23 Fla. L. Weekly Supp. 277a
Online Reference: FLWSUPP 2303WADEInsurance — Personal injury protection — Demand letter was defective where letter did not state exact amount due, or any amount due, and did not attach itemized statement from providers — Fact that the only issue in dispute was whether insurer improperly limited benefits to $2500 does not change result — Motion for summary judgment based on defective demand letter is granted
LAMON WADE, Plaintiff(s), v. PROGRESSIVE SELECT INSURANCE COMPANY, Defendant(s). County Court, 15th Judicial Circuit in and for Palm Beach County, Civil Division RF. Case No. 502014CC004978XXXXMB. June 24, 2015. Frank S. Castor, Judge. Counsel: Bill Bone, Larmoyeux & Bone, West Palm Beach, for Plaintiff. Randall Bishop and Neil V. Singh, Law Offices of Neil V. Singh, Fort Lauderdale, for Defendant.
[Editor’s note: Final summary judgment in favor of insured which was entered in this case on issue of sufficiency demand letter reversed on appeal: FLWSUPP 2606WADE (Progressive Select Insurance Co. v. Wade, 15 Jud. Cir. (Appellate), Case No. 502016AP900269, 8-21-2018]
ORDER GRANTING DEFENDANT’S AMENDEDMOTION FOR FINAL SUMMARY JUDGMENTBASED ON DEFECTIVE DEMAND LETTER
THIS CAUSE came before the Court on June 22, 2015 upon Defendant’s Amended Motion for Final Summary Judgment Based on Plaintiff’s Lack of Standing and Defective Demand Letter. The issue of standing will be addressed in a separate order. Both parties were represented by counsel. The Court heard argument and reviewed the applicable case law and finds as follows:
Plaintiff was involved in an automobile accident on June 1, 2013. Plaintiff filed suit against Defendant on May 1, 2014 for breach of contract claiming Defendant improperly limited Plaintiff’s PIP benefits to $2,500. Plaintiff alleges that Defendant ultimately paid a total of $4,769.40 in PIP benefits to two providers. Prior to filing suit, Plaintiff individually paid all outstanding bills, which totaled $27,756.08, but at a reduced, negotiated rate.
The demand letter at issue is titled “Notice of Intent” and was sent by certified mail to Defendant on July 25, 2013. The letter addresses the issue of whether Plaintiff’s injuries shall qualify as an Emergency Medical Condition under F.S. 627.732(16). Plaintiff claimed in the letter that Defendant was improperly limiting benefits to $2,500.
The demand letter is a “condition precedent to filing any action” for PIP benefits. F.S. 627.736(10). The specific requirements for the demand letter are stated in F.S. 627.736(10)(b)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 the treatment, service, or accommodation, and the type of benefit claimed to be due. . .”
According to MRI Associates of America, LLC v. State Farm Fire and Casualty Company, 61 So.3d 462 (Fla. 4th DCA 2011) [36 Fla. L. Weekly D960b], “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.’ ” MRI also states, “The statutory requirements surrounding a demand letter are significant, substantive preconditions to bringing a cause of action for PIP benefits.” Id., citing Menendez v. Progressive Express Ins. Co., 35 So.3d 873, 979-80 (Fla. 2010) [35 Fla. L. Weekly S81a].
Here, the Plaintiff’s pre-suit demand letter fails to state the exact amount due, or any amount due, and fails to attach an itemized statement from providers. It does attach medical records and treatment notes without billing ledgers for various providers.
Plaintiff argued that the statutory requirements of an amount due and itemization were not required because they were not at issue. According to Plaintiff, the only issue was whether Defendant improperly limited PIP benefits to $2500. The language of F.S. 627.736(10)(b)3 begins with “To the extent applicable. . .” Thus, Plaintiff was not required to list the amount due and itemize the charges from the providers.
The Court is bound by the MRI Associates case and its interpretation of F.S. 627.736(10). Thus, it is ORDERED AND ADJUDGED that Defendant’s Amended Motion for Final Summary Judgment as to Plaintiff’s Defective Demand is GRANTED.
