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Filing # 16520111 Electronically Filed 07/30/2014 01:31:16 PM
CORZO MEDICAL CENTER, INC., IN THE COUNTY COURT IN AND FOR
DANILO MEJIA, MIAMI-DADE COUNTY, FLORIDA
Plaintiff, CIVIL DIVISION
CASE NO: 14-000803 CC 25 (01)
* FL BAR NO. 145556
UNITED AUTOMOBILE INSURANCE
COMPANY, a Florida Corporation
Defendant.
~ DEFENDANTS MOTION FOR PROTECTIVE ORDER TO PLAINTIFF'S
SECOND SET OF INTERROGATORIES NUMBERS 1 THROUGH 12
COMES NOW, the Defendant, UNITED AUTOMOBILE INSURANCE COMPANY,
by and through undersigned counsel, and moves, pursuant to Rule 1.280(c), Florida Rules
of Civil Procedure, for the entry of a protective order to Second Set of Interrogatories
Numbers Ithrough 12, and as grounds therefore, states:
1. The Plaintiff has served the Defendant with Second Set of Interrogatories.
Although the Plaintiff is entitled to discovery, the serving of interrogatories beyond
(30), including subparts, requires Plaintiff to move for leave of Court and show
good cause to obtain same. Furthermore, propounding more that (30) interrogatories
to Defendant is not proper procedure and the Defendant is entitled to a protective
order. Please see attached as Exhibit “A”.
2. Pursuant to F.R.Civ.P1.340(a)."Interrogatories shall not exceed 30, including all
subparts, unless the court permits a larger number on motion and notice and for
good cause."
WHEREFORE, the Defendant, UNITED AUTOMOBILE INSURANCE
COMPANY, respectfully requests that this Court enter a Protective Order which relieves
the Defendant from responding to those Second Set of Interrogatories which exceed (30),
MOOT-962 145-6091including subparts, and grant Defendant’s Motion for Protective order from having to
answer these additional interrogatories without good cause.
CERTIFICATE OF SERVICE
1 HEREBY CERTIFY that a true and correct copy of the foregoing was sent via
U.S. Mail on July 29, 2014 to: Kevin Whitehead, Esq., at kw@kwwpa.com
MOOT-962 145-6091
Office Of The General Counsel
United Automobile Ins. Co. / Trial Division
Attorneys for the Defendant
P.O Box 694260
Miami, FL 33269-9854
E-Mail: oge_service@uaig.net
Phone (305) 774-6160
/s/ Camille A. White
Camille A. White, Esq.IN THE COUNTY COURT OF THE 11TH
JUDICIAL CIRCUIT, IN AND FOR
MIAMI DADE COUNTY. FLORIDA
CORZO MEDICAL CENTER INC. a/a/o CASE NO. 14-000803 CC 25 (1)
Danilo Mejia,
Plaintiff,
vs.
UNITED AUTOMOBILE INSURANCE
COMPANY,
Defendant.
————
NOTICE OF FILING INTERROGATORIES TO DEFENDANT
COMES NOW, Plaintiff, CORZO MEDICAL CENTER INC. a/a/o Danilo Mejia, by and
through undersigned counsel, and propounds the attached 19 Interrogatories to Defendant, UNITED
AUTOMOBILE INSURANCE COMPANY, herein to be answered under oath in writing, within
thirty (30) days from receipt hereof in accordance with Rule 1.340 of the Florida Rules of Civil
Procedure.
CERTIFICATE OF SERVICE
IT HEREBY CERTIFY that a true and correct copy of the foregoing was mailed via E-mail
on the 24th day of June, 2014, to: Camille White, Esq.. Office of the General Counsel,
oge_service@uaig.net.
Kevin W. Whitehead, PA
3250 Mary Street, Suite 307
Coconut Grove, FL 33133
Telephone No.: (305) 444-8226
/s/ Kevin W. Whitehead, Esq
Kevin W. Whitchead, Esq.
Florida Bar No.: 64939NV
we
PLAINTIFF’S PIP INTERROGATORIES TO DEFENDANT
Please state your name, business address and telephone number, employer, length of
employment, and your official position in the company.
List all the names and addresses of all persons who are believed or known by you. your
agents or atlomeys to have any knowledge concerning any of the issues raised by the
pleadings and specify the subject matter about which the witness has knowledge.
A. NAME(S ADDRESS SUBJECT MATTER
Describe in detail each act and/or omission on the part of the Plaintiff, patient, insured and/or
claimant which you contend constituted a breach of contract and/or precludes the Plaintiff(s)
from receiving PIP benefits under the applicable policy of insurance.
