14 Fla. L. Weekly Supp. 395b
Insurance — Personal injury protection — Demand letter — Demand letters submitted to insurer by medical providers, and demand letters submitted to insurer by insured’s attorney on behalf of medical providers, were defective where they were submitted after medical providers had revoked assignment of benefits and reassigned all benefits and potential cause of action to insured — Insured lacked standing to file action against insurer for nonpayment of benefits where insured failed to comply with statutory requirement to furnish demand letter — Final summary judgment entered in favor of insurer
JORGE L. SANCHEZ, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County, General Jurisdiction Division. Case No. 04-2977 CC 24. January 26, 2007. Darren P. Gayles, Judge. Counsel: James Payor, for Plaintiff. Edward N. Winitz, Conroy, Simberg, Ganon, Krevans, Abel, Lurvey, Morrow & Schefer, P.A., Hollywood, for Defendant.
REVERSED at 15 Fla. L. Weekly Supp. 1153a
ORDER GRANTING DEFENDANT’S MOTION FOR FINAL SUMMARY JUDGMENT AND ENTERING FINAL JUDGMENT IN FAVOR OF DEFENDANT, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, AND ORDER DENYING PLAINTIFF’S MOTION FOR PARTIAL SUMMARY JUDGMENTON ISSUE OF PLAINTIFF’S COMPLIANCE
THIS CAUSE came on to be heard on January 8, 2007, upon Defendant’s Motion for Final Summary Judgment and Plaintiff’s Motion for Partial Summary Judgment on Issue of Compliance. Both parties appeared through counsel and the Court having heard argument of counsel, having reviewed the pleadings and discovery taken in this case, as well as being otherwise duly advised, the Court finds that there is no genuine issue of any material fact and that it can rule as a matter of law as to whether Plaintiff had standing to file its Complaint against Defendant. Therefore, this Court
ORDERS AND ADJUDGES, as follows:
UNDISPUTED FACTS
1. Plaintiff, JORGE SANCHEZ, filed this action for nonpayment of Personal Injury Protection benefits for the following medical providers: Neurology Associates Group (hereafter “NAG”) and Stand Up MRI of Miami, P.A. (hereafter “Stand-Up”).
2. Plaintiff, Sanchez, had originally assigned his benefits to NAG on October 22, 2003. However, NAG then revoked its Assignment of Benefits (“AOB”) on November 17, 2004. (Exhibit “D” attached to State Farm’s Motion for Summary Judgment). Thereafter, on November 18, 2004, Sanchez’ attorney furnished State Farm with a Demand Letter indicating that the “medical provider (NAG) is herewith issuing a demand letter for the payment of medical services provided to the above named insured. . .” (Exhibit “B” attached to State Farm’s Motion for Final Summary Judgment). At the time this demand letter was furnished to State Farm on behalf of NAG, and despite plaintiff counsel’s assertion to the contrary, NAG did not have standing to do so due to the revocation and reassignment of any benefits and causes of action to Plaintiff, Sanchez.
3. Plaintiff, Sanchez, submitted another demand letter to State Farm Mutual Automobile Insurance Company dated March 23, 2005 (after Plaintiff’s Complaint was filed on December 9, 2004) for NAG attaching the same bills for dates of service October 31, 2003 through February 26, 2004. (Exhibit “E” attached to State Farm’s Motion for Summary Judgment).
4. On January 12, 2005, Stand-Up, like NAG, revoked its Assignment of Benefits and reassigned all benefits and causes of action to Plaintiff, Sanchez. The Revocation was attached as Exhibit “H” to State Farm’s Motion for Summary Judgment. On January 28, 2005 Plaintiff’s attorney submitted to State Farm a demand letter for treatment rendered at Stand-Up. A copy of this demand letter was attached as Exhibit “G” to State Farm’s Motion for Summary Judgment.
