27 Fla. L. Weekly Supp. 62a
Online Reference: FLWSUPP 2701FOREInsurance — Personal injury protection — Demand letter — Sufficiency — PIP statute does not require that demand letter state exact amount owed by insurer
NORTH FLORIDA CHIROPRACTIC & REHABILITATION CENTER, as assignee of Ladeirdre Forehand, Plaintiff, v. GEICO GENERAL INSURANCE COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Duval County, Small Claims. Case No. 16-2018-SC-004911, Division CC-A. February 19, 2019. Emmet F. Ferguson, III, Judge. Counsel: Ashley-Britt Hansen, for Plaintiff. Mark Kupcinskas, Jr., for Defendant.
ORDER GRANTING PLAINTIFF’S MOTION FORSUMMARY JUDGEMENT THAT PLAINTIFF’SPRESUIT DEMAND LETTER SATISFIEDTHE CONDITIONS PRECEDENT IN F.S. §627.736(10)
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). Both parties were represented by counsel. The Court, having heard arguments of the parties, ORDERED and ADJUDGED that:
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. The issue presented 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).
3. 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).
4. On February 21, 2018 Plaintiff submitted a presuit demand letter to Defendant, demanding full payment for treatment rendered to its patient, Ladeirdre Forehand, from January 28, 2013 through May 24, 2013. Plaintiff’s presuit demand letter stated that the total amount billed was $8,780.00 and that Plaintiff received payment of $6,526.31, leaving a balance of $2,253.69 owed.
5. 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. Forehand, assigning payment of her No-Fault benefits to Plaintiff.
6. Defendant responded to Plaintiff’s presuit demand letter and made partial payment to Plaintiff for No-Fault benefits, including interest, penalty and postage.
7. Defendant argued that if Plaintiff’s each exact amount claimed to be due is not accurate down to the penny, then Plaintiff’s presuit demand letter is non-compliant because the amount demanded by Plaintiff was not “exact” and Plaintiff’s suit must be dismissed due to not meeting the conditions precedent to suit. 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”.
8. 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 Coastal Care Medical Center, Inc. a/a/o Sharon Wilson v. State Farm Mut. Auto. Ins. Co., 25 Fla. L. Weekly Supp. 808a (Duval Cty. Ct., Judge Shore, Nov. 2, 2017); McGowan Spinal Rehab Center a/a/o Jaynell Cameron v. State Farm Mut. Auto. Ins. Co., 22 Fla. L. Weekly Supp. 708a (Duval Cty. Ct., Judge Shore, Dec. 17, 2014); Neurology Partners, P.A. a/a/o Sherry Roy v. State Farm Mut. Auto. Ins. Co., (Duval Cty. Ct., Judge Flower, June 4, 2014) [21 Fla. L. Weekly Supp. 927a]; 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 (Duval Cty. Ct., Judge Mitchell, Aug. 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 (Duval Cty. Ct., Judge Derke, Aug. 28, 2014); 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 (Duval Cty. Ct., Judge Hudson, Sep. 24, 2015); and Coastal Care Medical Center, Inc. a/a/o Michael Palkowski v. State Farm Mut. Auto. Ins. Co., 24 Fla. L. Weekly Supp. 824a (Duval Cty. Ct., Judge Hudson, Dec. 22, 2016)
9. 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 question of presuit demand validity is “substantial compliance” and not “strict compliance”. There is no reason to construe F.S. §627.736(10) in a manner that results in an unreasonable denial of access to courts due to presuit requirements. Plaintiff medical providers cannot meet the “claimed to be due” standard argued by Defendant.
10. Plaintiff provided Defendant with adequate information in order for Defendant to adjust the claim after review of Plaintiff’s presuit demand letter in compliance with F.S. §627.736(10).
