17 Fla. L. Weekly Supp. 38b
Online Reference: FLWSUPP 1701ARIA
Insurance — Personal injury protection — Demand letter — Medical provider failed to provide “itemized statement” required by PIP statute where provider attached to demand letter HCFA forms that included charges in excess of amount sought in letter, and neither letter nor HCFA forms identified which charges and dates of service provider contends were paid and which remained due and owing — Insurer’s motion for summary judgment is granted
WEST COAST SPINE & INJURY CENTER A/A/O AIMEE ARIAS, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE CO., Defendant. County Court, 13th Judicial Circuit in and for Hillsborough County. Case No. 09 CC 5243, Division H. October 22, 2009. Eric R. Myers, Judge. Counsel: J. Ron Pliego. Xavier J. Jackman, Ramey & Kampf, P.A., Tampa, for Defendant.
ORDER
THIS CAUSE having come on to be heard on Defendant’s Motion for Summary Judgment and the Court having heard argument of counsel, and being otherwise advised in the Premises, this Court grants the Motion as follows;
1. Plaintiff filed this action seeking payment of personal injury benefits and medical payments benefits for medical services provided to Defendant’s insured following a motor vehicle accident that occurred on January 5, 2007.
2. On November 20, 2008, Plaintiff submitted a Pre-Suit Demand Letter pursuant to Fla. Stat. §627.736(10) (2007).
3. Said letter sought payment for dates of services from January 10, 2007 through June 8, 2007 wherein demand was made for $652.00, plus postage and interest, and alleged the amount reflects the total amount billed by the provider at 80%.
4. Plaintiff attached Health Care Financing Administration CMS-1500 forms (hereinafter referred to as “HCFAs”) to the pre-suit demand letter that totaled $5,810.00 in charges. Neither Plaintiff’s demand letter, nor the HCFAs attached identify which charges and/or dates of service Plaintiff contends were properly paid by State Farm, nor which charges Plaintiff contended to remain due and owing.
5. Florida Statute §627.736(10) requires that the demand letter contain, “[A]n itemized statement specifying each exact amount, the date of treatment, service, or accommodation, and the type of benefit claimed to be due.”
6. By merely attaching all HCFAs billed during a certain time period without providing any notice to the insurer of the specific charges and/or dates of service upon which demand is being made, Plaintiff has failed to provide an “itemized statement specifying each exact amount, the date of treatment, service or accommodation, and the type of benefit being claimed due” and thus has failed to comply with the requirements of Fla. Stat. §627.736(10) (2007).
7. As such, Plaintiff has failed to fulfill a condition precedent to suit, therefore Defendant’s Motion for Summary Judgment is GRANTED. The Court specifically reserves jurisdiction with regard to any outstanding Motions regarding fees, costs, or sanctions that have or may accrue as a result of this litigation.
