14 Fla. L. Weekly Supp. 207a
Insurance — Personal injury protection — Demand letter — Sufficiency — Attachment to demand letter of claim forms setting forth amount of original claims without reflecting partial payments made by insurer on forms or elsewhere in demand letter does not comply with statutory requirement that demand letter set forth exact amount claimed to be due — Demand letter with handwritten costs that were illegible and demand letter with attached claim forms that postdated the date the insurer received the demand letter were also erroneous — No error in entry of summary judgment in favor of insurer
CHAMBERS MEDICAL GROUP, INC. (a/a/o Marie St. Hillare), Appellant, vs. PROGRESSIVE EXPRESS INSURANCE CO., Appellee. Circuit Court, 13th Judicial Circuit (Appellate-Civil) in and for Hillsborough County. Case No. 06-1217, Division X. L.C. Case No. 05-1145-SC. CHAMBERS MEDICAL GROUP, INC. (a/a/o Shirley Musa), Appellant, vs. PROGRESSIVE AUTO PRO INSURANCE CO., Appellee. Case No. 06-1280, Division X. L.C. Case No. 05-3111-SC. December 1, 2006. On review of a final order of the County Court for Hillsborough County, The Hon. Cheryl K. Thomas, County Court Judge. Counsel: William K. Saron, St. Petersburg, for Appellant. Valeria Hendricks, Davis & Harmon, Tampa, for Appellee.
(GREGORY P. HOLDER, J.) Although Appellant has taken a voluntary dismissal in this appeal, we nonetheless issue an opinion because the situation is one that is likely to recur. Therefore, this Court retains jurisdiction to review this case. Kelley v. Rice, 800 So. 2d 247 (Fla. 2d DCA 2001).
In this appeal, Appellant Chambers Medical Group (the provider), prior to filing the underlying consolidated lawsuits, sent Progressive Express Insurance Company a pre-suit demand letter in accordance with section 627.736(11), Florida Statutes (2005). Section 627.736(11)(b) contains seven requirements. Stated generally, they are: 1) that the written notice state that it is a “demand letter;” 2) that it state the name of the insured; 3) that a copy of the assignment of benefits be attached; 4) that the notice set forth the policy or claim number; 5) that it set forth the name of the medical provider who rendered services or treatment; 6) that it contain an itemized statement specifying the exact amount, the date of treatment, service, or accommodation, and the type of benefit claimed to be due (a completed form or lost-wage statement previously submitted may be used as the itemized statement); and 7) that the notice be delivered to the insurer by U.S. certified mail and be sent to the person specified by the insurer for the purpose of receiving notices under this subsection.
In each of its demand letters in this consolidated case, the provider attached a number of claim forms pursuant to section 627.736(b)(3). The claim forms had previously been submitted to Progressive. Although the forms stated that nothing had been paid on the claims, most had, according to Progressive, been paid at 80 percent of the usual and customary rates for the treatment and services provided. Others were denied as having been already paid as part of other claims. Not only did the claim forms as submitted by the provider not reflect the payments, but the demand letter also did not set forth an itemized statement of the final amount claimed to be due. The provider contends that the attachment of the claim forms complied with the letter of the law, as set forth in section 627.736(11)(b)(3), as though accuracy were not a factor to he considered in their attachment. We disagree with the provider that it has complied with the law.
Section 627.736(11), Florida Statutes (2005), requiring a demand letter as a condition precedent to filing a lawsuit to recover personal injury protection (PIP) benefits, is intended to minimize needless litigation and encourage payment of outstanding claims. We conclude that strict compliance with the notice requirements is required to effect the purpose of the statute. A “substantial compliance” standard would trigger significant litigation as to the sufficiency of the papers attached to a demand letter, the result of which would be that payment of claims would cease to be automatic, and providers would be relieved of their obligation under the statute.
Inaccurate, misleading, illegible, or stale information contained in a demand does not strictly comply with the statutory requirements. The mere attachment of claim forms setting forth the amount of the original claim, where partial payments are not reflected on the form or elsewhere in the demand, does not set forth the “exact amount claimed to be due.” See section 627.736(11)(b)(3), Florida Statutes (2005).
The foregoing omissions were not the only errors in the demand. In one of the demand letters, certain costs were handwritten in a blank provided for that purpose; however, the amount was illegible. Additionally, the CMS/1500 forms the provider attached to the demand letters actually postdate the date Progressive received the demand letter, which, aside from being illogical, made it impossible for Progressive to correlate the forms to any payments it had made. Certainly, such carelessness does not enhance an insurer’s ability to quickly review such claims inaneffort to avoid a lawsuit; indeed, it defeats the purpose of the statute.
The correct remedy when a party has failed to comply with pre-suit notice requirements is summary judgment. See Bridgeport, Inc. v. Tampa Roofing Co., 903 So. 2d 306 (Fla. 2d DCA 2005) (the failure to adhere to the notice requirements in the Mechanic’s Lien Law entitled a surety to summary judgment). Therefore, the trial court was correct to enter summary judgment in both cases. (PENDINO and CRENSHAW, JJ., Concur.)