Please provide the following information pertaining to the subject PIP claim: the insured
under the subject PIP policy, the effective dates of the subject policy, the policy number, the
claim number, the date of accident, the amount of the deductible (if applicable), whether the
patient/claimant is subject to the deductible, and whether there are any coverage defenses,
and if so, state with specificity the defense(s) and all facts that support this defense.Do you intend to call any medical expert witnesses at the trial of this case? If so. please
identify each witnes
describe his/her qualifications as an expert; state the subject matter
upon which he/she is expected to testify; state the substance of the facts and opinions to
which he/she is expected to testify; and give a summary of the grounds for each opinion.
Please state whether the patient. claimant, and/or Plaintiff(s) did any of the following prior
to filing this lawsuit:
Submitted to a recorded statement and/or Examination Under Oath (EUO) and if so,
the date of the statement(s), and if not, whether an EUO or statement was requested
and if so, the date the notice was sent, the addressee(s) of the notice, including name
and address, and whether the addressee(s) received the notice and if so, the date
received and the address received at;
Submitted to an Independent Medical Examination (IME) and if so, the date of the
IME; and if not, whether an IME was requested and if so, the date the notice was
sent, the addressee(s) of the notice, including name and address, and whether the
addressee(s) received the notice and if so, the date received and the address received
at; and/orc. Reported the accident as soon as practicable as may be required by the applicable
policy of insurance and/or Florida Statutes, and if so, the date that notice was
provided to the insurance company of the subject accident, and who provided the
notice.
Please state whether the Defendant received any of the following documents and/or items
prior to the filing of the subject lawsuit and if so, the date received, which individual or entity
submitted the document, and the date the document was mailed to the Defendant:
A. Florida Traffic Crash Report;
B. IME report;
Cc. Peer Review Report;
D. PIP Application and/or No Fault Affidavit;
E. Assignment of Benefits, and if so, name of each provider and the date the insurance
company received the assignment of benefits and/or
F. Demand letter pursuant to Fla. Stat. § 627.736(11).
Please state whether the Plaintiff(s), and/or its agents, and/or its attorney(s), and/or any of
the medical care providers have failed to cooperate with the Defendant’s attempt to obtain
the information necessary to process their claim and determine the amounts due, if any. If
yes, please explain in detail and how they failed to cooperate and whether the failure to
cooperate was a basis for denying those charges, and if so the specific charges, including
provider, dates of service and amount.9.
Please specifically state how the medical treatment and/or diagnostic testing received by the
patient, claimant, and/or Plaintiff(s) was not related, reasonable and/or medically necessary.
A. In response to this interrogatory please list the medical care provider along with a
brief explanation describing how the treatment and/or diagnostic testing was not
related, reasonable or medically necessary;
B. Please list any and all witnesses that the Defendant expects to call at trial or any
documentation introduced into evidence to support the above assertion; and
c Please list any and all documents, including medical reports and/or peer reviews,
including the author, date of document, type of document, and the date that the
Defendant received the document that supports the above assertion.
Please state how the charges for bills submitted by the medical care provider(s) exceeded the
usual charges for similar providers in the community or were unreasonable in amount. In
response to this interrogatory, please list the following:
A. Specific charges submitted by the medical care provider(s) which exceed the usual
and customary charges for similar providers in the community or were unreasonable;
B. The corresponding charges for similar providers in the community. Please list those
medical care providers name, business, address, doctors, and contact person;c.
When the Defendant ascertained this information. and how the Defendant ascertained
this information; and
If the Defendant notified anyone of its determination, and if so. who was notified, the
method of notification (i.e. letter), and the date when the Defendant notified them.
Please list specifically the following:
All bills for medical services submitted on behalf of the medical care provider(s) and
received by the Defendant, including the name of the provider, dates of service, and
total amount of the bill;
The date each bill was received by the Defendant:
The amount that the Defendant paid for each bill received, the date that the
Defendant sent the payment, where the Defendant sent the payment, and the date that
the medical care provider cashed the payment;
Whether or not the Defendant paid statutory interest on the bill, the amount of
interest, and the date the interest was tendered; and
Any and all bills received by the Defendant which are currently outstanding and have
not been paid as of this date.15.
Please state with specificity the Defendant's reasonable proof that it is not responsible for
the payment of the Plaintiff(s) PIP claim(s) pursuant to §627.736(4)(b) and when it obtained
its reasonable proof, including date.
Describe in detail each claim which the patient, claimant, Plaintiff and/or the medical care
providers submitted for which you are denying coverage, or otherwise suspending,
withdrawing and/or withholding payment. Please specify the following: date of service or
loss, the name of the provider of the service, the amount of the charge or loss on which you
are denying coverage, withdrawing or withholding payment, the date you first made a
determination to deny the claim, withdraw or withhold payment, the date you first received
notice, the portion of the claim on which you are denying coverage. withdrawing or
withholding payment, and the date that you first informed or notified the Plaintiff and/or the
medical care provider of the denial, withdrawal or withhold of payment.
