On May 8, 2012, Palm Beach County Court Judge Sandra Bosso Pardo granted Final Judgment for State Farm in a claim for PIP benefits filed by Lake Worth Emergency Chiropractic Center, P.A.
Judge Bosso Pardo granted Defendant’s Motion for Final Summary Judgment, entering final judgment for the defendant, State Farm, upon finding that the pre-suit demand letter, required by Florida Statute 627.736(10) (2010), was insufficient in that it demanded payment for services that were never billed to State Farm. Judge Bosso-Pardo found that the Plaintiff’s “withdrawing” the unbilled service after suit had commenced was insufficient to cure the defect and that the demand letter requirements under Florida Statute 627.736(10) must be strictly construed and adhered to by those seeking to initiate litigation against a Florida PIP insurer.
The full text of the Court’s ruling is available here.
The Miami-Dade County 11th Circuit (sitting in its appellate capacity) overturned a County Court decision of Judge Ana Maria Pando, now ruling that an insurer was not required to obtain an adjudication of fraud prior to pleading as an affirmative defense fraud, under 627.736(5)(b)(1)(c).
Florida Statute 627.736(5)(b)(1) provides that:
An insurer or insured is not required to pay a claim or charges:
a. Made by a broker or by a person making a claim on behalf of a broker;
b. For any service or treatment that was not lawful at the time rendered;
c. To any person who knowingly submits a false or misleading statement relating to the claim or charges; …
In the PIP suit at issue, the medical provider argued that under Florida Statute 817.234
there are certain criteria set forth for what is considered a false or fraudulent insurance claim and in order to plead fraud the elements of 817.234
must be met. The Miami appellate court disagreed and ruled that even without an adjudication of fraud an insurer is authorized and allowed to plead fraud as an affirmative defense.