23 Fla. L. Weekly Supp. 584b
Online Reference: FLWSUPP 2306CARRInsurance — Personal injury protection — Demand letter — Pre-suit demand letter does not satisfy statutory condition precedent to suit where neither letter nor attached ledger reflect partial payments made by insurer — No merit to medical provider’s argument that letter substantially complied with notice requirements since insurer should be able to discern exact amount claimed to be due — Strict compliance with notice requirements is required
QUALITY AUTO REHAB, LLC, a/a/o RENALDO CARRASCO, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 6th Judicial Circuit in and for Hillsborough County, Civil Division. Case No. 13-CC-019257, Division I. Honorable Joelle Ann Ober, Judge. April 22, 2014. Counsel: Kendrick Blackwell, Clearwater, for Plaintiff. Cameron Frye, Oxendine & Oxendine, P.A., Tampa, for Defendant.
ORDER GRANTING DEFENDANT’S MOTIONFOR FULL AND FINAL SUMMARY JUDGMENT
THIS MATTER, having come before the Court on April 14, 2014 for hearing on Defendant’s Motion for Full and Final Summary Judgment and after reviewing the motions, the record, the applicable law, and after hearing argument of counsel for the parties finds as follows:
FACTUAL BACKGROUND
On June 18, 2011, Reinaldo Carrasco (“Carrasco”) was involved in an automobile accident. Carrasco was insured under a State Farm Mutual Automobile Insurance policy at the time of the accident. Carrasco sought treatment from the Plaintiff, Quality Auto Rehabilitation, LLC. Plaintiff submitted medical bills to the Defendant for treatment rendered to Carrasco from June 22, 2011 to September 1, 2011. On October 25, 2011, Defendant submitted payments on these claims to the Plaintiff, plus any applicable interest. On October 30, 2011, Plaintiff submitted to Defendant a pre-suit demand letter seeking payment for services rendered from June 22, 2011 to September 1, 2011, claiming an alleged balance due of $8,448.98. Attached to Plaintiff’s letter was a ledger reflecting all charges submitted to Defendant from June 22, 2011 to September 1, 2011. However, none of the payments that were previously issued by Defendant were listed or accounted for in Plaintiff’s cover letter or attached ledger. Plaintiff did not submit any corrected or subsequent demands. On December 5, 2011, Plaintiff, as assignee of Reinaldo Carrasco, filed a Complaint for breach of contract against Defendant alleging failure to pay applicable PIP and/or MedPay benefits. In response, Defendant filed an Answer and Affirmative Defenses, asserting lack of compliance with Florida Statute §627.736(10). Defendant’s Motion for Full and Final Summary Judgment followed thereafter and was called for hearing on April 14, 2014.
ANALYSIS AND DISCUSSION
This Court finds that the pre-suit demand letter is not in compliance with Florida Statute 627.736(10) and, thus, Plaintiff failed to meet the obligatory condition precedent to filing suit. This is because Florida Statute Section 627.736(10) requires that the demand letter contain “an itemized statement specifying each exact amount, date of treatment, service or accommodation and the type of benefit claimed to be due.” “Florida courts have held that this language is unambiguous and places the burden upon the plaintiff to fulfill the requirements outlined.” West Coast Chiropractic and Medical Center, Inc. a/a/o Jorge Torres v. MGA Ins. Co. Inc., 19 Fla. L. Weekly Supp. 941a (13th Judicial Cir., Hillsborough Cty., April 26, 2012). “Courts have also held that the specifications of § 627.736, Fla. Stat. must be strictly construed.” Id. An insurer should be able to determine from a “demand letter” the exact amount claimed to be overdue so that it may be resolved without litigation. West Coast Spine & Injury Center a/a/o Aimee Arias v. State Farm Mut. Auto. Ins. Co., 17 Fla. L. Weekly Supp. 38b (Fla. Hillsborough Cty. Ct., 2009)(Myers, J.). Plaintiff’s demand fails to take into account State Farm’s prior payments for the dates of service alleged to be due.
This Court’s decision is influenced by the ruling in Chambers Medical Group, Inc., (a/a/o Marie St. Hillare) v. Prog. Exp. Ins. Co., 14 Fla. L. Weekly Supp. 207a (Fla. 13th Jud. Cir. (Appellate-Civil), December 1, 2006). In Chambers, the 13th Circuit held that the Plaintiff had not satisfied its burden of putting the Defendant on proper notice of a covered loss when it submitted pre-suit demand letters with attached claims forms that failed to account for partial payments made by Progressive. Id. The Court stated that “the mere attachment of claims forms setting forth the amount of the original claim, where partial payments are not reflected on the form or elsewhere in the demand, does not set forth the ‘exact amount claimed to be due.’ ” Id.
In the present case, as in Chambers, Plaintiff submitted a pre-suit demand letter to State Farm with an attached ledger setting forth the original claim but failed to reflect partial payments that had been made prior to the mailing of the demand letter. The demand and the attached letter simply repeated all previous charges that were submitted to Defendant. Even though the ledger had a column for payments received from the insurance company, none of the payments that were made by State Farm in this case were listed in the ledger. Plaintiff contends that it substantially complied with the notice requirements of Florida Statutes 627.736(10) and that Defendant, as the insurance company handling the claim, is in the best position to know, or should be able to discern from the demand letter, the exact amount claimed to be due. This Court, however, is not persuaded by Plaintiff’s contention that it substantially complied with the notice requirements. As the Court in Chambers noted, strict compliance with the notice requirements is required to effect the purpose of the statute. When partial payments are not reflected in the demand letter, it does not present accurate information regarding the amount claimed due. The Plaintiff’s failure to reflect partial payments in its demand letter results in a failure to set forth the “exact amount claimed to be due.”
As Plaintiff failed to comply with 627.736(10) which is a condition precedent to filing suit, this Court find that summary judgment is appropriate for the Defendant.
Accordingly, it is hereby:
ORDERED AND ADJUDGED
1. That Defendant’s Motion for Full and Final Summary Judgment is GRANTED.***FINAL JUDGMENT
The Court enters Final Judgment in favor of the Defendant and Plaintiff, QUALITY AUTO REHAB, LLC, shall take nothing by this action and the Defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY shall go hence without day.
This Court reserves jurisdiction to consider any applicable claims for reasonable attorneys’ fees and costs, if any.
