Preview
Filing # 15727270 Electronically Filed 07/09/2014 04:06:49 PM
IN THE COUNTY COURT IN AND FOR
CORZO MEDICAL CENTER, INC., MIAMI-DADE COUNTY, FLORIDA
a/alo DANILO MEJIA,
CIVIL DIVISION
Plaintiff, CASE NO: 14-803 CC 25
vs. FL BAR NO. 145556
UNITED AUTOMOBILE INSURANCE
COMPANY, a Florida corporation,
Defendant.
ANSWER & AFFIRMATIVE DEFENSE TO COUNT I
OF THE AMENDED PIP COMPLAINT
COMES NOW, Defendant, United Automobile Insurance Company, and files herewith its
Answer and Affirmative Defense to Count I of the Amended PIP Complaint and states:
1. Defendant hereby admits to the allegations set forth in paragraph 1 for sole purpose of
establishing this Court’s jurisdiction.
2. Defendant hereby admits to the allegations set forth in paragraphs 2, 4, 12 and 14.
3. Defendant is without knowledge as to the allegations set forth is paragraphs 3, 7, 8 and 16.
To the extent that an as answer is required, Defendant denies the allegations contained in paragraphs 3,
7, 8 and 16 and demands strict proof thereof.
4. Defendant hereby admits to the allegations set forth in paragraph 5 in that there was a policy
of insurance in effect issued to the Insured/Claimant with the stated policy number and claim number.
As to all other allegations in paragraph 5, Defendant is without knowledge and demand strict proof
thereof.5. Defendant hereby admits to the allegations set forth in paragraph 6 taking exception with
any claim for disability and death benefits wherein Defendant did not receive any claim for said
benefits. On those limited claims, Defendant denies the allegations and demands strict proof.
6. Defendant hereby denies allegations set forth in paragraphs 9, 10, 11, 13, 15, 18, 19,21, 22
and 23 and demands strict proof thereof.
7. Defendant hereby denies allegations set forth in paragraph 17 and demands strict proof
thereof. Defendant states that it has tendered payment pursuant to Florida Statute 627.736 and
Defendant’s policy of insurance in the amount of $1,547.00 with any applicable interest, penalty and
postage. As a result, no further payment is due and/or owing.
8. Defendant hereby admits to the allegations set forth in paragraph 20 in that all bills were
timely. Defendant denies all other allegations in said paragraph.
9. Defendant denies that the bills at issue in this lawsuit are reasonable, related or necessary.
Defendant states that, pursuant to Derius v. Allstate Indem. Co., 723 So. 2d 271 (Fla. 4" DCA 1998)
and Florida Statute § 627.736, it is Plaintiff's burden to prove that the medical expenses at issue were
reasonable, necessary and related to the alleged automobile accident set forth in the complaint.
Defendant denies that the medical services provided to the claimant were reasonable, related or
necessary and demands strict proof thereof.
10. Any and all allegations not specifically admitted herein are denied and Defendant demands
strict proof thereof.
11. Under separate cover, Defendant has filed a Motion to Dismiss Count III.AFFIRMATIVE DEFENSES
As and for its affirmative defense, Defendant states pursuant to §627.736(5)(a), the insurer
providing coverage may pay for charges directly to any physician, hospital, clinic, or other person or
institution lawfully rendering treatment to an injured person for a bodily injury covered by personal
injury protection insurance. Defendant states that ‘lawfully’ means in substantial compliance with all
relevant applicable criminal, civil, and administrative requirements of state and federal law related to
the provision of medical services or treatment.” §627.732(11). Finally, “An insurer or insured is not
required to pay a claim or charges: .. . [flor any service or treatment that was not law/il at the time
rendered.” §627.736(5)(b)(1)(b). Defendant states that treatment and/or services for which claims are
the subject of this suit under Fla. Stat. 627.732(1 1) and 627.736(5)(b)(1)(b) were not lawfully rendered,
and therefore are not payable. Specifically, Defendant states that the records were not in substantial
compliance with the record keeping requirements of Fla. Admin. Code R. 64B2-17.0065. Therefore,
the services were not lawfully rendered and Defendant is not required to pay for the claim or charges.
WHEREFORE, Defendant demands judgment against the Plaintiff.
JURY TRIAL DEMANDED
Defendant hereby demands trial by jury.
CERTIFICATE OF SERVICE
WE HEREBY CERTIFY that a true and correct copy of the foregoing was sent via
email on July 9, 2014 to: Kevin Whitehead, Esq./kw@kwwpa.com.Office of the General Counsel
United Automobile Insurance Company
Trial Division
Attorneys for the Defendant
P.O Box 694260
Miami, FL 33269-9854
Phone (305) 774-6160
By: __/s/ Camille White
Camille A. White, Esq.
