21 Fla. L. Weekly Supp. 357a
Online Reference: FLWSUPP 2104TIMOInsurance — Personal injury protection — Demand letter — Medical provider may only sue for amount billed and specified in demand letter
PRECISION DIAGNOSTIC OF LAKE WORTH, LLC (assignee of Timoleon, Violette), Plaintiffs, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 15th Judicial Circuit in and for Palm Beach County. Case No. 502012SC016824XXXXSBRD. January 10, 2014. Reginald Corlew, Judge.
ORDER ON PLAINTIFF’S MOTION FORSUMMARY JUDGMENT AND DEFENDANT’SCROSS MOTION FOR PARTIAL SUMMARYJUDGMENT AS TO PRE-SUIT DEMAND LETTER
COMES NOW, The Court and having heard argument on January 9, 2014, finds as follows:
BACKGROUND
1. This is a suit for No-fault benefits and both parties have moved for partial summary judgment as to the pre-suit demand notice requirement at Florida Statute Section 627.736(10).
2. At the bearing of this matter, Defendant conceded in part, the Plaintiff’s pre-suit demand material, which was attached to Plaintiff’s supporting Affidavit, was statutorily compliant but only as so far as the amounts specified as billed, at $3,200.00 ($1,600.00 each, for 2 MRI scans). As such, the Court grants Plaintiff’s Motion, in part.
3. The remaining matter before the Court is the defense assertion and Cross Motion that Plaintiff is constrained by the amounts specified in its bill and pre-suit demand and accordingly, is limited to presenting the figure of $1,600.00 as “reasonable.”
UNDISPUTED FACTS
4. Based upon Plaintiff’s supporting Affidavit which includes the bill or CMS-1500 Form and the demand letter, it is undisputed that Plaintiff billed the sum of $1,600.00, for the 2 subject MRI’s and furthermore, specified its demand as follows:
“$3,200.00 less $0 deductible at 80% =$2,560.00 less $0 payment = $2,560.00. . .”
ANALYSIS AND LAW
5. Defendant, in support of its proposition at argument, relies on the pre-suit demand letter requirements found at Florida Statute Section 627.736(10), which provides in pertinent part as follows:
(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:
. . . .
3. To the extend 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. . .
A completed form satisfying the requirements of paragraph (5)(d) or the lost-wage statement previously submitted may be used as the itemized statement.
6. In the instant action, among other things, the Plaintiff has indeed submitted the form satisfying the requirement of paragraph (5)(d) i.e. the CMS-1500 Form which bills the 2 MRI’s at $1,600.00 each.
7. Additionally, Defendant relies upon MRI Associates of America LLC (a/a/o Ebba Register) v. State Farm Fire and Casualty Company 61 So. 3d 462 (Fourth District, 2011) [36 Fla. L. Weekly D960b]. This decision of the Fourth District involves two issues on appeal, only one of which concerns the matter before this Court. The Fourth District set forth and discussed an additional opinion by the Fifteenth Judicial Circuit-Appellate Division in the matter of Fountain Imaging of West Palm Beach, LLC v. Progressive Express Insurance Company, 14 Fla. L. Weekly Supp. 614a, wherein that panel held that a pre-suit demand letter had been sent prematurely where proper notice of the exact amount owed had not been provided. More specifically, the Court observed the statutory requirements beginning with the submission of a medical bill itself and Florida Statute Section 627.736, subsection (4) and subsection (5) which requires proper and timely billing. The Court further observed the pre-suit demand letter [under then subsection (11) of the No-Fault Statute] “may not be sent until the payment is overdue.” Additionally, suit may not be initiated until a demand letter is sent. As such, the defense proposition is that Plaintiff is prohibited from suing on any other amount other than a) the precise amount billed and, b) only if that amount is consistent with the amount specified in the pre-suit demand letter.
8. By the time the Fourth District had decided MRI Associates the pre-suit demand language remained substantially unchanged and was renumbered at subsection (10) of the No-Fault Statute. The Fourth District in MRI Associates held as follows:
The language of subsection 627.736(10)(b)3, requires precision in a demand letter by its requirement of an “itemized statement specifying each exact amount;” it also allows a subsection 627.736(5)(d) Health Insurance Claim Form to be “used as the itemized statement”. . .
The Statute mandates that the amount at issue for a bill be specified early in the claims process. This requirement of precision in medical bills discourages gamesmanship on the part of those who might benefit from confusion and delay. The statutory requirements surrounding a demand letter, are significant, substantive preconditions to bringing a cause of action for PIP benefits.
9. Defendant also replies upon Jaszay v. HB Corporation, 598 So. 2d 112 (Fourth District, 1992), for the similar proposition that “gotcha” litigation maneuvers will not be condoned.1
FINDINGS
10. The amount billed was $1,500.00 and the formula specified in the pre-suit demand notice was based upon this amount. Due to the premise a pre-suit demand letter may not be sent until a bill is completed, submitted and becomes overdue, there is no other conceivable billed amount that could satisfy the requirements set forth in MRI Associates. Furthermore, the amount billed and specified in the pre-suit demand mirrors the allegations at Paragraph 12 of Plaintiff’s Complaint.
11. Accordingly, it is hereby ORDERED AND ADJUDGED that Defendant’s Cross Motion for Partial Summary Judgment is hereby GRANTED and Plaintiff’s Motion for Summary Judgment is granted only to the extent that $1,600.00 was the amount billed and demanded.
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1At argument Plaintiff conceded it may vary well ask the jury to consider an amount other than the amounts billed and set forth in the pre-suit demand.
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