12 Fla. L. Weekly Supp. 926b
Insurance — Personal injury protection — Claims — HCFA form — Error to grant summary judgment in favor of insurer on ground that HCFA forms were insufficient due to unidentifiable signature in box 31 — Statute does not contain express requirement that box be signed, insurer does not contend that failure to sign box legibly hindered its investigation of accident in any way, and insurer’s processing of claims for two years without raising problem with signature and its payment of portions of some claims submitted on forms with allegedly deficient signature implies intentional and voluntary waiver of alleged deficiency
W.R. MEDICAL CENTER, INC., As Assignee of Esperanza Alvarez, Appellant, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Appellee. Circuit Court, 11th Judicial Circuit (Appellate) in and for Miami-Dade County. Case No. 04-294 AP. L.C. Case No. 01-8194 CC 26. July 5, 2005. An Appeal from a decision of the Miami-Dade County Court. Counsel: Charles L. Vaccaro, Lidsky Vaccaro & Montes, P.A., for Appellant. David Hwaleck and Matt Hellman, for Appellee.
(BEFORE THOMAS S. WILSON, JR., BERNARD S. SHAPIRO, and MAXINE COHEN LANDO, JJ.)
(COHEN LANDO, J.) On June 3, 2001, Esperanza Alvarez was involved in an automobile accident in which she sustained personal injuries. At the time of the accident, Alvarez was insured with Appellee Progressive Express Insurance Company (“Progressive”) for a Personal Injury Protection (“PIP”) policy with a $2,000 deductible. Seeking treatment for her accident injuries, Alvarez went to Appellant W.R. Medical Center, Inc. (“Provider”) on June 7, 2001. Her treatment finished on July 20, 2001, and the provider submitted Health Care Finance Administration (“HCFA”) forms for medical bills totaling $9,218.00 to Progressive. Progressive received the bills in June and July, 2001. Progressive applied the $2,000 deductible to the bills, and paid another $3,253.60 towards Appellant’s bills. A few of the charges were questioned as being unnecessary or were reduced and partially paid by Progressive. Progressive never raised any concerns about the completeness of the forms.
The Provider filed suit against the insurer for breach of contract due to failure to fully pay for the medical bills. During discovery, the provider specifically asked why some bills were not paid or were paid at a reduced rate. Progressive replied that some of the charges were unnecessary or were unreasonable. On March 18, 2003, nearly two years after Progressive received the bills, the insurer filed a motion for summary judgment, where it made, for the first time, the argument that the claim forms had an unidentifiable signature in box 31. The insurer contended that this defect meant that the appellant failed to comply with sec. 627.736(5)(e), Fla. Stat. (2001). The trial court initially denied the summary judgment motion on October 24, 2003. On May 14, 2004, Progressive filed a second motion for summary judgment. This motion was granted by the trial court on May 14, 2004, on the basis that the HCFA forms were insufficient. A final judgment was entered and this appeal followed.
The standard of review for a summary judgment order is de novo and requires viewing the evidence in the light most favorable to the non-moving party. See Sierra v. Shevin, 767 So. 2d 524 (Fla. 3d DCA 2000). Judgment may be granted if the pleadings, depositions, interrogatories, admissions, and affidavits, if any, show there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law. Fla. R. Civ. P. 1.510(c). If the slightest doubt exists, summary judgment must be denied. Sierra, 767 So. 2d at 525 (citations omitted).
Appellant basically is arguing with the lower court’s interpretation of sec. 627.736 (2001). The lower court appears to have adopted the insurer’s position that the signature in box 31 is relevant or material in some way, and goes to the issue of whether or not the medical treatment was reasonable and necessary. It is important, however, to remember the intent and the purpose of Florida’s no-fault statutory scheme. “The purpose of the no-fault statutory scheme is to ‘provide swift and virtually automatic payment so that the injured insured may get on with his life without undue financial interruption.’ ” Ivey v. Allstate Ins. Co., 774 So. 2d 679, 683-84 (Fla. 2000) (citations omitted). Moreover, sec. 627.736 (2001) contains no express requirement that box 31 of the HCFA form 1500 be signed. Appellee does not contend that the failure to sign box 31 legibly has hindered its investigation of the accident in any way. For two years after the accident, Progressive processed the bills, never once raising any problems with the signature in box 31. Indeed, if there had been a problem with the claim, the insurer should have raised it within 30 days of receipt of the bills. In fact, on some of the claim forms with the alleged deficient signature, the insurer paid a portion of the claim. This conduct implies an intentional and voluntary waiver of the alleged box 31 deficiency. See ROM Diagnostics v. Allstate Ins. Co., 9 Fla. L. Weekly Supp. 392a (County Court 9th Cir., 2002). Progressive had all the relevant information it needed to process the claim, despite whether box 31 had a legible signature or not. Progressive never returned the forms to the provider for amendment, nor did the insurer request any additional information. As such, the lower court’s grant of summary judgment should be reversed.
REVERSED and REMANDED for proceedings consistent with this opinion. (Judges WILSON and SHAPIRO concur.)
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