9 Fla. L. Weekly Supp. 410b
Insurance — Personal injury protection — Medical expenses — Despite absence of insured’s countersignature on medical bills attached to HCFA Form 1500, insurer was required to pay bills for reasonable and necessary services related to automobile accident
Affirmed at 12 Fla. L. Weekly Supp. 218b
Jurisdiction declined by District Court of Appeal at 28 Fla. L. Weekly D2274a
USA DIAGNOSTICS, INC., (J. Cepero), Plaintiff, v. STAR CASUALTY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 01-000053 COCE 53. March 26, 2002. William W. Herring, Judge. Counsel: Roberts J. Bradford, Jr., Marks & Fleischer, P.A., Ft. Lauderdale, for Plaintiff.
AMENDED ORDER GRANTING USA DIAGNOSTICS,INC.’S MOTION FOR SUMMARY JUDGMENT ANDENTERING AMENDED FINAL SUMMARY JUDGMENT
THIS CAUSE was before the Court on January 10, 2002, on Plaintiff’s Motion for Summary Judgment. Having reviewed the pleadings filed incident to this matter, as well as being otherwise duly advised, the Court finds:
1. The Plaintiff, USA DIAGNOSTICS, INC. (“USA”), brought this action seeking recovery of Florida No-Fault Personal Injury Protection (“PIP”) Benefits under Section 627.736, Florida Statutes. Plaintiff seeks to recover for certain diagnostic testing provided on November 13, 2000 to STAR CASUALTY’S (“STAR”) insured, Jeronomo Cepero (“Cepero”).
2. The issue before the Court on USA’S Motion for Summary Judgment is whether pursuant to Sections 627.736(5)(a) and 627.736(5)(d), Florida Statutes1, the medical bills submitted by USA to STAR for the testing administered to Cepero had to be countersigned by Cepero before STAR was required to pay PIP benefits. STAR contends that in the absence of a countersignature, it is not responsible for said bills.Findings of Fact
3. Cepero was involved in a motor vehicle accident on or about September 29, 2000. At that time Cepero was covered by a policy of automobile insurance, including PIP benefits, issued by STAR, and said policy was in full force and effect on September 29, 2000.
4. On November 13, 2000, USA performed diagnostic testing on Cepero.
5. On November 13, 2000, USA and Cepero executed an assignment of benefits, which assigned PIP benefits from STAR to USA.
6. USA submitted to STAR its bill for the services rendered on November 13, 2000 on HCFA Form 1500, showing a total charge of $1850.00. USA also provided a copy of the assignment of benefits and a report showing the results of the testing.
7. The HCFA form includes a space for the “SIGNATURE OF PHYSICIAN OR SUPPLIER INCLUDING DEGREES OR CREDENTIALS,” immediately followed by this statement in parentheses: “I certify that the statements on the reverse apply to this bill and are made a part thereof.” The HCFA form also includes a space for the “INSURED’S OR AUTHORIZED PERSON’S SIGNATURE,” found on Line 13 of the form, and the text immediately following it states: “I authorize payment of medical benefits to the undersigned physician or supplier for services described below.” On Line 13 of the form at issue in the instant case, the words “SIGNATURE ON FILE” were typed.
8. STAR’S policy with Cepero provides for payment of 80% of the reasonable expenses for necessary medical treatment and testing which is related to a covered automobile accident, where the insurer has been furnished with written notice of the fact of a covered loss and the amount of same.
9. STAR denied payment of the bill at issue because of the lack of a countersignature on HCFA Form 1500 attesting that the treatment being billed was actually rendered. STAR did not contest the bill on the basis that it was unreasonable in amount, medically unnecessary, or unrelated to the accident.Arguments on Summary Judgment
10. USA’S Motion argues that the language of Section 627.736(5)(a), Florida Statutes, providing that the insurer “may pay” the medical provider if the insured has countersigned the bill, is merely permissive and does not preclude payment to the assignee-provider if the insured has not countersigned the bill. USA also argues that the reference to assignment of benefits in Section 627.736(5)(c), Florida Statutes, indicates that the Legislature knew that countersignature was only one mechanism for direct payment to providers, reinforcing the notion that countersignature is permitted but not required. USA also argues that an interpretation of Section 627.736 requiring a countersignature is contrary to the fundamental objective of the No-Fault Act, assuring swift payment of benefits to the insured, because billing is not prepared contemporaneously with treatment requiring the patient to return to the provider’s office for countersignature. Finally, the required billing form, the HCFA Form 1500, has no place for a patient/insurer to sign expressly attesting that the treatment being billed was actually rendered.