Preview
Filing # 15727270 Electronically Filed 07/09/2014 04:06:49 PM IN THE COUNTY COURT IN AND FOR CORZO MEDICAL CENTER, INC., MIAMI-DADE COUNTY, FLORIDA a/alo DANILO MEJIA, CIVIL DIVISION Plaintiff, CASE NO: 14-803 CC 25 vs. FL BAR NO. 145556 UNITED AUTOMOBILE INSURANCE COMPANY, a Florida corporation, Defendant. ANSWER & AFFIRMATIVE DEFENSE TO COUNT I OF THE AMENDED PIP COMPLAINT COMES NOW, Defendant, United Automobile Insurance Company, and files herewith its Answer and Affirmative Defense to Count I of the Amended PIP Complaint and states: 1. Defendant hereby admits to the allegations set forth in paragraph 1 for sole purpose of establishing this Court’s jurisdiction. 2. Defendant hereby admits to the allegations set forth in paragraphs 2, 4, 12 and 14. 3. Defendant is without knowledge as to the allegations set forth is paragraphs 3, 7, 8 and 16. To the extent that an as answer is required, Defendant denies the allegations contained in paragraphs 3, 7, 8 and 16 and demands strict proof thereof. 4. Defendant hereby admits to the allegations set forth in paragraph 5 in that there was a policy of insurance in effect issued to the Insured/Claimant with the stated policy number and claim number. As to all other allegations in paragraph 5, Defendant is without knowledge and demand strict proof thereof.5. Defendant hereby admits to the allegations set forth in paragraph 6 taking exception with any claim for disability and death benefits wherein Defendant did not receive any claim for said benefits. On those limited claims, Defendant denies the allegations and demands strict proof. 6. Defendant hereby denies allegations set forth in paragraphs 9, 10, 11, 13, 15, 18, 19,21, 22 and 23 and demands strict proof thereof. 7. Defendant hereby denies allegations set forth in paragraph 17 and demands strict proof thereof. Defendant states that it has tendered payment pursuant to Florida Statute 627.736 and Defendant’s policy of insurance in the amount of $1,547.00 with any applicable interest, penalty and postage. As a result, no further payment is due and/or owing. 8. Defendant hereby admits to the allegations set forth in paragraph 20 in that all bills were timely. Defendant denies all other allegations in said paragraph. 9. Defendant denies that the bills at issue in this lawsuit are reasonable, related or necessary. Defendant states that, pursuant to Derius v. Allstate Indem. Co., 723 So. 2d 271 (Fla. 4" DCA 1998) and Florida Statute § 627.736, it is Plaintiff's burden to prove that the medical expenses at issue were reasonable, necessary and related to the alleged automobile accident set forth in the complaint. Defendant denies that the medical services provided to the claimant were reasonable, related or necessary and demands strict proof thereof. 10. Any and all allegations not specifically admitted herein are denied and Defendant demands strict proof thereof. 11. Under separate cover, Defendant has filed a Motion to Dismiss Count III.AFFIRMATIVE DEFENSES As and for its affirmative defense, Defendant states pursuant to §627.736(5)(a), the insurer providing coverage may pay for charges directly to any physician, hospital, clinic, or other person or institution lawfully rendering treatment to an injured person for a bodily injury covered by personal injury protection insurance. Defendant states that ‘lawfully’ means in substantial compliance with all relevant applicable criminal, civil, and administrative requirements of state and federal law related to the provision of medical services or treatment.” §627.732(11). Finally, “An insurer or insured is not required to pay a claim or charges: .. . [flor any service or treatment that was not law/il at the time rendered.” §627.736(5)(b)(1)(b). Defendant states that treatment and/or services for which claims are the subject of this suit under Fla. Stat. 627.732(1 1) and 627.736(5)(b)(1)(b) were not lawfully rendered, and therefore are not payable. Specifically, Defendant states that the records were not in substantial compliance with the record keeping requirements of Fla. Admin. Code R. 64B2-17.0065. Therefore, the services were not lawfully rendered and Defendant is not required to pay for the claim or charges. WHEREFORE, Defendant demands judgment against the Plaintiff. JURY TRIAL DEMANDED Defendant hereby demands trial by jury. CERTIFICATE OF SERVICE WE HEREBY CERTIFY that a true and correct copy of the foregoing was sent via email on July 9, 2014 to: Kevin Whitehead, Esq./kw@kwwpa.com.Office of the General Counsel United Automobile Insurance Company Trial Division Attorneys for the Defendant P.O Box 694260 Miami, FL 33269-9854 Phone (305) 774-6160 By: __/s/ Camille White Camille A. White, Esq.