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Filing # 163387629 E-Filed 12/20/2022 12:34:53 PM
ORTHOPEDIC CENTER OF FLORIDA, IN THE COUNTY COURT IN AND
INC FOR ST. LUCIE COUNTY, FLORIDA
a/a/o Alice Worthington
CASE NO.:
Plaintiff,
vs.
ALLSTATE FIRE AND CASUALTY
INSURANCE COMPANY
Defendant
COMPLAINT
COMES NOW, Plaintiff, ORTHOPEDIC CENTER OF FLORIDA, INC
a/a/o Alice Worthington (hereinafter “Plaintiff’) sues the Defendant, ALLSTATE
FIRE AND CASUALTY INSURANCE COMPANY (hereinafter “Defendant”),
and in support thereof alleges the following:
GENERAL ALLEGATIONS
1. This is an action for Breach of Contract, which does exceed One Dollar
($1.00), but does not exceed Ninety Nine Dollars and ninety nine cents ($99.99),
exclusive of interest, attorney’s fees and costs.
2. Defendant was and remains a corporation organized and existing
under the laws of the State of Florida and is otherwise sui juris.
3. Defendant was and is a corporation authorized to do business,
maintains an office and agents in ST. LUCIE COUNTY and regularly sells
automobile insurance policies to the general public in ST. LUCIE COUNTY. The
Defendant and/or its affiliates and/or its subsidiaries which issued the policy of
insurance have substantial identities of interest.
4. At all times material hereto, Plaintiff was a corporation duly licensed
to perform medical services in the State of Florida.
5. On or about September 09, 2020, Alice Worthington (hereinafter
“Claimant’”’) was involved in a motor vehicle accident.6. As a result of that motor vehicle accident, Plaintiff provided Claimant
with medical services and/or treatment.
7. As a direct and proximate result of the injuries sustained by Claimant
in the accident, Claimant incurred reasonable expenses for necessary medical and
rehabilitative care by the Plaintiff for an Emergency Medical Condition as
evidenced by the Claimant’s entire medical record. To date, Defendant refuses to
pay the full amount due.
8. Defendant issued a policy of insurance to Alice Worthington which
provided personal injury protection benefits coverage required by law to comply
with Florida Statutes Sections 627.730 thru 627.7405. Plaintiff does not have a
copy of the policy to attach; however, Plaintiff believes that the Defendant has a
copy of said policy. Upon receipt of a certified copy of the insurance policy, same
is hereby attached and incorporated herein by reference.
9. The above described policy was in full force and effect on the date of
the accident and provided PIP coverage for Alice Worthington for bodily injuries
sustained in said accident.
10. Plaintiff and Claimant have performed the statutorily required
conditions precedent to entitle Plaintiff to recover benefits for said necessary
medical, rehabilitative and remedial treatment regarding the above-described
policy and statutory conditions precedent to instituting this action.
11. Claimant equitably assigned to Plaintiff and/or also executed a written
assignment of benefits, assigning to Plaintiff certain benefits payable pursuant to
the policy of insurance issued by Defendant.
12 Pursuant to said Assignment, Plaintiff gave notice of the covered
losses and Plaintiff made demand for PIP benefits for reasonable, necessary and
related medical treatment.
13. Defendant has denied coverage for, withheld or reduced the medical
bill(s) that were submitted by Plaintiff for date(s) of service October 21, 2020
through November 06, 2020 and/or misapplied the application of the deductible.
Furthermore, Defendant was precluded from applying a deductible at all because
the nonexistence of a properly executed deductible election form. A copy of the
HCFA bills and/or patient ledger and/or explanation of benefits/review are
attached hereto and incorporated by reference. Due to the failure of Defendant to
pay these PIP benefits in accordance with the law, Plaintiff has been required to
retain the undersigned law firm to act on their behalf in this suit. Plaintiff has
[8197-00272/41217682/1]agreed to pay, and the attorneys for Plaintiff have agreed to accept, any court
awarded fee.
BREACH OF CONTRACT FOR FAILURE TO PAY AMOUNTS OWED.
14. Plaintiff reavers and realleges paragraphs 1 through 13 of this
complaint.
15. Despite prior demand by Plaintiff, Defendant has refused and
continues to refuse to issue payment of all sums due Plaintiff, in violation of
Section 627.736, Florida Statutes, and in breach of its contact with claimant.
