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Filing # 80790107 E-Filed 11/14/2018 02:25:38 PM
IN THE CIRCUIT COURT,SEVENTH
JUDICIAL CIRCUIT,IN AND FOR
VOLUSIA COUNTY,FLORIDA
CASE NO.: 2018 31276 CICI
ERNESTINE HARDY,
Plaintiff,
V.
GEICO GENERAL INSURANCE
COMPANY,
Defendant,
NOTICE OF FILING
PLEASE take notice that the following attached documents in the above-styled cause have
been filed with the Clerk ofthis Honorable Court:
1. Settlement Statement.
I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished
via regular mail and electronic email service on this 14th day of November, 2018, to Earnestine
Hardy, 1352 Virginia Ave., Apt 24, Daytona Beach, FL 32114; Optum, Attn: Melissa Calderon,
11000 Optum Circle, MN102-0300, Eden Prairie, MN 55344; Coastal Neurology, 725 W.
Granada Blvd., Suite 22, Ormond Beach,FL 32174; and Michael J. Stewart, Esquire, Law Office
of Deborah N. Hartwell, 1000 Legion Place, Suite 850, Orlando, FL 32801,
orlandogeicogeico.corn, mistewart(&,geico.corn.
Jonathan I. Rotstein, Esquife
Law Office of Rotstein & Shiffman, LLP
309 Oakridge Blvd., Suite B
Daytona Beach,FL 32118
Florida Bar No. 909580
(386)252-5560 /(386) 238-6999 fax (sec)
Primary: s.carter@rotstein-shiffinan.com
Secondary: 1.bonner@rotstein-shiffman.com
t.dallarosa@rotstein-shiffman.corn
Attorney for Plaintiff
SETTLEMENT STATEMENT
RE: EARNESTINE HARDY V. GEICO
D/A: 2-21-17 Our File No.: 17-4136 AUTO
I. Gross Settlement $ 10,000.00
(Settled 2018)
II. Attorney's Fee :
(40%) $ 4,000.00
III. Case Expenses, LLP:
Filing Fee 415.00
Acceptance Fee 15.00
Medical Records 36.50
Administration Fee 100.00
Postage 15.00
Copies 35.00
Total Case Expenses, LLP : $ 616.50
IV. Outstanding Medicals to be Paid:
Coastal Neurology (LOP) 0.00
725 W. Granada Blvd., Suite 22
Ormond Beach, FL 32174
(full and final payment for a balance of $2,075.82)
Optum (LIEN) 494.39
75 Remittance Drive, Suite 6019
Chicago, IL 60675
(full and final payment for a balance of $823.99)
Optum (LIEN) 1,664.99
75 Remittance Drive, Suite 6019
Chicago, IL 60675
(full and final payment for a balance of $2,774.99)
Total Medicals to be Paid $ 2,159.38
Outstanding Medicals NOT to be Paid:
East Central Florida Outpatient 3,857.00
Total Medicals NOT to be Paid : $ 3,857.00
(client responsible for payment)
V. Net Client Recovery $ 3,224.12
The undersigned agrees to indemnify and hold harmless the law firm
of ROTSTEIN & SHIFFMAN, LLP from any further liability vis-a-vis
the above cause and specifically agrees to assume all liability
for all outstanding medical bills and other expenses arising out
of the above occurrence. The undersigned relieves the law firm of
ROTSTEIN & SHIFFMAN, LLP from all further liability and
responsibility in the above matter and is FULLY SATISFIED with the
services of ROTSTEIN & SHIFFMAN, LLP in the above styled cause.
PLEASE NOTE: No medical bills are being paid out of the settlement
proceeds except those itemized above. Any other medical bills
will be the responsibility of the client and the client's
insurance company.
