9 Fla. L. Weekly Supp. 250b
Insurance — Personal injury protection — Medical bills — Where medical bills are not countersigned by insured, insurer may not pay the assignee medical provider directly — Insurer cannot in good faith pay insured who has assigned claim — Where medical provider failed to follow guidelines of HCFA form 1500 which require patient’s signature in addition to that of physician or medical supplier, insurer has not been provided with notice of a covered loss and has not breached its duties under statutes and policy — Form reflecting words “Signature on file” does not attest to treatment rendered — Line of HCFA form which authorizes insurer to issue payment to medical provider does not comply with statutory requirement that insured attest that medical charges have actually been rendered to best knowledge of insured — Even if medical provider were now to resubmit HCFA form countersigned, medical provider would be barred from recovery because both 30-day and 60-day periods for claims will have expired — Insurer’s motion for summary judgment granted
AMC REHAB & PAIN CENTER, A/a/o Tangela Brown, Plaintiff, v. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County, Civil Division. Case No. 00-14813 SP 05 08. October 9, 2001. A. Leo Adderly, Judge. Counsel: Juan Andreu, for Plaintiff. Kara O’Donnell, Gregory J. Willis & Associates, Ft. Lauderdale, for Defendant.
ORDER GRANTING DEFENDANT’S MOTION FORSUMMARY JUDGMENT IN FAVOR OF DEFENDANT,UNITED AUTOMOBILE INSURANCE COMPANY
The CAUSE having come before the Court on October 4, 2001, on Defendant’s, UNITED AUTOMOBILE INSURANCE COMPANY’s (“UNITED AUTOMOBILE”), Motion for Final Summary Judgment and Applicable Law in Support Thereof — Failure to Comply With Statute and the court having considered the pleadings, evidence of record and argument of counsel:
1. The Court finds the following facts:
(a) Insured, TANGELA BROWN (“BROWN”), was allegedly involved in an automobile accident on May 14, 2000 and sustained injuries.
(b) That at the time of the accident, there was in full force and effect a policy of insurance issued to BROWN which provided personal injury protection (“PIP”), benefits for BROWN for alleged bodily injuries sustained in said accident.
(c) BROWN executed an Assignment of Benefits which assigned insurance benefits of UNITED AUTOMOBILE INSURANCE COMPANY, and directed payment, to AMC REHAB & PAIN CENTER, (“AMC REHAB.”) (See copy of assignment of benefits attached and made a part hereof as Defendant’s Exhibit “A.”)
(d) AMC REHAB brought this Personal Injury Protection (“PIP”) suit alleging that Defendant, UNITED AUTOMOBILE, wrongfully refused to pay medical bills that BROWN incurred for treatment rendered by AMC REHAB from May 16, 2000 to September 11, 2000. (See copy of medical bills (HCFA’s) attached and made a part hereof as Defendant’s Composite Exhibit “B.”)
(e) That the HCFA-1500 Forms attached as Exhibit “A” to UNITED AUTOMOBILE’s Motion for Final Summary Judgment and Applicable Law in Support Thereof clearly and unequivocally show in box number 12 the typed words “signature on file” in place of the “Patient’s or authorized person’s signature” requested by the form.
(f) That the HCFA-1500 Forms attached as Exhibit “A” to UNITED AUTOMOBILE’s Motion for Final Summary Judgment and Applicable Law in Support Thereof clearly and unequivocally show in box number 13 the typed words “signature on file” in place of the “Insured’s or authorized person’s signature” requested by the form.
2. The Court makes the following conclusions of law based on the foregoing undisputed facts:
(a) The medical bills submitted by the Plaintiff, AMC REHAB, failed to comply with §627.735(5)(a) and (5)(d), Florida Statutes, and thus the Defendant, UNITED AUTOMOBILE, is not responsible for the subject bills. (See affidavit of Theresa Rodriguez attached and made a part hereof as Defendant’s Exhibit “C”).
(b) §627.735(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 the patient as a “second or verifying” signature.
(c) In the instant case, the medical bills are in violation of the statute because the insured, BROWN, or his guardian, failed to countersign the medical bills as mandated by the statute.
(d) The HCFA forms submitted by AMC REHAB contained an original signature of the “Physician or Supplier” as required in box number 31. Indeed, an original, i.e. ink, signature of provider, Jeffrey S. Senter, D.C., appears in Box 31 on each HCFA submitted. (See copy of medical bills (HCFA’s) attached and made a part hereof as Defendant’s Composite Exhibit “B.”)
(e) In pertinent part, the statute states that the insurer may pay AMC REHAB 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.
(f) However, the language of the statute, begs the question that: if the insurer may not pay AMC REHAB directly, cannot the insurer then pay the insured directly? We would agree that the statute seems to infer this second option. In the present case however, BROWN has assigned her benefits to AMC REHAB.2 Since an “assignment transfers to the assignee all the interest of the assignor under the assigned contract, the assignor has no right to make any claim on the contract once the assignment is complete, unless authorized to do so by the assignee.” State Farm Fire & Casualty Co. v. Ray, 556 So. 2d 811, 813 (Fla. 5th DCA 1990). In the present case the assignment rescinds the insurer’s right to exercise the second option of paying the insurer.