5. Despite Stand-Up having previously revoked on January 12, 2005, the Assignment of Benefits and having reassigned such benefits and any causes of action to Plaintiff, Sanchez, Stand-Up, on January 20, 2005, furnished to State Farm, a demand letter for treatment rendered at Stand-Up for date of service January 22, 2004. (Exhibit “F” attached to State Farm’s Motion for Summary Judgment). Yet, it had no standing to do so since it revoked its AOB on January 12, 2005. (Exhibit “H” attached to State Farm’s Motion for Summary Judgment). Notwithstanding Stand-Up’s notice, Plaintiff Sanchez’s attorney, also sent a demand letter to State Farm dated January 28, 2005, again stating, “that the below referenced medical provider (Stand-Up) is herewith issuing a demand letter for the payment of medical services. . . .” Despite plaintiff’s counsel’s interpretation to the contrary, this Court finds there is no evidence in the record before this Court that Plaintiff, Sanchez, ever furnished to State Farm a notice demanding payment of his medical bill from Stand-Up.
CONCLUSIONS OF LAW
A summary judgment may only be granted when there is no genuine issue as to any material fact and the moving party is entitled to a judgment as a matter of law. The Court finds in the instant action, that there is no genuine issue as to any material fact and the Defendant, State Farm Mutual Automobile Insurance Company, is entitled to a summary judgment as a matter of law.
“Subject matter” jurisdiction is so vital to the court’s power to adjudicate, that its absence can be raised at anytime. Fortune Ins. Co. v. Lugo, 7Fla. L. Weekly Supp. 435b (Fla. 11th Judicial Circuit, Miami-Dade County, April 4, 2000), citing Hernandez v. Coopervision, Inc., 661 So. 2d 33, 35 (Fla. 2d DCA 1995). As cited by the Lugo court, “the general rule is that the right of a complainant to the relief prayed must be determined according to the facts existing at the time the original bill was filed,” citing Shackelford v. Old Dominion Ins. Co., 6 Fla. L. Weekly Supp. 335 (Fla. 20th Cir. Ct., Jan. 20, 1999). The Shackelford Court “explained that ‘[i]f a plaintiff had no valid cause of action on the facts existing at the time of filing suit, the defect cannot ordinarily be remedied by the acquisition or accrual of one while the suit is pending.’ ” Lugo, supra.
The requirements of Section 627.736(11) are very specific. The language of this statute is also “unambiguous and conveys a clear and ordinary meaning so that there isno need to resort to other rules of statutory construction. Thus, the language of the statute must be given effect. Woodham v. Blue Cross and Blue Shield of Florida, 793 So.2d 41 (Fla. 3rd DCA 2001).
Plaintiff, Sanchez, lacked standing to file his Complaint against State Farm due to the Plaintiff’s failure to comply with F.S. 627.736(11). The evidence reviewed clearly shows the providers, NAG and Stand-Up, furnished State Farm with its demand letter when it had previously revoked the Assignment of Benefits and reassigned all benefits and potential causes of action to Jorge Sanchez. Thus, the demand letter did not comply with F.S. 627.736(11). Moreover, if such demand letter was defective, then the Complaint filed by Plaintiff, Sanchez, was premature and failed to state a cause of action because Plaintiff, Sanchez, failed to comply with the pre-requisites of the aforementioned statute.
Plaintiff’s argument at the time of the hearing that the demand letters were those of his client, Sanchez, is not supported by the record. The demand letters are clear that they were written for “the below referenced medical provider.” (NAG and Stand-Up). There is no evidence or affidavit in the record contradicting such language in the demand letters.
Due to the facts and other evidence before this Court, including that Plaintiff failed to comply with the statutory conditions precedent to filing his Complaint and any other reasons this Court concluded at the hearing which was transcribed, State Farm is entitled to a final summary judgment. The other arguments raised by State Farm regarding the defects in the CMS or HCFA-1500 forms are not addressed herein due to this Court’s order that Plaintiff did not have standing to file his Complaint.
As a result of Plaintiff’s failure to comply with the specific requirements pursuant to Section 627.736(11) it is hereby
ORDERED AND ADJUDGED that the Motion for Final Summary Judgment filed by Defendant, State Farm Mutual Automobile Insurance Company is hereby GRANTED. Plaintiff’s Motion for Partial Summary Judgement on the issue that Plaintiff complied with the statutory condition is DENIED.
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FINAL JUDGMENT FOR STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY
Pursuant to the foregoing, Final Judgment is hereby entered in favor of Defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, and against Plaintiff JORGE SANCHEZ. Plaintiff shall take nothing by this action, and Defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, shall go hence without day. It is further:
ORDERED AND ADJUDGED that this Court reserves jurisdiction in order to tax fees and costs against Plaintiff and Plaintiff’s counsel, if authorized by law.
