9 Fla. L. Weekly Supp. 738b
Insurance — Personal injury protection — Claim form — Countersignature — Sections 627.736(5)(a) and (d) do not require HCFA forms to be countersigned by insured when the medical provider has accepted an assignment of benefits — Summary judgment in favor of insurer reversed and remanded — Attorney’s fees awarded to medical provider contingent on prevailing on recovery on policy
HIALEAH MEDICAL ASSOCIATES, INC., AND DIAGNOSTICS STUDIES, INC. a/a/o Manuel Martinez, Appellant, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Appellee. Circuit Court, 11th Judicial Circuit (Appellate) in and for Miami Dade County. Case No. 01-322 AP. L.T. Case No. 01-9412 CC 05(08). September 17, 2002. On appeal from the County Court for Miami-Dade County. Counsel: Virginia M. Best, for Appellants. Hinda Klein, for Appellee.
(BERNARD S. SHAPIRO, MAYNARD A. GROSS, and RONALD C. DRESNICK, JJ.)
(RONALD C. DRESNICK, J.) This is an appeal from a Summary Judgment granted in favor of the insurer, United Automobile Insurance Company (UAIC). The lower court found that because the insured, Manuel Martinez, had failed to countersign the Health Care Administration Financing Act 1500(HCFA) forms as provided in F.S. §627.736(5)(a), the appellee, United Automobile Insurance Company, was relieved from paying the insurer’s obligation for medical services provided by appellants, Hialeah Medical Associates, Inc. and Diagnostic Studies, Inc. For the reasons discussed below, the trial court’s order granting summary judgment in favor of the insurer is hereby reversed and the case remanded for further proceedings consistent with this opinion.
On April 23, 2000, the insured, Manuel Martinez, was involved in an automobile accident requiring medical treatment which was provided by appellants, Hialeah Medical Associates, Inc., and Diagnostic Studies, Inc. At the time of the accident there was in full force and effect a policy of insurance providing personal injury protection (PIP) benefits to the insured for his bodily injuries sustained in the accident. When the insured sought medical treatment from the appellants, he executed and the appellants accepted, an assignment of PIP benefits for the medical services. Thereafter, all of the medical bills in issue were timely submitted and received on Health Care Administration Financing Act (HCFA) 1500 forms approved by the Department of Insurance. However, in the space provided on the form for the insured’s signature was a notation “(signature on file)”. Due to the insured’s failure to sign the forms, the appellee refused to pay any of the medical bills.
Appellants’ brought suit for breach of contract and for violation of F.S. §627.736. Appellee filed a motion for summary judgment alleging that the appellants’ failure to comply with F.S. §627.736(5)(a) barred it from having to pay for the medical services provided. The lower court agreed with the appellee and granted a summary judgment in its favor. Appellants filed a Notice of Appeal and a motion for attorneys fees pursuant to F. S. §627.428.
Appellee’s position is that it is not obligated to pay PIP benefits to a medical provider who has agreed to and has been provided with a valid assignment of PIP benefits because the insured had not countersigned the HCFA form. This is the equivalent of saying that F.S. §627.736(5)(a) & (d) is the legislature’s method of providing for assignments of PIP benefits.
F. S. §627.736(5)(a) & (d) reads in pertinent part as follows:
(5) Charges for treatment of injured persons.
(a) Any physician, hospital, clinic, or other person or institution lawfully rendering treatment to an injured person for a bodily injury covered by personal injury protection insurance may charge only a reasonable amount for the services and supplies rendered, and the insurer providing such coverage may pay 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 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 supplied]
(d) 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 … For purposes of paragraph (4)(b), an insurer shall not be considered to have been furnished with notice of the amount of covered loss or medical bills due unless the statements or bills comply with this paragraph.
The standard of review for a summary judgment is de novo. See Volusia County v. Aberdeen at Ormond Beach, L. P., 760 So. 2d 126, 130 (Fla. 2000). “Statutes must be given their plain and obvious meaning, and courts should assume that the legislature knew the plain and ordinary meaning of the words when it chose to include them in the statute.” Hankey v. Yarian, M.C., 755 So. 2d 93, 96 (Fla. 2001); see also Chase v. United Automobile Insurance Company, 8 Fla. Supp. 458, 459 (Fla. Dade Cty. Ct., 2001). F.S. §626.736(5)(a) makes no reference to “an assignment of benefits.” Florida courts have, despite the lack of any mention of “assignment” in F.S. §627.736(5)(a), recognized the assignment of an insured’s interest in a PIP claim. In fact, in Rittman v. Allstate Ins. Co., 727 So. 2d 391 (Fla. 1st DCA 1999), the court held that “an assignment of an insured’s interest in personal injury protection benefits to a medical services provider is irrevocable.” Id. at 39; See State Farm Fire and Casualty Co. v. Ray, 556 So. 2d 811 (Fla. 5th DCA 1990).
When examining the plain language of Section 627.736(5)(a), the use of the word “may” in paragraph 5(a) indicates that there is an option on the part of the insurance company to pay the medical provider directly or the insured. See The Premier Center For Personal Injuries v. United Automobile Insurance Company, 8 Fla. Supp. 501 (Fla. Dade Cty. Ct., 2001); see also, Chase v. United Automobile Insurance Company, 8 Fla. Supp. 458, 459 (Fla. Dade City. Ct., 2001). However, an assignment of benefits precludes the insurer from exercising the option of paying the insured. See The Premier Center For Personal Injuries, 8 Fla. Supp. at 502; see also, Chase, 8 Fla. Supp. at 458. The long standing policy of the courts of Florida in construing provision of the Florida No Fault Act has been to construe the act liberally in favor of the insured. Palma v. State Farm Fire and Casualty Co., 489 So. 2d 147 (Fla. 4th DCA 1986). The Florida Supreme Court has indicated that the PIP statute should be construed in order to give effect to the legislative purpose of providing a broader and more liberal standard of coverage. See GEICO v. Novak, 453 So. 2d 1116 (Fla. 1984); see also Pena v. All State, 463 So. 2d 1256 (Fla. 3rd DCA 1985). Thus, appellee’s argument that F.S. §626.736(5) is the legislative method for assignments of PIP benefits further fails to pass muster since the statute’s very language provides that the insurer “may pay, for such charges directly to” the insured or the provider. There can be no assignment under Florida law since the choice of whom to pay is left to the obligor. An assignment is an unqualified transfer to the assignee of all of the interest of the assignor under the contract giving the assignee any and all rights under the contract once the assignment is complete. State Farm Fire and Casualty Co., 556 So. 2d at 813.
The very notion that the insured’s signature on each and every HCFA form is necessary for payment is contrary to the express legislative intent of providing for the swiftest and most direct payment of PIP claims. An assignment to the provider of benefits as happened in this case is the most effective and swiftest way to ensure the legislative intent as expressed in the no fault statute, i.e. to provide for medical treatment to an injured. Furthermore, the well established and fundamental objective of the PIP statute is to guarantee swift and virtually automatic payment of benefits. United Automobile Co. v. Viles, 726 So. 2d 320 (Fla. 3rd DCA 1999); See Nationwide Mutual Fire Ins. Co. v. Pennacle Medical, Inc., 753 So. 2d 55 (Fla. 2000); and Crooks v. State Farm, 659 So. 2d 1266 (Fla. 3rd DCA 1995), Rev. dism. 662 So. 2d 933 (Fla. 1993).
Appellee cites to Security National Insurance Company v. Biotronix, 6 Fla. Supp. 314 (Fla. 11th Cir. Ct. 1999) and note that in the instant case the HCFA forms provided to the insurer had, instead of the insured’s signature, the indication “signature of file”. However, the case at hand is distinguishable. In Security National, the provider did not reveal that there was an assignment of benefits until three months after it had filed suit. The court found this action to be a blatant attempt to set up the insurance company for attorney’s fees, thereby reversing an award of attorney’s fees to the provider. In the instant case, both parties acknowledge the existence of the assignment and notice of said assignment is not at issue.
Further, appellee’s argue the legislature’s intent to eliminate fraud as a reason to construe the statute as requiring a countersignature on each HCFA form before the insurer can be required to pay. There is no claim of fraud on the part of the appellant or the insured in this case. This case has nothing to do with fraud. Thus, appellee’s argument of a legislative intent designed to thwart fraud is misplaced. Additionally, requiring the insurer’s signature on each HCFA claim form would not prevent fraud. The insured is required to sign the medical notes each and every visit to the provider. Those medical notes are provided to the insurance company for them to verify that the services were rendered. Any claim that services were not rendered could be verified by a review of those notes, by an examination under oath (EUO), by the scheduling of an independent medical examination or a peer review of the medical records to determine whether the treatment was appropriate and necessary.
In light of the above, this court holds that section 627.736(5)(a) & (d) does not require the HCFA forms to be countersigned by the insured where the medical provider has accepted an assignment of benefits. Therefore, Martinez’s failure to countersign the HCFA forms does not discharge appellee’s obligation to pay PIP benefits for medical care and treatment provided by appellant.
As to appellant’s motion for attorney’s fees, it is granted conditioned upon the insured ultimately prevailing with a recovery on the policy. See Trench v. Reliance Ins. Co., 671 So. 2d 801, 802 (Fla. 3rd DCA 1996).
Accordingly, we Reverse and Remand for further proceedings consistent herewith. (SHAPIRO and GROSS, JJ., concur.)
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