15 Fla. L. Weekly Supp. 1008a
Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form that listed “medical treatment” on line where services rendered should have been specified was insufficient to put insurer on notice of covered loss — Defense of defective D&A form can be raised at any time, even after payment of claim — Defect in D&A form cannot be cured
MANASSAS MEDICAL CENTER, INC., (a/a/o MORSA, MANUEL), Plaintiff, vs. PROGRESSIVE AMERICAN INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County, Civil Division. Case No. 08-1671 SP 23 (5). August 20, 2008. Lisa Walsh, Judge. Counsel: Daniel Davidovic, for Plaintiff. Reuven T. Herssein, Law Offices of Herssein & Herssein PA, North Miami, for Defendant.
FINAL ORDER GRANTING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS CAUSE came before the Court for hearing on July 31, 2008, on Defendant’s Motion for Summary Final Judgment, alleging that Plaintiff failed to submit a proper Standard Disclosure and Acknowledgment Form. The Court, having reviewed the Motion, and legal authorities, and having heard the argument of counsel, finds as follows:
Factual Background: This is a PIP case. Defendant seeks summary final judgment as to all services rendered, alleging that the Plaintiff failed to submit a proper Standard Disclosure and Acknowledgment Form.
The Plaintiff’s Standard Disclosure and Acknowledgment Form submitted to the Defendant, listed “medical treatment” on the line where the specific services should have been delineated. This case only involved the initial date of service, as that was the only date the claimant was treated by this provider.
Legal Conclusion: This Court finds that the Disclosure and Acknowledgment Form in the instant case was insufficient, as it lacked any indication of what services were rendered and, therefore, what the insured testified was done.
The purpose of the disclosure and acknowledgment form is to prevent fraud by requiring the physician and the patient to attest to exactly what services are rendered during the initial visit. Writing “medical treatment” in the line provided to specify what the insured and the provider are attesting was done, is akin to leaving the line blank.
Additionally, not specifying the treatment that was actually rendered, is contrary to the minimum requirements set forth in Florida Statutes §627.736(5)(e)1a.
In relevant part, Florida Statutes §627.736(5)(e)1a. states as follows:
(e)1. At the initial treatment or service provided, each physician, other licensed professional, clinic, or other medical institution providing medical services upon which a claim for personal injury protection benefits is based shall require an insured person, or his or her guardian, to execute a disclosure and acknowledgment form, which reflects at a minimum that:
a. The insured, or his or her guardian, must countersign the form attesting to the fact that the services set forth therein were actually rendered;
Simply listing “medical treatment,” therefore, does not comply with the minimum requirements of the Statute, and is akin to leaving the form blank.
Accordingly, the services for the patient’s initial visit with the Plaintiff are not compensable.
Moreover, pursuant to Florida Statutes §627.736(4)(b), this Court does not find Plaintiff’s waiver argument applicable.
Florida Statutes §627.736(4)(b) states in relevant part:
“This paragraph does not preclude or limit the ability of the insurer to assert that the claim was unrelated, was not medically necessary, or was unreasonable or that the amount of the charge was in excess of that permitted under, or in violation of, subsection (5). Such assertion by the insurer may be made at any time, including after payment of the claim or after the 30-day time period for payment set forth in this paragraph.”
Thus, in following the intent of the PIP Statute for the prompt payment of PIP claims, the Statute inserts a mechanism for insurers to raise certain defenses, even after payment of the claim. In this instance, Florida Statutes §627.736(4)(b) specifically states that insurer can raise the violation of subsection (5) defense, at any time, even after payment of the claim. Accordingly, the insurer has the right to raise the defense — that the Standard Disclosure and Acknowledgment Form submitted violated Subsection 5, and was insufficient to put the insurer on notice of a covered loss — even after payment of the claim.
Finally, this Court also holds that a defect in the Standard Disclosure and Acknowledgment Form cannot be cured. The intent of the Legislature in requiring the form is to prevent insurance fraud. Allowing the provider to go back and cure a faulty Standard Disclosure and Acknowledgment Form, circumvents the point of the minimum requirements under Florida Statutes §627.736(5)(e).
Accordingly, it is:
ORDERED AND ADJUDGED:
The Defendant’s Motion for Summary Final Judgment is hereby GRANTED.
The Defendant shall go hence forth without day.
This Court reserves jurisdiction to tax attorney’s fees and costs.
