16 Fla. L. Weekly Supp. 1155a
Online Reference: FLWSUPP 1612PIER
Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — Where medical provider submitted self-generated D&A form that transcribed D&A form adopted by Office of Insurance Regulation verbatim except for state seal and Office’s name at top of form, form substantially complied with section 627.736(5)(e) and provided notice of covered loss
MARK PIERCE CHIROPRACTIC CLINIC, P.A., as assignee of GLORIA DIXON, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. Small Claims Court, 4th Judicial Circuit in and for Duval County. Case No. 16-2008-SC-010709 Division, A. October 8, 2009. Emmet F. Ferguson, III, Judge. Counsel: D. Scott Craig, D. Scott Craig, P.A., Jacksonville. James B. Eubanks.
ORDER DENYING DEFENDANT’S AMENDED MOTION FOR SUMMARY DISPOSITION RE:IMPROPER DISCLOSURE AND ACKNOWLEDGMENT FORM
THIS CAUSE having come before the Court on Defendant’s Amended Motion for Summary Disposition Re: Improper Disclosure And Acknowledgment Form. Having heard arguments of counsel and having considered relevant Florida Law, it is ORDERED AND ADJUDGED as follows:
This is a case seeking No-Fault benefits, arising from a motor vehicle accident of January 25, 2008. Plaintiff filed suit in this case seeking payment for treatment rendered to Gloria Dixon on date of service May 12, 2008. All other bills submitted to by Plaintiff for treatment rendered to Gloria Dixon have been paid by State Farm. State Farm’s denial of this date of service was based on its position that the bill was not payable under Florida No-Fault Law, due to its allegedly being in violation of the National Correct Coding Initiative database.
After the lawsuit was filed, and after conducting discovery in this case, State Farm took the position for the first time that the Disclosure And Acknowledgment Form (“Form”) submitted by Plaintiff was not in compliance with Florida Statute § 627.736(5)(e). State Farm then filed its Motion for Summary Disposition, arguing that as the Form submitted was not the standard Form authored and adopted by the Office of Insurance Regulation (“OIR”), the unpaid bill at issue in this lawsuit is not payable as a matter of law, and that Plaintiff’s suit must be dismissed.
Plaintiff has provided unrefuted evidence that the Form submitted by Plaintiff was signed on the initial date of service by both the patient and licensed medical professional. This Court finds that the Form submitted by Plaintiff transcribed the Form authored and adopted by the Office of Insurance Regulation virtually word for word. While the Form submitted by Plaintiff did not contain the header with the State seal and the name “Office of Insurance Regulation” at the top of the page, it is in all material respects essentially identical to the OIR Form.
Defendant urges this Court to utilize a strict compliance standard in interpreting Florida No-Fault Law, and to rule that because of the Form used, Defendant never received “written notice of fact of a covered loss”, pursuant to F.S. § 627.736(4)(b), and therefore none of Plaintiff’s bills are payable. This Court is not persuaded by Defendant’s argument, and disagrees that a strict compliance standard of review should be employed. Rather, the Court finds that Plaintiff’s Form is in substantial compliance with the statute.
In Maritza Lahodik v. Progressive Express Insurance Company, 16 Fla. L. Weekly Supp. 175c (Fla. 4th Jud. Circuit, Duval County, June 12, 2008), this Court ruled that the Form submitted by the medical provider in that case did not provide the insurer with the required written notice of fact of a covered loss, and granted the insurer’s Motion for Partial Summary Judgment on that issue. In making its ruling in Lahodik, this Court recognized the application of a substantial compliance standard in interpreting F.S. § 627.736(5)(e), but found that the Form submitted did not meet that standard. In Lahodik, as in this case, the medical provider utilized a self-generated Form that was not the exact Form authored by the Office of Insurance Regulation. However, unlike the Form in this case, the Form submitted in Lahodik did not list or describe the services rendered; did not contain a section of affirmations by the treating physician; and did not contain language identical to the OIR Form. It was because the Form in Lahodik differed in numerous material respects from the OIR Form that this Court declined to apply the doctrine of substantial compliance, and not because the Form was self-generated.
Furthermore, Florida No-Fault Law provides guidance to courts in ruling on disputes such as this, indicating that a substantial compliance standard should be used. For example, Florida Statute § 627.736(5)(b)(1)(d) indicates that an insurer is not responsible for payment of a bill, unless the bill or statement “substantially meets” the billing requirements contained in F.S. § 627.736(5)(d). Likewise, Florida Statute § 627.732(11) defines “lawful” in the No-Fault context as a bill “in substantial compliance with all relevant criminal, civil and administrative requirements of state and federal law related to the provision of medical services or treatment.” Accordingly, the Legislature has expressed its intent that medical providers need only be in substantial compliance with the No-Fault Law in order to receive payment. In addition, courts are bound to construe Florida No-Fault Law liberally in favor of the insured, pursuant to the ruling in Palma v. State Farm Mutual Automobile Ins. Co., 489 So. 2d 147, 149 (Fla. 4th DCA 1986) review denied 496 So. 2d 143, 149 (Fla. 1986).
This Court finds that the Form utilized by Plaintiff substantially complied with Florida Statute § 627.736(5)(e). The Form submitted in this case is substantially identical to that promulgated by the Office of Insurance Regulation. The Form submitted fully satisfies the intent of the Legislature in enacting the statutory subsection, which was to help prevent insurance fraud and to assure that patients give informed consent for treatment. The Disclosure And Acknowledgment Form submitted by Plaintiff in this case therefore constitutes written notice of fact of a covered loss to Defendant, as required by Florida Statute § 627.736(4)(b).
IT IS THEREFORE ORDERED AND ADJUDGED that Defendant’s Amended Motion for Summary Disposition Re: Improper Disclosure And Acknowledgment Form is DENIED, with prejudice.
