25 Fla. L. Weekly Supp. 970b
Online Reference: FLWSUPP 2511CLEMInsurance — Personal injury protection — Demand letter — Sufficiency — Demand letter did not strictly or substantially comply with requirements of PIP statute where letter stated that $914.40 was owed by insurer while the attached ledger stated that zero was owed by insurer, and where amount claimed to be owed did not account for deductible or application of statutory fee schedule — Insurer’s motion for summary judgment on insufficiency of demand letter is granted
FLORIDA INJURY LONGWOOD, LLC a/a/o Aaron Clements, Plaintiff, v. USAA CASUALTY INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 2016-SC-003717-O. September 28, 2017. Faye L. Allen, Judge.
ORDER GRANTING DEFENDANT’S MOTIONFOR SUMMARY JUDGMENT REGARDING THEINSUFFICIENCY OF PLAINTIFF’S DEMAND LETTER
THIS CAUSE, having come before this Court on the 28th day of March, 2017, upon the Defendant’s Motion for Summary Judgment Regarding the Insufficiency of the Plaintiffs Demand Letter, and the Court having heard argument of counsel, having reviewed the court file and relevant legal authorities, and being otherwise fully advised in the premises, the Court finds as follows:
1. The Plaintiff, Florida Injury Longwood, LLC, submitted a pre-suit demand letter dated September 11, 2013 to the Defendant, USAA Casualty Insurance Company. The pre-suit demand letter attached a billing ledger.
2. The pre-suit demand letter requested payment of $914.40 from the Defendant. However, the attached billing ledger indicated a zero balance being owed by the Defendant and a balance of $879.30 being owed by the patient/claimant.
3. The allowed amount of the Plaintiff bills under the applicable fee schedules is $879.30.
4. The pre-suit notice requirement, also knows as the “demand letter” requirement, of Florida’s PIP statute is found in section 627.736(10), Florida Statutes, and states, in relevant part, as follows:
(10) Demand letter. —
(a) As a condition precedent to filing any action for benefits under this section, written notice of an intent to initiate litigation must be provided to the insurer. Such notice may not be sent until the claim is overdue, including any additional time the insurer has to pay the claim pursuant to paragraph (4)(b).
(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 or policy number upon which such claim was originally submitted to the insurer.
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. 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 claimant 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, Fla. Stat. (2012).
5. 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”. See MRI Assoc. of Am. v. State Farm Fire and Cas. Co., 61 So.3d 462 (Fla. 4th DCA 2011) [36 Fla. L. Weekly D960b]. “The statute mandates that the amount at issue for a bill be specified early in the claims process. This requirement of precision in medical bills discourages gamesmanship on the part of the those who might benefits from confusion and delay. Id.
6. The pre-suit demand letter submitted by the Plaintiff fails to strictly, nor even substantially comply with the requirements of Florida Statute 627.736(10)(b)(3).
7. The pre-suit demand letter submitted by the Plaintiff is confusing and fails to put the Defendant on notice of the amount to be paid to avoid litigation.
8. The demand letter states $914.40 is owed by the insurance company, however, the ledger attached states that zero is owed by the insurance company. Therefore the document attached to the demand letter is inconsistent with the demand letter.
9. Further, the Plaintiff concedes that the amount of $914.40 would never be owed by the insurance company as it does not take into consideration the deductible and/or the allowed amounts under the fee schedule.
10. At the hearing, the Plaintiff argued that $104.21 is owed. This number is neither reflected in the demand letter or the billing ledger attached to the demand letter.
11. The demand letter has no effect if it does not put the Defendant on notice of the amount owed.
12. In this case, the Defendant was not provided the opportunity to resolve the claim without litigation due as the pre-suit demand failing to specify the exact amount at issue and due to the discrepancy between the demand letter and the attached billing ledger.
13. The demand letter fails to strictly, nor substantially comply with the Florida Statute 627.736(10)(b)(3), therefore the Plaintiff has failed to meet a condition precedent to filing suit.
ORDERED AND ADJUDGED that the Defendant’s Motion for Summary Judgment Regarding the Insufficiency of the Plaintiff’s Demand Letter is GRANTED.
