13 Fla. L. Weekly Supp. 190a
Insurance — Personal injury protection — Notice of loss — Claim form — Insurer’s motion for summary judgment on ground that HCFA-1500 was not proper notice of loss, as plaintiff did not include signature on Box 31, but instead typed “Signature in File,” denied
FLORIDA MRI, INC. (Nabila Raza), Plaintiff, v. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 02-023526 COCE 55. September 16, 2005. Eric M. Beller, Judge. Counsel: Steven Lander, Law Offices of Lander and Goldman, Fort Lauderdale. Matt Hellman.
ORDER DENYING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT (as to Box 31 argument-notice of covered loss)
The Defendant filed its Motion for Summary Judgment arguing that the Plaintiff’s HCFA-1500 was not proper notice of a covered loss as the Plaintiff did not include a signature on Box 31, instead typing “Signature in File”. For the foregoing reasons the Defendants’ Motion for Summary Judgment is hereby DENIED.
The Defendant cites to the relevant portion of Florida Statute 627.736 in support of its position, which provides “all charges for medical services rendered by any physicians, hospitals, clinics or any other person or institution shall be submitted to the insurer on a properly completed Centers for Medicare and Medicaid Services (CMS) 1500 Form, UB 92 Forms or any other standard form . . .”
The Defendant contends that because the Plaintiff did not have the provider sign its name in Box 31 of the HCFA 1500 Form it did not comply with 627.736(5)(d) and therefore the Defendant did not have notice of a covered loss. This Court finds that no such requirement existed at the time of the services at issue here.
This Court aligns itself with Medical Specialists and Diagnostic Services a/a/o Richard Navas v. United Automobile Ins. Co., 9 Fla. L. Weekly Supp. 708a, (August 28, 2002), wherein Judge Jeffery Arnold entered summary judgment against the Defendant UNITED AUTOMOBILE on the issue by ruling, in pertinent part, that: “There is no language in Florida Statutes § 627.736(5)(d) that requires the doctor or medical provider who actually provided the service or treatment to sign an HCFA-1500 form. . . .” Further supported by the 9th Circuit Court (Appellate Division) in United Automobile Ins. Co. v. Medical Specialists and Diagnostic Services a/a/o Richard Navas, 11 Fla. L. Weekly Supp. 508a, wherein the 9th Circuit Court agreed that:
“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. . .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, 9 Fla. L. Weekly Supp. at 196c (patient nor provider is required to sign Form nor is provider required to include credentials or degrees).”
This Court holds that the foregoing decisions are in line with the holding of the Third District Court of Appeal’s decision in Pedro Ortega v. United Automobile Ins. Co., 847 So.2d 994 (Fla. 3rd DCA 2003), wherein the Court therein explained that there were only 2 requirements in Section 627.736(5), Florida Statutes (Supp.1998).
“This section contains two affirmative requirements First, the statements and bills for the medical services rendered are required to be submitted on a Health Care Finance Administration 1500 form, UB 92 forms, or another standard form approved by the Department of Insurance. Second, those bills are required, to the extent applicable, to follow the Physicians’ Current Procedural Terminology (CPT) in the year in which the services are rendered. While Section 627.736(5)(d) contains no other affirmative requirements, it states that no such statement for medical services may include charges performed by a person or entity who did not possess the valid licenses to perform such services. On appeal, the Circuit Court interpreted the foregoing to impose a third affirmative requirement — that “the notice must contain in addition to the bills some statement that the providers had the required licenses.”
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Here, the language of Section 627.736(5)(d), Florida Statutes (Supp.1998), makes it clear that the affirmative requirements for the statutory notice pertain to the form of the bill completed by the medical providers, and the terminology utilized to describe the services listed on the bill. The statute does no contain an affirmative requirement that an additional statement of licensure be appended to the bills. Rather, the statute only declares that the statement of medical services cannot contain charges for services performed by unlicensed individuals or entities. This is a far cry from requiring substantiation of a medical provider’s licensure. Thus, the Circuit Court departed from the essential requirements of the law by affirming the directed verdict entered in favor of United Auto based upon Ortega’s failure to provide evidence of compliance with a statutory requirement that simply does not exist.” Id. at 996, 997.
This Court holds that the affirmative requirements for the statutory notices pertain to: (i) the form of the bill, it must be on a Health Care Finance Administration 1500 form, UB 92 forms, or another standard form approved by the Department of Insurance and (ii) bills are required, to the extent applicable, to follow the Physicians’ Current Procedural Terminology (CPT) in the year in which the services are rendered. In the instant case there is no dispute that the bills were submitted on Health Care Finance Administration 1500 forms and there is no dispute that they did comply with the Physicians’ Current Procedural Terminology (CPT) in the year in which the services are rendered. Therefore, under Ortega the statutory requirements for notice of a covered loss have been met.
The Plaintiff properly completed and submitted the HCFA-1500 pursuant to Section 627.736(5)(d), Florida Statutes (2001) and Ortega v. United Automobile. Accordingly, the Defendant’s Motion for Summary Judgment is hereby DENIED.
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