EVERY EFFORT HAS BEEN MADE TO ACCURATELY SET FORTH THE BALANCES
DUE TO HEALTH CARE PROVIDERS AT THIS TIME. CERTAIN BILLS WILL BE
PAID IN WHOLE OR IN PART BY INSURANCE. IF YOU HAVE INSURANCE
BENEFITS DUE, THE PORTION OF YOUR PROCEEDS WHICH WE ARE HOLDING
WILL BE PAID TO YOU IF AND WHEN YOUR INSURANCE COMPANY PAYS THE
HEALTH CARE PROVIDERS. OTHER BILLS WILL NOT BE PAID UNLESS CLIENT
MAKES PAYMENT. PLEASE REMEMBER THAT THE ATTORNEYS PAY NO BILLS
THEMSELVES AND PROVIDE FOR PAYMENT OF NO BILLS OTHER THAN THOSE
SET FORTH ABOVE. SOMETIMES MISUNDERSTANDINGS OCCUR, SO PLEASE ASK
AND WE WILL BE GLAD TO EXPLAIN THIS TO YOU.
FURTHER, LIENS MAY OCCUR AT A LATER TIME. WE HAVE NO CONTROL OVER
WHETHER OR NOT CERTAIN COMPANIES ASSERT LIENS AT A LATER TIME. IF
YOU ARE AWARE OF LIENS, PLEASE LET US KNOW IF YOUR WISH IS TO
RESOLVE THESE LIENS OR DO NOTHING.
FURTHERMORE, THE CLIENT INDICATES THAT TO THE BEST OF HIS/HER
KNOWLEDGE, THERE ARE NO OUTSTANDING LETTERS OF PROTECTIONS (LOP)
RELATING TO THIS CASE. IF A LETTER OF PROTECTION SHOULD ARISE AT
A LATER DATE, RELATING TO THE PROCEEDS FROM THIS CASE, THE CLIENT
WILL HAVE FULL RESPONSIBILTY TO SATISFY THE LETTER OF PROTECTION.
i/
Approved And Accepted /On this / November, 2018.
/I 1
\
Jonathan I.'aotstein, Eq. for
The Law Office of Rotstein & Shiffman, LLP
DATE
nestine Hardy
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Filing # 80790107 E-Filed 11/14/2018 02:25:38 PM IN THE CIRCUIT COURT,SEVENTH JUDICIAL CIRCUIT,IN AND FOR VOLUSIA COUNTY,FLORIDA CASE NO.: 2018 31276 CICI ERNESTINE HARDY, Plaintiff, V. GEICO GENERAL INSURANCE COMPANY, Defendant, NOTICE OF FILING PLEASE take notice that the following attached documents in the above-styled cause have been filed with the Clerk ofthis Honorable Court: 1. Settlement Statement. I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished via regular mail and electronic email service on this 14th day of November, 2018, to Earnestine Hardy, 1352 Virginia Ave., Apt 24, Daytona Beach, FL 32114; Optum, Attn: Melissa Calderon, 11000 Optum Circle, MN102-0300, Eden Prairie, MN 55344; Coastal Neurology, 725 W. Granada Blvd., Suite 22, Ormond Beach,FL 32174; and Michael J. Stewart, Esquire, Law Office of Deborah N. Hartwell, 1000 Legion Place, Suite 850, Orlando, FL 32801, orlandogeicogeico.corn, mistewart(&,geico.corn. Jonathan I. Rotstein, Esquife Law Office of Rotstein & Shiffman, LLP 309 Oakridge Blvd., Suite B Daytona Beach,FL 32118 Florida Bar No. 909580 (386)252-5560 /(386) 238-6999 fax (sec) Primary: s.carter@rotstein-shiffinan.com Secondary: 1.bonner@rotstein-shiffman.com t.dallarosa@rotstein-shiffman.corn Attorney for Plaintiff SETTLEMENT STATEMENT RE: EARNESTINE HARDY V. GEICO D/A: 2-21-17 Our File No.: 17-4136 AUTO I. Gross Settlement $ 10,000.00 (Settled 2018) II. Attorney's Fee : (40%) $ 4,000.00 III. Case