13 Fla. L. Weekly Supp. 608b
Insurance — Personal injury protection — Demand letter — Sufficiency — Demand letter with attached patient ledger which contained all dates of service but was not marked in any way to indicate which charges medical provider was disputing as having been improperly reduced or denied was not sufficiently specific to satisfy statutory demand letter requirement — No merit to claim that demand letter was deficient due to misspelling of insured’s name where attached assignment of benefits containing correct spelling dispelled any ambiguity as to name of insured — Claim forms — Defense that HCFA forms lacking insured’s signature and containing wrong accident date were false, misleading, incomplete or patently deceptive was waived by insurer’s payment of prior HCFA submissions without raising objection
INDIAN ROCKS CHIROPRACTIC, INC., ON BEHALF OF FLORENCE REICHERT, Plaintiff(s), vs. STATE FARM FIRE & CASUALTY COMPANY, Defendant(s). County Court, 6th Judicial Circuit, Pinellas County, Small Claims Division. Case No. 04-005776SC048. UCN: 522004SC005776XXSCSC. March 2, 2006. Dorothy Vaccaro, Judge. Counsel: David A. Papa, Clearwater. Kimberly A. Sandefer, Gale L. Young, P.A., Tampa.
FINAL SUMMARY JUDGMENT FOR STATE FARM FIRE & CASUALTY COMPANY
THIS CAUSE having come before the Court for hearing on January 25, 2006, on Defendant, STATE FARM FIRE & CASUALTY COMPANY’S Motion for Final Summary Judgment and the Court having reviewed the file, Defendant’s motion, including affidavits and pleadings, heard arguments of counsel and being otherwise fully advised in the premises, it is hereby
ORDERED AND ADJUDGED that the Defendant’s Motion for Final Summary Judgment is hereby granted. The Court finds that:
A. The Plaintiff, medical provider, through his attorneys, sent to Defendant a pre-suit demand letter with an attached patient ledger for treatment rendered by the medical provider on behalf of the insured, Florence Reichert, from August 7, 2003 to May 19, 2004. That patient account ledger contained fifty-six (56) different dates of service on which the insured received treatment and listed each procedure performed on those dates (i.e. a total of one hundred sixty-four (164) entries). However, the patient ledger was not marked in any way so as to allow the Defendant to be able to distinguish which charges the Plaintiff was disputing as having been improperly reduced or denied. This Court holds that the Plaintiff did not comply with F.S. 627.736(11) by providing more specificity as to the unpaid services that remain at issue. See Chiro-Medical Rehabilitation of Orlando, Inc. vs. Progressive Express Insurance Company, 12 Fla. L. Weekly Supp. 162b (17 Jud.Cir. 2004). For this reason, the Defendant is entitled to the relief sought.
B. The Court denies the other claims raised by the Defendant. Although the Plaintiff did not strictly adhere to the essential requirements under F.S. 627.736(11) by providing the correct spelling of the name of the insured, the attached assignment of benefits reflected the correct spelling and thereby dispelled the Defendant of any ambiguity of the true name of the insured. In addition, although the Plaintiff did not strictly adhere to the essential requirements under F.S. 627.736(11) by providing the true claimant’s corporate name, again the Assignment of Benefits dispelled the Defendant of any ambiguity of the true name of the claimant corporation.
Finally, the Defendant claims that the HCFA forms failed to provide the patient’s signature and incorporated the wrong date of accident in paragraphs 12 and 14, respectively. However, both the Plaintiff and Defendant agree that payments were made previously by Defendant on several HCFA payment submissions without raising that objection. In Dr. Kevin L. Payton vs. Progressive Express Insurance Company, 11 Fla. L. Weekly Supp. 1029a (17 Cir. 2004), the failure of Defendant to raise an objection to the payment on false, misleading, incomplete, or patently deceptive HCFA forms by making previous payments, the insurer waives this defense. The same holds true in the instant case.
However, based on the Plaintiff’s failure to strictly adhere to the demand letter requirements under F.S. 627.736(11), it is hereby
ORDERED AND ADJUDGED that the Plaintiff, Indian Rocks Chiropractic, Inc., on behalf of Florence Reichert, taken nothing by this action and Defendant, State Farm Fire & Casualty Company, shall go hence without day and the Court retains jurisdiction for the purpose of determining any motion by the Defendant to tax fees and costs.
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