Court Opinion

ID: 9902512
Source: CourtListenerOpinion
Date Created: 2023-11-27 15:18:11.200676+00
Date Added: 2024-06-11T09:22:19.003964
License: Public Domain

FIFTH DISTRICT COURT OF APPEAL
                STATE OF FLORIDA
                 _____________________________

                       Case No. 5D22-603
                 LT Case No. 2020-11958-CODL
                 _____________________________

MERCURY INDEMNITY COMPANY
OF AMERICA,

    Appellant,

    v.

CENTRAL FLORIDA MEDICAL &
CHIROPRACTIC CENTER, INC.
d/b/a STERLING MEDICAL GROUP
a/a/o STHEFANY SANTIAGO,

    Appellee.
                 _____________________________

On appeal from the County Court for Volusia County.
Robert A. Sanders, Jr., Judge.

Diane H. Tutt, of Conroy Simberg, Hollywood, for Appellant.

Douglas H. Stein, of Douglas H. Stein, P.A., Coral Gables, for
Appellee.

                        October 27, 2023

EISNAUGLE, J.

    Mercury Indemnity Company of America (“Mercury”)
appeals a summary final judgment in favor of Central Florida
Medical & Chiropractic Center, Inc. d/b/a Sterling Medical Group
a/a/o Sthefany Santiago (“Sterling”), arguing that Sterling failed
to comply with a condition precedent to suit because its notice of
intent to initiate litigation (the “notice of intent” or “notice”) did
not provide the information required by section 627.736(10),
Florida Statutes (2019).        Specifically, Mercury argues that
Sterling’s notice was deficient because it stated the amount
originally billed for each individual charge rather than “each
exact amount claimed to be due” after adjustments and
subtracting prior payments made by Mercury. We disagree with
Mercury’s reading of the statute and affirm.

                 Facts and Procedural History

     The operative facts are not in dispute. Mercury issued an
automobile insurance policy with Personal Injury Protection
(“PIP”) benefits to Sthefany Santiago (the “insured”). During the
effective dates of coverage, the insured was involved in an
automobile accident, received medical treatment from Sterling,
and assigned her benefits under the insurance policy to Sterling.

     Sterling submitted medical bills to Mercury for treatment
rendered to the insured. When Mercury failed to make payment
in full, Sterling sent Mercury a notice pursuant to section
627.736 alleging that Mercury failed to pay overdue PIP benefits.
The notice listed, among other items, benefits due as “$1,597.91
(minus prior payments made, if any),” and included an itemized
statement of each original charge. Mercury failed to make any
additional payment on the overdue claim, and Sterling filed suit.

      Sterling eventually moved for summary judgment, and
Mercury responded by filing a cross-motion, arguing that Sterling
failed to comply with a condition precedent to suit because the
notice failed to allege “each exact amount claimed to be due.” The
trial court rejected Mercury’s argument and rendered summary
final judgment for Sterling. This appeal follows.

                    Statutory Interpretation

     When interpreting a statute, we “follow the ‘supremacy-of-
text principle’—namely, the principle that ‘[t]he words of a
governing text are of paramount concern, and what they convey,

                                  2
in their context, is what the text means.’” Richman v. Calzaretta,
338 So. 3d 1081, 1082 (Fla. 5th DCA 2022) (alteration in original)
(quoting Ham v. Portfolio Recovery Assocs., LLC, 308 So. 3d 942,
946 (Fla. 2020)). Importantly, we must “arrive at a ‘fair reading’
of the text by ‘determining the application of [the] text to given
facts on the basis of how a reasonable reader, fully competent in
the language, would have understood the text at the time it was
issued.’” USAA Cas. Ins. Co. v. Mikrogiannakis, 342 So. 3d 871,
873 (Fla. 5th DCA 2022) (alteration in original) (quoting Lab’y
Corp. of Am. v. Davis, 339 So. 3d 318, 323–24 (Fla. 2022)).

