Today the 3rd District Court of Appeal issued a ruling that will affect every medical provider's practice and require your practice and staff to be incredibly diligent when processing payments from insurance companies. You must pay attention to the language on checks for payment of your bills to ensure that they do not contain the words “FULL AND FINAL PAYMENT OF PIP BENEFITS” or words similar.
The elements of the affirmative defense of common law Accord and Satisfaction are set forth in Republic Funding Corp. v. Juarez, 563 So. 2d 145, 146 (Fla. 5th DCA 1990): (1) a preexisting dispute as to the amount due from one party to another, (2) a mutual intent to effect the settlement of that dispute by a superseding agreement, and (3) the subsequent tender and acceptance of performance of the new agreement in full satisfaction of the prior disputed obligation.
The scenario involving Accord and Satisfaction that comes up most often is when an insurance company will issue a check for an amount lower than what is due to the provider. When a provider deposits and/or cashes the check, the insurance company will claim that the client accepted this check as a full and final payment. It's the insurance company's position that they would no longer be responsible for ANY future payments for those dates of service incorporated with the payment of the check, even if the insurance company has calculated the payments incorrectly.
In the recent past, the arguments to be made against the insurance companies were that the full and final language was not conspicuous; that there was no preexisting dispute between the parties on those sets of bills being encompassed in the check with the Full and Final language; and that the tender was in an attempt to fully resolve the disagreement.
The ruling by the 3rd DCA has a binding effect. Don’t let the insurance companies trick you into accepting less than what you are owed.
For any issue involving checks with this type of language, you MUST be sure it is for the amount that you are owed or what you are willing to accept. If you are not willing to be stuck with the amount offered on the check, the best practice is to return the check and ask that the check be reissued without any FULL AND FINAL language.
Please email us and we will be happy to customize and send you a template to use for this purpose.
As always, the Fischetti Law Group is staying up to date on all the relevant case law that effects your practice. If you would like to speak to us you can ALWAYS reach us at 833-MIKE-247 or follow us on Social media.