16 Fla. L. Weekly Supp. 575c
Online Reference: FLWSUPP 166BALDW
Insurance — Personal injury protection — Claim form — Where medical provider first submitted CMS 1500 form lacking professional license number, and more than 35 days after date of service provider resubmitted form with license number, failure to submit statutorily compliant form within 35 days of date of service is fatal to claim
CARA BALDWIN, an insured individual, by and through her assignee, ALTAMONTE SPRINGS IMAGING, L.C., d/b/a MID FLORIDA IMAGING, Plaintiff, v. USAA CASUALTY INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 2008-SC-8019. April 23, 2009. Antoinette Plogstedt, Judge. Counsel: David S. Dougherty, Coury Law Firm, P.A., Lake Mary. Wendy L. Pepper, Rissman, Barrett, Hurt, Donahue & McLain, P.A., Tampa.
REVERSED. FLWSUPP 1910BALD
FINAL SUMMARY JUDGMENT FOR THE DEFENDANT
THIS CAUSE having come before this Court on March 30, 2009 upon Defendant’s Motion for Final Summary Judgment (Certificate of Service January 13, 2009) and the Court having heard argument of counsel and being otherwise fully advised in the premises, finds as follows:
1. On or about June 13, 2008, Plaintiff, as assignee of Defendant’s insured, filed a Complaint seeking Personal Injury Protection (“PIP”) benefits against Defendant for an unpaid date of service, December 10, 2007.
2. The CMS 1500 form for that date of service was received by the Defendant and was subsequently denied because the CMS 1500 form at issue did not contain the medical provider’s professional license number in Box 31, in violation of the requirements set forth in Florida Statute §627.736(5)(d).
3. Plaintiff resubmitted the CMS 1500 form to Defendant, which then contained the professional license number in Box 31. The Defendant received the corrected bill on January 28, 2008, forty-eight days after the date of service.
4. Florida Statute 627.736(5)(c) states in pertinent part: “[T]he statement of charges must be furnished to the insurer by the provider and may not include, and the insurer is not required to pay, charges for treatment or services rendered more than 35 days before the postmark date or electronic transmission date of the statement. . .”.
5. There is no provision in Florida Statute §627.736 which allows resubmission of a non-compliant medical bill for treatment or services rendered more than 35 days before the postmark date of the statement.
6. Plaintiff’s failure to submit a statutorily compliant CMS 1500 form within 35 days of the date of service is fatal to Plaintiff’s claim and Defendant is not required to pay those charges.
IT IS HEREBY ORDERED and ADJUDGED that the Defendant’s Motion for Final Summary Judgment is hereby GRANTED. Plaintiff shall take nothing by this action and the Court shall retain jurisdiction to determine any entitlement to reasonable attorney’s fees and costs submitted to the Court for consideration. A Final Summary Judgment for defendant is hereby awarded.
