25 Fla. L. Weekly Supp. 49a
Online Reference: FLWSUPP 2501KRUIInsurance — Personal injury protection — Demand letter — Medical provider was not required to submit demand letter as condition precedent to filing amended complaint to include charges for dates of service not mentioned in original complaint — No merit to argument that demand letter is required where amendment alleges additional charges that were denied by insurer for reasons other than those given for denying charges that were subject of original complaint
MARK PIERCE CHIROPRACTIC CLINIC, P.A., as assignee of Karen Ruiz, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Duval County, Small Claims Court. Case No. 16-2013-SC-000715, Division CC-C. February 7, 2017. Brent D. Shore, Judge. Counsel: Ellis W. Peetluk, Law Office of D. Scott Craig, LLC, Jacksonville, for Plaintiff. James C. Rinaman, III, Dutton Law Group, Jacksonville, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTION FORFINAL SUMMARY JUDGMENT THAT PLAINTIFF’SPRESUIT DEMAND LETTER SATISFIED THECONDITIONS PRECEDENT IN F.S. 627.736(10) ANDDENYING DEFENDANT’S MOTION FOR PARTIALSUMMARY JUDGMENT
This cause came to be heard on January 18, 2017 as to 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 Motion for Partial Summary Judgment related to the same issue. Both parties were represented by counsel. The Court, having heard arguments of the parties, grants Plaintiff’s Motion for Final Summary Judgment that Plaintiff’s Presuit Demand Letter Satisfied the Conditions Precedent in F.S. §627.736(10) and denies Defendant’s Motion for Partial Summary Judgment.
1. Plaintiff’s initial Complaint was filed on February 1, 2013. Plaintiff’s Complaint sought full payment for dates of service November 30, 2011 through April 20, 2012, for medical services rendered by Plaintiff to its patient, Karen Ruiz. Defendant does not contest that, as to the initial Complaint, Plaintiff met the statutory requirements of F.S. §627.736(10), by submitting a “demand letter” compliant with that statute, prior to filing the action.
2. Plaintiff and Defendant agreed to the filing of Plaintiff’s Amended Complaint and this Court signed an Agreed Order submitted by the parties on August 9, 2016. Plaintiff’s Amended Complaint now seeks full payment for all dates of service from April 8, 2011 through April 20, 2012. Defendant argues that, as to dates of service April 8, 2011 through November 21, 2011, Plaintiff has not met the statutory requirements of F.S. §627.736(10), and that Defendant is therefore entitled to a summary judgment in Defendant’s favor, based on Plaintiff’s failure to submit a “demand letter” seeking payment of those dates of service only.
3. This Court has previously ruled, in Janice Newcomb v. State Farm Mutual Automobile Insurance Company, 21 Fla. L. Weekly Supp. 676B (Duval County, Division C, March 11, 2014) that “Based on F.S. §627.736(10)(a), Plaintiff is not required to submit a demand letter to Defendant as a condition precedent to filing an Amended Complaint. An amendment to a Complaint does not constitute a separate action for benefits. Once an action for No-Fault Benefits is filed and conditions precedent met, it is unnecessary to send additional demand letters and, possibly, file separate lawsuits, when Plaintiff is simply amending the amount of damages in the Complaint.”
4. This Court affirms its previous ruling, as Defendant has provided no argument to cause this Court to reconsider. The Legislature did not provide for any provision or language in F.S. §627.736(10) requiring a subsequent demand letter be submitted prior to amending existing actions.
5. Defendant, however, urges this Court to rule that Plaintiff must submit a subsequent demand letter, if the dates of service which are the subject of Plaintiff’s Amended Complaint were denied by Defendant based on some different reason than the bills denied by Defendant which were the subject of Plaintiff’s initial Complaint. This Court finds no such language in F.S. §627.736(10) justifying any such distinction.
6. If Defendant’s position is the law, then in determining whether a suit may be amended only to seek additional bills without the submission of a subsequent demand letter, courts would be required to parse whether the bills which are the subject of the Amended Complaint were denied for a different reason, or denied for similar reasons to the dates already sought in the initial suit. This is unnecessary, as the statutory language provides support for no such procedure. Once an action seeking No-Fault benefits is filed, then it may be amended, pursuant to the dictates of Florida Rules of Civil Procedure 1.190, just like any other civil action.
7. Defendant should not be heard to argue that Defendant is somehow prejudiced due to Plaintiff’s failure to submit the subsequent demand letter, prior to filing the Amended Complaint. Plaintiff’s Motion to Amend was filed more than a year ago, and if Defendant had chosen to pay the bills prior to Plaintiff’s filing suit seeking them, Defendant certainly had sufficient opportunity to do so. That Defendant chose to stipulate to the filing of Plaintiff’s Amended Complaint also forecloses any argument of prejudice by Defendant, and no such prejudice exists.
8. The dispute and lawsuit is concerning a single issue — did Defendant pay Karen Ruiz’ No-Fault benefits claim in full, pursuant to the law and policy? F.S. §627.736(15) encourages litigants to try to litigate all No-Fault benefits issues in one action. Whether State Farm refused to pay this bill in full because of a chiropractic IME; refused to pay this bill in full because it claims the billed amount was unreasonable; refused to pay this other bill in full because it claims it was not billed timely; or refused to pay another bill in full because of a medical doctor IME — these are all one dispute — the insurer’s refusal to pay No-Fault Benefits in full, as billed by the medical provider. In order to prevail in this suit, as to both the bills which were the subject of the initial Complaint and those which were amended — the primary issues that Plaintiff must prove to prevail are that the billed charges were usual, customary and reasonable; and that the medical treatment was reasonable and necessary and for injuries related to the covered accident.
9. Defendant cites to the ruling of Judge Roberto Arias in Neurology Associates, P.A., a/a/o Michael Cua v. State Farm Mutual Automobile Insurance Company, (Duval County, Case 16-2013-SC-001562) as support for its argument that Plaintiff’s Amended Complaint must be dismissed in part, as to the amended dates of service. Judge Arias found that because the bills Neurology Associates sought in its Amended Complaint were denied for a different reason than the bills already in suit, the provider was required to submit a subsequent demand letter. That ruling is currently the subject of a pending appeal by Neurology Associates, and is not binding authority, and this Court is not persuaded by the ruling (4th Judicial Circuit Appellate Case Number 16-2016-AP000087).
10. Neither party disputes that, prior to the filing of the initial action, Plaintiff must submit a demand letter compliant with F.S. §627.736(10). Nor do the parties dispute that as to the initial action, Plaintiff has met that standard. F.S. §627.736(10) does not apply to amending existing No-Fault actions. Whether or not the bills which are the subject of Plaintiff’s Amended Complaint were denied for a different reason than those in the initial action is of no legal significance, as there is no language in F.S. §627.736(10) addressing the issue of Amended Complaints, nor of different defenses. Therefore, it is
ORDERED and ADJUDGED:
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 and Defendant’s Motion for Partial Summary Judgment is DENIED.
