24 Fla. L. Weekly Supp. 824a
Online Reference: FLWSUPP 2410PALKInsurance — Personal injury protection — Demand letter — Discrepancies in statement of amounts billed by medical provider and amounts paid by insurer do not render demand letter invalid
COASTAL CARE MEDICAL CENTER, INC., aso Michael Palkowski, Plaintiff(s), v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant(s). County Court, 4th Judicial Circuit in and for Duval County. Case No. 16-2015-SC-004796, Division CC-Q. December 22, 2016. Dawn K. Hudson, Judge. Counsel: D. Scott Craig, Law Office of D. Scott Craig, LLC., Jacksonville, for Plaintiff. David Gagnon, Taylor, Day, Grimm, & Boyd, Jacksonville, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTION FOR FINALSUMMARY JUDGMENT ON PRE-SUIT DEMAND LETTERAND ORDER DENYING DEFENDANT’S MOTION FORSUMMARY JUDGMENT AS TO DEMANDLETTER AND STANDING
This cause came before the Court on November 21, 2016, on Plaintiff’s and Defendant’s Cross-Motions for Summary Judgment.
FACTS
The facts of this case are not in dispute. Mr. Palkowski was in a car accident on October 20, 2011, and sought treatment for those injuries at Coastal Care. The Plaintiff, Coastal Care, sought payment for those services rendered to Mr. Palkowski from Mr. Palkowski’s insurance company, State Farm Mutual Automobile Insurance Company, the Defendant in this instant case.
The Plaintiff sent the Defendant a “demand letter” prior to filing its lawsuit alleging standing to sue via signed assignment of benefits and the amount billed and amount paid.
SUMMARY JUDGMENT STANDARD
A party is entitled to summary judgment as a matter of law when it is proven that there is no genuine issue as to a material fact. Fla. R. Civ.P 1.510. The moving party has the burden of providing the absence of any issue of material fact, which includes overcoming all reasonable inferences in favor of the non-moving party. See Holl v. Talcott, 292 So.2d 40 (Fla. 1966). Once the moving party has proven there is no genuine issue of material fact, the burden shifts to the non-moving party to rebut the same. Id,; Castenada v. General Building Services Corporation, 746 So.2d 491 (Fla. 3rd DCA 1999) [24 Fla. L. Weekly D2387b].
ANALYSIS
Defendant and Plaintiff disagree as to the Plaintiff’s compliance with the condition precedent required in a valid pre-suit “demand letter” established in 627.736(10), Florida State Statutes.
The Statute requires that the Plaintiff, prior to suit, provide a notice that meets the following criteria:
(b). The notice must state that it is a “demand letter under s. 627.736” and 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 of policy number upon which such claim was originally submitted to the insurer.
3. To the extent applicable, the name of any medical provided 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 dame of treatment, service, or accommodation, and the type of benefits 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. To the extent that the demand involves an insurer’s withdrawal of payment under paragraph (7)(a) for future treatment not yet rendered, the claiming shall attach a copy of the insurer’s notice withdrawing such payment and an itemized statement of the type, frequency, and duration of future treatment claimed to be reasonable and medically necessary. . . . .
§ 627.736(10)(b), Fla. Stat. Ann.
The demand letter sent by the Plaintiff in this case states that it is in fact a “demand letter under Section 627.736(10), Florida Statutes” and provides the name of the insured who received treatment and upon whom benefits are being sought, in compliance with (b)1 of the Statute.
The demand letter also attached is a signed Assignment of Benefits which states in part . . . “hereby authorize payment to be assigned by my insurance company directly to the physicians at Coastal Plus Medical Centers. PLEASE DIRECT ALL MEDICAL BENEFITS TO THEIR OFFICE.” The Assignment is required to be attached per (b)1 of the Statute.
The demand letter provides the claim number as required in (b)2 of the Statute.
The demand letter provides the name of the medical provider and also attaches the “patient ledger” in compliance with (b)3 of the Statute.
The Defendant complied with the Plaintiff’s demand letter by responding in writing and failing to provide payment in full.
In spite of the above, the Defendant now claims the demand letter is insufficient because it didn’t comply with 627.736(10). The Defendant also asserts that the demand letter is invalid because it incorrectly stated the amount Plaintiff billed and amount Defendant paid. This Court finds the arguments unpersuasive and relief upon. The Defendant also asserts that the demand letter is invalid because it incorrectly stated the amount Plaintiff billed and amount Defendant paid. This Court finds the argument unpersuasive and relies upon River City Medical Associates, Inc., dba Absolute Medical Clinic, a/a/o Holly Connell vs. Peak Property & Casualty Ins. Corp., 22 Fla. L. Weekly Supp 825a (Duval Cty. Ct. January 16, 2015).
CONCLUSION OF LAW
This Court finds that the demand letter complies with 627.736(10) and the discrepancies in the amounts listed are not sufficient to invalidate the letter, therefore, Plaintiff’s Motion for Summary Judgment on Presuit Demand Letter is GRANTED and Defendant’s Motion for Summary Judgment as to Demand Letter and Standing is DENIED.
