4 Fla. L. Weekly Supp. 753a
Insurance — Personal injury protection — Written notice of claim — Attorney’s fees — Personal injury protection benefits are deemed overdue if they are not paid within thirty days after the insurer is furnished “written notice of the fact of a covered loss and the amount of same” — Where Health Insurance Claim Form submitted by one of insured’s health care providers indicated insured’s condition was related to an auto accident, indicated a date which was either the date of injury or date insured first noticed symptoms of injury, contained personal information about insured, contained amount of loss, and listed the claim number that insurer assigned to the claim, the form contains sufficient information to constitute “written notice” of claim for covered loss and the amount of loss — Where insurer has received written notice of the claim, burden is on insurer to investigate and then to pay the claim within thirty days from the date of receipt of written notice if it cannot prove it was not responsible for payment — Where insurer failed to pay the claim within the requisite thirty days, insured’s health care provider was entitled to an award of costs and attorney’s fees
NEW HAMPSHIRE INDEMNITY COMPANY, Appellant, vs. PINNACLE MEDICAL, INC., d/b/a ISO DATA DIAGNOSTICS, Appellee. 9th Judicial Circuit in and for Orange County. Appellate Case No. CVA196-53. L.T. Case No. SO96-2180. June 10, 1997. R. James Stroker, Judge. Counsel: Kevin H. O’Neill, Haas, Arend, Ramey & Beik, Tampa, for Appellant. Harley N. Kane, Greenspan & Kane, Boca Raton, for Appellee.
OPINION ON APPEAL
New Hampshire Indemnity Company (New Hampshire) appeals the order of the trial court assessing attorney’s fees and costs against New Hampshire and in favor of Pinnacle Medical, Inc. (Pinnacle). The question presented by this case is whether a “Health Insurance Claim Form” (HCFA form) constitutes sufficient written notice under section 627.736(4)(b), Florida Statutes, so as to require an insurer to investigate and pay a claim within thirty days of receipt of an HCFA form. This Court finds that the HCFA form at issue in this case contains sufficient information to put New Hampshire on notice of the claim, and therefore, that New Hampshire was required to pay the claim within thirty days of receipt of the HCFA form. New Hampshire failed to pay the claim within the requisite thirty days; thus, Pinnacle was entitled to an award of costs and attorney’s fees. Accordingly, this Court affirms.
The facts giving rise to this appeal are as follows: Ms. Carol Merilus was a passenger in a vehicle that was involved in an automobile accident. Following the accident, Merilus sought medical attention. On March 26, 1996, New Hampshire received an HCFA form along with some related billing matters from one of Merilus’s healthcare providers. On April 23, 1996, New Hampshire received Merilus’s “Application for Benefits — Personal Injury Protection” form (“Application for Benefits” form). On May 6, 1996, Pinnacle filed suit for unpaid benefits under section 627.736(4)(b), Florida Statutes. On May 21, 1996, New Hampshire paid all benefits that were owed to Pinnacle. The benefits were paid less than thirty days after New Hampshire received the “Application for Benefits” form, but more than thirty days after New Hampshire received the HCFA form. Pinnacle sought, and was awarded, attorney’s fees and costs pursuant to section 627.736(4)(b), Florida Statutes, based on the fact that New Hampshire had not paid the claim within thirty days of receipt of the HCFA form. New Hampshire appeals from said award.
New Hampshire argues the trial court improperly interpreted and applied section 627.736(4)(b), Florida Statutes, by ruling that the submission of an HCFA form along with billing information from the healthcare provider constituted “written notice” which required the healthcare provider to pay the personal injury protection benefits within thirty days from the date of receipt of the HCFA form. Furthermore, New Hampshire claims that the “Application for Benefits” form (which New Hampshire received after the HCFA form), constituted the “written notice” required by section 627.736(4)(b), and that New Hampshire had thirty days from the date of receipt of the “Application for Benefits” form in which to pay the personal injury protection benefits under the insurance policy.
Under Florida law, personal injury protection benefits are deemed overdue if they are not paid within thirty days after the insurer is furnished “written notice of the fact of a covered loss and the amount of same.” §627.736(4)(b), Fla. Stat. However, quite often the issue is not whether the insurer receives “written notice,” but rather what is sufficient to constitute “written notice.” “No-Fault Applications” constitute “written notice” under section 627.736(4)(b), Florida Statutes. See Martinez v. Fortune Ins. Co., 684 So. 2d 201 (Fla. 4th DCA 1996) and Dunmore v. Interstate Fire Ins. Co., 301 So. 2d 502 (Fla. 1st DCA 1974). Additionally, a letter from an attorney may constitute written notice under section 627.736(4)(b), Florida Statutes. See Crooks v. State Farm, 659 So. 2d 1266 (Fla. 3d DCA), rev. dismissed 662 So. 2d 933 (Fla. 1995).
In Crooks, Crooks, through his attorney, wrote a letter to State Farm listing the itemized bills for three medical providers who had yet to be paid, and requesting that State Farm pay the bills within thirty days of receipt of the letter. More than three months passed, and State Farm still had not paid the bills. State Farm’s sole reason for not paying the bills within the thirty-day time period was that the bills were not submitted on a particular in-house claims form. Crooks filed suit and claimed entitlement to attorney’s fees under section 627.736(4)(b), Florida Statutes. After Crooks filed suit, State Farm paid the bills. Following a non-jury trial on the attorney’s fees issue, the trial court found that State Farm technically violated the time requirements of section 627.736(4)(b), but that State Farm had not violated the “intent” of section 627.736(4)(b). The Third District Court of Appeal reversed, finding that “State Farm clearly violated the express requirements of [s]ection 627.736(4)(b) by failing to pay Crooks’ medical bills within thirty days of being notified, in writing, of these charges.” Id. at 1268-69. In reaching this decision, the Third District Court of Appeal noted that the trial court “erroneously ignored the plain meaning and intent of [s]ection 627.736(4)(b), which is to guarantee swift payment of [personal injury protection] benefits.” Id. at 1268.
In the instant case, the HCFA form indicates that Merilus’ condition was related to an auto accident; it indicates a date which is either the date of the injury or the date Merilus first noticed symptoms of the injury; it contains the name, address, telephone number, date of birth, and “I.D. NUMBER” of the insured; and it contains the amount of the loss. Additionally, and most importantly, the trial court found that the number listed in the space on the HCFA form called “INSURED’S POLICY GROUP OR FECA NUMBER” was actually the claim number that New Hampshire had assigned to the claim. The fact that a claim number was assigned to the claim by New Hampshire indicates that new Hampshire had already been notified of the accident by its insured. Although the information contained on the HCFA form does not include specific details about the accident, it does contain sufficient information to constitute “written notice” under section 627.736(4)(b). Thus, upon receipt of the HCFA form, the burden was on New Hampshire to authenticate the claim within thirty days; if New Hampshire could not prove it was not responsible for the payment, it should have paid the claim within thirty days of the date of receipt of the HCFA form. See Crooks, 659 So. 2d 1266. See also Martinez, 684 So. 2d at 203 (holding that section 627.736(4)(b), Florida Statutes, requires a personal injury protection insurer to pay the claimed benefits within thirty days of receipt of written notice of the claim).
Therefore, it is hereby ORDERED and ADJUDGED that the Final Judgment Assessing Attorney Fees and Costs is AFFIRMED. This Court reserves jurisdiction on the issue of entitlement to appellate attorney’s fees and costs.
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