Expenses, LLP: Filing Fee 415.00 Acceptance Fee 15.00 Medical Records 36.50 Administration Fee 100.00 Postage 15.00 Copies 35.00 Total Case Expenses, LLP : $ 616.50 IV. Outstanding Medicals to be Paid: Coastal Neurology (LOP) 0.00 725 W. Granada Blvd., Suite 22 Ormond Beach, FL 32174 (full and final payment for a balance of $2,075.82) Optum (LIEN) 494.39 75 Remittance Drive, Suite 6019 Chicago, IL 60675 (full and final payment for a balance of $823.99) Optum (LIEN) 1,664.99 75 Remittance Drive, Suite 6019 Chicago, IL 60675 (full and final payment for a balance of $2,774.99) Total Medicals to be Paid $ 2,159.38 Outstanding Medicals NOT to be Paid: East Central Florida Outpatient 3,857.00 Total Medicals NOT to be Paid : $ 3,857.00 (client responsible for payment) V. Net Client Recovery $ 3,224.12 The undersigned agrees to indemnify and hold harmless the law firm of ROTSTEIN & SHIFFMAN, LLP from any further liability vis-a-vis the above cause and specifically agrees to assume all liability for all outstanding medical bills and other expenses arising out of the above occurrence. The undersigned relieves the law firm of ROTSTEIN & SHIFFMAN, LLP from all further liability and responsibility in the above matter and is FULLY SATISFIED with the services of ROTSTEIN & SHIFFMAN, LLP in the above styled cause. PLEASE NOTE: No medical bills are being paid out of the settlement proceeds except those itemized above. Any other medical bills will be the responsibility of the client and the client's insurance company. EVERY EFFORT HAS BEEN MADE TO ACCURATELY SET FORTH THE BALANCES DUE TO HEALTH CARE PROVIDERS AT THIS TIME. CERTAIN BILLS WILL BE PAID IN WHOLE OR IN PART BY INSURANCE. IF YOU HAVE INSURANCE BENEFITS DUE, THE PORTION OF YOUR PROCEEDS WHICH WE ARE HOLDING WILL BE PAID TO YOU IF AND WHEN YOUR INSURANCE COMPANY PAYS THE HEALTH CARE PROVIDERS. OTHER BILLS WILL NOT BE PAID UNLESS CLIENT MAKES PAYMENT. PLEASE REMEMBER THAT THE ATTORNEYS PAY NO BILLS THEMSELVES AND PROVIDE FOR PAYMENT OF NO BILLS OTHER THAN THOSE SET FORTH ABOVE. SOMETIMES MISUNDERSTANDINGS OCCUR, SO PLEASE ASK AND WE WILL BE GLAD TO EXPLAIN THIS TO YOU. FURTHER, LIENS MAY OCCUR AT A LATER TIME. WE HAVE NO CONTROL OVER WHETHER OR NOT CERTAIN COMPANIES ASSERT LIENS AT A LATER TIME. IF YOU ARE AWARE OF LIENS, PLEASE LET US KNOW IF YOUR WISH IS TO RESOLVE THESE LIENS OR DO NOTHING. FURTHERMORE, THE CLIENT INDICATES THAT TO THE BEST OF HIS/HER KNOWLEDGE, THERE ARE NO OUTSTANDING LETTERS OF PROTECTIONS (LOP) RELATING TO THIS CASE. IF A LETTER OF PROTECTION SHOULD ARISE AT A LATER DATE, RELATING TO THE PROCEEDS FROM THIS CASE, THE CLIENT WILL HAVE FULL RESPONSIBILTY TO SATISFY THE LETTER OF PROTECTION. i/ Approved And Accepted /On this / November, 2018. /I 1 \ Jonathan I.'aotstein, Eq. for The Law Office of Rotstein & Shiffman, LLP DATE nestine Hardy