22 Fla. L. Weekly Supp. 825a
Online Reference: FLWSUPP 2207CONNInsurance — Personal injury protection — Demand letter — Sufficiency — PIP statute does not require that demand letter include bills already reduced to Medicare fee schedule — Compliance with demand letter requirement is question of law, not jury question — Accordingly, there is not merit to insurer’s contention that plaintiff’s suit must fail if a jury ultimately issues a verdict in the provider’s favor for an amount other than the exact amount specified in demand letter
RIVER CITY MEDICAL ASSOCIATES, INC. d/b/a ABSOLUTE MEDICAL CLINIC, a/a/o HOLLY CONNELL, Plaintiff, vs. PEAK PROPERTY & CASUALTY INSURANCE CORPORATION, Defendant. County Court, 4th Judicial Circuit in and for Duval County, Small Claims Court. Case No. 16-2013-SC-005291, Division CC-Q. January 16, 2015. Honorable Dawn K. Hudson, Judge. Counsel: D. Scott Craig, Ellis Peetluk and David Salisbury II, Jacksonville, for Plaintiff. Ashley Ward-Singleton, Tampa, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTION FORFINAL SUMMARY JUDGMENT THAT PLAINTIFF’SPRESUIT DEMAND LETTER SATISFIED THECONDITIONS PRECEDENT IN F.S. § 627.736(10)
THIS CAUSE came before the Court for hearing on December 3, 2014 at 10:30 a.m. On Plaintiff’s Motion for Final Summary Judgment that Plaintiff’s Demand Letter Satisfied the Conditions Precedent in F.S. 627.736(10). The Court, having heard argument of counsel and otherwise being advised on the premises thereof, it is hereby ORDERED AND ADJUDGED as follows:
1. Plaintiff’s Presuit Demand Letter met the following factors in F.S. 627.736(10):
· 627.736(10)(a): Prior to filing this action for No-Fault benefits, Plaintiff supplied the Defendant insurer with a written notice of an intent to initiate litigation.
· 627.736(10)(b)(1): Plaintiff’s Demand Letter stated the name of the insured upon which such benefits are being sought, including an assignment of the rights to the claimant.
· 627.736(10)(b)(2): Plaintiff’s Demand Letter provided the policy number upon which such claim was originally submitted to the insurer.
· 627.736(10)(b)(3): Along with the Demand Letter, Plaintiff provided an itemized statement specifying each exact amount, the date of the treatment, and the type of benefit claimed to be due.
· 627.736(10)(c): Plaintiff sent said Demand Letter by United States certified mail with return receipt requested to Defendant.
· 627.736(10)(d): Defendant did not pay the overdue claim within 30 days after receipt of Plaintiff’s Demand Letter.
2. Plaintiff’s Demand Letter substantially complied with Florida Statute § 627.736(10), meeting the condition precedent to filing this action.
3. Pursuant to the ruling of the Florida Supreme Court in GEICO Gen. Ins. Co. v. Virtual Imaging Sers., Inc., (No. SC12-905 Fla. July 3, 2013) [38 Fla. L. Weekly S517a], there is no duty that medical providers submit bills already reduced to the Medicare fee schedule.
4. Defendant has argued that compliance with Florida Statute § 627.736(10) may only be determined after the jury has reached verdict as to the amount of benefits payable. Defendant argues that if a jury issues a final monetary verdict in Plaintiff’s favor for an amount other than the exact amount demanded and “claimed to be due”, Plaintiff’s suit must fail, because Plaintiff demanded an amount that was not overdue and therefore, Plaintiff did not meet the statutory condition precedent to suit.
5. There is nothing in the No-Fault statute to support Defendant’s strict interpretation. The purpose of the presuit demand requirement is to provide insurers with an opportunity to pay the claim, and avoid suit. The kind of strict compliance urged by Defendant, where claimant has to perfectly demand the exact amount ultimately determined to be payable, would be impossible and would deprive a No-Fault Benefits Plaintiff of the right to sue for the denied claims. Such strict interpretation would be contrary to the stated intent of the No-Fault Law, which is to provide “swift and virtually automatic payment” of benefits, Custer Medical Center v. United Automobile Insurance Company, 62 So.3d 1086 (Fla. 2011) [35 Fla. L. Weekly S640a]. This Court finds that the Defendant’s interpretation of F.S. § 627.736(10) would create a system where compliance with the statutory requirement is not virtually automatic, but virtually impossible. Plaintiff has demanded “each exact amount claimed to be due”, which may differ from the exact amount which a jury may determine is payable in its verdict.
6. Compliance with F.S. 627.736(10) is a question of law, not a jury question. Once compliance with the statute has been determined by the Court, a jury may determine what is payable.
7. Plaintiff has satisfied the intent of F.S. 627.736(10), by providing Defendant an ample opportunity to avoid suit. The facts of the case are to be considered when determining compliance with the statute. Here, Defendant has denied all future treatment due to a compulsory IME opinion. Defendant is in possession of the claim file, and knows what has been paid and not paid. There is no suggestion of confusion in the record, only that Defendant has declined to pay the demand.
8. Therefore, Plaintiff’s Motion for Final Summary Judgment that Plaintiff’s Demand Letter Satisfied the Conditions Precedent in F.S. 627.736(10) is GRANTED, with prejudice.
