25 Fla. L. Weekly Supp. 178b
Online Reference: FLWSUPP 2502WOOLInsurance — Personal injury protection — Demand letter was sufficient to comply with statute — Demand letter was not required to account for policy deductible
FLORIDA HOSPITAL MEDICAL CENTER, as assignee of Terra Wooley, Plaintiff, vs. PROGRESSIVE AMERICAN INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 2014-SC-009250-O. September 19, 2016. Tina L. Caraballo, Judge. Counsel: William S. England, Bradford Cederberg, P.A., Orlando, for Plaintiff. Henry R. Ramos, Orlando, for Defendant.
ORDER ON DEFENDANT’S MOTION FORSUMMARY FINAL JUDGMENT REGARDINGPLAINTIFF’S INVALID PRESUIT DEMAND LETTER
THIS MATTER having come before this Court on Defendant’s Motion for Summary Final Judgment on July 27, 2016, the Court having reviewed the evidence, heard the arguments of counsel, and being otherwise fully advised in the premises, finds as follows:
1. Plaintiff filed a personal injury protection (“PIP”) suit against Defendant for reduced and/or unpaid medical bills for treatment rendered to Terra Wooley on dates service January 28, 2010, as a result of injuries she sustained in an automobile accident which occurred on January 28, 2010.
2. Plaintiff sent a demand letter to Defendant on or about June 9, 2014, pursuant to Florida Statute §627.736(10). A copy of the bill for date of service January 28, 2010, and a document entitled “Consent to Treatment and Admission Agreement” were attached to the demand letter.
3. Pursuant to §627.736(10), Florida Statutes (2010), a Pre Suit Demand letter is a statutory condition precedent to filing any action for benefits under the PIP statute and must state with specificity “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).
4. Plaintiff’s demand letter specified the exact amount claimed as $1,152.60 under a basic PIP policy with 80% coverage. This amount did not account for the $1,000.00 deductible on the subject policy issued to Terra Wooley. At the time the demand letter is sent, the medical provider may not know what the deductible is or even if the policy has a deductible and the Court finds that identifying a deductible amount is not required by the statute.
5. The opinion of the 9th Judicial Circuit acting in its appellate capacity affirming the trial court’s summary judgment in favor of the insurer where the medical provider’s demand letter failed to account for payments previously made by the insurer is distinguishable. Med. Therapies, LLC a/a/o Sonia M. Ricks v. State Farm Mut. Auto. Ins. Co., 22 Fla. L. Weekly Supp. 34a (Fla. 9th Cir. Ct. Jul. 1, 2014). This Court has previously relied upon the appellate decision in granting summary judgment in favor of the insurer where the medical provider’s demand letter failed to deduct amounts that were paid. However, the medical provider in the instant case did not request payment for amounts that were previously paid and the decision is not applicable.
6. The demand letter in the instant case provide an accurate accounting of the amount claimed to be due and complied with the statue. It identified the policy holder, claim number, date of loss, provider, dates of service at issue, amount billed and amount billed and amount paid.
Accordingly, it is hereby
ORDERED and ADJUDGED that Defendant’s Motion for Summary Final Judgment Regarding Plaintiff’s Invalid Presuit Demand Letter is DENIED