For each denial, suspension, or withdrawal of payment of each claim listed in the preceding
interrogatory, state in detail the legal grounds and the factual basis upon which the claim was
denied or not paid. including the exact wording of any physician, the exact wording of any
policy provisions or the exact wording of any statutory language or case law upon which you
base your denial or withdrawing of payment.
Please specify the exact amount of PIP benefits remaining under the subject insurance policy.
and any med-pay coverage (if applicable) available to patient, claimant, and/or Plaintiff(s)
under the subject policy for the subject claim.16.
17.
Please state whether the Defendant is alleging that the patient and/or claimant’s injuries
and/or medical care and treatment are not related to the subject accident on 11/16/2012.
If yes, please state the following:
A.
The Defendant’s factual and/or opinion basis for alleging that the patient and/or
claimant’s injuries and/or medical care and treatment are not related to the subject
accident on 11/16/2012;
The names of all witnesses, expert and/or lay, that the Defendant intends on calling
to trial to testify that the patient and/or claimant’s injuries and/or medical care and
treatment are not related to the subject accident on 11/16/2012:
The date that the Defendant discovered that the patient and/or claimant’s injuries
and/or medical care and treatment are not related to the subject accident on
11/16/2012; and
Whether the Defendant has made anyone aware that the patient and/or claimant's
injuries and/or medical care and treatment are not related to the subject accident on
11/16/2012.
If the answer to interrogatory number 16(D) is yes, please state the following:
The person and/or entity that the Defendant informed that the patient and/or
claimant’s injuries and/or medical care and treatment are not related to the subject
accident on 11/16/2012, including address and date that the Defendant informed this
individual and/or entity; and
How the Defendant notified this person and/or entity that the patient and/or
claimant’s injuries and/or medical care and treatment are not related to the subject
accident on 11/16/2012.19.
If the Defendant has suspended, withdrawn, denied or not paid PIP benefits as a result of
an Independent Medical Examination (IME) or records review a/k/a "peer review," please
provide the following: the date of the IME and/or peer review, the name of the IME and/or
peer review doctor, the date the Defendant received the report(s), the date of the letter sent
by the Defendant suspending, withdrawing, or denying PIP benefits (if applicable), the
addressee(s) of the letter including name and address, and the date the letter was received
by the addressee(s).
In regards to cach of the above interrogatories to which the Defendant is claiming a privilege
(work product or attorney-client, etc.), please state the following:
A. The privilege upon which the Defendant relies on refusing to answer the
Interrogatory. and all facts upon which the Plaintiff relies in support of the privilege;
B. The names, business addresses, resident addresses, telephone numbers, positions and
occupations of all persons known or believed by the Defendant to has knowledge
concerning the factual basis for the Defendant’s assertion with regard to the
information; and
Cc. Any policy provision, statutory language, or case law for which the Defendant relies
upon in asserting the privilege.By:
Title:
STATE OF FLORIDA )
COUNTY OF )
BEFORE ME the undersigned authority, personally appeared ,on
thes day of , 200__. who has produced as
identification and who did/did not take an oath, deposes and says that he/she has read the foregoing
Answers to Interrogatories and that the statements and facts therein contained are true and correct
to the best of his/her knowledge and that he/she is the person in and who executed the same.
Print Name:
Notary Public State of Florida
My Commission Expires:IN THE COUNTY COURT OF THE 11TH
JUDICIAL CIRCUIT, IN AND FOR
MIAMI DADE COUNTY, FLORIDA
CORZO MEDICAL CENTER INC. a/a/o CASE NO. 14-000803 CC 25 (1)
Danilo Mejia,
Plaintiff,
vs.
UNITED AUTOMOBILE INSURANCE
COMPANY,
Defendant.
————
NOTICE OF FILING SECOND SET OF INTERROGATORIES TO DEFENDANT
COMES NOW, Plaintiff, CORZO MEDICAL CENTER INC. a/a/o Danilo Mejia, by and
through undersigned counsel, and propounds the attached 12 Interrogatories to Defendant, UNITED
AUTOMOBILE INSURANCE COMPANY, herein to be answered under oath in writing, within
thirty (30) days from receipt hereof in accordance with Rule 1.340 of the Florida Rules of Civil
Procedure.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing was mailed via E-mail
on the 21st day of July, 2014. to: Camille White, Esq., Office of the General Counsel,
oge_service@uaig.net.
Kevin W. Whitehead, PA
3250 Mary Street, Suite 307
Coconut Grove, FL 33133
Telephone No.: (305) 444-8226
/s/ Kevin W. Whitehead, Esq.
