8 Fla. L. Weekly Supp. 501a
Insurance — Personal injury protection — Section 627.736 does not require HCFA form to be countersigned by insured if medical provider has accepted an assignment of benefits
THE PREMIER CENTER FOR PERSONAL INJURIES, as assignee of Zureya A. Ruiz, Plaintiff, v. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County, General Jurisdiction Division. Case No. 00-4818 CC 26 (1). May 21, 2001. Bonnie Rippingille, Judge. Counsel: Charles L. Vaccaro. Norma Kassner.
ORDER DENYING DEFENDANT’SMOTION FOR SUMMARY JUDGMENT
THIS CAUSE having come before the Court for hearing on March 23, 2001, and the Court, having reviewed the pleadings, heard the argument of counsel, and being otherwise duly advised in the premises, the Court finds as follows:
FACTS OF CASE
This was an action for PIP benefits under a policy of insurance issued by Defendant, UNITED AUTOMOBILE INSURANCE COMPANY (“UNITED”) that arose out of an automobile accident that occurred on June 7, 1999. As a result of the accident, Zureya A. Ruiz was injured and sought medical treatment at Plaintiff’s facilities. At the time of the accident, Zureya A. Ruiz had a policy of insurance issued by UNITED which provided PIP benefits with a $2,000.00 deductible. Zureya A. Ruiz assigned her benefits under the policy to Plaintiff.
Plaintiff submitted $8,861 in medical bills for services rendered to Zureya A. Ruiz as a result of the subject automobile accident. It was undisputed that all of Plaintiff’s bills were submitted to the Defendant on Health Care Finance Administration 1500 (HCFA) forms. It is further undisputed that UNITED did not pay any of Plaintiff’s medical bills.
Defendant has filed a motion for summary judgment claiming that it does not have an obligation to pay any of the medical bills of Plaintiff due to the fact that the insured failed to countersign the HCFA forms submitted to the Defendant. In support of its argument, Defendant cites Florida Statutes Sec. 627.736(5)(a) and (5)(d). The Court however disagrees with Defendant’s interpretation of those sections of the PIP statute.
THE ULTIMATE PURPOSE OF THE PIPSTATUTE IS TO PROVIDE FOR THEPROMPT PAYMENT OF PIP BENEFITS.
Florida Statute Sec. 627.736(4)(b) states in relevant part:
(b) Personal injury protection insurance benefits paid pursuant to this section shall be overdue if not paid within 30 days after the insurer is furnished written notice of the fact of a covered loss and of the amount of same.
Florida Statute Sec. 627.736(4)(b), emphasis added.
“An objective of Florida’s Motor Vehicle No-Fault Law was to provide persons injured in an accident with prompt payment of benefits.” Nationwide Mut. Fire Ins. Co. v. Pinnacle Medical, Inc., 753 So.2d 55, 59 (Fla. 2000) (emphasis added); see, also, Government Employees Ins. Co. v. Gonzalez, 512 So.2d 269 (Fla. 3rd DCA 1987) (the legislative purpose of PIP insurance is to provide “swift and virtually automatic payment” of the benefits submitted to the insurance company); Crooks v. State Farm Mut. Auto. Ins. Co., 659 So. 2d 1266 (Fla. 3d DCA), rev. denied, 662 So. 2d 933 (Fla. 1995) (the “intent of Section 627.736(4)(b) is to guarantee swift payments of PIP benefits) (emphasis added).
Additionally, it is the policy of Florida Courts to construe the No-Fault act liberally in favor of the insured.” Palma v. State Farm Fire & Casualty Co., 489 So.2d 147 (Fla. 4th DCA 1986). The Florida Supreme Court has further indicated that a broader and more liberal standard of coverage is applied in PIP. Race v. Nationwide Mutual Fire Insurance Company, 542 So.2d 347 (Fla. 1989). Indeed, the application of broad coverage of benefits is found throughout the cases involving personal injury protection benefits in the state of Florida. See GEICO v. Novak, 453 So.2d 11, 16 (Fla. 1984); Pena v. Allstate, 463 So.2d 1256 (Fla. 3rd DCA 1985).
Florida Statute Sec. 627.736(5)(a) does not make any reference whatsoever to an “assignment of benefits.” The legislature clearly knows the term since Subsection 5(c) of the very same statute refers to “assignment of personal injury protection benefits.” Thus, because the legislature has expressed its knowledge as to “assignments” in subsection 5(c), and omitted that word in subsection 5(a), the Court concludes, based on a liberal construction of the statute, that subsection 5(a) was not intended to apply to situations in which the insured assigned his benefits to the medical provider. Instead, the Court finds that section 5(a) is only applicable to situations in which the medical provider did not accept an assignment and wants to be paid directly for the medical services.
In further support of this finding, the Court notes that subsection 5(a) states that “the insurer providing coverage may pay for such charges directly to such person or institution lawfully rendering such treatment” if the insured countersigns the HCFA form. Since the use of the word “MAY” indicates an option on the part of the insurer, it leaves the insurance company on option to also pay the insured for those same benefits in lieu of the medical provider. This cannot happen in a situation where the medical provider has accepted an assignment of benefits.
Once an insured assigns his benefits, the insured (assignor) has no further right to make any claim on the contract unless authorized to do so by the medical provider (assignee). Olgesby v. State Farm, 26 FLW D762 (Fla. 5th DCA 2001); State Farm Fire and Cas. Co. v. Ray, 556 So.2d 811, 813 (Fla. 5th DCA 1990). When an insured assigns his benefits under the policy to the medical provider, the insured no longer has a claim, at which point, the insurance company is required to pay the medical provider directly. There is no option as to who the insurer should pay when there is an assignment of benefits.
UNITED also relies on F.S. 627.736(5)(d), which provides that medical bills must be submitted on a standard form such as a HCFA or UB-90 form. However, there is no provision in Section F.S. 627.736(5)(d) which states that the HCFA form must be “countersigned” by the insured. Such an omission is significant. This Court must construe the PIP statute liberally and in favor of coverage. Thus, if there is any doubt as to whether the statute requires the HCFA form to be countersigned, the Court must construe the statute in a liberal way that would facilitate the payment of benefits, in which case no countersignature would be required.
UNITED maintains that because the insured executed an assignment of benefits, UNITED cannot pay the insured directly. UNITED further states that since the HCFA forms submitted by the medical provider were not countersigned by the insured, UNITED cannot pay the medical provider directly either. Thus UNITED argues that it “is statutorily prohibited from paying the provider directly and cannot, in good faith, pay the claimant because the claimant surrendered any rights to this action.” (emphasis added). Therefore UNITED asks this Court to interpret the PIP statute in such a manner as to allow UNITED to avoid the payment of PIP benefits altogether.
UNITED’S argument is contrary to the fundamental objective behind PIP insurance — the guarantee of “swift and virtually automatic” payment of benefits. The Court is not required to and will not interpret the PIP statute in such a manner that leads to an unreasonable or ridiculous result or a result obviously not intended by the legislature. United Automobile Insurance Co. v. Viles, 726 So.2d 320 (Fla. 3d DCA) rev. denied, 735 So.2d 1288 (Fla. 1999).
Therefore, the Court concludes that F.S. 627.736 does not require the HCFA form to be countersigned by the insured if the medical provider has accepted an assignment of benefits.
Based on the foregoing, it is ORDERED AND ADJUDGED that UNITED’S Motion for Summary Judgment be and the same is hereby DENIED.
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