16. Plaintiff has retained the undersigned firms to represent it in this
action and has agreed to pay a reasonable fee for said services.
17. Pursuant to Section 627.428, Florida Statutes, Plaintiff is entitled to
recover from Defendant reasonable attorney’s fees and costs for the necessity of
this action.
WHEREFORE, Plaintiff requests:
a. That this Honorable Court declare that Defendant is overdue in
payment of all sums due to Plaintiff;
b. That Defendant pay all sums due to Plaintiff under Claimant’s policy
of Insurance with Defendant;
c. That Defendant pay interest on all unpaid sums in accordance with
Section 627.736(4), Florida Statutes;
d. That Defendant pay Plaintiff pre-suit penalty, postage, and interest in
accordance with Section 627.736(10), Florida Statutes.
e. That the Defendant correctly apply the deductible “to 100 percent of
the expenses and losses” as described in Fla. Stat. 627.736, if
applicable;
f. That The Defendants pay all sums due to Plaintiff under any medical
payment’s (med-pay) coverage’s in accordance with the
Claimant’s/policy holder’s policy of Insurance with Defendant;
[8197-00272/41217682/1]g. That Defendant pay Plaintiff reasonable attorney’s fees and costs
pursuant to Sections 627.428, Florida Statutes, and/or 627.736(5),
Florida Statutes, for the necessity of this action;
h. Any other relief this Court deems just and appropriate.
WHEREFORE, Plaintiff demands judgment for personal injury
protection benefits together with pre-judgment interest, costs and attorneys’ fees
pursuant to Florida Statute 627.428 and Florida Statute sections 627.736(5) and
(8) and any other relief this Court deems proper and just.
Plaintiff demands trial by jury on all issues triable as of right.
LANDAU & ASSOCIATES, P.A.
1619 NW 136th Avenue, Suite 2C
Sunrise, Florida 33323
Telephone (954) 744-8383
Facsimile (954) 391-7805
Email: efilings@pip-lawyers.com
By: — /s/Gregory E. Gudin
GREGORY E. GUDIN, ESQ.
Florida Bar # 14347
[8197-00272/41217682/1]2394822009 10:57:13a.m. 10-21-2020 aig
ORTHOPEDIC CENTER OF FLORIDA + 12670 CREEKSIDE LANE SUITE 202, FORT MYERS FL 33919-3370
WOF
Last Name: WORTHINGTON
First Name: ALICE
Middle Name:
Patient email:
Home Phone:
Mobile Phone:
ASSIGNMENT AND RELEASE:
« I hereby assign my insurance benefits to be paid directly to the physician.
« l understand that | am financially responsible for all non-covered services, copays,
deductibles and/or coinsurance. | authorize and give consent for my provider to bill me
directly for recommended services performed that are not covered under the terms of my health plan.
« tauthorize the physician to release any medical information required to process this claim.
« Afee for no shows may apply.
CONSENT TO CALL and/or EMAIL:
DO NOTauthorize my provider's office to contact me by telephone and/or email to remind me of my
provider, office and health notifications. ***PLEASE VERIFY EMAIL AND PHONE NUMBERS ARE CORRECT
wn owe lulz 20
appointment
ABOVE™™,
vom ltORTHOPEDIC CENTER printed 10/12/2022 09:03 PM
OF FLORIDA
ORTHOPEDIC CENTER OF FLORIDA
PO BOX 11811
BELFAST, ME 04915-4009
billing phone: (239) 482-2663
GUARANTOR NAME AND ADDRESS PATIENT # PATIENT NAME
ALICE WORTHINGTON 86892 ALICE WORTHINGTON
Billing Summary
Claim ID Procedure Date of Service PostDate Type Reason Plan Supervising Ins. 1
Provider
Claim ID 361206
361206 20553,LT 10/21/2020 01/28/2021 CHARGE 20553,LT ALLSTATE GEORGE $145.75
SOLIMAN
361206 20553,LT 10/21/2020 01/28/2021 PAYMENT CHECK ALLSTATE GEORGE $-137.16
684629816 SOLIMAN
361206 99072 10/21/2020 01/28/2021 CHARGE 99072 ALLSTATE GEORGE $40.00
