12 Fla. L. Weekly Supp. 1069b
Insurance — Personal injury protection — Demand letter — Where demand letter was sufficiently specific to allow insurer’s claims representative to understand what claim was referenced and identity of provider claiming not to have been paid, it is irrelevant that demand letter was sent by provider’s billing agency — Insurer’s motion for summary judgment is denied
NORTHEAST FLORIDA NEUROLOGY CLINICS, INC. (as assignee of Brad Crow), Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, a foreign corporation, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 05-SC-3634, Division B. August 26, 2005. Roberto A. Arias, Judge. Counsel: Kelly B. Hampton, Jacksonville. Christopher K. Leifer, Jacksonville.
AMENDED ORDER DENYING DEFENDANT’S MOTION FOR SUMMARY DISPOSITION
THIS CAUSE having come before the Court on Defendant’s Motion for Summary Disposition, and the Court having heard argument of the parties with the Court being otherwise fully advised in the premises, it is upon consideration thereof
ORDERED:
1. The intent of Fla. Stat. 627.736(11) is to put an insurer on notice of an intent to initiate a lawsuit against said insurer for PIP benefits not paid to a medical provider. That statute further requires the demand letter to provide the necessary information to be able to identify the specific claim(s) which are subject of the dispute. See F.S.A. Section 627.736(11) for the specific requirements of the demand letter.
2. The fifteen (15) day demand letter and attachments submitted by Medical Billing Services, Inc. on behalf of Plaintiff dated 3/23/05, is sufficient to put Defendant on notice that litigation will be initiated against the Defendant for it’s failure to pay the PIP benefits alleged to be past due. The Defendant’s medical claims representative, Saundra Renn, understood the referenced demand letter to refer to Claim #044128116-SJW, the claim involved herein. Her letter responding to the demand letter received was mailed to the medical provider, the Plaintiff, herein and specifically stated the reason for the denial of payment of date of service of February 24, 2005 for patient Brad Crow, the claim herein.
3. The Court finds that it is irrelevant who sends the fifteen (15) day demand letter so long as the letter conforms to the requirements of Fla. Stat. 627.736(11) and all subsections thereunder, and specifically, so long as the insurer is put on notice of the identity of the medical provider who claims he has not been paid. That is, it does not matter that the demand letter is sent by a medical provider’s billing agency, as the case herein. A different holding would go against the Legislature’s intent expressed through Section 627.736(3)(b), Florida Statutes Annotated, that proper medical expenses be paid within thirty (30) days after written notice of the loss. Additionally, to hold otherwise, would also lead to the absurd results that the insured could not send the written notice to its insurer, when he/she has been notified that the insurer has refused to pay the medical service provider’s bill(s) and allow the provider to sue. Section 627.736(11)(a) cannot be so interpreted. Drury v. Harding, 461 So. 2d 104 (Fla. 1984).
4. Defendant’s Motion for Summary Disposition is hereby DENIED, without prejudice.
5. With respect to the fifteen (15) day demand letter language, indicating that Medical Billing Services, Inc., is “an assignee” of Plaintiff, this Court does not reach the issue of whether or not Medical Billing Services, Inc., was in fact an assignee of Plaintiff.
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