(g) Therefore, the Defendant, UNITED AUTOMOBILE, is statutorily prohibited from paying the provider directly and cannot, in good faith, pay the claimant because the claimant has surrendered any rights to this action.
(h) Secondly, the bills submitted by AMC REHAB are in violation of Florida Statute 627.736(5)(d) which requires that:
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 Care Finance Administration 1500 form, UB 92 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. In this case, AMC REHAB had chosen to use the Health Care Finance Administration Form which, on its face, requires both the “SIGNATURE OF PHYSICIAN OR SUPPLIER INCLUDING DEGREES OR CREDENTIALS” and the “INSURED’S OR AUTHORIZED PERSON’S SIGNATURE.” There is no question that the subject bills were submitted on the correct forms: the HCFA-1500. However, AMC REHAB has failed to comply with the requirements of the HCFA form by failing to obtain the “Patient’s or Authorized Person’s signature” in addition to the signature of the “physician or supplier.”
(i) 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 AMC REHAB’s failure to comply with this paragraph by failing to follow the guidelines of the authorized form, the Defendant, UNITED AUTOMOBILE, has not been furnished with notice of a covered loss for purposes of subsection (4)(b) of Florida Statute 627.736. Therefore, it follows that until the Plaintiff complies with the statute, the statutory thirty (30) day period in which an insurer must authenticate the claim, under subsection (4)(b), does not begin to run. Accordingly, in this case, UNITED AUTOMOBILE 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.
(j) In the present case, in response to the signature requested on lines 12 or 13 of the HCFA form is typed “SIGNATURE ON FILE.” (See copy of medical bills attached hereto as Composite Exhibit “A”). Pursuant to the appellate opinion in Security National Insurance Company v. Biotronix, 6 Fla. L. Weekly Supp. 314 (11th Cir. App. Div., March 12,1999), the Court found that a form reflecting the words “Signature On File” does not attest to anything and characterizes this issue as an “inescapable fact.”
(k) The fact that AMC REHAB may have the Insured’s, BROWN’s, signature on file in no way establishes that BROWN is attesting to all of the treatment that was rendered at any future time as represented on the HCFA forms that were submitted to UNITED AUTOMOBILE. Furthermore, even if the typed words “Signature On File” were sufficient, line 13 of the HCFA form only authorizes the insurance company to issue payment to the medical provider in no way complies with the statute requiring the insured to attest that the medical charges have “actually been rendered, to the best knowledge of the insured.”
(l) Finally, even if AMC REHAB were to now comply with the statute and the Insured were to co-sign the medical bills attesting to their authenticity, recovery would still be barred. Pursuant to Florida Statute 627.736(5)(b),
the insurer and the injured party are not required to pay charges for treatment or services rendered more than 30 days before the postmark date of the statement […] except that, if the provider submits a notice of initiation of treatment within 21 days after its first examination of treatment of the claimant, the statement may include charges for treatment or services rendered up to, but not more than, 60 days before the postmark date of the statement.
In this case, even if AMC REHAB were to now resubmit the HCFA form correctly filled out, i.e. countersigned, both the thirty and sixty day time period will have already expired and AMC REHAB would be barred from recovery.
(m) Accordingly, there being no genuine issue of material fact as to the Plaintiff’s, AMC REHAB’s, failure to comply with Florida Statute 627.736(5)(a) and (d), the Defendant, UNITED AUTOMOBILE INSURANCE COMPANY, is entitled to Final Summary Judgment as a matter of law.
(n) The Court finds that since it is undisputed that the bills furnished to UNITED AUTOMOBILE did not comply with §627.736(5)(a) and (d), UNITED AUTOMOBILE 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. UNITED AUTOMOBILE’s Motion for Final Summary Judgment for Failure to Comply with Statute is GRANTED in all respects.
B. Final Judgment is hereby rendered in favor of Defendant, UNITED AUTOMOBILE
INSURANCE COMPANY, and against Plaintiff, AMC REHAB AND PAIN CENTER.
C. Plaintiff, AMC REHAB AND PAIN CENTER shall take nothing by this action and Defendant, UNITED AUTOMOBILE INSURANCE COMPANY shall go hence without day.
D. This Court reserves jurisdiction to tax attorney’s fees and costs, if authorized by law.
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1Webster’s II New College Dictionary, (Houghton Mifflin Company, 1995) pg. 258.
2An assignment of the claimant’s interest in personal injury protection benefits to a medical services provider is irrevocable. See Sec. 682.02, Fla, Stat. (1995); State Farm Mutual Automobile Insurance Company v. Gonnella, 677 So. 2d 1355-1357 (Fla. 5th DCA 1996).
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