Weekly Supp. 397b (Fla. Dade Cty. Ct. 2002); The Premier Center for Personal Injuries v. United Automobile Ins. Co., 8 Fla. L. Weekly Supp. 501a (Fla. Dade Cty. Ct. 2001); Chase v. United Automobile Ins. Co., 8 Fla. L. Weekly Supp. 458a (Fla. Dade Cty. Ct. 2001); Choice Medical Center v. Seminole Casualty Ins. Co., 9 Fla. L. Weekly Supp. 196c (Fla. Palm Beach Cty. Ct. 2002); Kam Habibi, D.C., P.A. v. United Automobile Ins. Co., 10 Fla. L. Weekly Supp. 1042b (Fla. Broward Cty. Ct. 2003); U.S.A. Diagnostics, Inc. v. Star Casualty, 9 Fla. L. Weekly Supp. 410b (Fla. Broward Cty. Ct. 2002), jurisdiction declined and case transferred in Star Casualty v. U.S.A. Diagnostics, Inc., 855 So. 2d 251 (Fla. 4th DCA 2003); Ron Wechsel D.C., Inc. v. United Automobile Ins. Co., 10 Fla. L. Weekly Supp. 133b (Fla. Broward Cty. Ct. 2002); Marucci v. United Automobile Ins. Co., 9 Fla. L. Weekly Supp. 871b (Fla. Broward Cty. Ct. 2002); Brown v. Progressive Express Ins. Co., 9 Fla. L. Weekly Supp. 567a (Fla. Broward Cty. Ct. 2002); Rom Diagnostics v. Allstate Ins. Co., 9 Fla. L. Weekly Supp. 392a (Fla. Orange Cty. Ct. 2002).

Florida circuit courts sitting in their appellate capacity have held likewise. See Mochnick v. State Farm Mutual Automobile Ins. Co., 7 Fla. L. Weekly Supp. 1a (Fla. 4th Cir. Ct. 1999); All Care Health & Wellness v. United Automobile Ins. Co., 11Fla. L. Weekly Supp. 4b (Fla. 11th Cir. Ct. 2003); Hialeah Medical Assoc., Inc. v. United Automobile Ins. Co., 9 Fla. L. Weekly Supp. 738b (Fla. 11th Cir. Ct. 2002); Total Health Care of Florida, Inc. v. United Automobile Ins. Co., 9 Fla. L. Weekly Supp. 659a (Fla. 11th Cir. Ct. 2002), reh’g denied 9 Fla. L. Weekly Supp. 737a (2002).

Although there is no Florida District Court of Appeal decision that analyzes the issue, the question has been certified to the Fourth District Court of Appeal. See Star Casualty, 855 So. 2d at 251. The County Court of the Seventeenth Judicial Circuit certified the question of whether Section 627.736(5)(a) and/or Section 627.736(5)(d) require an insured to countersign the Form where there is an assignment of benefits. Star Casualty, 855 So. 2d at 251. The appellate court noted that the statute was originally passed in 1971, it has remained essentially unchanged, and the county and circuit courts have uniformly interpreted the signature requirement under Section 627.736(5)(a) as a permitted, not mandatory, requirement where there has been an assignment of benefits. Star Casualty, 855 So. 2d at 252. Thus, due to the plethora of cases uniformly interpreting the statute, the court declined to exercise its discretionary jurisdiction and transferred the appeal to the circuit court of Broward County. Id. The court also noted that most of the county and circuit court cases were brought by United, a related company to Star Casualty. Id.

This Court has not been confronted with the question while sitting in its appellate capacity. In Motion X-Ray, Inc. v. State Farm Mutual Automobile Ins. Co., 10 Fla. L. Weekly Supp. 346a (Fla. Orange Cty. Ct. 2002), our county court certified the question to the Fifth District Court of Appeal; however, that court declined to address the issue because the substance of the appeal was unrelated to the certified question. See Motion X-Ray, Inc. v. State Farm Mutual Automobile Ins. Co., No.5D03-1156 (Fla. 5th DCA April 16, 2003).

In New Hampshire Indemnity Co. v. Equinox Business Credit Corp., 10 Fla. L. Weekly Supp. 172a (Fla. 9th Cir. Ct. 2002), our circuit court was confronted with the issue at the trial level. The court held that a provider who accepts an assignment of benefits from an insured must provide a copy of same to the insurer as a condition precedent to filing a suit against the insurer. Id. It further held that a provider who does not have an assignment of benefits may not create standing by typing “Signature on File” in lieu of the insured’s signature on the Form. Id. Conversely, the court held that typing “Signature on File” in box 31 of the Form in lieu of the signature of the provider or supplier was legally insufficient. Id.

