15 Fla. L. Weekly Supp. 735a
Insurance — Personal injury protection — Notice of loss — HCFA form — Professional license number — Failure to include professional license number in box 31 of HCFA forms fails to put insurer on notice of covered loss and bars suit
A KAUFMAN CHIROPRACTIC CLINIC, INC., Plaintiff, vs. PROGRESSIVE SELECT INSURANCE COMPANY, Defendant. County Court, 15th Judicial Circuit in and for Palm Beach County, Civil Division. Case No. 502007CC006201 XXXXMB, Division RB. April 21, 2008. Ted Booras, Judge.
ORDER DENYING MOTION FOR REHEARINGON DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
[Original Opinion at 15 Fla. L. Weekly Supp. 626a]
THIS CAUSE having come before the Court upon Defendant’s Motion for Rehearing on the Court’s granting of Defendant’s Motion for Summary Judgment.
This case involves a claim for personal injury protection (PIP) benefits. Defendant, in their Motion for Summary Judgment, argued that they were not put on proper notice of Plaintiff’s claim for PIP benefits because Plaintiff failed to properly complete the Health Insurance Claim Form (HCFA) as required by section 627.736(5)(d), when they submitted their bills to Defendant for payment. Specifically, Defendant argued that Plaintiff, medical provider, failed to include the professional license number in Box 31 of the HCFA forms. The Court finds that in the instant case the professional license number was not contained in Box 31.
In a similar case, this Court previously ruled that, as a matter of law, there is no specific requirement that Box 31 of the HCFA forms be signed. American Med-Care Centers vs. Progressive, 14 Fla. L. Weekly Supp. 576a (Fla. Palm Beach Cty.Ct. 3/30/07). However, the new issue before the Court is whether Box 31 must contain the professional license number pursuant to section 62y.736(5)(d).
At issue is whether section 627.736(5)(d) actually requires the professional license number to be included in Box 31of the HCFA forms. Section 627.736(5)(d), states in part that:
All statements and bills for medical services rendered by any physician, hospital, clinic, or 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 approved by the office or adopted by the commission for purposes of this paragraph. . . . All providers other than hospitals shall include on the applicable claim form the professional license number of the provider in the line or space provided for ‘Signature of Physician or Supplier, Including Degrees or Credentials.’ ”
When the language of the statute is clear and unambiguous, and conveys a clear and definite meaning, the statute must be given its plain and obvious meaning. State v. Warren, 796 So. 2d 489 (Fla. 2001). Several Florida courts have ruled, and this Court agrees, that the plain and obvious meaning of section 627.736(5)(d), does in fact require the professional license number be included in Box 31. (“All providers other than hospitals shall include on the applicable claim form the professional license number of the provider in the line or space provided for “Signature of Physician or Supplier, Including Degrees or Credentials.”)
In Hope Health & Wellness v. Geico, 14 Fla. L. Weekly Supp. 292a (Fla. Palm Beach Cty.Ct 7/28/06), the court concluded that the clear language contained in section 627.736(5)(d) supported GEICO’s defense that the provider must include the professional license number in Box 31 of a bill submitted for payment of PIP benefits. Judge Bosso-Pardo then ruled that “[a]s such, failure to include the professional license number is fatal to the subject bills, as they do not qualify as putting the insurer on written notice of the fact of a covered loss.”
In Finlay Diagnostic Center v. Progressive, 13 Fla. L. Weekly Supp. 610b (Fla. Dade Cty.Ct. 01/31/06) the court held that “[i]n light of the use of the word “shall” in the Statute, with regards to the requirement that the professional license number be included in Box 31 of the HCFA form and the specific language that such deficiency may be asserted, even after payment, the Court cannot find that the defendant waived such deficiency.” The court went on to rule that defendant, as a matter of law, has not been placed on notice of a covered loss pursuant to section 627.736(5)(d).
In Magic Chiropractic Clinic v. Progressive, 14 Fla. L. Weekly Supp. 796a (Fla. Orange Cty.Ct. 06/18/07), the court in granting defendant’s motion for summary judgment ruled that plaintiff failed to include the professional license number on the CMS 1500 forms it submitted to defendant, “[t]hus, plaintiff failed to comply with Florida Statutes §627.736(5)(d) and, in turn, failed to place defendant on notice of a covered loss for purposes of Florida Statutes §627.736(4)(b).”
In Advanced Spine v. Progressive, 14 Fla. L. Weekly Supp. 893b (Fla. Pinellas Cty.Ct. 06/22 /07), the Court found that the defendant did not “waive its right to assert the deficiency in the HCFA forms; i.e. the absence of the professional license number of the provider in Box 31, since the deficiency may be asserted even after payment is made or after the 30 day time period for payment has expired.” The court went on to hold that by failing to put defendant on notice of a covered loss, plaintiff failed to meet the statutory condition precedent to filing this lawsuit.
Several other courts have likewise held that failure to include the professional license number in Box 31 is fatal to the subject bills, as they do not qualify as putting the insurer on written notice of the fact of a covered loss. New Life v. U.S. Security, 14 Fla. L. Weekly Supp. 480c (Fla. Miami Cty.Ct. 2/16/07) (Where bills submitted to insurer by medical provider do not contain professional license number of provider, insurer was not provided with written notice of covered loss, and bills are not payable.); Top Chiropractic v. Nationwide Mutual, 12 Fla. L. Weekly Supp. 152c (Fla. Orange Cty.Ct. 11/19/04) (Where medical provider failed to include professional license number of provider in box 31 of HCFA form, insurer was not furnished with notice of amount of covered loss or medical bills and is not responsible for payment.); and, Trans Imaging v. U.S. Security, 12 Fla. L. Weekly Supp. 781a (Fla. Miami Cty.Ct. 5/5/05) (Insurer has met burden for summary judgment based on medical provider’s failure to satisfy condition precedent of submitting complete claim form where insurer submitted both incomplete claim form and affidavit of claims adjuster indicating HCFA form received from provider did not reflect provider’s professional license number — Retroactive submission of complete HCFA form does not cure failure to satisfy condition precedent.)
After reviewing the above cases and section 627.736(5)(d), the Court finds that section 627.736(5)(d) is clear and unambiguous, and conveys a clear and definite meaning, thus the statute must be given its plain and obvious meaning. Therefore, as a matter of law, the requirements of Box 31, of the HCFA forms, mandates that the professional license number be included, failure to do so acts to bar a legal claim of action.
IT IS THEREFORE ORDERED AND ADJUDGED that Plaintiff’s Motion for Rehearing is hereby DENIED.