Kevin W. Whitehead, Esq.
Florida Bar No.: 64939PLAINTIFF’S SECOND SET OF PIP INTERROGATORIES TO DEFENDANT
You" or "your" as used in these Interrogatories means your corporation, company, or
partnership, or anyone who handles, adjusts, or investigates claims on its behalf.
1. State your complete corporate name, nature of your business, whether you are licensed to do
business in the State of Florida, whether you maintain agents for the transacting of your
customary business in Miami Dade County, Florida, and whether your name as it appears in
Plaintiff's Complaint is correct.
2. List the name of the current litigation adjuster, and the names, residence addresses, business
addresses and telephone numbers of all persons who, on your behalf, or on behalf of your
agents, have adjusted or handled Plaintiff's claim for benefits which is the subject of this
action and specify the date and nature of the participation of each such person.
For Plaintiff's claim which is the subject of this action and for which payment was reduced
or denied, please state in detail the factual basis upon which the claim and/or charge was
reduced or denied, including, verbatim, the wording of any opinion of any explanation of
benefits, explanation of review, coding experts and/or physicians upon which you relied to
either reduce, deny or withhold payment.
weList the names, addresses, and official positions of each person in your employ or in the
employ of anyone on your behalf who had any involvement in the decision to reduce, deny
or withhold payment of Plaintiff's claim that is the subject of this action and state in what
capacity each individual was involved, the basis of the denial or reduction, the date they were
involved, and the nature of their involvement.
Please provide the names, business addresses, and phone numbers of any and all corporations
or individuals, including claims review services or companies, you have hired, retained, or
consulted, within the twelve months preceding the filing of the subject claim, to review any
claims for benefits submitted by any of your insureds or others claiming benefits under
policies of your insureds; specifically, those corporations or individuals hired, retained, or
consulted to determine whether medical treatment rendered to the claimants was reasonable,
related, or necessary.
Please provide the name of any expert, or any other source, that has provided you with an
opinion regarding the usual and customary charges, medical necessity, and/or reasonableness
of the treatment and/or charges provided to the claimant by Plaintiff and/or the legal
sufficiency of the codes utilized by Plaintiff to bill for the services provided to the claimant
and a description of the opinion provided and what that opinion is based upon.Please state in detail how the Defendant determined to reimburse medical care providers,
including the Plaintiff, at a statutory fee schedule, sate the fee schedule, i.e. 200% Medicare
Part B, worker's compensation, including when this decision was made, who made this
decision, and the basis for this decision.
For the CPT codes at issue in this case which were either reduced or denied, please list all
charges received for these same medical services by Defendant for dates of service in the
same months, from medical providers utilizing the same zip code in Miami Dade County for
the twelve (12) month period prior to receiving the Plaintiff's bills. Include the provider’s
name, the date of service, the subject CPT code, and the amount charged. If this request is
too burdensome, please provide the basis for your objection. Further, if you determine that
a sampling is more appropriate, please inform the Plaintiff on what you propose in order to
fairly and adequately provide an independent sampling. (You may redact patient’s
confidential information if necessary.)
If it is your opinion that any of the CPT codes utilized by Plaintiff for the dates of service at
issue in Plaintiff's complaint were unbundles, upcoded, improper and/or incorrect codes to
utilize for the services rendered and billed to the Defendant, please identify the code or codes
which you allege should have been utilized and the reasoning behind this position as well as
identify the names and addresses of any individuals, including but not limited to experts, who
have provided you this opinion.10
If it is your position that the billing, records, or any other documents submitted by Plaintiff
to Defendant, in regards to the dates of service at issue in the complaint, are deficient in
anyway, please explain the alleged deficiency in detail and provide the identity of any
individuals, including but not limited to experts, who have provided you this opinion.
If you are relying on any policy language to support your decision to withdraw, deny or
reduce any of the subject charges submitted by the Plaintiff in regard to the subject claim,
please provide the policy language, the effective date of the subject policy, and the subject
form or edition of the policy in effect on the date of loss which is applicable to the subject
PIP claim and the date that policy was first issued by the Defendant to citizens of the State
of Florida
In regards to each of the above interrogatories to which the Defendant is claiming a privilege
(work product or attorney-client, etc.), please state the following:
A. The privilege upon which the Defendant relics on refusing to answer the
Interrogatory, and all facts upon which the Plaintiff relics in support of the privilege;
B. The names, business addresses, resident addresses, telephone numbers, positions and
occupations of all persons known or believed by the Defendant to has knowledge
concerning the factual basis for the Defendant’s assertion with regard to the
information; andCc. Any policy provision, statutory language, or case law for which the Defendant relies
upon in asserting the privilege.
