23 Fla. L. Weekly Supp. 263a
Online Reference: FLWSUPP 2303SALMInsurance — Personal injury protection — Standing — Assignment — Facts indicate there is equitable assignment of PIP benefits — Demand letter — Demand letter that contains CMS 1500 form and states amount medical provider claims to be due satisfies condition precedent to filing suit — PIP statute does not require that demand letter state exact amount that is ultimately determined to be due
ADVANCED 3-D DIAGNOSTICS, INC. A/A/O CLAUDETTE SALMON, Plaintiff, v. STATE FARM FIRE AND CASUALTY COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 2013-SC-010370-O. June 22, 2015. Honorable Steve Jewett, Judge. Counsel: David Bender, Shuster & Saben, LLC, Satellite Beach, for Plaintiff. Julie Lewis Hauf, Law Office of Julie Lewis Hauf, Fort Myers, for Defendant.
ORDER DENYING DEFENDANT’S MOTIONFOR SUMMARY JUDGMENT REGARDING STANDINGAND INVALID PRE-SUIT DEMAND LETTER
THIS CAUSE, having come before the Court on Defendant’s Motion For Summary Judgment 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 payment to the Plaintiff in an amount it determined to be reasonable, which Plaintiff disputes. Plaintiff thereafter sent the Defendant a pre-suit demand letter as required under F.S. s. 627.736(10). Defendant has alleged an affirmative defense that Plaintiff lacks standing to bring this lawsuit. Specifically, that the assignment of benefits is to another entity other than Plaintiff, and that the assignment of benefits is merely a direction to pay. Plaintiff maintains that there is 1) no legal distinction between a direction to pay and an assignment of benefits, 2) Plaintiff is the real party in interest, and 3) there was an equitable assignment. Defendant has also 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 does not indicate the correct payment amounts by the Defendant, and 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 CMS 1500 form, 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:
ASSIGNMENT OF BENEFITSEQUITABLE ASSIGNMENT
“No particular words or form of instrument is necessary to effect an equitable assignment and any language, however informal, which shows an intention on one side to assign a right or chose in action and an intention on the other to receive, if there is valuable consideration, will operate as an effective equitable assignment.” Giles v. Sun Bank, N.A., 450 So.2d 258, 260 (Fla. 5th DCA 1984). In this case, the facts indicate that there is an equitable assignment of benefits (assuming an express assignment didn’t exist) for the facts as stated above. In our case, the Plaintiff pled, in the alternative of an express assignment of benefits, there was, at least, an equitable assignment of benefits.
DEMAND LETTER
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 theinsured.
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. A completed form satisfying the requirements of paragraph (5)(d) or the lost-wage statement previously submitted may be used as the itemized statement.
This Court is aware of the case Medical Therapies, LLC v. State Farm Mutual Automobile Ins. Co., 22 Fla. L. Weekly Supp. 34a (9th Judicial Circuit (Appellate) 2014). However, this case is distinguishable. 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. See Xtreme Chiropractic & Rehab, Inc. (assignee Jeena Park) v. State Farm Mutual Automobile Ins. Co., 20 Fla. L. Weekly Supp. 620a (17th Judicial Circuit, Judge Robert W. Lee, 2013). The statute also states that a completed form satisfying the requirements of paragraph (5)(d) may be used as the itemized statement. That is exactly what Plaintiff did in this case by attaching the CMS 1500 form as its itemized statement.
In this case, Plaintiff’s demand letter contains an itemized statement in the form of the Plaintiff’s CMS 1500 form 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: Defendant’s Motion for Summary Judgment is DENIED.