      Of course, when interpreting any legal text, grammar and
punctuation matter. “The legislature is presumed to know the
meaning of words and the rules of grammar, and the only way
the court is advised of what the legislature intends is by giving
the generally accepted construction, not only to the phraseology
of an act but to the manner in which it is punctuated.” Fla. State
Racing Comm’n v. Bourquardez, 42 So. 2d 87, 88 (Fla. 1949);
accord Antonin Scalia & Bryan A. Garner, Reading Law: The
Interpretation of Legal Texts 141 (2012) (“[D]rafters . . . are
presumed to be grammatical in their compositions.”). That said,
the “presumption of legislative literacy is a rebuttable one,” and
can be “overcome by other textual indications of meaning.”
Scalia & Garner, Reading Law at 141.

The PIP Statute’s Notice of Intent and Itemized Statement

       When interpreting a statute, it is always wise to begin with
the text itself. Section 627.736 provides, in pertinent part:

     (10) Demand letter. —

     (a) As a condition precedent to filing any action for
     benefits under this section, written notice of an intent to
     initiate litigation must be provided to the insurer. Such
     notice may not be sent until the claim is overdue,
     including any additional time the insurer has to pay the
     claim pursuant to paragraph (4)(b).

     (b) The notice must state that it is a “demand letter
     under s. 627.736” and state with specificity:

                                 3
    1. The name of the insured upon which such benefits are
    being sought, including a copy of the assignment giving
    rights to the claimant if the claimant is not the insured.

    2. The claim number or policy number upon which such
    claim was originally submitted to the insurer.

    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. A completed form satisfying the requirements of
    paragraph (5)(d) or the lost-wage statement previously
    submitted may be used as the itemized statement.

§ 627.736, Fla. Stat. (2019) (emphasis added).

      On appeal, Mercury offers two primary reasons why the
itemized statement required by section 627.736(10)(b)3. must
include “each exact amount” remaining due after adjusting the
claim and accounting for previous payments. First, Mercury
reads the statute to require the disclosure of “each exact amount
claimed to be due,” arguing that the clause “claimed to be due”
applies to all three antecedents, and not only the last
antecedent—the “type of benefit.”

      Second, Mercury argues that its interpretation of “each
exact amount” is necessary to accomplish the “purpose” of the
statute, which in Mercury’s view, is to put an insurer on notice of
the actual amount for which it will be sued, relying on our sister
courts’ decisions in Rivera v. State Farm Mutual Automobile
Insurance Co., 317 So. 3d 197, 204 (Fla. 3d DCA 2021) and Chris
Thompson, P.A. v. Geico Indemnity Co., 347 So. 3d 1, 2 (Fla. 4th
DCA 2022).1

    1 Mercury’s initial brief does not clearly or directly argue
that the notice of intent in this case was deficient because it
included too many items in the itemized statement. In other

                                4
      As a preliminary matter, we acknowledge that interpreting
section 627.736(10) is complicated by the fact that the provision
does not directly address the question raised on appeal. In other
words, the text of the statute could call for “each exact amount
overdue” or “each exact amount originally billed for the charge.”
And while this difficulty is evidenced by a split among our sister
courts, we conclude the statute’s plain language does not require
Sterling’s notice of intent to calculate “each exact amount claimed
to be due” by adjusting the claim and accounting for any prior
payments.

       First, we will explain why the doctrine of the last
antecedent, a rule of grammar, refutes Mercury’s argument that
the phrase “claimed to be due” modifies the term “each exact
amount.” Second, we will demonstrate that Mercury’s view of the
statute’s “purpose” is overly broad and not supported by the text
of the statute. Third, and finally, we will analyze the statute as a
whole to discern the plain and ordinary meaning of the phrase
“each exact amount.”

           The Statute’s Grammatical Construction

      We first address Mercury’s argument that the phrase
“claimed to be due” modifies the phrase “each exact amount.”
Based on the doctrine of the last antecedent, we disagree.

    “The doctrine of the last antecedent is a rule of
grammatical construction providing that ‘relative and qualifying

words, as we read it, Mercury makes no “kitchen sink” argument
in its initial brief. To the extent such an argument is raised in
the reply brief, we do not consider it. See Johnson v. State, 135
So. 3d 1002, 1029 n.11 (Fla. 2014) (“An issue may not be raised
for the first time in a reply brief.”); Hoskins v. State, 75 So. 3d
250, 257 (Fla. 2011) (“[T]his argument was not raised in the
initial brief filed here.”).

