8 Fla. L. Weekly Supp. 851a
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
USA DIAGNOSTICS, a/a/o CEPERO, Plaintiff, vs. STAR CASUALTY INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 01-53 COCE (53). October 3, 2001. William W. Herring, Judge. Counsel: Roberts J. Bradford, Jr., Marks and Fleischer, P.A., Fort Lauderdale. Jennifer N. Lucy, North Miami Beach.
ORDER DENYING DEFENDANT’S MOTIONFOR SUMMARY JUDGMENT
This civil cause having been heard on September 10, 2001 on Defendant’s motion for summary judgment asserting that the Plaintiff provider in this PIP suit may not recover benefits, due to its noncompliance with Section 627.736(5)(a,d), Florida Statutes, in that Plaintiff did not have the patient countersign the HCFA form to attest that the treatment/service had actually been rendered, to the best knowledge of the patient, thereby rendering the form as one not mandated by the latter subsection, the Court having heard argument, received the later filing of supporting case authorities, and being advised, it is
ORDERED that the motion of the Defendant, Star Casualty Insurance Co., for summary judgment on the above-referenced issue is denied, the Court making the following mixed findings-conclusions:
1) Subsection (5)(a) of the statute omits any reference to an assignment of benefits, yet subsection (5)(c) does make such reference, evincing a legislative intent that the former subsection deals solely with a situation in which the provider has not accepted an assignment yet desires direct payment, which is not the case here; see The Premier Center for Personal Injuries v. United Automobile Insurance Co., 8 F.L.W. Supp. 501a (County Ct., 11th Judicial Circuit, decided May 21, 2001).
2) The subsection employs the permissive, not mandatory, term “may” relative to the insurer’s making of direct payment to the provider in the absence of an assignment, according the insurer the option of paying benefits either to the provider or the insurer, such option being foreclosed in the assignment context; Ibid.
3) Subsection (5)(d) does not require the countersignature/attestation of the patient/insured, but merely prescribes that bills must be submitted on a standard form, such as a HCFA form; it is undisputed that Plaintiff’s medical bills were so submitted; Id.
4) It is further significant that the standard HCFA does not provide for countersignature or attestation by the insured that the services were actually performed. (One would think that the pertinent governmental agency responsible for drafting the HCFA form would have made it easy, not hard, for providers to comply with the statute, if the statute required what the Defendant insurer asserts that it does.) And
5) Judicial adoption of the Defendant’s position would create a timing and logistical nightmare for providers vis-a-vis their billing practices: they would either have to implement instantaneous billing each time the patient came into the office for treatment (not a feasible solution), or they would have to constantly contact the patient to come in and countersign the bills, after the fact, multiplied over perhaps numerous visits, being at the mercy of their patients, all in the context of providers having to comply with the time strictures of Section 627.736(5)(b), Florida Statutes, for submission of bills to the insurer. (No, the Plaintiff is not a treating physician or facility, but only a diagnostic testing one, but the premise is still valid across the board as to health care.)
This Court fully agrees with the well-reasoned order of Miami-Dade County Judge Bonnie Rippingille in the The Premier Center for Personal Injuries case, supra. She concluded, and this Court concurs, that the argument and position of the Defendant creates a “Catch-22” situation in which it may evade altogether its statutory obligation to make prompt, swift payment of PIP benefits, an absurd or unreasonable result which this Court cannot and will not countenance.
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