11 Fla. L. Weekly Supp. 829a
Insurance — Personal injury protection — Demand letter- — Where medical provider is not claiming entire amount set forth in patient ledger attached to demand letter, greater specificity is required identifying specific services, dates, and amounts sought — Case dismissed without prejudice
PONTE VEDRA CHIROPRACTIC MEDICINE & P.T. (As assignee of ALIYA RYABO VA), Plaintiff(s), vs. PROGRESSIVE AMERICAN INS. CO., Defendant(s). County Court, 7th Judicial Circuit in and for St. Johns County. Case No. SP03-2565, Division 65. July 8, 2004. Patti A. Christensen, Judge. Counsel: D. Scott Craig, Farah, Farah & Abbott, P.A., Jacksonville. Jason C. Taylor, McFarlain & Cassedy, P.A., Tallahassee.
ORDER OF DISMISSAL
THIS CAUSE was before the Court upon Defendant’s Motion for Final Summary Judgment. The Court has heard argument of Counsel and otherwise being fully advised in the premises, the Court
FINDS:
This is an action to recover PIP benefits. Plaintiff provided ALYIA RYABOVA with medical treatment and pursuant to an assignment of benefits now seeks payment for that treatment.
As a condition precedent to filing an action for PIP benefits, the insurer must be provided with written notice of an intent to initiate litigation. §627.736(11)(a), F.S. The notice “shall state with specificity”. . . “an itemized statement specifying each exact amount, the date of treatment, service or accommodation, and the type of benefit claimed to be due.” §627.726(11)(b), F.S.
Plaintiff did provide Defendant with a letter dated November 3, 2003, notifying Defendant: “No-Fault benefits and interests are due — See attached itemized statement and assignment of benefits.” Attached was Defendant’s Patient Ledger showing treatments from September 19, 2003 through October 28, 2003. The Patient Ledger shows the date of treatment, type of benefit claimed to be due, and the exact amount charged. It also shows some payments by the Defendant. The balance due according to the Patient Ledger is $428.20.
According to Plaintiff’s Amended Complaint, demand is made for payment in the amount of $281.60 for dates of service September 19, 2003 through February 23, 2004. Although no specific amount is claimed in the original Complaint, the Amended Complaint sets forth “additional claims.” (See paragraph 4 of Plaintiff’s Motion to Amend Complaint.) The total amount of claims for services as shown in the Amended Complaint is $281.60 which is less than the amount shown on the Patient Ledger attached to Plaintiff’s demand letter. Therefore, at least some of the charges set forth in the Patient Ledger are not being claimed. Even though the Defendant and its adjuster would be intimately familiar with the claims file, it is not clear from the Patient Ledger attached to the demand letter what specific treatment, date of treatment, and charge is being claimed.
The Statute allows for a completed statement such as a (CMS 1500 form, UB92 form, or any other standard form approved by the office or adopted by the commission, to be used as the statutorily required itemized statement (§627.736(5)(d), F.S.) Unless Plaintiff is claiming the amount set forth in the Patient Ledger (which it does not appear to be doing), then more specificity is required. If Plaintiff prefers to use its Patient Ledger, then in order to be compliant with the Statute, those specific services, dates, and amounts, should be marked accordingly. A running history of Plaintiff’s treatments is not sufficient. The list includes amounts that have been paid, amounts claimed by Plaintiff, and apparently amounts not claimed.
Based on the foregoing considerations, it is
ORDERED AND ADJUDGED
Defendant’s Motion for Summary Judgment is granted. This cause is dismissed without prejudice for failure to fulfill a condition precedent as required by statute.
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