By:
Title:
STATE OF FLORIDA )
)
COUNTY OF )
BEFORE ME the undersigned authority, personally appeared ;on
the day of - 2014, who has produced as
identification and who did/did not take an oath, deposes and says that he/she has read the foregoing
Answers to Interrogatories and that the statements and facts therein contained are true and correct
to the best of his/her knowledge and that he/she is the person in and who executed the same.
Print Name:
Notary Public State of Florida
My Commission Expires:
Preview
Filing # 16520111 Electronically Filed 07/30/2014 01:31:16 PM CORZO MEDICAL CENTER, INC., IN THE COUNTY COURT IN AND FOR DANILO MEJIA, MIAMI-DADE COUNTY, FLORIDA Plaintiff, CIVIL DIVISION CASE NO: 14-000803 CC 25 (01) * FL BAR NO. 145556 UNITED AUTOMOBILE INSURANCE COMPANY, a Florida Corporation Defendant. ~ DEFENDANTS MOTION FOR PROTECTIVE ORDER TO PLAINTIFF'S SECOND SET OF INTERROGATORIES NUMBERS 1 THROUGH 12 COMES NOW, the Defendant, UNITED AUTOMOBILE INSURANCE COMPANY, by and through undersigned counsel, and moves, pursuant to Rule 1.280(c), Florida Rules of Civil Procedure, for the entry of a protective order to Second Set of Interrogatories Numbers Ithrough 12, and as grounds therefore, states: 1. The Plaintiff has served the Defendant with Second Set of Interrogatories. Although the Plaintiff is entitled to discovery, the serving of interrogatories beyond (30), including subparts, requires Plaintiff to move for leave of Court and show good cause to obtain same. Furthermore, propounding more that (30) interrogatories to Defendant is not proper procedure and the Defendant is entitled to a protective order. Please see attached as Exhibit “A”. 2. Pursuant to F.R.Civ.P1.340(a)."Interrogatories shall not exceed 30, including all subparts, unless the court permits a larger number on motion and notice and for good cause." WHEREFORE, the Defendant, UNITED AUTOMOBILE INSURANCE COMPANY, respectfully requests that this Court enter a Protective Order which relieves the Defendant from responding to those Second Set of Interrogatories which exceed (30), MOOT-962 145-6091including subparts, and grant Defendant’s Motion for Protective order from having to answer these additional interrogatories without good cause. CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing was sent via U.S. Mail on July 29, 2014 to: Kevin Whitehead, Esq., at kw@kwwpa.com MOOT-962 145-6091 Office Of The General Counsel United Automobile Ins. Co. / Trial Division Attorneys for the Defendant P.O Box 694260 Miami, FL 33269-9854 E-Mail: oge_service@uaig.net Phone (305) 774-6160 /s/ Camille A. White Camille A. White, Esq.IN THE COUNTY COURT OF THE 11TH JUDICIAL CIRCUIT, IN AND FOR MIAMI DADE COUNTY. FLORIDA CORZO MEDICAL CENTER INC. a/a/o CASE NO. 14-000803 CC 25 (1) Danilo Mejia, Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. ———— NOTICE OF FILING INTERROGATORIES TO DEFENDANT COMES NOW, Plaintiff, CORZO MEDICAL CENTER INC. a/a/o Danilo Mejia, by and through undersigned counsel, and propounds the attached 19 Interrogatories to Defendant, UNITED AUTOMOBILE INSURANCE COMPANY, herein to be answered under oath in writing, within thirty (30) days from receipt hereof in accordance with Rule 1.340 of the Florida Rules of Civil Procedure. CERTIFICATE OF SERVICE IT HEREBY CERTIFY that a true and correct copy of the foregoing was mailed via E-mail on the 24th day of June, 2014, to: Camille White, Esq.. Office of the General Counsel, oge_service@uaig.net. Kevin W. Whitehead, PA 3250 Mary Street, Suite 307 Coconut Grove, FL 33133 Telephone No.: (305) 444-8226 /s/ Kevin W. Whitehead, Esq Kevin W. Whitchead, Esq. Florida Bar No.: 64939NV we PLAINTIFF’S PIP INTERROGATORIES TO DEFENDANT Please state your name, business address and telephone number, employer, length of employment, and your official position in the company. List all the names and addresses of all persons who are believed or known by you. your agents or atlomeys to have any knowledge concerning any of the issues raised by the pleadings and specify the subject matter about which the witness has knowledge. A. NAME(S ADDRESS SUBJECT MATTER Describe in detail each act and/or omission on the part of the Plaintiff, patient, insured and/or claimant which you contend constituted a breach of contract and/or precludes the Plaintiff(s) from receiving PIP benefits under the applicable policy of insurance. Please provide the following information pertaining to the subject PIP claim: the insured under the subject PIP policy, the effective dates of the subject policy, the policy number, the claim number, the date of accident, the amount of the deductible (if applicable), whether the patient/claimant is subject to the deductible, and whether there are any coverage defenses, and if so, state with specificity the defense(s) and all facts that support this defense.Do you intend to call any medical expert witnesses at the trial of this case? If so. please identify each witnes describe his/her qualifications as an expert; state the subject matter upon which he/she is expected to testify; state the substance of the facts and opinions to which he/she is expected to testify; and give a summary of the grounds for each opinion. Please state whether the patient. claimant, and/or Plaintiff(s) did any of the following prior to filing this lawsuit: Submitted to a recorded statement and/or Examination Under Oath (EUO) and if so, the date of the statement(s), and if not, whether an EUO or statement was requested and if so, the date the notice