                                 5
words, phrases and clauses are to be applied to the words or
phrase immediately preceding, and are not to be construed as
extending to, or including, others more remote.’” Principal Life
Ins. Co. v. Halstead as Tr. of Rebecca D. McIntosh Revocable
Living Tr., 310 So. 3d 500, 503 (Fla. 5th DCA 2020) (quoting
Kasischke v. State, 991 So. 2d 803, 811 (Fla. 2008)). While “the
doctrine can ‘be overcome by other indicia of meaning[,]’ . . . use
of the doctrine is ‘quite sensible as a matter of grammar.’” Id.
(quoting Barnhart v. Thomas, 540 U.S. 20, 26 (2003)).

      Also, as we have explained, the doctrine of the last
antecedent has “a well-established corollary rule based on simple
punctuation.” Id. Therefore, “[w]here the modifier is set off from
two or more antecedents by a comma, the supplementary ‘rule of
punctuation’ states that the comma indicates the drafter’s intent
that the modifier relate to more than the last antecedent.”
Bingham, Ltd. v. United States, 724 F.2d 921, 925 n.3 (11th Cir.
1984) (emphasis omitted).

       Here, the modifying phrase “claimed to be due” is not set-
off by a comma. Therefore, the corollary rule does not apply, and
the doctrine itself indicates the modifier applies only to the
phrase immediately preceding it—“type of benefit.” Accord Bain
Complete Wellness, LLC v. Garrison Prop. & Cas. Ins. Co., 356
So. 3d 866, 872 (Fla. 2d DCA 2022) (“[T]he phrase ‘claimed to be
due’ does not modify the phrase ‘each exact amount,’ but rather
the phrase it immediately follows—‘type of benefit.’”).

      Importantly, we find no “other indicia of meaning” in the
statutory language that would overcome application of the
doctrine. Instead, other parts of the statute seem to support the
same conclusion. For instance, if the phrase “claimed to be due”
modifies the phrase “each exact amount,” as advanced by
Mercury, then it must also modify the phrase “date of treatment,
service, or accommodation.”

      However, the sentence would be awkward if we read it to
require a claimant to state the “date of treatment, service, or
accommodation claimed to be due.” As the text seems to
contemplate, by the time the type of itemized statement in this

                                6
case is sent, the “treatment” is already rendered and the “date” is
in the past. § 627.736(10)(b)3. (requiring the notice to state the
“name of any medical provider who rendered . . . treatment”)
(emphasis added).2 Given the context, we fail to see how
previously rendered treatment, or the date thereof, could be
“due.”

      Therefore, the doctrine of the last antecedent instructs that
the phrase “claimed to be due” modifies only the last
antecedent—“type of benefit”—and not the phrase “each exact
amount.”

                     The Statute’s “Purpose”

      Next, we address Mercury’s argument that the purpose of
the notice is not just notice of intent to sue, but also to “notif[y]
the insurer as to the exact amount for which it will be sued if the
insurer does not pay the claim,” quoting Rivera and Chris
Thompson.

      We disagree with Mercury and conclude that both Rivera
and Chris Thompson misinterpret section 627.736(10) based on
an overly broad understanding of the statute’s purpose. While
the fair reading method “requires an ability to comprehend the
purpose of the text, which is vital to its context . . . the purpose is
to be gathered only from the text itself, consistently with the
other aspects of context.” Scalia & Garner, Reading Law at 33.
In other words, a court must identify a statute’s purpose based on
the text alone, and not based on what, in its own estimation,
might “make a lot of sense.” Id. at 39 (“Not only is legal drafting
sometimes imperfect, but often the imperfection is the
consequence of a compromise that it is not the function of the
courts to upset.”).

    2  We recognize that the statute also anticipates a notice
could be sent for “future treatment not yet rendered.” However,
in such a circumstance, the text requires the itemized statement
to state “the type, frequency, and duration of future treatment
claimed to be reasonable and medically necessary.”

                                  7
     Yet Rivera and Chris Thompson expressly do just that.
Indeed, Rivera reasoned:

    If the intent of § 627.736(10) is to reduce the burden on
    the courts by encouraging the quick resolution of PIP
    claims, it makes sense to require the claimant to make a
    precise demand so that the insurer can pay and end the
    dispute before wasting the court’s and the parties’ time
    and resources.

