The court rejected the insurer's claim that it was not required to pay medical provider's bills because provider did not provide insurer with proper written notice of a covered loss where initial set of bills did not include a disclosure and acknowledgment form, and box 31 of CMS-1500 form did not contain physician's license number. The court concluded that the bills furnished to insurer, which contained the physician's name and were substantially complete, provided proper notice to insurer. Further, the court noted that even if physician's license number were deemed a material provision of statements or bills, the absence of license number was cured by later submission of number to insurer. In addition, the court concluded that the failure of the medical provider to provide disclosure and acknowledgment form with initial set of bills was cured by submitting form prior to litigation.

The court held that “based upon the statute's plain language, a bill or statement need only be “substantially complete” and “substantially accurate” as to relevant information and material provisions in order to provide notice to an insurer.” Further, the court stated that there was nothing in the statute that suggested that any of these omissions could not be cured with later submissions . . . read more

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