was sent, the addressee(s) of the notice, including name and address, and whether the addressee(s) received the notice and if so, the date received and the address received at; Submitted to an Independent Medical Examination (IME) and if so, the date of the IME; and if not, whether an IME was requested and if so, the date the notice was sent, the addressee(s) of the notice, including name and address, and whether the addressee(s) received the notice and if so, the date received and the address received at; and/orc. Reported the accident as soon as practicable as may be required by the applicable policy of insurance and/or Florida Statutes, and if so, the date that notice was provided to the insurance company of the subject accident, and who provided the notice. Please state whether the Defendant received any of the following documents and/or items prior to the filing of the subject lawsuit and if so, the date received, which individual or entity submitted the document, and the date the document was mailed to the Defendant: A. Florida Traffic Crash Report; B. IME report; Cc. Peer Review Report; D. PIP Application and/or No Fault Affidavit; E. Assignment of Benefits, and if so, name of each provider and the date the insurance company received the assignment of benefits and/or F. Demand letter pursuant to Fla. Stat. § 627.736(11). Please state whether the Plaintiff(s), and/or its agents, and/or its attorney(s), and/or any of the medical care providers have failed to cooperate with the Defendant’s attempt to obtain the information necessary to process their claim and determine the amounts due, if any. If yes, please explain in detail and how they failed to cooperate and whether the failure to cooperate was a basis for denying those charges, and if so the specific charges, including provider, dates of service and amount.9. Please specifically state how the medical treatment and/or diagnostic testing received by the patient, claimant, and/or Plaintiff(s) was not related, reasonable and/or medically necessary. A. In response to this interrogatory please list the medical care provider along with a brief explanation describing how the treatment and/or diagnostic testing was not related, reasonable or medically necessary; B. Please list any and all witnesses that the Defendant expects to call at trial or any documentation introduced into evidence to support the above assertion; and c Please list any and all documents, including medical reports and/or peer reviews, including the author, date of document, type of document, and the date that the Defendant received the document that supports the above assertion. Please state how the charges for bills submitted by the medical care provider(s) exceeded the usual charges for similar providers in the community or were unreasonable in amount. In response to this interrogatory, please list the following: A. Specific charges submitted by the medical care provider(s) which exceed the usual and customary charges for similar providers in the community or were unreasonable; B. The corresponding charges for similar providers in the community. Please list those medical care providers name, business, address, doctors, and contact person;c. When the Defendant ascertained this information. and how the Defendant ascertained this information; and If the Defendant notified anyone of its determination, and if so. who was notified, the method of notification (i.e. letter), and the date when the Defendant notified them. Please list specifically the following: All bills for medical services submitted on behalf of the medical care provider(s) and received by the Defendant, including the name of the provider, dates of service, and total amount of the bill; The date each bill was received by the Defendant: The amount that the Defendant paid for each bill received, the date that the Defendant sent the payment, where the Defendant sent the payment, and the date that the medical care provider cashed the payment; Whether or not the Defendant paid statutory interest on the bill, the amount of interest, and the date the interest was tendered; and Any and all bills received by the Defendant which are currently outstanding and have not been paid as of this date.15. Please state with specificity the Defendant's reasonable proof that it is not responsible for the payment of the Plaintiff(s) PIP claim(s) pursuant to §627.736(4)(b) and when it obtained its reasonable proof, including date. Describe in detail each claim which the patient, claimant, Plaintiff and/or the medical care providers submitted for which you are denying coverage, or otherwise suspending, withdrawing and/or withholding payment. Please specify the following: date of service or loss, the name of the provider of the service, the amount of the charge or loss on which you are denying coverage, withdrawing or withholding payment, the date you first made a determination to deny the claim, withdraw or withhold payment, the date you first received notice, the portion of the claim on which you are denying coverage. withdrawing or withholding payment, and the date that you first informed or notified the Plaintiff and/or the medical care provider of the denial, withdrawal or withhold of payment. For each denial, suspension, or withdrawal of payment of each claim listed in the preceding interrogatory, state in detail the legal grounds and the factual basis upon which the claim was denied or not paid. including the exact wording of any physician, the exact wording of any policy provisions or the exact wording of any statutory language or case law upon which you base your denial or withdrawing of payment. Please specify the exact amount of PIP benefits remaining under the subject insurance policy. and any med-pay coverage (if applicable) available to patient, claimant, and/or Plaintiff(s) under the subject policy for the subject claim.16. 