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Division Director

Toma Wilkerson


Assistant Division Director

Mary Linzee Branham


Division of Rehabilitation and Liquidation
Alexander Building
2020 Capital Circle SE
Suite 310
Tallahassee, FL 32301
1-800-882-3054

Claim Evaluation Codes

The following Evaluation Codes may be located on your Notice of Determination. They are provided to help you better understand how your claim was evaluated.

 

Evaluation Code Evaluation Description
1 THE AMOUNT CLAIMED IS NOT A COVERED EXPENSE ITEM
2 GUARANTY ASSOCIATION COVERAGE APPLIES AND NO ADDITIONAL PAYMENT IS DUE
5 THE INSURANCE COMPANY POLICY CONTRACT DID NOT PROVIDE COVERAGE FOR THIS LOSS
6 THE INSURANCE POLICY WAS EITHER VOIDED, CANCELLED OR EXPIRED BEFORE LOSS
9 YOUR CLAIM WAS PAID IN FULL BY A GUARANTY ASSOCIATION
10 DENIED DUE TO INSUFFICIENT DOCUMENTATION
12 YOUR CLAIM WAS DENIED BECAUSE THE RECEIVER COULD NOT VERIFY COVERAGE CONFIRMATION
14 DUPLICATE CLAIM PREVIOUSLY SUBMITTED
21 YOUR CLAIM IS DENIED DUE TO PROCEDURAL ERROR
24 THE POLICY WAS UNDERWRITTEN BY ANOTHER COMPANY
27 CLAIM BELONGS TO THE PARENT CORPORATION
41 AMOUNT ALLOWED TO PROVIDER UNDER A DIFFERENT CLAIM ID#
52 YOUR CLAIM WAS PREVIOUSLY PAID BY THE FLORIDA RECEIVER
53 AMOUNT CLAIMED IS RECOMMENDED
54 DUPLICATE CLAIM
55 AMOUNT RECOMMENDED OTHER THAN AMOUNT CLAIMED
58 CLAIM ALREADY PAID
60 YOUR CLAIM WAS DENIED BY INSURANCE COMPANY PRIOR TO LIQUIDATION
64 STATUTE OF LIMITATION EXPIRED
66 TPA ADJUDICATED - MEDICARE
67 TPA ADJUDICATED - MEDICAID
68 TPA ADJUDICATED - NHD (DIVERSION)
69 TPA ADJUDICATED - MEDICARE - GUARANTY ASSOCIATION COVERAGE APPLIES AND NO ADDITIONAL PAYMENT IS DUE
70 TPA ADJUDICATED - MEDICAID - GUARANTY ASSOCIATION COVERAGE APPLIES AND NO ADDITIONAL PAYMENT IS DUE
71 TPA ADJUDICATED - NHD - GUARANTY ASSOCIATION COVERAGE APPLIES AND NO ADDITIONAL PAYMENT IS DUE