11. STAR relies upon the arguments set forth in its Motion for Summary Judgment, which was previously denied by this Court. STAR argues that since the insurer may pay the medical provider if the insured countersigns the bills, it follows that the insurer may not pay the provider if the bills are not countersigned. Moreover, STAR argues, the assignment of benefits to USA precludes STAR from paying the insured in the absence of a countersignature, since once the assignment is complete, the assignor has no further right to benefits. Also, USA is in violation of Section 627.736(5)(d), Florida Statutes, STAR argues, because the statute requires submission of the bill on an approved form, and USA failed to comply with the guidelines of the authorized form (HCFA Form 1500). Because USA failed to properly complete the HCFA Form, STAR contends it has not been furnished with notice of a covered loss for purposes of Section 627.736(4)(b), Florida Statutes, and therefore has no obligation to make payment under the policy. Finally, STAR argues the use of the words “SIGNATURE ON FILE” on Line 13 of the HCFA form in no way establishes that the insured, Cepero, attests that treatment has actually been rendered, which is the intent of the statute.Conclusions of Law
12. Section 627.736, Florida Statutes, does not provide any sanctions for the lack of a countersignature. In particular, the statute does not provide that a provider loses the right to have bills paid from PIP benefits. The Legislature has had opportunities to create express sanctions for the lack of a countersignature, but has failed to do so.
13. Section 627.736(5)(a), Florida Statutes, does not apply where there is an assignment of benefits, but merely gives the insurer the option of paying either the insured or the medical provider where there is a countersignature and where there is no assignment. Section 627.736(5)(c), Florida Statutes, addresses assignments, and subsections (5)(a) and (5)(c) are mutually exclusive.
14. Line 13 of the HCFA form does not require a countersignature or provide for an attestation by the insured that the services were rendered, but merely provides authorization for direct payment.
15. Despite the absence of a countersignature, STAR was required to pay USA’S bill, as it was not disputed that the bill was reasonable in amount, related to the accident, and for medically necessary services.Certification to the Fourth District Court of Appeal
16. The Court notes that there is no controlling precedent, as none have addressed the legal issues presented here and passed on by this Court.2 Given the widespread practice of medical providers of not obtaining the insured’s signature on medical billing forms, attesting that services were actually rendered, and the fact that there are numerous instances of carriers treating the absence of a countersignature as a basis for denial of benefits causing an increase in County Court suits for the denial of PIP benefits, this Court finds and concludes that the matters presented and ruled upon here are of great public importance.
17. Accordingly, pursuant to Florida Rule of Appellate Procedure 9.160, this Court hereby certifies that this case involves issues of great importance, including but not limited to the following:
(1) Where the insured has assigned his/her benefits to his/her medical provider, do Section 627.736(5)(a) and/or Section 627.736(5)(d), Florida Statutes, require the insured to countersign the medical bills submitted on HCFA Form 1500, and is the insurer permitted under these circumstances to deny payment entirely of reasonable, necessary, and related medical bills incurred by the insured in the absence of a countersignature?
Final Judgment
18. ORDERED AND ADJUDGED that Plaintiff’s Motion for Summary Judgment is hereby GRANTED.
19. Pursuant to the foregoing, Final Judgment is hereby entered in favor of Plaintiff, USA DIAGNOSTICS, INC., in the amount of $1640.99 ($1480.00 plus $160.99 in interest pursuant to Section 627.736(4)(c), Florida Statutes (2000)), for which let execution issue.
20. The Court reserves jurisdiction to consider a motion by Plaintiff to tax attorney’s fees and costs, pursuant to the requirements of Sections 627.736 and 627.428, Florida Statutes.
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1Sections 627.736(5)(a) and 627.736(5)(d), Florida Statutes, provide in pertinent part as follows:
(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 products, services, and accommodations 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. (emphasis added).
(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. All billings for such services shall, to the extent applicable, follow the Physicians’ Current Procedural Terminology (CPT) in the year in which services are rendered. No statement of medical services may include charges for medical services of a person or entity that performed such services without possessing the valid licenses required to perform such services. 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.
2Circuit and County Courts in the Eleventh Judicial Circuit have ruled on this issue. Security National Ins. Co. v. Biotronix Laboratories, Inc., 6 Fla. L. Weekly Supp. 314a (11th Cir. App. Div., Mar. 12, 1999) (phrase “signature on file” does not attest to authenticity of bills); The Premier Center for Personal Injuries v. United Automobile Ins. Co., 8 Fla. L. Weekly Supp. 501a (11th Cir. Cty. Ct., May 21, 2001) (countersignature not required); Rodriguez v. Ocean Harbor Casualty Ins. Co., 8 Fla. L. Weekly Supp. 500b (11th Cir. Cty. Ct., April 20, 2001) (requiring countersignature); Chase v. United Automobile Ins. Co., 8 Fla. L. Weekly Supp. 458a (11th Cir. Cty. Ct., April 24, 2001) (countersignature not required).
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