6 Fla. L. Weekly Supp. 114a
Insurance — Personal injury protection — Error to grant summary judgment in favor of medical services provider in action to collect benefits which insurer had paid directly to its insured after it received provider’s bill where there was disputed issue of material fact as to whether insurer received only an unsigned billing form or whether it also received assignment of benefits form
SECURITY NATIONAL INSURANCE COMPANY, Appellant, v. USA DIAGNOSTICS, Appellee. 17th Judicial Circuit, in and for Broward County. Lower Div. Case No. 96-3733 COCE 54. Appellate Case No. 97-12692 (07). May 27, 1998. John T. Luzzo, Judge. Counsel: Carole Wolf Miller and Mary Anne Philips, Mary Anne Philips, P.A., Ft. Lauderdale, for Appellant. Sina Negahbani and James Loren, for Appellee.
OPINION
The Appellant, SECURITY NATIONAL INSURANCE COMPANY, appealed from a lower court decision granting Appellee’s Motion for Summary Judgment.
On October 20, 1994, Miracia Thellus was involved in an automobile accident, and claimed injuries as a result thereof. Miracia Thellus was covered under a policy of insurance issued by the Appellant, SECURITY NATIONAL INSURANCE COMPANY, to Jerome Archilles. The policy of insurance issued by SECURITY NATIONAL INSURANCE COMPANY provided PIP/No-Fault benefits in accordance with Florida law. Appellee, USA DIAGNOSTICS, claimed that it was an assignee of PIP/No-Fault benefits from Security National’s insured, Miracia Thellus.
On October 31, 1995, the SECURITY NATIONAL INSURANCE COMPANY received from the USA DIAGNOSTICS a HCFA 1500 form, representing billing from USA DIAGNOSTICS for services provided to Miracia Thellus in the amount of $1,450.00. The space for the patient’s signature on the HCFA 1500 form was marked “signature on file,” and was stamped, “Benefits Assigned.” The Appellant consistently maintained on the record that no supporting medical records or assignment of benefits was attached to the HCFA 1500 form. On November 7, 1995, the Appellant issued full payment for 80 percent of said billing as required by law, and made payment directly to the insured, Miracia Thellus. On November 17, 1995, after Appellant paid its insured directly, the Appellant received the actual assignment of benefits form from the Appellee, USA DIAGNOSTICS. The legal sufficiency of that form is irrelevant to the issues on this appeal.
USA DIAGNOSTICS filed suit, and both parties filed motions for summary judgment. The lower court granted Plaintiff, USA DIAGNOSTICS’ motion for summary judgment and denied Defendant, SECURITY NATIONAL INSURANCE COMPANY’s motion for summary judgment.
Appellant, SECURITY NATIONAL INSURANCE COMPANY, contended that the trial court erred in granting USA DIAGNOSTICS’ Motion for Summary Judgment when there remained a disputed and genuine issue of material fact to be determined, and upon which the trial court made no specific finding.
This Court finds that there remained a disputed issue of material fact, i.e., whether SECURITY NATIONAL INSURANCE COMPANY received only the unsigned HCFA 1500 form or whether it also received the assignment of benefits on October 31, 1995. The lower court order did not resolve or address this disputed factual issue when it granted Appellee’s motion. Appellant, SECURITY NATIONAL INSURANCE COMPANY, contended throughout the hearing on both parties’ Motions for Summary Judgment, that it received only the unsigned HCFA 1500 form prior to payment to its insured.
Security National contended that an unsigned HCFA 1500 form, standing alone, does not constitute notice of an assignment which is sufficient to require it to pay the medical provider directly, as opposed to paying its insured promptly.
There remained a disputed issue of material fact with regard to what documentation was received by the Defendant, SECURITY NATIONAL INSURANCE COMPANY, from the Plaintiff, USA DIAGNOSTICS, prior to the Defendant’s direct payment to the patient.
Therefore, this Court reverses the lower court’s order granting Plaintiff’s Motion for Summary Judgment, and remands for further proceedings consistent with this opinion.
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