17. Please state whether the Defendant is alleging that the patient and/or claimant’s injuries and/or medical care and treatment are not related to the subject accident on 11/16/2012. If yes, please state the following: A. The Defendant’s factual and/or opinion basis for alleging that the patient and/or claimant’s injuries and/or medical care and treatment are not related to the subject accident on 11/16/2012; The names of all witnesses, expert and/or lay, that the Defendant intends on calling to trial to testify that the patient and/or claimant’s injuries and/or medical care and treatment are not related to the subject accident on 11/16/2012: The date that the Defendant discovered that the patient and/or claimant’s injuries and/or medical care and treatment are not related to the subject accident on 11/16/2012; and Whether the Defendant has made anyone aware that the patient and/or claimant's injuries and/or medical care and treatment are not related to the subject accident on 11/16/2012. If the answer to interrogatory number 16(D) is yes, please state the following: The person and/or entity that the Defendant informed that the patient and/or claimant’s injuries and/or medical care and treatment are not related to the subject accident on 11/16/2012, including address and date that the Defendant informed this individual and/or entity; and How the Defendant notified this person and/or entity that the patient and/or claimant’s injuries and/or medical care and treatment are not related to the subject accident on 11/16/2012.19. If the Defendant has suspended, withdrawn, denied or not paid PIP benefits as a result of an Independent Medical Examination (IME) or records review a/k/a "peer review," please provide the following: the date of the IME and/or peer review, the name of the IME and/or peer review doctor, the date the Defendant received the report(s), the date of the letter sent by the Defendant suspending, withdrawing, or denying PIP benefits (if applicable), the addressee(s) of the letter including name and address, and the date the letter was received by the addressee(s). In regards to cach of the above interrogatories to which the Defendant is claiming a privilege (work product or attorney-client, etc.), please state the following: A. The privilege upon which the Defendant relies on refusing to answer the Interrogatory. and all facts upon which the Plaintiff relies in support of the privilege; B. The names, business addresses, resident addresses, telephone numbers, positions and occupations of all persons known or believed by the Defendant to has knowledge concerning the factual basis for the Defendant’s assertion with regard to the information; and Cc. Any policy provision, statutory language, or case law for which the Defendant relies upon in asserting the privilege.By: Title: STATE OF FLORIDA ) COUNTY OF ) BEFORE ME the undersigned authority, personally appeared ,on thes day of , 200__. who has produced as identification and who did/did not take an oath, deposes and says that he/she has read the foregoing Answers to Interrogatories and that the statements and facts therein contained are true and correct to the best of his/her knowledge and that he/she is the person in and who executed the same. Print Name: Notary Public State of Florida My Commission Expires:IN THE COUNTY COURT OF THE 11TH JUDICIAL CIRCUIT, IN AND FOR MIAMI DADE COUNTY, FLORIDA CORZO MEDICAL CENTER INC. a/a/o CASE NO. 14-000803 CC 25 (1) Danilo Mejia, Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. ———— NOTICE OF FILING SECOND SET OF INTERROGATORIES TO DEFENDANT COMES NOW, Plaintiff, CORZO MEDICAL CENTER INC. a/a/o Danilo Mejia, by and through undersigned counsel, and propounds the attached 12 Interrogatories to Defendant, UNITED AUTOMOBILE INSURANCE COMPANY, herein to be answered under oath in writing, within thirty (30) days from receipt hereof in accordance with Rule 1.340 of the Florida Rules of Civil Procedure. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing was mailed via E-mail on the 21st day of July, 2014. to: Camille White, Esq., Office of the General Counsel, oge_service@uaig.net. Kevin W. Whitehead, PA 3250 Mary Street, Suite 307 Coconut Grove, FL 33133 Telephone No.: (305) 444-8226 /s/ Kevin W. Whitehead, Esq. Kevin W. Whitehead, Esq. Florida Bar No.: 64939PLAINTIFF’S SECOND SET OF PIP INTERROGATORIES TO DEFENDANT You" or "your" as used in these Interrogatories means your corporation, company, or partnership, or anyone who handles, adjusts, or investigates claims on its behalf. 1. State your complete corporate name, nature of your business, whether you are licensed to do business in the State of Florida, whether you maintain agents for the transacting of your customary business in Miami Dade County, Florida, and whether your name as it appears in Plaintiff's Complaint is correct. 