There is no provision under Section 627.736 that specifically requires the signature of the provider or physician, or the inclusion of credentials or degrees on the Form. In the instant case, some of the Forms submitted by the Provider for payment did not contain the physician’s signature in box 31 of the Form. Unlike the situation in New Hampshire Indemnity Co., however, these Forms contain the typed name of “Alexander Jungreis” rather than “Signature on File;” therefore the person providing the services was identified. The majority of the Forms submitted by the Provider contain both the typed name of “Alexander Jungreis,” along with a corresponding signature and “M.D.” Thus, we find no legal basis that would support United’s argument that the Form requires the signature of the supplier/provider and medical degrees or credentials that would justify United’s denial of the claims. See Choice Medical Center, 9Fla. L. Weekly Supp. at 196c (patient nor provider is required to sign Form nor is provider required to include credentials or degrees).

Likewise, we find no legal basis supporting United’s denial of the claims due to the lack of Navas’ signature on the Forms. Section 627.736(5)(a), Florida Statutes (2000) provides that an insurer “may” pay benefits directly to the insured or to the provider. Consistent with the rationale of the cited cases herein, the use of the word “may” indicates that the Florida Legislature gave the insurer the option to pay the provider directly or the insured. An assignment of benefits constitutes an unqualified transfer to a medical provider of the insured’s interest under an insurance policy, giving the provider any and all rights under the policy once the assignment is complete. State Farm Fire and Casualty Co. v. Ray, 556 So. 2d 811, 813 (Fla. 5th DCA 1990). Thus, where there is a valid assignment of benefits, the insurer no longer has the option of paying the insured directly; therefore, Section 627.736(5)(a) would not be applicable.

The long-standing policy of Florida courts has been to construe the No-Fault Act liberally in favor of the insured and give effect to the legislative purpose of providing broader and a more liberal standard of coverage. Palma v. State Farm Fire & Casualty Co., 489 So. 2d 147 (Fla. 4th DCA 1986); GEICO v. Novak, 453 So. 2d 1116 (Fla. 1984). In the instant case, it is undisputed that Navas executed a valid assignment of his PIP benefits to the Provider, and that this was provided to United before the Provider filed suit. Moreover, under box 27 of the Forms, the Provider checked “yes,” to indicate that an assignment of benefits had been accepted. Thus, United was on notice that there was an assignment of benefits immediately upon its receipt of the Forms. See Kam Habibi, D.C., P.A., 10 Fla. L. Weekly Supp. at 1042b (if the Florida Legislature intended a countersignature requirement in box 13 of the Form to constitute the only method of executing an assignment of benefits, then box 27 would be completely meaningless). Accordingly, Navas’ failure to sign the Forms is not a valid basis to discharge United’s obligation to pay the PIP benefits sought by the Provider.

There are two cases that have held the contrary, and both are relied upon by United. See Rodriguez v. Ocean Harbor Casualty Ins. Co., 8 Fla. L. Weekly Supp. 500b (Fla. Dade County Ct. 2001); Security National Ins. Co. v. Biotronix Laboratories, Inc., 6 Fla. L. Weekly Supp. 314a (Fla. 11th Cir. Ct. 1999), reh’g denied 6 Fla. L. Weekly Supp. 479d (1999). In Rodriguez, the court held that where the insured and the health care provider failed to sign the Form, the insurer was not timely placed on notice of the loss, and “Signature on File” in lieu of the insured’s signature on the Form would not suffice. Rodriguez,8 Fla. L. Weekly Supp. at 500b. Based upon the foregoing analysis concerning the signature requirements and the overwhelming cases that hold the contrary, we do not find Rodriguez persuasive. Moreover, there was no assignment of benefits executed by the insured in Rodriguez; therefore, it is distinguishable from the instant case. Likewise, in Biotronix, the court held that the provider may be paid directly only if the insured signs the Form, and “Signature on file” would not suffice. Biotronix Laboratories, Inc., 6 Fla. L. Weekly Supp. at 314a. Unlike the instant case, however, the provider in that case failed to provide the insurer the properly executed assignment of benefits before filing suit. Id. Thus, we find this case inapplicable as well.

This Court aligns itself with the reasoning contained within the majority of Florida cases which hold that Section 627.736, Florida Statutes, does not require the signature, or the credentials or degree of a supplier or provider on the Form, nor does it require the insured’s countersignature on the Form where there is a valid assignment of benefits.

It is, therefore, hereby ORDERED and ADJUDGED that the trial court’s Final Order Granting Plaintiff’s Motion for Summary Judgment is AFFIRMED.

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