SOLIMAN
361206 99072 10/21/2020 01/28/2021 PAYMENT CHECK ALLSTATE GEORGE $-28.06
684629816 SOLIMAN
361206 99205,25 10/21/2020 01/28/2021 CHARGE 99205,25 ALLSTATE GEORGE $501.90
SOLIMAN
361206 99205,25 10/21/2020 01/28/2021 PAYMENT CHECK ALLSTATE GEORGE $-308.72
684629816 SOLIMAN
361206 +J1885 10/21/2020 01/28/2021 CHARGE J1885 ALLSTATE GEORGE $3.00
SOLIMAN
361206 J1885 10/21/2020 01/28/2021 PAYMENT CHECK ALLSTATE GEORGE $-2.10
684629816 SOL IMAN
361206 J3301 10/21/2020 01/28/2021 CHARGE J3301 ALLSTATE GEORGE = $32.00
SOLIMAN
361206 J3301 10/21/2020 01/28/2021 PAYMENT CHECK ALLSTATE GEORGE $-22.45
684629816 SOLIMAN
363801 | 64479,LT 11/06/2020 | 01/28/2021 CHARGE 64479,LT | ALLSTATE GEORGE | $821.00
SOLIMAN
363801 64479,LT 11/06/2020 01/28/2021 PAYMENT CHECK ALLSTATE GEORGE $-411.45
684640276 SOLIMAN
363801 64480,LT 11/06/2020 01/28/2021 CHARGE 64480,LT ALLSTATE GEORGE $382.05
SOLIMAN
363801 64480,LT 11/06/2020 01/28/2021 PAYMENT CHECK ALLSTATE GEORGE | $-191.47
684640276 SOLIMAN
363801 J1100 11/06/2020 01/28/2021 CHARGE J1100 ALLSTATE GEORGE $28.56
SOLIMAN
363801 J1100 11/06/2020 01/28/2021 PAYMENT CHECK ALLSTATE GEORGE $-16.38
684640276 SOLIMAN9966 11/06/2020 01/28/2021 CHARGE
Q9966 11/06/2020 01/28/2021 PAYMENT
Charges: 1969.6
Payment:1121.77
9966 ALLSTATE
CHECK ALLSTATE
684640276
GEORGE
SOLIMAN
GEORGE
SOLIMAN
$15.00
$-4.01
Preview
Filing # 163387629 E-Filed 12/20/2022 12:34:53 PM ORTHOPEDIC CENTER OF FLORIDA, IN THE COUNTY COURT IN AND INC FOR ST. LUCIE COUNTY, FLORIDA a/a/o Alice Worthington CASE NO.: Plaintiff, vs. ALLSTATE FIRE AND CASUALTY INSURANCE COMPANY Defendant COMPLAINT COMES NOW, Plaintiff, ORTHOPEDIC CENTER OF FLORIDA, INC a/a/o Alice Worthington (hereinafter “Plaintiff’) sues the Defendant, ALLSTATE FIRE AND CASUALTY INSURANCE COMPANY (hereinafter “Defendant”), and in support thereof alleges the following: GENERAL ALLEGATIONS 1. This is an action for Breach of Contract, which does exceed One Dollar ($1.00), but does not exceed Ninety Nine Dollars and ninety nine cents ($99.99), exclusive of interest, attorney’s fees and costs. 2. Defendant was and remains a corporation organized and existing under the laws of the State of Florida and is otherwise sui juris. 3. Defendant was and is a corporation authorized to do business, maintains an office and agents in ST. LUCIE COUNTY and regularly sells automobile insurance policies to the general public in ST. LUCIE COUNTY. The Defendant and/or its affiliates and/or its subsidiaries which issued the policy of insurance have substantial identities of interest. 4. At all times material hereto, Plaintiff was a corporation duly licensed to perform medical services in the State of Florida. 5. On or about September 09, 2020, Alice Worthington (hereinafter “Claimant’”’) was involved in a motor vehicle accident.6. As a result of that motor vehicle accident, Plaintiff provided Claimant with medical services and/or treatment. 7. As a direct and proximate result of the injuries sustained by Claimant in the accident, Claimant incurred reasonable expenses for necessary medical and rehabilitative care by the Plaintiff for an Emergency Medical Condition as evidenced by the Claimant’s entire medical record. To date, Defendant refuses to pay the full amount due. 8. Defendant issued a policy of insurance to Alice Worthington which provided personal injury protection benefits coverage required by law to comply with Florida Statutes Sections 627.730 thru 627.7405. Plaintiff does not have a copy of the policy to attach; however, Plaintiff believes that the Defendant has a copy of said policy. Upon receipt of a certified copy of the insurance policy, same is hereby attached and incorporated herein by reference. 