16 Fla. L. Weekly Supp. 464b
Online Reference: FLWSUPP 165DORSA
Insurance — Personal injury protection — Claim form — Professional license number — Omission of professional license number from claim form constitutes failure to provide notice of claim — Failure to list omission of license number on explanation of benefits did not waive defense of lack of notice of claim
DAVID E. YACHTER, D.C., P.A., a Florida Corporation, (a/o Dorsainvil, Josette), Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 08-1055 COCE (55). February 20, 2009. Sharon Zeller, Judge. Counsel: Russel Lazega, for Plaintiff. Matt Hellman, Matt Hellman, P.A., Plantation, for Defendant.
ORDER ON DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS CAUSE having come on to be heard on Defendant’s Motion For Summary Judgment As To Box 31 on the issue of whether the failure to complete Box 31 with the professional license number of the physician is a material provision of Florida Statute Section 627.736(5) and whether the Defendant waived the affirmative defense of “Lack of Notice”, and the Court having heard argument of counsel, and being otherwise advised in the premises, the court finds as follows:
The Plaintiff, David E. Yachter, D.C., P.A., treated Josette Dorsainvil from October 4, 2006 to December 6, 2006, for injuries suffered in an auto accident on or about October 3, 2006. The Defendant failed to pay any of Plaintiff’s bills or furnish an itemized explanation of benefits.
Defendant alleges that Plaintiff’s bills failed to comply with the requirement of F.S. §627.736(5)(d): specifically they failed to include the license number of the treating physician.
In support of their Motion for Summary Judgment, the affidavit of the litigation adjuster states that at no time did Defendant waive its defense with regard to the requirement of a professional license number and physician signature in Box 31. (The court notes that some are signed and some are not.)
Florida Statutes 627.736(5)(d) provides in part:
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.”
No statement of medical services may include charges for medical services of a person or entity that performed such services without possessing the valid licenses required to perform such services. For purposes of paragraph (4)(b), an insurer shall not be considered to have been furnished with notice of the amount of covered loss or medical bills due unless the statements or bills comply with this paragraph, and unless the statements or bills are properly completed in their entirety as to all material provisions, with all relevant information being provided therein.
The statute specifically requires that the medical provider must include his or her license number, the omission of which constitutes a failure to provide notice of the claim to the insurer.
The issue then becomes whether the insurer knowingly waived its right to assert this defense as evidenced by their course of conduct. Did they proceed with processing the claim “as though no prima facie defect in the claim existed?” United Auto Insurance Company vs. Mary Brown, 15 Fla. L. Weekly Supp. 893 (17th Jud. Cir. App., Broward County July 2008). There is no evidence that this was done. Failure to list the omission on an EOB, Pro Imaging v. United, 14 Fla. L. Weekly Supp. 982a (17th Jud. Cir. Broward 2007); and even after partial payment is made; Advanced Spine & Inj. Center vs. Progressive Select Insurance Company, 14 Fla. L. Weekly Supp. 893b (6th Jud. Cir., Pinellas County 2007) is insufficient to show a knowing waiver of lack of notice. Therefore it is hereby
ORDERED AND ADJUDGED that Defendant’s Motion for Summary Judgment be, and the same is hereby GRANTED.