317 So. 3d at 204 (emphasis added) (quoting Venus Health Ctr.
(a/a/o Joally Rojas) v. State Farm Fire & Cas. Co., 21 Fla. L.
Weekly Supp. 496a (Fla. 11th Cir. Ct. Mar. 13, 2014)).3

      When a court interprets statutory text based on what
“makes sense” to the court, rather than what the text demands,
the court creates a new statute. Scalia & Garner, Reading Law
at 39 (“What the purposivist has done is to create a new
ordinance.”). But we have no authority to write a new statute,
regardless of how much sense it might make to us. See Buechel v.
Shim, 340 So. 3d 507, 511 (Fla. 5th DCA 2021) (“Any public
policy considerations raised by [a statute] are for the legislative
branch, not a court.” (citing Art. II, § 3, Fla. Const.)).

      Critically, we find nothing in section 627.736(10)’s text
requiring a notice of intent to put the insurer on notice of the
“exact amount for which it will be sued.” Although not mentioned
in Rivera or Chris Thompson, it is true that the statute’s text
affords an insurer the opportunity to avoid litigation. To that
end, section (10)(d) provides:

    If, within 30 days after receipt of notice by the insurer,
    the overdue claim specified in the notice is paid by the
    insurer together with applicable interest and a penalty
    of 10 percent of the overdue amount paid by the insurer,

    3 Chris Thompson, in turn, relied on both Rivera and Venus

Health Center.

                                8
    subject to a maximum penalty of $250, no action may be
    brought against the insurer.

§ 627.736(10)(d), Fla. Stat. (2019).

      While this language certainly gives the insurer an
opportunity to avoid litigation by paying an overdue “claim,” it
says nothing about a right to be told the “exact amount for which
[an insurer] will be sued.”4 As such, Mercury’s argument
attempts to expand the purpose of the statute beyond its text,
and in essence, seeks to improperly “create a new” statute.
Scalia & Garner, Reading Law at 39; State v. McKenzie, 331 So.
3d 666, 671 (Fla. 2021) (“Context is important as ‘a tool for
understanding the terms of the law, not an excuse for rewriting
them.’” (quoting King v. Burwell, 576 U.S. 473, 500-01 (2015)
(Scalia, J., dissenting))).

       As this case illustrates, statutory interpretation can be a
complicated task. And it is all too easy to misidentify the purpose
of a statute when the search for meaning begins with conclusions
about the policy the legislature might have been trying to
advance rather than simply scrutinizing the text of the statute.
But the error is drawn into even sharper focus in this case
because the text of the statute not only fails to sustain the
purpose announced in Rivera and Chris Thompson, but instead
conclusively forecloses such a broad purpose.

      Specifically, as discussed further below, section 627.736(10)
provides that an insured or assignee may submit a completed
Centers for Medicare and Medicaid Services (CMS) 1500 form “as
the itemized statement.” § 627.736(5)(d), (10)(b)3. But the CMS
1500 form5 does not contemplate the use of adjusted amounts6 or

    4 Rivera also mentions the statute’s express purpose stated

in section 627.731. But again, the text in that section does not
establish that the notice of intent must put an insurer on notice
of “the exact amount for which it will be sued.”
    5 Having afforded the parties a “reasonable opportunity to
present information” as required, we take judicial notice of form

                                  9
subtracting prior payments made by Mercury,7 and therefore
could not, if used as an itemized statement and “properly
completed,” put an insurer on notice of the amount for which it
will be sued. In short, the fact that the legislature chose to
permit a party to utilize such a form as the itemized statement
eviscerates Mercury’s expansive reading of the statute’s purpose.

           The Meaning of “Each Exact Amount”

      While the doctrine of the last antecedent tells us that the
modifying phrase “claimed to be due” does not modify the phrase
“each exact amount,” and we have explained why Mercury’s
reliance on an overly broad statutory “purpose” is without merit,

CMS 1500 (a version of which appears in our record) and its
instructions (which do not appear in our record) pursuant to
section 90.204, Florida Statutes (2023). We conclude that taking
judicial notice is necessary because the form is substantively
incorporated into the statute. See § 627.736(5)(d), (10)(b)3.
Therefore, we cannot read the statute as a whole without
considering the form itself.
    6 The form’s instructions for Item Number 24F—labeled “$