9. The above described policy was in full force and effect on the date of the accident and provided PIP coverage for Alice Worthington for bodily injuries sustained in said accident. 10. Plaintiff and Claimant have performed the statutorily required conditions precedent to entitle Plaintiff to recover benefits for said necessary medical, rehabilitative and remedial treatment regarding the above-described policy and statutory conditions precedent to instituting this action. 11. Claimant equitably assigned to Plaintiff and/or also executed a written assignment of benefits, assigning to Plaintiff certain benefits payable pursuant to the policy of insurance issued by Defendant. 12 Pursuant to said Assignment, Plaintiff gave notice of the covered losses and Plaintiff made demand for PIP benefits for reasonable, necessary and related medical treatment. 13. Defendant has denied coverage for, withheld or reduced the medical bill(s) that were submitted by Plaintiff for date(s) of service October 21, 2020 through November 06, 2020 and/or misapplied the application of the deductible. Furthermore, Defendant was precluded from applying a deductible at all because the nonexistence of a properly executed deductible election form. A copy of the HCFA bills and/or patient ledger and/or explanation of benefits/review are attached hereto and incorporated by reference. Due to the failure of Defendant to pay these PIP benefits in accordance with the law, Plaintiff has been required to retain the undersigned law firm to act on their behalf in this suit. Plaintiff has [8197-00272/41217682/1]agreed to pay, and the attorneys for Plaintiff have agreed to accept, any court awarded fee. BREACH OF CONTRACT FOR FAILURE TO PAY AMOUNTS OWED. 14. Plaintiff reavers and realleges paragraphs 1 through 13 of this complaint. 15. Despite prior demand by Plaintiff, Defendant has refused and continues to refuse to issue payment of all sums due Plaintiff, in violation of Section 627.736, Florida Statutes, and in breach of its contact with claimant. 16. Plaintiff has retained the undersigned firms to represent it in this action and has agreed to pay a reasonable fee for said services. 17. Pursuant to Section 627.428, Florida Statutes, Plaintiff is entitled to recover from Defendant reasonable attorney’s fees and costs for the necessity of this action. WHEREFORE, Plaintiff requests: a. That this Honorable Court declare that Defendant is overdue in payment of all sums due to Plaintiff; b. That Defendant pay all sums due to Plaintiff under Claimant’s policy of Insurance with Defendant; c. That Defendant pay interest on all unpaid sums in accordance with Section 627.736(4), Florida Statutes; d. That Defendant pay Plaintiff pre-suit penalty, postage, and interest in accordance with Section 627.736(10), Florida Statutes. e. That the Defendant correctly apply the deductible “to 100 percent of the expenses and losses” as described in Fla. Stat. 627.736, if applicable; f. That The Defendants pay all sums due to Plaintiff under any medical payment’s (med-pay) coverage’s in accordance with the Claimant’s/policy holder’s policy of Insurance with Defendant; [8197-00272/41217682/1]g. That Defendant pay Plaintiff reasonable attorney’s fees and costs pursuant to Sections 627.428, Florida Statutes, and/or 627.736(5), Florida Statutes, for the necessity of this action; h. Any other relief this Court deems just