2. List the name of the current litigation adjuster, and the names, residence addresses, business addresses and telephone numbers of all persons who, on your behalf, or on behalf of your agents, have adjusted or handled Plaintiff's claim for benefits which is the subject of this action and specify the date and nature of the participation of each such person. For Plaintiff's claim which is the subject of this action and for which payment was reduced or denied, please state in detail the factual basis upon which the claim and/or charge was reduced or denied, including, verbatim, the wording of any opinion of any explanation of benefits, explanation of review, coding experts and/or physicians upon which you relied to either reduce, deny or withhold payment. weList the names, addresses, and official positions of each person in your employ or in the employ of anyone on your behalf who had any involvement in the decision to reduce, deny or withhold payment of Plaintiff's claim that is the subject of this action and state in what capacity each individual was involved, the basis of the denial or reduction, the date they were involved, and the nature of their involvement. Please provide the names, business addresses, and phone numbers of any and all corporations or individuals, including claims review services or companies, you have hired, retained, or consulted, within the twelve months preceding the filing of the subject claim, to review any claims for benefits submitted by any of your insureds or others claiming benefits under policies of your insureds; specifically, those corporations or individuals hired, retained, or consulted to determine whether medical treatment rendered to the claimants was reasonable, related, or necessary. Please provide the name of any expert, or any other source, that has provided you with an opinion regarding the usual and customary charges, medical necessity, and/or reasonableness of the treatment and/or charges provided to the claimant by Plaintiff and/or the legal sufficiency of the codes utilized by Plaintiff to bill for the services provided to the claimant and a description of the opinion provided and what that opinion is based upon.Please state in detail how the Defendant determined to reimburse medical care providers, including the Plaintiff, at a statutory fee schedule, sate the fee schedule, i.e. 200% Medicare Part B, worker's compensation, including when this decision was made, who made this decision, and the basis for this decision. For the CPT codes at issue in this case which were either reduced or denied, please list all charges received for these same medical services by Defendant for dates of service in the same months, from medical providers utilizing the same zip code in Miami Dade County for the twelve (12) month period prior to receiving the Plaintiff's bills. Include the provider’s name, the date of service, the subject CPT code, and the amount charged. If this request is too burdensome, please provide the basis for your objection. Further, if you determine that a sampling is more appropriate, please inform the Plaintiff on what you propose in order to fairly and adequately provide an independent sampling. (You may redact patient’s confidential information if necessary.) If it is your opinion that any of the CPT codes utilized by Plaintiff for the dates of service at issue in Plaintiff's complaint were unbundles, upcoded, improper and/or incorrect codes to utilize for the services rendered and billed to the Defendant, please identify the code or codes which you allege should have been utilized and the reasoning behind this position as well as identify the names and addresses of any individuals, including but not limited to experts, who have provided you this opinion.10 If it is your position that the billing, records, or any other documents submitted by Plaintiff to Defendant, in regards to the dates of service at issue in the complaint, are deficient in anyway, please explain the alleged deficiency in detail and provide the identity of any individuals, including but not limited to experts, who have provided you this opinion. If you are relying on any policy language to support your decision to withdraw, deny or reduce any of the subject charges submitted by the Plaintiff in regard to the subject claim, please provide the policy language, the effective date of the subject policy, and the subject form or edition of the policy in effect on the date of loss which is applicable to the subject PIP claim and the date that policy was first issued by the Defendant to citizens of the State of Florida In regards to each of the above interrogatories to which the Defendant is claiming a privilege (work product or attorney-client, etc.), please state the following: A. The privilege upon which the Defendant relics on refusing to answer the Interrogatory, and all facts upon which the Plaintiff relics in support of the privilege; B. The names, business addresses, resident addresses, telephone numbers, positions and occupations of all persons known or believed by the Defendant to has knowledge concerning the factual basis for the Defendant’s assertion with regard to the information; andCc. Any policy provision, statutory language, or case law for which the Defendant relies upon in asserting the privilege. By: Title: STATE OF FLORIDA ) ) COUNTY OF ) BEFORE ME the undersigned authority, personally appeared ;on the day of - 2014, who has produced as identification and who did/did not take an oath, deposes and says that he/she has read the foregoing Answers to Interrogatories and that the statements and facts therein contained are true and correct to the best of his/her knowledge and that he/she is the person in and who executed the same. Print Name: Notary Public State of Florida My Commission Expires: