9 Fla. L. Weekly Supp. 659a
NOT FINAL VERSION OF OPINION
Subsequent Changes at 9 Fla. L. Weekly Supp. 737a
Insurance — Personal injury protection — Claim forms — Countersignature — Sections 627.736(5)(a) & (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
TOTAL HEALTH CARE OF FLORIDA INC., (OSCAR BLAS), Appellant, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Appellee. Circuit Court, 11th Judicial Circuit (Appellate) in and for Miami-Dade County. Case No. 01-262 AP. L.C. No. 00-8661 CC. August 13, 2002. On appeal from the County Court for Miami-Dade County, Florida. Counsel: Kevin W. Whitehead, for Appellant. Hinda Klein, for Appellee.
(Before STEVEN D. ROBINSON, ARTHUR L. ROTHENBERG, and LEON M. FIRTEL, JJ.)
(ARTHUR L. ROTHENBERG, J.) This is an appeal from a Summary Judgment granted in favor of the insurer, United Auto Insurance Company (UAIC). The court found that the failure of the insured, Oscar Blas, to countersign the Health Care Administration Financing Act 1500 (HCFA) forms relieved and/or discharged the Appellee, the insurer’s, obligation to pay for the medical services provided by the Appellant, Total Health Care of Florida, Inc. For the reasons discussed below, the trial court’s order granting summary judgment in favor of the insurer is hereby reversed with the case remanded for further proceedings consistent with our opinion.
The facts of this case arose when Oscar Blas was involved in an automobile accident in which he suffered personal injuries. Blas had an insurance policy with the Appellee, UAIC, that provided personal injury protection (PIP) benefits. Blas sought medical treatment from the Appellant, Total Health Care of Florida, Inc., and executed an assignment of PIP benefits for said medical services to the appellant. The subject medical bills were timely submitted and received on HCFA forms. Due to the insured’s failure to countersign the forms, the Appellee refused to pay PIP benefits to the Appellant, the medical provider.
Appellant filed a PIP complaint for breach of contract and its violation of Section 627.736 of the Florida Statutes. The Appellee filed a motion for summary judgment alleging that the Appellant failed to comply with the requirements of the HCFA form and Section 627.736. A hearing convened and an order was entered granting a motion for summary judgment in favor of the insurer. Appellant filed a Notice of Appeal and a motion for attorneys fees pursuant to Section 627.428 of the Florida Statutes.
The issue before the court is whether the lower court erred in granting the Appellee, insurer’s, motion for summary judgment. The court held that the insured’s failure to countersign HCFA forms discharges the appellee’s obligation to pay PIP benefits for medical care and treatment provided by Appellant, the medical provider.
Section 627.736(5)(a) & (d) of the Florida Statutes read, 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 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 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 …
(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.D., 755 So. 2d 93, 96 (Fla. 2001); see also Chase v. United Automobile Insurance Company, 8 Fla. L. Weekly Supp. 458, 459 (Fla. Dade Cty. Ct., 2001). 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. L. Weekly Supp. 501 (Fla. Dade Cty. Ct., 2001); see also, Chase v. United Automobile Insurance Company, 8 Fla. L. Weekly Supp. 458, 459 (Fla. Dade Cty. 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. L. Weekly Supp. at 502; see also, Chase, 8 Fla. L. Weekly Supp. at 458. Therefore, paragraph 5(a) does not apply when there is an assignment. See The Premier Center For Personal Injuries, 8 Fla. L. Weekly Supp. at 502; see also, Health Care Associates of South Florida, Inc., and Miami Medical Group, Inc., v. United Automobile Ins. Co., 9 Fla. L. Weekly Supp. 397b (Fla. Dade Cty. Ct. 2002).
Further, under the laws of assignment, the assignee, Total Health Care of Florida, Inc., stands in the shoes of the assignor, Oscar Blas, and has all the rights as Blas possessed. See, Shreve Land Co., Inc. v. J & D Financial Corp., 421 So. 2d 722 (Fla. 3d DCA 1982); see also, Health Care Associates of South Florida, Inc., and Miami Medical Group Inc., 9 Fla. L. Weekly Supp. at 397b. Based on the plain language of Section 627.736(5)(a) & (d), there is no requirement that the insured sign each and every HCFA form to receive payment for the benefits due and owing. Id. Since the insured, the assignor, is not required to sign the medical forms to receive payment for services rendered, then the medical provider, the assignee, cannot be required to obtain the insured’s signature in order to receive payments for benefits due and owing.
Additionally, Appellee contends that Section 627.736(5)(a) and (5)(d) are bound together, thereby making the countersignature of the insured mandatory in order to receive payment of benefits. However, “Section 627.736(5)(d) only states that certain forms must be used to submit a claim to the insurer.” Health Care Associates of South Florida, Inc., and Miami Medical Group, Inc., 9 Fla. L. Weekly Supp. at 397b. The statute makes no references to the countersignature of the insured. Id. Further, there is no mention of “assignment of benefits” in paragraphs (a) or (d) of the above-quoted section.
“It is well established that the fundamental objective of the PIP statute is to guarantee swift and virtually automatic payment of benefits and the PIP statute should not be interpreted in a manner that leads to an unreasonable or absurd result or a result obviously not intended by the legislature.” Chase v. United Automobile Insurance Company, 8 Fla. L. Weekly Supp. 458, 459 (Fla. Dade Cty. Ct., 2001); see also United Automobile Insurance Co. v. Viles, 726 So. 2d 320 (Fla. 3d DCA 1999). “Moreover, statutory provisions under Florida’s no fault laws will be construed liberally in favor of the insured.” United Automobile Insurance Co., 726 So. 2d at 321. “Defendant’s attempt to controvert the purpose and intent of the statute to provide swift payment for medical services needed by an insured when injured in an automobile accident regardless of fault cannot be subverted by defendant’s attempt to create a technical Catch 22 to allow the insurer to fail to meet its responsibilities to pay for medical benefits that are reasonable, related and medically necessary.” Health Care Associates of South Florida, Inc., and Miami Medical Group, Inc., 9 Fla. L. Weekly Supp. at 397b.
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 when the medical provider has accepted an assignment of benefits. In the present case, the HCFA forms comply with the requirements of the statute. Therefore, Oscar Blas’ failure to countersign the HCFA forms does not discharge the 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 arecovery on the policy. See Tench v. American Reliance Ins. Co., 671 So. 2d 801, 802 (Fla. 3d DCA 1996).
Accordingly, we REVERSE and REMAND for further proceedings consistent herewith. (FIRTEL, J., concurs. ROBINSON, J., dissents with an opinion.)
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(ROBINSON, J., dissenting.) The language of the statute does not indicate that the legislature intended to exclude assignees from the scope of section 627.736(5)(a), Florida Statutes. The legislature has clearly stated that there is a need for protection against fraudulent claims. A signature is required to verify that the claim to the insurer is only for “such treatment . . .as having actually been rendered, to the best knowledge of the insured or his or her guardian . . .” There was no such signature submitted by the appellant.
If an insured assigns her claim, isn’t the need to protect against fraud even greater as the insured might otherwise never see her bill? At the same time, requiring an insured to countersign in no way restricts the insured from validly collecting a claim. The statute reads that the insurer may pay the provider only if there is a countersignature. It does not say shall because there may be circumstances when paying the insured is more appropriate, such as if an insurer learns that there is no assignment or if other legal requirements are not met.
As the statute neither excludes nor even mentions assignments, I would affirm.
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