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
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 GUARANTY ASSOCIATION COVERAGE APPLIES AND NO ADDITIONAL PAYMENT IS DUE
10 DENIED DUE TO INSUFFICIENT DOCUMENTATION
12 YOUR CLAIM WAS DENIED BECAUSE THE RECEIVER COULD NOT VERIFY COVERAGE CONFIRMATION
13 YOUR CLAIM WAS FORMALLY WITHDRAWN
21 YOUR CLAIM IS DENIED DUE TO PROCEDURAL ERROR
24 THE POLICY 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
39 SERVICES RENDERED AFTER POLICY CONTRACT WAS CANCELLED BY COURT ORDER
42 AMOUNT ALLOWED UNDER A DIFFERENT RECEIVER CLAIM NUMBER
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
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