Receivership Claim Evaluation Codes

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	YOUR CLAIM WAS PAID IN FULL BY THE INSURANCE COMPANY PRIOR TO LIQUIDATION
3	APPLICABLE POLICY LIMITS HAVE BEEN EXHAUSTED
4	YOUR CLAIM IS LESS THAN THE APPLICABLE POLICY DEDUCTIBLE
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
7	THE WARRANTY WAS EITHER CANCELLED, VOIDED OR EXPIRED BEFORE LOSS
8	THE BOND CONTRACT WAS EITHER CANCELLED, VOIDED OR EXPIRED BEFORE LOSS
9	GUARANTY ASSOCIATION COVERAGE APPLIES AND NO ADDITIONAL PAYMENT IS DUE
10	DENIED DUE TO INSUFFICIENT DOCUMENTATION
11	OBSOLETE DO NOT USE - DENIED BECAUSE OF INSUFFICIENT DOCUMENTATION
12	YOUR CLAIM WAS DENIED BECAUSE THE RECEIVER COULD NOT VERIFY COVERAGE CONFIRMATION
13	YOUR CLAIM WAS FORMALLY WITHDRAWN
14	OBSOLETE DO NOT USE - DUPLICATE CLAIM PREVIOUSLY SUBMITTED
15	YOUR CLAIM WAS SETTLED BY PRINCIPAL/CONTRACTOR
16	THE CLAIM WAS SETTLED BY INSURED/POLICY HOLDER
17	OBSOLETE DO NOT USE - YOUR CLAIM WAS NOT COVERED UNDER POLICY CONTRACT
18	YOUR CLAIM IS NOT COVERED UNDER WARRANTY CONTRACT
19	YOUR CLAIM IS NOT COVERED UNDER BOND CONTRACT
20	YOUR LOSS OCCURRED OR WAS VESTED AFTER BOND CANCELLATION DATE
21	YOUR CLAIM IS DENIED DUE TO PROCEDURAL ERROR
22	YOUR CLAIM WAS PAID FROM COLLATERAL
23	YOUR CLAIM WAS ADJUDICATED IN PRIOR LITIGATION
24	THE POLICY WAS UNDERWRITTEN BY ANOTHER COMPANY
25	THE BOND WAS UNDERWRITTEN BY ANOTHER COMPANY
26	THE WARRANTY WAS UNDERWRITTEN BY ANOTHER COMPANY
27	CLAIM BELONGS TO THE PARENT CORPORATION
28	YOUR CLAIM BELONGS TO A SUBSIDIARY CORPORATION
29	YOUR CLAIM IS DENIED DUE TO RECEIVER’S OFFSET CLAIM
30	PREEXISTING MEDICAL CONDITION
31	PATIENT IS NOT A GUARANTY DEPENDENT UNDER INSURED/SUBSCRIBER POLICY CONTRACT
32	OBSOLETE DO NOT USE - PATIENT IS NOT ELIGIBLE FOR BENEFITS UNDER THE INSURED'S POLICY CONTRACT
33	THE AMOUNT CLAIMED IS APPLIED TOWARD MEETING POLICY DEDUCTIBLE
34	OBSOLETE DO NOT USE - SERVICE RENDERED ARE NOT COVERED UNDER POLICY CONTRACT
35	SERVICES RENDERED PROVIDED NO BENEFIT TO INSOLVENT COMPANY OR ITS AFFILIATE
36	ROUTINE EXAMINATIONS AND NOT COVERED
37	MAXIMUM BENEFIT ALLOWED UNDER PLAN BENEFITS FOR THIS EXPENSE
38	DOES NOT MEET CRITERIA OF A QUALIFIED PROVIDER
39	SERVICES RENDERED AFTER POLICY CONTRACT WAS CANCELLED BY COURT ORDER
40	SERVICES RENDERED AFTER POLICY CONTRACT WAS NO LONGER IN EFFECT
41	OBSOLETE DO NOT USE - AMOUNT ALLOWED TO PROVIDER UNDER A DIFFERENT CLAIM ID#
42	AMOUNT ALLOWED UNDER A DIFFERENT RECEIVER CLAIM NUMBER
43	AMOUNT ALLOWED AT PLAN COINSURANCE RATE
44	NOT A FLORIDA POLICY
45	OBSOLETE DO NOT USE - ALL PREMIUM EARNED
46	UNABLE TO LOCATE POLICY
47	LIABILITY ASSUMES TO DEALERS
48	AMOUNT RECOMMENDED IS THE RESIDUAL AMOUNT OF COVERAGE AVAILABLE UNDER POLICY CONTRACT LIMIT
49	THE AMOUNT RECOMMENDED IS THE PRO-RATA SHARE OF THE AVAILABLE UNDER POLICY CONTRACT LIMIT
50	INADEQUATE PERFORMANCE OF WORK
51	OBSOLETE DO NOT USE - PREMIUM NOT RECEIVED BY COMPANY OR PREMIUM FINANCE COMPANY
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
56	ALLOWED BY CLAIMANT PRIOR TO CANCELLATION OF BOND
57	BOND WRITTEN IN OTHER STATE
58	CLAIM ALREADY PAID
59	JUDGEMENT ENTERED
60	YOUR CLAIM WAS DENIED BY INSURANCE COMPANY PRIOR TO LIQUIDATION
61	YOUR CLAIM WAS PAID IN FULL BY ANOTHER INSURANCE COMPANY
62	YOUR CLAIM HAS BEEN ADJUDICATED TO THE BENEFIT OF THE CLAIMANT
63	LOSS OCCURRED BEFORE POLICY INCEPTION DATE
64	STATUTE OF LIMITATION EXPIRED
65	TPA ADJUDICATED
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
72	ADJUDICATED - MEDICARE
73	ADJUDICATED - MEDICAID
74	ADJUDICATED - NHD(DIVERSION)
75	POST-LIQUIDATION CHARGES HAVE BEEN DENIED
76	AMOUNT RECOMMENDED IS THE STATUTORY DEDUCTIBLE NOT PAID BY THE GUARANTY ASSOCIATION
77	CLAIM NOT EVALUATED FOR AMOUNT RECOMMENDED AS THERE ARE INSUFFICIENT FUNDS TO PAY YOUR CLAIM
78	UNEARNED PREMIUM CALCULATED DUE TO COMPANY LIQUIDATION
79	INTEREST ACCRUED PER F.S. 631.271(1)(J) ON CLAIM PREVIOUSLY PAID
80	NO CLAIMS AND/OR EXPENSE AMOUNTS REPORTED
N/C	NONE CHOSEN