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3rd DCA Rules upon specificity requirements in No-Fault Pre-suit demand letters

Submitted by William Foman on 05 Mar, 2021

The suit in this Miami-Dade County case involved and action for No-Fault benefits. Specifically, the Claimant/Plaintiff sought payment of transportation cost to and from medical appointments. Prior to filing suit, the Plaintiff issued a letter to the insurance carrier seeking reimbursement of mileage for 16 trips to and from a chiropractic clinic. The letter lacked specifics as to exact treatment dates, the address for the clinic at issue, and the total dollar amount sought per trip. The carrier then responded with a request that the Claimant provided specific information regarding the dates of the trip, and the specific mileage. Claimant sent a second letter which gave specific dates for 12 dates of service (as opposed to the original 16 dates) and further advised that the trips averaged 6 miles. Counsel for the Plaintiff Plaintiff’s counsel then issue a purported “Demand Letter under FS 627.736(10)” to the insurance carrier. Same attached a copy of the first letter, and requested reimbursement for twelve dates of travel, but provided no further information. The carrier responded by sending a letter that asserted that the demand did not satisfy the specificity requirements of Florida Statute 627.736(10), but also made payment for the benefits they felt were due. Plaintiff’s counsel did not agree to the amounts paid and filed suit. The carrier filed an answer which asserts as an affirmative defense that Plaintiff’s Pre-suit demand failed to comply with the specificity requirements of section 627.736(10). Defendant filed for summary judgment arguing lack of specificity defense and Plaintiff argued that the demand properly placed the carrier on notice of the claim. The trial court ruled in favor of the defendant insurance carrier finding that the pre-suit demand failed to comply with section 627.736 because it failed to state with specificity or included an itemized statement specifying each exact amount, date of treatment, services or accommodation, and the type of benefits claimed to be due”. Plaintiff appealed the trial Court ruling, arguing that the Court committed reversible error by too narrowly construing the statute in favor of the carrier, thus precluding the Plaintiff’s claim.

The 3rd DCA reviewed the trial Court case in order to decide whether the demand letter met the specificity requirements of section 627.736(10). The Court reviewed the plain language of the statue to determine the legislative intent behind the 627.736(10) specificity requirements. The Court found that the purpose of the demand letter was not just notice of intent to sue. The demand letter’s purpose was to notify the insurer as to the exact amount for which it will be sued if the insurer does not pay the claim. The Appellate Court specifically addressed the “substantial compliance” argument by ruling that it was clear from the legislative interest that strict specificity must be adhered to regarding the demand letter requirement. The Court ruled that in order for a pre-suit demand letter to comply with section 627.736(10), it must provide the exact information listed in the statute. (David Rivera v. State Farm Mutual Automobile Insurance Company, 3rd DCA, 46 Fla L. Weekly D447a)