20 Fla. L. Weekly Supp. 620a
Online Reference: FLWSUPP 2006XTREInsurance — Personal injury protection — Demand letter that contained itemized statement in form of billing ledger and stated amount claimed to be due satisfied statutory condition precedent to suit — Statute does not require that demand letter state amount ultimately determined to be due or itemized statement of amount claimed by CPT code
XTREME CHIROPRACTIC & REHAB, INC., a Florida Corporation (assignee of Park, Jeena), Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 12-05544 COCE 53. March 8, 2013. Robert W. Lee, Judge. Counsel: Rafael Katz, Katz and Katz, P.A.; Russel Lazega, Florida Advocates, Dania Beach, for Plaintiff. Frantz C. Nelson, Vernis & Bowling of Broward, P.A., for Defendant.
ORDER GRANTING PLAINTIFF’S MOTIONFOR PARTIAL SUMMARY JUDGMENT(RE: INVALID PRE-SUIT DEMAND LETTER)
THIS CAUSE, having come before the Court on Plaintiff’s Motion For Partial Summary Judgment (Re: Invalid Pre-Suit Demand Letter) on January 29, 2013 and the Court, having reviewed the motion, evidence, and heard argument of counsel, finds as follows:
Factual Background: This is a suit brought by an assignee medical provider for payment of PIP benefits. The Plaintiff treated the patient and submitted the associated medical bills to the Defendant. Upon receipt of said bills, Defendant issued reduced payment to the Plaintiff. Plaintiff thereafter sent the Defendant a pre-suit demand letter as required under F.S. s. 627.736(10). Defendant has alleged as an affirmative defense that Plaintiff’s demand letter does not comply with F.S. s. 627.736(10). Specifically, Defendant maintains the demand letter: 1) does not contain an exact itemization of each CPT code due; 2) does not indicate the correct payment amounts by the Defendant; and, 3) therefore, does not indicate the exact amount owed. Plaintiff maintains the demand letter complies with F.S. s. 627.736(10) as: 1) attached to the demand letter was Plaintiff’s billing ledger, which itemized each date of service Plaintiff claimed was due, and 2) F.S. s. 627.736(10) does not require a demand letter indicate payment amounts or the exact amount owed.
Conclusions of Law: Florida Statute, 627.736(10), states in pertinent part:
10) DEMAND LETTER. —
(a) As a condition precedent to filing any action for benefits under this section, the insurer must be provided with written notice of an intent to initiate litigation. Such notice may not be sent until the claim is overdue, including any additional time the insurer has to pay the claim pursuant to paragraph (4)(b).
(b) The notice required shall state that it is a “demand letter under s. 627.736(10)” and shall state with specificity:
1. The name of the insured upon which such benefits are being sought, including a copy of the assignment giving rights to the claimant if the claimant is not the insured.
2. The claim number or policy number upon which such claim was originally submitted to the insurer.
3. To the extent applicable, the name of any medical provider who rendered to an insured the treatment, services, accommodations, or supplies that form the basis of such claim; and an itemized statement specifying each exact amount, the date of treatment, service, or accommodation, and the type of benefit claimed to be due.
(emphasis added in italics)
Nowhere in F.S. s. 627.736(10) does it state that the demand letter must state the exact amount that is ultimately determined to be due. Rather, F.S. s. 627.736(10) merely requires the demand letter must set forth the amount claimed to be due.
Additionally, nowhere in F.S. s. 627.736(10) does it state that the demand letter must itemize what Plaintiff claimed was due for each treatment or service by CPT code. There is nothing in F.S. s. 627.736(10) that provides for any such requirement and the Defendant’s posture that F.S. s. 627.736(10) requires an itemized statement for each and every service or treatment by CPT code essentially asks this Court to rewrite the statute, which this Court is not at liberty to do. Seagrave v. State, 802 So. 2d 281, 287 (Fla. 2001) [26 Fla. L. Weekly S481a] citing to Hayes v. State, 750 So.2d 1, 4 (Fla.1999) [24 Fla. L. Weekly S467a] and Overstreet v. State, 629 So.2d 125, 126 (Fla.1993).
In this case, Plaintiff’s demand letter contains an itemized statement in the form of the Plaintiff’s billing ledger and states the amount Plaintiff claimed to be due as required by F.S. s. 627.736(10) and, thus, Plaintiff has complied with Florida Statute 627.736(10) and satisfied the condition precedent to filing this lawsuit.
Accordingly, it is hereby,
ORDERED AND ADJUDGED: Plaintiff’s Motion For Partial Summary Judgment (Re: Invalid Pre-Suit Demand Letter) is GRANTED.
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