8 Fla. L. Weekly Supp. 500b

Insurance — Personal injury protection — Statute provides that health care provider providing treatment covered by PIP insurance may be paid directly if insured countersigns medical bills — Where insured and health care provider failed to comply with statute by failing to comply with guidelines of authorized claim form requiring signature by both insured and health care provider, insurer has not been furnished with notice of amount of a covered loss and 30-day period in which insurer must authenticate claim has not begun to run — Phrase “signature on file” typed in signature box does not satisfy statutory requirement to countersign bill or claim form

YOLANDA RODRIGUEZ, Plaintiff, vs. OCEAN HARBOR CASUALTY INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County, Civil Division. Case No. 00-8968 SP 25. April 20, 2001. Wendell M. Graham, Judge. Counsel: Leo Becerra, for Plaintiff. Edward N. Winitz, Conroy, Simberg, Ganon, Krevans & Abel, P.A., for Defendant.

ORDER GRANTING DEFENDANT’S MOTION FORSUMMARY JUDGMENT AND ENTERING FINALSUMMARY JUDGMENT IN FAVOR OF DEFENDANTOCEAN HARBOR CASUALTY INSURANCE COMPANY

THIS CAUSE having come before the Court on April 17, 2001 on Defendant OCEAN HARBOR CASUALTY INSURANCE COMPANY’s (“OCEAN HARBOR”) Motion for Final Summary Judgment and Supplement to Defendant’s Motion for Final Summary Judgment and the court having considered the pleadings, evidence of record and argument of counsel:

1. The Court finds the following facts:

(a) Plaintiff, YOLANDA RODRIGUEZ (“RODRIGUEZ”) was involved in an automobile accident on November 6, 1999. That at the time of the accident, there was in full force and effect a policy of insurance issued to Rigoberto Ruiz which provided personal injury protection benefits for RODRIGUEZ for alleged bodily injuries sustained in said accident.

(b) RODRIGUEZ brought this personal injury protection suit alleging that OCEAN HARBOR wrongfully refused to pay medical bills RODRIGUEZ incurred for treatment rendered by B&J Diagnostic on December 16, 1999.

(c) That the HCFA Form-1500 attached as Exhibit “A” to OCEAN HARBOR’s Supplement to its Motion for Final Summary Judgment clearly and unequivocally shows in box number 13 the typed words “signature on file” in place of a signature of the insured or patient. Moreover, box number 31 also contains the typed words “signature on file” in place of the signature of the physician of supplier including the physician’s degrees or credentials.

2. The Court makes the following conclusions of law based on the foregoing undisputed facts:

(a) The medical bills submitted by the Plaintiff or by Plaintiff’s health care providers failed to comply with §627.736(5)(a) and (5)(d) , Florida Statutes, and the Defendant, OCEAN HARBOR, is not responsible for the subject bills.

(b) §627.736(5)(a) states in pertinent part that:

[T]he insurer providing such coverage may pay for such charges directly to such person or institution lawfully rendering such treatment, if the insured receiving such treatment or his or her guardian has countersigned (emphasis added) the invoice, bill, or claim form approved by the Department of Insurance upon which such charges are to be paid for as having actually been rendered, to the best knowledge of the insured or his or her guardian. (Emphasis added).

The Statute specifically requires the medical bills to be countersigned. “Countersigned” is defined by Webster’s II New College Dictionary as “to sign (a previously signed document), as for authentication; a second or verifying signature, as on a previously signed document.¹ Therefore, the Statute requires the signature of both the patient and the medical provider.

(c) In the case sub judice, the medical bills are in violation of the Statute on two grounds. First, the medical provider failed to sign the medical bills. Secondly, the insured, Yolanda Rodriguez, or her guardian, failed to countersign the medical bills as mandated by the Statute.

(d) In pertinent part, the Statute states that the insurer may pay the medical provider directly if the medical bills are countersigned. It, therefore, follows that, if the medical bills are not countersigned, the insurer may not pay the provider directly. In the instant case, the medical bills are not countersigned, and, therefore, the insurer may not pay the provider directly.

(e) Secondly, such bills are in violation of Florida Statute §627.736(5)(d) which requires:

All statements and bills for medical services rendered by any physician, hospital, clinic, or other person or institution shall be submitted to the insurer on a health claim finance administration 1500 form, UB92 Forms, or any other standard form approved by the Department for purposes of this paragraph.

The Statute requires that medical bills shall be submitted on one of the approved forms. The medical providers in this case have chosen to use health care finance administration forms which, on its face, require both the signature of the physician or supplier, including degrees or credentials and the insured’s signature. There is no question that the subject bills were submitted on the correct forms, i.e., HCFA; however, the Plaintiff’s medical providers have failed to comply with the requirements of the HCFA form.

(f) Subsection 627.736(5)(d) further states that an insurer shall not be considered to have been furnished with notice of a covered loss or medical bills due unless the statements or bills comply with this paragraph. Based upon the health care providers and Plaintiff’s failure to comply with this paragraph by failing to follow the guidelines of the authorized form, the Defendant, OCEAN HARBOR, has not been furnished with notice of a covered loss for purposes of Subsection (4)(b) of Florida Statute 627.736. It, therefore, follows that, until the Plaintiff complies with the Statute, the statutory 30-day period in which an insurer must authenticate the claim, under Subsection (4)(b), does not begin to run. Accordingly, in this case, Ocean Harbor has not been provided with notice of a covered loss, and it, therefore, has not breached its duties and obligations under Florida Statutes and the subject insurance policy. As such, the suit is without merit.

(g) In the present case, in response to the signature request on line 13 of the HCFA form is typed “Signature on file.” Pursuant to Security National Insurance Company v. Biotronix, 6 Fla. L. Weekly Supp. 314 (11th Circuit Appellate Division, March 12, 1999), the Court found that a form with “Signature on File” does not attest anything and characterizes this issue as an inescapable fact.

(h) The fact that the Plaintiff’s medical providers had the insured’s signature on file or even that of a physician’s signature on file, in no way establishes that Yolanda Rodriguez is attesting to all of the treatment that was rendered at any future time as represented on the HCFA form that was submitted to the Defendant for payment. Further, even if “Signature on File” was sufficient, line 13 of the HCFA form only authorizes the insurance company to issue payment to the medical provider and in no way complies with the Statute requiring the insured to attest that the medical charges have been actually rendered, to the best knowledge of the insured.

(i) The Court finds that because the bills furnished to OCEAN HARBOR did not comply with §627.736(5)(a) and (d), OCEAN HARBOR shall not be considered to have been furnished with notice of the amount of a covered loss for purposes of §627.736(4)(b). It is, therefore,

ORDERED AND ADJUDGED that:

(A) OCEAN HARBOR’S Supplement to its Motion for Final Summary Judgment is GRANTED in all respects.

(B) That this Court did not reach the issues as set forth in the original Motion for Final Summary Judgment filed by OCEAN HARBOR and, therefore, makes no ruling thereon.

(C) Final Judgment is hereby rendered in favor of Defendant OCEAN HARBOR CASUALTY INSURANCE COMPANY and against Plaintiff, YOLANDA RODRIGUEZ.

(D) Plaintiff, YOLANDA RODRIGUEZ shall take nothing by this action and Defendant, OCEAN HARBOR CASUALTY INSURANCE COMPANY shall go hence without day.

(E) This Court reserves jurisdiction to tax attorneys’ fees and costs, if authorized by law.

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¹Webster’s II New College Dictionary, (Houghton Mifflin Company, 1995) Pg. 258.

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