and appropriate. WHEREFORE, Plaintiff demands judgment for personal injury protection benefits together with pre-judgment interest, costs and attorneys’ fees pursuant to Florida Statute 627.428 and Florida Statute sections 627.736(5) and (8) and any other relief this Court deems proper and just. Plaintiff demands trial by jury on all issues triable as of right. LANDAU & ASSOCIATES, P.A. 1619 NW 136th Avenue, Suite 2C Sunrise, Florida 33323 Telephone (954) 744-8383 Facsimile (954) 391-7805 Email: efilings@pip-lawyers.com By: — /s/Gregory E. Gudin GREGORY E. GUDIN, ESQ. Florida Bar # 14347 [8197-00272/41217682/1]2394822009 10:57:13a.m. 10-21-2020 aig ORTHOPEDIC CENTER OF FLORIDA + 12670 CREEKSIDE LANE SUITE 202, FORT MYERS FL 33919-3370 WOF Last Name: WORTHINGTON First Name: ALICE Middle Name: Patient email: Home Phone: Mobile Phone: ASSIGNMENT AND RELEASE: « I hereby assign my insurance benefits to be paid directly to the physician. « l understand that | am financially responsible for all non-covered services, copays, deductibles and/or coinsurance. | authorize and give consent for my provider to bill me directly for recommended services performed that are not covered under the terms of my health plan. « tauthorize the physician to release any medical information required to process this claim. « Afee for no shows may apply. CONSENT TO CALL and/or EMAIL: DO NOTauthorize my provider's office to contact me by telephone and/or email to remind me of my provider, office and health notifications. ***PLEASE VERIFY EMAIL AND PHONE NUMBERS ARE CORRECT wn owe lulz 20 appointment ABOVE™™, vom ltORTHOPEDIC CENTER printed 10/12/2022 09:03 PM OF FLORIDA ORTHOPEDIC CENTER OF FLORIDA PO BOX 11811 BELFAST, ME 04915-4009 billing phone: (239) 482-2663 GUARANTOR NAME AND ADDRESS PATIENT # PATIENT NAME ALICE WORTHINGTON 86892 ALICE WORTHINGTON Billing Summary Claim ID Procedure Date of Service PostDate Type Reason Plan Supervising Ins. 1 Provider Claim ID 361206 361206 20553,LT 10/21/2020 01/28/2021 CHARGE 20553,LT ALLSTATE GEORGE $145.75 SOLIMAN 361206 20553,LT 10/21/2020 01/28/2021 PAYMENT CHECK ALLSTATE GEORGE $-137.16 684629816 SOLIMAN 361206 99072 10/21/2020 01/28/2021 CHARGE 99072 ALLSTATE GEORGE $40.00 SOLIMAN 361206 99072 10/21/2020 01/28/2021 PAYMENT CHECK ALLSTATE GEORGE $-28.06 684629816 SOLIMAN 361206 99205,25 10/21/2020 01/28/2021 CHARGE 99205,25 ALLSTATE GEORGE $501.90 SOLIMAN 361206 99205,25 10/21/2020 01/28/2021 PAYMENT CHECK ALLSTATE GEORGE $-308.72 684629816 SOLIMAN 361206 +J1885 10/21/2020 01/28/2021 CHARGE J1885 ALLSTATE GEORGE $3.00 SOLIMAN 361206 J1885 10/21/2020 01/28/2021 PAYMENT CHECK ALLSTATE GEORGE $-2.10 684629816 SOL IMAN 361206 J3301 10/21/2020 01/28/2021 CHARGE J3301 ALLSTATE GEORGE = $32.00 SOLIMAN 361206 J3301 10/21/2020 01/28/2021 PAYMENT CHECK ALLSTATE GEORGE $-22.45 684629816 SOLIMAN 363801 | 64479,LT 11/06/2020 | 01/28/2021 CHARGE 64479,LT | ALLSTATE GEORGE | $821.00 SOLIMAN 363801 64479,LT 11/06/2020 01/28/2021 PAYMENT CHECK ALLSTATE GEORGE $-411.45 684640276 SOLIMAN 363801 64480,LT 11/06/2020 01/28/2021 CHARGE 64480,LT ALLSTATE GEORGE $382.05 SOLIMAN 363801 64480,LT 11/06/2020 01/28/2021 PAYMENT CHECK ALLSTATE GEORGE | $-191.47 684640276 SOLIMAN 363801 J1100 11/06/2020 01/28/2021 CHARGE J1100 ALLSTATE GEORGE $28.56 SOLIMAN 363801 J1100 11/06/2020 01/28/2021 PAYMENT CHECK ALLSTATE GEORGE $-16.38 684640276 SOLIMAN9966 11/06/2020 01/28/2021 CHARGE Q9966 11/06/2020 01/28/2021 PAYMENT Charges: 1969.6 Payment:1121.77 9966 ALLSTATE CHECK ALLSTATE 684640276 GEORGE SOLIMAN GEORGE SOLIMAN $15.00 $-4.01