Category Archives: Demand Letter

Defective Pre-Suit Demand Letter Leads to Defense Ruling

The double billing of $450 for one date of service with multiple CPT codes ultimately led to the granting of defendant’s Motion for Final Summary Judgment.

Earlier this year the Palm Beach County Court addressed the case of Foundation Chiropractic Clinic, Inc. v. State Farm Mutual, involving PIP benefits.

The undisputed facts involved a motor vehicle accident on November 1, 2010. Foundation Chiropractic Clinic, the plaintiff, sent a May 23, 2011 pre-suit demand letter to defendant State Farm, which was received on May 25, 2011. Plaintiff requested $7,310, with various discounts, for allegedly overdue PIP benefits in accordance with Florida Statute §627.736(10). Medical treatment was rendered between January 3, 2011 and March 9, 2011.

The real trouble began during a deposition of Dr. Charles Mitzelfeld on September 10, 2012. During his testimony, Dr. Mitzelfeld acknowledged that a $450 service rendered on January 6, 2011, was incorrectly double-billed as $900.

Initial Court hearings took place on February 19, 2013, at which time the court ordered an abatement until March 21, 2013 to grant plaintiff time to comply with the Statute.

Key facts emphasized by the Court included but were not limited to the following:

1)    The pre-suit demand letter was defective, since:
a)    Demand letters must strictly adhere to Florida Statute §627.736(10)
b)    PIP claims require medical billing precision
c)    The $450 double-billing means the amount was never due and payable
2)    Dismissal, not abatement, was the appropriate remedy for the facts of the case

Accordingly, the Court granted defendant’s Motion for Final Summary Judgment.

Case Details

The case is Foundation Chiropractic Clinic, Inc. v. State Farm Mutual, Case No. 502011SC006973XXXXMB(RJ), Claim No. 59-A670-488, heard in Palm Beach County Court. John M. Gioannetti was the lead attorney for Roig Lawyers. The case initially began as a small claim. Click on the link to read the Amended Final Judgment for the Defendant.

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Filed under Case Law, Demand Letter, Fla. Stat. 627.736 (2008), Fla. Stat. 627.736 (2012)

Palm Beach County Court: PIP Demand Letter Requirements Must Be Strictly Adhered

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.

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Filed under Case Law, Demand Letter, Fla. Stat. 627.736 (2008)

Senate Passes Amended House Bill 119 on March 9, 2012

On the final day of the 2012 Florida legislative Session, the Florida Senate passed (22-17) a modified PIP/No-Fault law with significant changes from the 2008 version of the statute.

According to Senator Mike Haridopolos, the 2012 legislative session was an effective one.  “[T]he legislature also made sweeping changes to the state’s personal injury protection (PIP) medical benefits under the No-Fault law and laws related to motor vehicle insurance fraud.  Currently, PIP is wrought with fraud and abuse, and this legislation, sponsored by Senator Joe Negron (R-Stuart), reforms PIP from start to finish and will end the cycle of rising auto insurance premiums.”

A copy of the amended No-Fault Statute can be found below:

Florida PIP/No-Fault Law (2012 Amendment)

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Filed under Demand Letter, Examinations Under Oath (EUO), Fla. Stat. 627.736 (2008), Fla. Stat. 627.736 (2012), Independent Medical Examinations (IME), The Statutory "Fee Schedules"