Charges”—require entry of the “total billed amount for each
service line.” CMS 1500 form instrs. at 40 (emphasis added).
Likewise, the instructions for Item Number 28—labeled “Total
Charge”—require “the total billed amount for all services entered
in 24F.” CMS 1500 form instrs. at 50 (emphasis added).
    7 On appeal, Mercury appears to take the position that CMS

1500 requires a claimant to account for “prior payments” because
the form calls for a claimant to enter the “Amount Paid” in Item
Number 29. But a cursory reference to the form’s instructions
reveals that the “Amount Paid” in Item Number 29 “is the
payment received from the patient or other payers.” CMS 1500
form instrs. at 51 (emphasis added). Given the fact that form
CMS 1500 would put Mercury on notice of a claim for payment in
the first instance, and considering the form and instructions in
their entirety, we conclude “other payers” excludes prior
payments from Mercury.

                               10
our work is not yet finished. To resolve this case, we must now
discern the meaning of the phrase “each exact amount.” While
the phrase itself, when considered in isolation, does not clearly
indicate which “exact amount” is required, we can glean the
term’s plain meaning from the text and structure of the statute
when read as a whole. See Kidwell Grp., LLC v. ASI Preferred
Ins. Corp., 351 So. 3d 1176, 1179 (Fla. 5th DCA 2022) (“[S]ound
interpretation requires paying attention to the whole law, not
homing in on isolated words or even isolated sections.” (citation
omitted)).

       To begin this part of our analysis,8 we observe the statute
establishes that an assignee or insured can seek reimbursement
pursuant to a PIP policy by putting the insurer on notice of “a
covered loss and of the amount of same.” § 627.736(4)(b).
Importantly, the statute then describes this initial written notice
of a covered loss as the “claim.” § 627.736(4)(b)1.–2.9

      The statute likewise anticipates that a “claim” can include
any number of individual charges, and if only a portion of a claim
is paid, an insurer must provide a claimant with “an itemized
specification of each item that the insurer had reduced, omitted,
or declined to pay.” § 627.736(4)(b)2. Generally, a claim is
overdue “if not paid within 30 days after the insurer is furnished
written notice.” § 627.736(4)(b), (6)(b).

      With that background in mind, we turn our focus to the
specific subsection at issue in this case. Subsection (10)(a)

    8  While we must consider the entirety of the statute to
determine the meaning of “each exact amount” in this case, we
caution that our discussion of other parts of the statute is solely
to explain our interpretation of subsection (10)’s requirements for
an itemized statement. We do not, and cannot in this case, reach
a holding concerning other parts of the PIP statute.
    9 Consistent with the statute, the instructions for form CMS

1500 also use the term “claim.” CMS 1500 form instrs. at 7
(“Enter in the white, open carrier area the name and address of
the payer to whom this claim is being sent.”).

                                11
requires a claimant to send a notice of intent to initiate litigation
as a condition precedent to filing an “action for benefits,” and
provides that the “notice may not be sent until the claim is
overdue, including any additional time the insurer has to pay the
claim pursuant to paragraph (4)(b).” § 627.736(10)(a) (emphasis
added). Moreover, (10)(b)2. requires the notice to state with
specificity the “claim number or policy number upon which such
claim was originally submitted to the insurer.” § 627.736(10)(b)2.
(emphasis added). The notice must also disclose the name of the
medical provider who rendered “the treatment, services,
accommodations, or supplies that form the basis of such claim.” §
627.736(10)(b)3. (emphasis added).

      Thus, based on the text, the notice of intent is anchored in
the original “claim” sent pursuant to subsection (4)(b), which put
the insurer on notice of the covered loss in the first instance (or in
this case, a number of covered losses). Importantly, we find no
indication in the statute, and Mercury has identified none, that
subsection (4) and subsection (10) use the term “claim” to
describe two substantively different things.

       To the contrary, when the legislature intended to describe
something other than the original “claim,” it knew how to do so.
Specifically, subsection (10)(d) differentiates between an “overdue
claim” and the “overdue amount” for purposes of calculating a
penalty on overdue claims. In that situation, the legislature saw
fit to calculate the penalty based only on the “overdue amount”—
not on the “overdue claim.”

