25 Fla. L. Weekly Supp. 808a
Online Reference: FLWSUPP 2509WILSInsurance — Personal injury protection — Demand letter — Sufficiency — PIP statute does not require that demand letter state exact amount owed by insurer — Inclusion in demand letter of claim for one bill that insurer claims it did not receive does not render demand letter invalid
COASTAL CARE MEDICAL CENTER, INC., D/B/A COASTAL CARE PLUS MEDICAL CENTER, as assignee of Sharon Wilson, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 16-2015-SC-003280. Division CC-K. November 2, 2017. Brent D. Shore, Judge. Counsel: Ashley-Britt Hansen, for Plaintiff. Stephen G. Mellor, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTION FOR FINALSUMMARY JUDGMENT THAT PLAINTIFF’S PRESUITDEMAND LETTER SATISFIED THE CONDITIONSPRECEDENT IN F.S. §627.736(10) AND DENYINGDEFENDANT’S ORE TENUSMOTION FOR SUMMARY JUDGMENT
This cause came to be heard upon Plaintiff’s Motion for Final Summary Judgment that Plaintiff’s Presuit Demand Letter Satisfied the Conditions Precedent in F.S. §627.736(10) and Defendant’s Ore Tenus Motion for Summary Judgment. Both parties were represented by counsel. The Court, having heard arguments of the parties, finds:
A. The issue in this case is whether Plaintiff complied with its condition precedent of placing Defendant on notice of its intent to initiate litigation by sending a presuit demand letter that satisfies F.S. §627.736(10).
B. The statute states, in pertinent part:
DEMAND LETTER.
(b) The notice required shall state that it is a “demand letter under s. 627.736(10)” and shall state with specificity:
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.
(Emphasis added).
C. The facts in this case are not in dispute. On January 29, 2015 Plaintiff submitted a presuit demand letter to Defendant, demanding full payment for treatment rendered to its patient, Sharon Wilson, from August 19, 2011 through December 1, 2011. Plaintiff’s presuit demand letter stated that the total amount billed was $9,074.00 and that Plaintiff received payment of $7,226.91, leaving a balance of $1,847.09 owed.
D. Plaintiff attached a “Patient Ledger” satisfying the requirement of an “itemized statement specifying each exact amount”. Plaintiff also attached an Assignment of Benefits executed by Ms. Wilson, assigning payment of her No-Fault benefits to Plaintiff.
E. Defendant responded to Plaintiff’s presuit demand letter and indicated that the bill for date of service November 11, 2015, billed in the amount of $278.00, had not been received by Defendant. Defendant argued that because said date of service had not been received, Plaintiff’s presuit demand letter was non-compliant because the amount demanded by Plaintiff was incorrect due to the November 11, 2015 bill Defendant had not received. Defendant argued that pursuant to MRI Associates of America, LLC as assignee of Ebba Register v. State Farm Mutual Fire and Casualty Company, 61 So. 3d 462 (Fla. 4th DCA 2011) [36 Fla. L. Weekly D960b], Plaintiff’s presuit demand letter did not strictly comply with the requirements of an “itemized statement specifying each exact amount”.
F. The “exacting” standard goes to the itemized bill and not to any calculation made by Plaintiff. Defendant’s position that Plaintiff failed to “strictly comply” with the condition precedent because it failed to calculate the exact amount owed so that it matches the amount Defendant states should be at issue is not supported by the language of F.S. §627.736(10), and sister courts have rejected this argument. See McGowan Spinal Rehab Center a/a/o Jaynell Cameron v. State Farm Mut. Auto. Ins. Co., 22 Fla. L. Weekly Supp. 708a (Order of Duval County Court Judge Brent D. Shore dated December 17, 2014); EBM Internal Medicine a/a/o Jasmine Gaskin v. State Farm Mutual Automobile Insurance Company, 19 Fla. L. Weekly Supp. 382a, (Order of Duval County Court Judge Angela Cox dated December 9, 2011); St. Johns Medical Center a/a/o Melissa Brown v. State Farm Mutual Automobile Insurance Company, 22 Fla. L. Weekly Supp. 457a (Order of Duval County Court Judge Brent Shore dated October 22, 2014); EBM Internal Medicine a/a/o Bernadette Dorelien v. State Farm Mutual Automobile Insurance Company, 19 Fla. L. Weekly Supp. 410a (Order of Duval County Court Judge Gary Flower dated February 8, 2012); Neurology Partners, P.A., d/b/a Emas Spine & Brain a/a/o Scott Bray v. State Farm Mutual Automobile Insurance Company, 22 Fla. L. Weekly Supp. 101b (Order of Duval County Court Judge Scott Mitchell dated August 7, 2014); North Florida Chiropractic & Rehabilitation Center a/a/o Kenneth Brown v. State Farm Mutual Automobile Insurance Company, 22 Fla. L. Weekly Supp. 266b (Order of Duval County Court Judge Eleni E. Derke dated August 28, 2014); and Silver Consulting Services, Inc. d/b/a Silver Chiropractic a/a/o Marvin Whalen v. United Service Automobile Association, 23 Fla. L. Weekly Supp. 549b (Order of Duval County Court Judge Dawn K. Hudson dated September 24, 2015).
G. The absence of $278.00 in the amount Defendant claims was billed due to non-receipt of one (1) date of service does not render Plaintiff’s presuit demand letter invalid. Defendant is in a better position to adjust a claim, and the burden to adjust a claim is on the insurance company, not the provider. The amount at issue exceeds $278.00 and even if Plaintiff had submitted the bill for date of service November 15, 2011 subsequent to receiving Defendant’s response, and had Defendant paid said bill, Defendant would not have avoided this litigation. The receipt or alleged non-receipt of a medical bill may be a defense to payment of that bill, but is not a factor to be considered as to whether Plaintiff complied with F.S. §627.736(10).
Therefore, it is
ORDERED and ADJUDGED:
1. Plaintiff’s Motion for Final Summary Judgment that Plaintiff’s Presuit Demand Letter Satisfied the Conditions Precedent in F.S. §627.736(10) is GRANTED.
2. Defendant’s Ore Tenus Motion for Summary Judgment is DENIED.
