12 Fla. L. Weekly Supp. 664c
Insurance — Personal injury protection — Demand letter — Pre-suit demand letter with attached patient ledger showing twenty-three dates of service for treatment rendered by medical provider and explanation of benefits documents identifying seven dates of service for which insurer either reduced or refused to pay bills only placed insurer on notice as to claims for seven dates of service represented by EOBs — Partial summary judgment granted in favor of insurer as to all unpaid charges except those included in EOBs
AARON E. THOMAS, Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 04-SC-1364, Division B. March 18, 2005. Roberto A. Arias, Judge. Counsel: David G. Candelaria, Farah, Farah & Abbot, Jacksonville, for Plaintiff. Patrick J. Snyder, James C. Rinaman, III & Associates, P.A., Jacksonville, for Defense.
ORDER GRANTING DEFENDANT’S MOTION FOR PARTIAL SUMMARY DISPOSITION (JUDGMENT)
THIS CAUSE came on to be heard upon the Defendant’s Motion for Partial Summary Disposition for failure to satisfy conditions preceding pursuant to Florida Statute 627.736(11). Present before the Court appeared David G. Candelaria, Esquire, attorney for Plaintiff, and Patrick J. Snyder, Esquire, attorney for Defendant. After having reviewed the file and affidavits and depositions filed herein, the Court finds that Defendant’s Motion should be granted. The Court finds that:
A. The Plaintiff, insured, through his attorneys, sent to the Defendant a pre-suit demand letter with an attached patient account ledger for treatment rendered by a medical provider, Neurotech, Inc. from May 14, 2003 through September 11, 2003. That patient account ledger contained twenty three (23) different dates of service on which the Plaintiff received treatment and listed each procedure performed on those dates. Additionally, also attached to the pre-suit demand letter were seven (7) explanations of benefit documents which specifically identifies seven (7) dates of service, and further identifies and explained their reason why the Defendant’s insurance company had either reduced or refused to pay the invoiced amounts.
B. Florida Statutes 627.736(11) requires that “as a condition preceding to filing in any action for benefits under this section, the insurer must be provided with the written notice of an intent to initiate litigation.” Subsection (11)(b)(3) of Florida Statute 627.736 further requires that the notice provided “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.”
C. This Court has always taken the view that Florida Statute 627.736(11) was essentially a “notice” statute. That is, the section sought and imposed the requirement that the insurer be specifically told what payments were being sought which had not been made by the insurer before the lawsuit could be instituted. In this case, the Court finds that, pursuant to the affidavits filed and the deposition of the Defendant’s pre-suit handler, the letter and attachments only put the Defendant on notice that the Plaintiff was disputing the amounts not paid on the dates of service listed in the explanation of benefit documents, which were attached to the pre-suit demand letter.
D. While the Defendant’s pre-suit handler testified that she did not go into the Plaintiff’s file and check every single date of service listed under the Neurotech’s patient account ledger entries, this Court finds that such a failure has no legal significance, where as here, the pre-suit demand letter was sent by someone other than the insurer itself. Had the insured personally sent a letter to the insurance company requesting for the payments of medical expenses, incurred by him/her which had not been paid by the insurance company to the medical provider, and had appended the ledger sheet showing the dates of service and other information contained in the ledger sheet used in this case, this Court might be faced with the issue of whether the pre-suit handler had a duty to more closely examine the file and respond to the insured’s personal request. However, those are not the facts present in this cause and the pre-suit demand letter in this cause and its attachments only place the Defendant on notice as to the seven (7) explanations of benefit forms that were attached to the ledger sheet and the pre-suit demand letter.
For the above stated reasons, it is hereby
ORDERED:
The Defendant’s Motion for Partial Summary Disposition for failure to satisfy conditions preceding pursuant to Florida Statutes 627.7360(11) is hereby GRANTED as to all unpaid charges with the exception of the seven (7) explanation of benefit documents and charges included therein which accompany the pre-suit demand letter.
* * *
