Letter,Correspondence: VIDA CHIROPRACTIC MIAMI A/A/O JOSE SARDINAS VS UNITED AUTOMOBILE INSURANCE COMPANY

• 
• 
• 
• 
• 
• 

						
                                
Preview
                                Filing # 75152362 E-Filed 07/18/2018 02:50:41 PM

@®

DIVERSE
LEGAL SOLUTIONS

A R a OW & : z ha

July 18, 2018
Via Service of Process
United Automobile Insurance Company
c/o Chief Financial Officer (for the State of Florida)

200 East Gaines Street
Tallahassee, Florida 32399

Re: Case — VIDA Chiropractic, Inc., a/a/o Jose G. Sardinas v. United Automobile
Insurance Company
Your Claim No. - 0100162142

To Whom it May Concern:

As you are aware, my office represents the plaintiff in the above-referenced matter. A
lawsuit has been filed against United Automobile Insurance Company (“United”) for its failure
to properly reimburse my client the benefits owed under an automobile insurance policy
belonging to an assignor who received medical treatment at my client’s medical facility and
assigned to my client the contractual right to collect PIP insurance proceeds. In accordance with
this litigation against United, we require the testimony of witnesses in your custody or control.
As such, please provide my office with three dates and times within the next 45 days for the
following individuals to sit for deposition:

1. Your Rule 1.310(b)(6) Corporate Representative for the following areas of inquiry

* The factual aspects of the underlying insurance claim at issue in this lawsuit, including,
but not limited to, any conversations with the insured, pertinent and material dates, names
of witnesses and adjusters with knowledge of the underlying facts of the claim, how the
claim was reported, etc.;

* The provisions of the subject policy that are determinative of coverage and extent of
coverage in this case;

+ Reimbursement levels in the community (where the plaintiff's facility is located) for the
medical treatments administered in this case and limited to the time period when

Pptreatments were administered in this case. This request is tailored to payments made by
United.

+ The rationale for application of each reduction code applied in United’s explanations of
payment of the plaintiff’ s bills;

+ Any “coding modifiers” used by United in this case;

+ Knowledge of any software or computer systems employed by United in this case to
process the plaintiff's bills;

+ The factual basis of all responses to the plaintiff's Complaint, including affirmative
defenses or any counterclaims raised, if applicable;

* The factual basis of all responses to discovery in this case, including knowledge about
all documents exchanged in discovery. The witness should be prepared to testify as to the
significance of all written responses and documents exchanged.

* The rationale for United’s decision to deny payment of any additional benefits in
response to the plaintiff’ s demand letter.

+ Whether United is disputing the medical necessity of the treatment administered by the
plaintiff, and, if so, the factual basis for such a determination;

+ Whether United is disputing the relatedness of the treatment administered by the
plaintiff (Ze. — whether the treatment administered was related to the automobile
accident), and, if so, the factual basis for such a determination;

+ Whether United is disputing the reasonableness of the charges for the treatment
administered by the plaintiff, and, if so, the factual basis for such a determination;

+ Any correspondence exchanged by United with the plaintiff and/or the assignor in this
case;

+ Knowledge of what United considers “a reasonable amount pursuant to both the terms
and conditions of the policy of insurance under which the subject claim is being made as
well as the Florida No-Fault Statute 627.736.”

* Knowledge of United’s decision to reimburse the plaintiff according to “various federal
and state medical fee schedules applicable to automobile and other insurance coverages,”
including, but not limited to, which fee schedules were utilized and why;2. Defendant’s Pre-Suit Adjuster who was assigned to the underlying PIP claim at the time
that a decision was made by United as to whether the plaintiff's bills would be paid.

Pursuant to the Florida Rules of Civil Procedure and well-settled case law, we are entitled to
conduct these depositions of material witnesses. As previously requested, please_provide at
least three dates and times within the next 45 days that each of these witnesses is available for
deposition. Also, please advise us of the county where your witnesses are located so proper
arrangements may be made at a convenient location. If our office does not receive this
information within 14 days from the date that service is achieved upon you, we will immediately
proceed to seek a court order binding your witnesses to appear for deposition within 30 days.

Should you have any questions or concerns, please do not hesitate to contact me immediately
either via our office’s__— telephone = number or my _ e-mail address
(ejimenez@diverselegalsolutions.com). Thank you for your anticipated time and attention to this

matter.

Sincerely,

Z_

Edward G. Jimenez, Esq.