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 CodeEvaluation Description
1THE AMOUNT CLAIMED IS NOT A COVERED EXPENSE ITEM
2YOUR CLAIM WAS PAID IN FULL BY THE INSURANCE COMPANY PRIOR TO LIQUIDATION
5THE INSURANCE COMPANY POLICY CONTRACT DID NOT PROVIDE COVERAGE FOR THIS LOSS
6THE INSURANCE POLICY WAS EITHER VOIDED, CANCELLED OR EXPIRED BEFORE LOSS
9GUARANTY ASSOCIATION COVERAGE APPLIES AND NO ADDITIONAL PAYMENT IS DUE
10DENIED DUE TO INSUFFICIENT DOCUMENTATION
12YOUR CLAIM WAS DENIED BECAUSE THE RECEIVER COULD NOT VERIFY COVERAGE CONFIRMATION
13YOUR CLAIM WAS FORMALLY WITHDRAWN
21YOUR CLAIM IS DENIED DUE TO PROCEDURAL ERROR
24THE POLICY WAS UNDERWRITTEN BY ANOTHER COMPANY
27CLAIM BELONGS TO THE PARENT CORPORATION
28YOUR CLAIM BELONGS TO A SUBSIDIARY CORPORATION
29YOUR CLAIM IS DENIED DUE TO RECEIVER’S OFFSET CLAIM
39SERVICES RENDERED AFTER POLICY CONTRACT WAS CANCELLED BY COURT ORDER
42AMOUNT ALLOWED UNDER A DIFFERENT RECEIVER CLAIM NUMBER
52YOUR CLAIM WAS PREVIOUSLY PAID BY THE FLORIDA RECEIVER
53AMOUNT CLAIMED IS RECOMMENDED
54DUPLICATE CLAIM
55AMOUNT RECOMMENDED OTHER THAN AMOUNT CLAIMED
58CLAIM ALREADY PAID
60YOUR CLAIM WAS DENIED BY INSURANCE COMPANY PRIOR TO LIQUIDATION
64STATUTE OF LIMITATION EXPIRED
66TPA ADJUDICATED - MEDICARE
67TPA ADJUDICATED - MEDICAID
68TPA ADJUDICATED - NHD (DIVERSION)
69TPA ADJUDICATED - MEDICARE - GUARANTY ASSOCIATION COVERAGE APPLIES AND NO ADDITIONAL PAYMENT IS DUE
70TPA ADJUDICATED - MEDICAID - GUARANTY ASSOCIATION COVERAGE APPLIES AND NO ADDITIONAL PAYMENT IS DUE
71TPA ADJUDICATED - NHD - GUARANTY ASSOCIATION COVERAGE APPLIES AND NO ADDITIONAL PAYMENT IS DUE
75POST-LIQUIDATION CHARGES HAVE BEEN DENIED
76AMOUNT RECOMMENDED IS THE STATUTORY DEDUCTIBLE NOT PAID BY THE GUARANTY ASSOCIATION
77CLAIM NOT EVALUATED FOR AMOUNT RECOMMENDED AS THERE ARE INSUFFICIENT FUNDS TO PAY YOUR CLAIM
78UNEARNED PREMIUM CALCULATED DUE TO COMPANY LIQUIDATION
79INTEREST ACCRUED PER F.S. 631.271(1)(J) ON CLAIM PREVIOUSLY PAID
80NO CLAIMS AND/OR EXPENSE AMOUNTS REPORTED