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PIP Niche Defense: Box 31

Box 31 sounds like an invitation to something special and mysterious. In the world of personal injury protection insurance (PIP), Box 31 is an archaic defense implemented by our beloved PIP insurance companies. This defense is archaic in that the insurer “should know” the amounts/and type of treatment the medical provider has filed suit for. That is, so long as the Medical Provider has provided the requisite information.

What is this defense?

Pursuant to Florida Statutes Section 627.736(5)(D) all medical providers “must include on the applicable claim form the professional license number of the provider on the line or space provided for Signature of Physician or Supplier, Including Degrees or Credentials.” Basically, the provider has to include his/her professional license number in the box marked 31 on each bill. Hospitals are excluded from this provision altogether.

Insurance companies usually miss the boat on this very defense. An insurer will answer a medical provider’s demand letter stating that the provider’s demand letter is flawed in broad terms. The insurer will most likely pay a portion of the bills despite the absence of the signature in Box 31. At the litigation stage, counsel for the insurer will argue that the failure to include a license number or credentials in box 31 was fatal to the claim.

Isn’t the signature a mandatory condition precedent?

The beauty of the legal system is that some courts allow for substantial compliance with conditions.  The most important aspect of this condition/requirement notices. So long as the provider provided the insurer with enough information that is reasonably needed to process the claim, failure to sign the box should not operate to extinguish a claim. Likewise, if the insurer makes a payment and otherwise processes the claim as though the signature was in fact present, the defense should fail. Id. Another logical argument is that the insurer waived the alleged Box 31 omission by processing the claim and failing to give their own notice of the disputed issue. The insurer paid, processed, and litigated as if the signature was present in Box 31.

Another issue arises with Explanations of Benefits. The question becomes, did the insurer waive their defense by making payment and not providing an explanation of benefits detailing the reason(s) for withholding payment of certain bills. Florida Courts have ruled that waiver occurs in the realm of disclosure and acknowledgment agreements. It would not be a stretch to apply the same rationale to Box 31 cases.

Why should medical providers care about this?

As a medical provider, time is of the essence. If multiple bills are being filed for one claim, omissions are bound to occur. If you forget to sign Box 31, fear not, because supplemental information can easily remedy the situation. It is essential that you contact an experienced PIP litigation attorney. We have fought this ancient battle for years, and we will not dismiss a claim for failure to sign Box 31. An insurer should have enough information at its disposal to sufficiently process a claim with/without a signature.

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