       These statutory breadcrumbs lead us to a fair reading of
the phrase “each exact amount” as used in the statute. To
summarize, if: (1) the “claim” is the initial demand for payment of
benefits, (2) a “claim” can include more than one individual item,
(3) the notice of intent puts an insurer on notice that a “claim” is
overdue, and (4) an “overdue claim” is different than an “overdue
amount,” then the “itemized statement specifying each exact
amount” is a reference to the various individual items included in
the original (and now overdue) “claim.” In other words, the
legislature could have based the notice of intent and itemized
statement on the “overdue amount” if it wanted to do so, but did

                                 12
not. Instead, the notice requirement is grounded on the overdue
“claim.”

       Our interpretation of the phrase “each exact amount” is
bolstered by, and we find this part particularly persuasive, the
statute’s authorization to use a form as the itemized statement—
such as a CMS 1500 form, UB 92 form or any other standard
form approved by the office and adopted by the commission. See
§ 627.736(5)(d), (10)(b)3. The statute indicates that the primary
use of CMS 1500 is to put an insurer on notice of a claim in the
first instance—when a claimant initially bills an insurer. See §
627.736(4) & (5)(d). Moreover, if “properly completed,” the form
itself calls for the billed amount for each charge, and as one
might expect given the form’s primary use in a PIP claim, does
not anticipate adjustment of any given charge based on prior
payments from the insurer, the insurer’s chosen reimbursement
rate, or otherwise.10 In short, the permissible use of a form, such
as CMS 1500, as the itemized statement supports our
interpretation of the statute, and is in tension with the meaning
Mercury advances.11 But see Mercury Indem. Co. of Am. v. Pan
Am Diagnostic of Orlando, 368 So. 3d 27, 31 (Fla. 3d DCA 2023)
(“Our decision in Rivera, . . . is therefore distinguishable because

    10  In fact, the form’s instructions indicate that previous
versions of the form required a claimant to identify the “Balance
Due” at Item Number 30, but on the current form, “this field has
been eliminated.” CMS 1500 form instrs. at 51.
    11 Sterling argues that, due to an information gap, it could

not know certain information necessary to adjust the claim (for
example, the reimbursement methodology chosen by the insurer)
at the time the notice of intent is sent. While we cannot foreclose
the possibility that, in some cases, there could remain a
meaningful information gap at the time of the notice, at least in
this case, the Explanation of Benefits appears to disclose the
reimbursement methodology and the amount of the reduction for
the items at issue. As such, our record does not appear to
demonstrate any information gap. Nevertheless, this is of no
consequence because, as we have explained, the statute’s text
does not require Sterling to adjust the claim.

                                13
the insured in that case did not endeavor to comply with the
statute through the alternative of attaching the completed CMS-
1500 form.”).12

                          Conclusion

      Therefore, reading the entire statute as a whole, we
conclude that the plain and ordinary meaning of section
627.736(10) requires an itemized statement to list “each exact
amount” as billed in the claim and not “each exact amount
claimed to be due,” or “each overdue amount,” after adjusting the
claim and subtracting any prior payments made by Mercury.13

    We certify conflict with Rivera and Chris Thompson.

    AFFIRMED; CONFLICT CERTIFIED.

KILBANE and MACIVER, JJ., concur.

    12  We recognize that the panel in Pan Am Diagnostic
distinguished Rivera based on use of the form by the claimant in
that case. However, we do not read subsection (10) as creating
two substantively different types of itemized statements.
Instead, the plain language of the statute says the “completed
form satisfying the requirements of paragraph (5)(d) . . . may be
used as the itemized statement.” § 627.736(10)(b)3. (emphasis
added).
    13  We have not overlooked that the statute permits a
claimant to submit “[a] completed form . . . or the lost-wage
statement previously submitted” as the itemized statement. §
627.736(10)(b)3. (emphasis added). If the phrase “previously
submitted” modifies the phrase “completed form,” then this is
further evidence to support our interpretation of the statute. But
given the other indicia of meaning to support our interpretation
of the term “each exact amount,” including that the statute
requires the form to be properly completed (i.e. pursuant to the
instructions) without regard to when the form is completed, we do
not languish over this additional point.

                               14
          _____________________________

Not final until disposition of any timely and
authorized motion under Fla. R. App. P. 9.330 or
9.331.
           _____________________________

                       15