17 Fla. L. Weekly Supp. 209a
Online Reference: FLWSUPP 1703DIA2Insurance — Personal injury protection — Claim form — Professional license number — Where medical provider failed to include professional license number of individual provider who actually performed services billed on claim form, provider’s bills are non-compensable
TOWN MEDICAL & REHAB CENTER, INC., a/a/o YUSNIEL DIAZ, Plaintiff, v. MERCURY INSURANCE COMPANY OF FLORIDA, Defendant. County Court, 13th Judicial Circuit in and for Hillsborough County. Case No. 08-CC-21409-SC Division I. October 13, 2009. Dick Greco, Judge. Counsel: Dorothy Sneed, Operations Manager, Masten, Lyerly, Peterson & Denbo, LLC, Orlando.
FINAL JUDGMENT FOR DEFENDANT
THIS CAUSE came before the Court for hearing on October 8, 2009 upon Defendant’s Amended Motion for Summary Judgment, and having been otherwise duly advised in the premises, the Court finds:
UNDISPUTED MATERIAL FACTS
1. Defendant, Mercury Insurance Company of Florida issued an automobile insurance policy applicable to Yusniel Diaz, which included Personal injury Protection (“PIP”) benefits.
2. Mr. Diaz claimed injuries as a result of a purported January 23, 2006 auto accident.
3. Mr. Diaz received medical treatment from individual healthcare providers working for Plaintiff, Town Medical & Rehab, Inc., a healthcare clinic.
4. Pursuant to an Assignment of Benefits, Plaintiff billed Defendant for reimbursement under Mr. Diaz’s claim for PIP benefits.
5. Plaintiff submitted to Defendant its CMS-1500 claim forms (“bills”) for the dates of service at issue in this suit: January 26, 2006 through August 18, 2006.
6. Defendant denied Plaintiff’s bills based on Mr. Diaz’s alleged material misrepresentations in the claim.
7. Plaintiff filed this lawsuit to recover Mr. Diaz’s PIP benefits from Defendant.
8. Plaintiff’s bills failed to include the professional license number of the individual medical provider who actually rendered the services.
9. Defendant filed for summary judgment on the grounds that Plaintiff’s bills were non-compensable under Florida Law based on Plaintiff’s failure to include the professional license number of the individual medical provider who actually performed the services billed.
LEGAL ANALYSIS
10. In 2003, the Legislature expressly added within §627.736(5)(d) Fla. Stat. the requirement that bills submitted for reimbursement of PIP benefits must include the professional license number of the provider who rendered the services billed. Subsection (5)(d) provides in pertinent 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.’
(Emphasis added).
11. The applicable subsection also provides the conseqence for failing to adhere to this provision by stating:
. . . 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 §627.736(5)(d) Fla Stat. (Emphasis added).
12. As a result, the inclusion of the professional license is not optional and it is the healthcare clinic’s burden to adhere to the strict billing requirements under the PIP Statute.
13. The ruling of this Court is consistent with this jurisdiction’s binding appellate decision in The Aries Insurance Company v. First Chiropractic Clinic, Inc. a/a/o Yvette Orneus, 12 Fla. L. Weekly Supp. 637a (Fla. 13th Jud. Cir. App. April 25, 2005).
RULING
Based on the undisputed facts and above-cited law, Plaintiff’s bills at issue in this case are non-compensable. Accordingly, it is hereby
ORDERED and ADJUDGED that Final Summary Judgment is entered for Defendant.
Plaintiff shall take nothing from this action and Defendant shall go hence without day. The Court retains jurisdiction to determine attorney fees and taxable costs as appropriate.
