12 Fla. L. Weekly Supp. 637a
Insurance — Personal injury protection — Claim form — Signature and credential of medical provider — Where statute does not expressly require provider’s signature on notice of loss to insurer but does suggest credentials must be supplied, typewritten name of provider supplied in box 31 of HCFA claim forms is not fatal to provider’s claim, but failure to supply credentials in box 31 or on any other form leads to conclusion that provider failed to provide notice of covered loss — Error to enter summary judgment finding insurer improperly denied payment
THE ARIES INSURANCE COMPANY, Appellant, vs. FIRST CHIROPRACTIC CLINIC, INC. a/a/o Yvette Orneus, Appellee. Circuit Court, 13th Judicial Circuit (Appellate) for Hillsborough County. Case No. 01-8897, Division X. L.C. Case No. 00-15316 SC. April 25, 2005. Review of a final order of the County Ct., Hillsborough County. Counsel: Eric S. Zufelt and Scott E. Samis, St. Petersburg. Steven. M. Johnson, Johnson & Williams, P.A., Orlando, for Appellee. Stephan W. Carter, Lewis Crichton & Carter, P.A., Winter Park, for Appellee.
On Motion for Rehearing
(GREGORY P. HOLDER, J.) This matter came before the Court on Appellant’s motion for rehearing. The stay on this cause having expired, the Court now revokes its previous opinion, and substitutes the following.
Appellant Aries Insurance Company appeals the summary judgment of the county court against it that concluding that it improperly denied payment. Appellant Aries Insurance Company contends that it correctly denied benefits on the basis that the healthcare provider did not sign the Health Care Finance Administration (HCFA) form in its box 31, which requires the signature and credentials of the healthcare provider. Appellant argues that §627.736(5)(d) requires this information for the HCFA to constitute adequate notice of a covered loss. We agree in part and reverse.
While the relevant version of §627.736(5)(d) does not expressly require a healthcare provider’s signature on notices to insurance companies, it does suggest that credentials must be supplied.1 On the HCFA claim forms Appellee healthcare provider submitted to Appellant for payment, Appellee provided only a typewritten name in box 31. While the typewritten name is not fatal to the provider’s original claim, the fact that credentials were not supplied in box 31, or in any other form, leads us to conclude that the provider has not provided notice of covered loss in accordance with the statute. It is therefore
ORDERED that the decision of the county court is REVERSED and the cause REMANDED for proceedings consistent with this opinion. It is further ORDERED that Appellee’s motion for rehearing on attorney’s fees is also DENIED. (Maye and Pendino, JJ., concur.)
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1Section 627.736(5)(d) states, in pertinent part: “No statement . . .may include charges for medical services of a person or entity that performed such services without possessing the valid licenses required to perform such services. . . . [A]n insurer shall not be considered to have been furnished with notice of the amount of covered loss . . .unless the statements. . .comply with this paragraph.” (Emphasis supplied.)
The simplest way for an insurer to be able to confirm credentials to process payment on a claim is for the provider to supply those credentials with the notice of covered loss in the area provided for such purpose on the HCFA form. Otherwise, separate documentation would seem to be required.
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