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| 13 | YOUR CLAIM WAS FORMALLY WITHDRAWN |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 |
| 79 | INTEREST ACCRUED PER F.S. 631.271(1)(J) ON CLAIM PREVIOUSLY PAID |
| 80 | NO CLAIMS AND/OR EXPENSE AMOUNTS REPORTED |