9 Fla. L. Weekly Supp. 196c
Insurance — Personal injury protection — Dispute between medical provider and insurer — Section 627.736 does not specifically require medical provider to countersign HCFA form or include its credentials or degrees on HCFA form — Medical provider granted summary judgment with prejudice on affirmative defense that provider failed to comply with proof section of statute by failing to countersign HCFA form and include credentials or degrees on form — Medical provider granted summary judgment without prejudice on affirmative defense that bill for radiology services did not have enclosed with it a report to substantiate charges where insurer failed to allege sufficient ultimate facts to support defense — Medical provider granted summary judgment without prejudice on affirmative defense that medical bills were not timely submitted to insurer for payment where insurer failed to allege with sufficient particularity which bill was untimely filed — Affirmative defense that there is a deductible is not a valid or appropriate affirmative defense under Florida law — Affirmative defense that there are no justiciable issues of law or fact and insurer is entitled to sanctions under section 57.105 is not a valid or appropriate affirmative defense under Florida law
CHOICE MEDICAL CENTER d/b/a INJURY TREATMENT CENTER OF BOYNTON BEACH, INC., as assignee for Marx Laurore, vs. SEMINOLE CASUALTY INSURANCE COMPANY, Defendant. County Court, 15th Judicial Circuit in and for Palm Beach County. Case No. MS-01-18338-RL. January 15, 2002. Krista Marx, Judge. Counsel: Cris Boyar, for Plaintiff. Fred Fulmer, for Defendant.
ORDER ON PLAINTIFF’S MOTION FOR PARTIALSUMMARY JUDGMENT
THIS CAUSE having come before the Court for hearing on December 17, 2001, and the Court, having reviewed the pleadings, heard argument of counsel, and being otherwise duly advised in the premises, the Court finds as follows:
This is an action for PIP benefits under a policy of insurance issued by the Defendant, SEMINOLE CASUALTY INSURANCE COMPANY, that arose out of an automobile accident on April 28, 2001. As a result of the accident, patient Marx Laurore, was injured and sought medical treatment with the Plaintiff. The Defendant issued a policy of insurance which included Personal Injury Protection Benefits to Mr. Laurore. The Plaintiff medical provider submitted medical bills to the Defendant for payment. Certain bills were not paid and the Plaintiff filed suit for PIP benefits. The Defendant filed an Answer and Affirmative Defenses. The Plaintiff seeks a Partial Summary Judgment on the Affirmative Defenses found in paragraph numbers 3, 4, 5, 7, 8, and 9.
The fourth and ninth Affirmative Defenses allege the Plaintiff does not have standing as the assignment is not valid. The Defendant has withdrawn these affirmative defenses.
With regard to the third affirmative defense, the Defendant alleges the Plaintiff failed to comply with the proof section of Fla. Stat. Section 627.736 because: a) the Plaintiff medical provider failed to counter sign the HCFA form; b) the signature of the provider does not contain its credentials or degrees, and c) the bill for radiology services did not enclose with it a report to substantiate the charges presented. With regard to part a and b, the Court finds, Florida Statute Section 627.736 does not specifically require the Plaintiff medical to counter sign the HCFA form. Nor does it require the Plaintiff medical provider to include the credentials or degrees on the HCFA form. There has been a long standing policy of Florida Courts to construe the PIP statute liberally in favor of coverage and the insured. Palma v. State Farm, 489 So.2d 147 (Fla. 4th DCA 1986). Unless the Statute specifically requires the medical provider’s signature on the HCFA claim form when the Plaintiff accepts an assignment of benefits the Defendant Insurance Company cannot require same.
In fact, Florida law does not even require the patient to counter sign the HCFA form when the patient assigns its PIP benefits of insurance to a medical provider. See The Premier Center for Personal Injuries v. United Automobile Insurance Co., 8 Fla. L. Weekly Supp. 501 (Fla. Dade Cty Court 2001); Dr. Steven Chase v. Untied Automobile Insurance Co., 8 Fla. L. Weekly Supp. 458 (Fla. Dade Cty Court 2001); and USA Diagnostics v. Star Casualty Insurance Co., 8 Fla. L. Weekly Supp. 851 (Fla. Broward Cty Court 2001). Accordingly, the Court grants the Plaintiff Motion for Partial Summary judgment as to part a and b of this affirmative defense with prejudice. With regard to part c, the Court grants the Plaintiff’s Motion without prejudice because the Defendant failed to allege sufficient ultimate facts to support this affirmative defense. The Defendant has 15 days to amend.
With regard the affirmative defense found in paragraph 5, wherein the Defendant alleges the medical bills were not timely submitted to the Defendant for payment, the Defendant failed to alleged with sufficient particularity which bill was filed untimely. The Court grants the Plaintiff’s Motion without prejudice. The Defendant shall have 15 days to amend this affirmative defense to state with particularity the medical bills at issue.
With regard the affirmative defenses found in paragraph 7, wherein the Defendant alleges there is a deductible, the Court finds this is not a valid or appropriate affirmative defense under Florida law. It is axiomatic that Affirmative Defenses which are conclusory in their content, lacking certainty, or lacking any real allegations of ultimate facts are legally insufficient. See Caddy v. Chevy Chase Savings and Loan, Inc., 528 So.2d 136 (Fla. 4th DCA 1988). The Court grants the Plaintiff’s Motion with Prejudice.
With regard to the affirmative defenses found in paragraph 8, wherein the Defendant alleges there is no justiciable issues of law or fact and the Defendant is entitled to sanctions under Florida Statute Section 57.105, the Court finds this is not a valid or appropriate affirmative defense under Florida law. See Caddy v. Chevy Chase Savings and Loan, Inc., 528 So.2d 136 (Fla. 4th DCA 1988). The Court grants the Plaintiff Motion with prejudice.Conclusion
IT IS ORDERED AND ADJUDGED the Plaintiff’s Motion for Partial Summary judgment is granted as stated above.
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