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Case Number: 14-000735-SC
. Filing # 9779372 Electronically Filed 01/31/2014 02:43:51 PM
IN THE COUNTY COURT OF THE SIXTH JUDICIAL CIRCUIT
IN AND FOR PINELLAS COUNTY, FLORIDA
SMALL CLAIMS DIVISION
MRI ASSOCIATES OF PALM HARBOR, INC.
D/B/A PALM HARBOR MRI A/A/O
JENNIFER KNUTSON
CASE NO.:
Plaintiff,
-vs-
STATE FARM MUTUAL AUTOMOBILE
INSURANCE COMPANY
Defendant.
COMPLAINT/DEMAND FOR JUDGMENT
COMES NOW, the Plaintiff, MRI ASSOCIATES OF PALM HARBOR, INC. D/B/A
PALM HARBOR MRI A/A/O JENNIFER KNUTSON, by and through the undersigned
attorney, sues the Defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE
COMPANY, and as grounds therefore would state as follows:
GENERAL ALLEGATIONS
1. The Plaintiff is a Florida corporation having its principal place of business in Pinellas
County, Florida.
2. Defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, is a
foreign company, having its principal place of business in the State of Illinois, with authority
to transact business in the State of Florida.
3. At all times hereto, Plaintiff is the assignee of PIP benefits, under an Assignment of Benefits,
executed by Defendant’s insured, JENNIFER KNUTSON. See Exhibit “A”.
4. Plaintiff has the requisite standing to bring forth this action by virtue of receiving an
***ELECTRONICALLY FILED 1/31/2014 2:43:49 PM: KEN BURKE, CLERK OF THE CIRCUIT COURT, PINELLAS COUNTY***
Assignment of Benefits from Defendant’s insured.
Page 1 of 310.
11.
12.
13,
14.
This is an action for damages whose amount in controversy is less than five thousand dollars
($5,000.00) and is in the jurisdiction of this Honorable Court.
COUNT I- BREACH OF CONTRACT FOR THE RECOVERY OF PIP BENEFITS
UNDER ELA. STAT. 627.736 ON BEHALF OF PATIENT
Plaintiff re-alleges Paragraphs 1 through 5, as if fully set herein.
Defendant is the insurer for JENNIFER KNUTSON under policy number 686543659C, for
which John Knutson paid valuable consideration.
Said policy, by its terms, provided inter alia personal injury coverage (otherwise known as
PIP), in the amount of $10,000.00.
Defendant’s insurance policy with JENNIFER KNUTSON was in full force and effect at the
time treatment and/or services were rendered.
. On or about April 7, 2011, JENNIFER KNUTSON was involved in a motor vehicle accident,
sustained bodily injuries, and subsequently incurred medical expenses for treatment,
including but not limited to chiropractic care and modalities, MRI and other radiological
imaging services, and medical doctor services.
JENNIFER KNUTSON came under the care and treatment of Plaintiff on or about October
2, 2013 and voluntarily executed an Assignment of Benefits with Plaintiff.
Plaintiff provided reasonable and necessary care and treatment to Defendant’s insured, for
the injuries resulting from the motor vehicle accident.
. Plaintiff timely submitted reasonable and necessary medical charges, relating to JENNIFER
KNUTSON’s treatment, to Defendant for payment under PIP.
Defendant has since refused to pay Plaintiff’s charges in the amount of $1,952.00 for date(s)
of service October 2, 2013, which is 80% of the total charges of 2,440.00.
Page 2 of 315. Plaintiff has complied with all prerequisites prior to filing this action by submitting a demand
letter for payment of overdue benefits, pursuant to Fla. Stat. 627.736(10). See Exhibit “B”.
16. As a result of Defendant’s refusal to pay Plaintiff, Defendant has heretofore breached the
contract with its insured; and also the Plaintiff by virtue of the assignment of benefits.
17. Consequently, it has become necessary for Plaintiff to hire the undersigned counsel, to whom.
Plaintiff is now obligated for the payment of attorney’s fees and costs.
WHEREFORE, Plaintiff, MRI ASSOCIATES OF PALM HARBOR, INC. D/B/A PALM
HARBOR MRI demands judgment against the Defendant, STATE FARM MUTUAL
AUTOMOBILE INSURANCE COMPANY, for the payment of overdue PIP beneiits of
$1,952.00 less any deductible, together with interest, costs, and attorney’s fees pursuant to Fla.
Stat. 627.736(8) and Fla. Stat. 627.428(1).
Dated this 23 day of January, 201
Stephen Farkas, Esquire
FBN: 84160
Matthew A. Dolman\ Esquire
FBN: 0729221 J
DOLMAN LAW GROUP
800 North Belcher Road
Telephone: (727) 451-6900
Facsimile: (727) 451-6907
service@dolmanlaw.com
Attorneys for Plaintiff
Page 3 of 3
Preview
Case Number: 14-000735-SC . Filing # 9779372 Electronically Filed 01/31/2014 02:43:51 PM IN THE COUNTY COURT OF THE SIXTH JUDICIAL CIRCUIT IN AND FOR PINELLAS COUNTY, FLORIDA SMALL CLAIMS DIVISION MRI ASSOCIATES OF PALM HARBOR, INC. D/B/A PALM HARBOR MRI A/A/O JENNIFER KNUTSON CASE NO.: Plaintiff, -vs- STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY Defendant. COMPLAINT/DEMAND FOR JUDGMENT COMES NOW, the Plaintiff, MRI ASSOCIATES OF PALM HARBOR, INC. D/B/A PALM HARBOR MRI A/A/O JENNIFER KNUTSON, by and through the undersigned attorney, sues the Defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, and as grounds therefore would state as follows: GENERAL ALLEGATIONS 1. The Plaintiff is a Florida corporation having its principal place of business in Pinellas County, Florida. 2. Defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, is a foreign company, having its principal place of business in the State of Illinois, with authority to transact business in the State of Florida. 3. At all times hereto, Plaintiff is the assignee of PIP benefits, under an Assignment of Benefits, executed by Defendant’s insured, JENNIFER KNUTSON. See Exhibit “A”. 4. Plaintiff has the requisite standing to bring forth this action by virtue of receiving an ***ELECTRONICALLY FILED 1/31/2014 2:43:49 PM: KEN BURKE, CLERK OF THE CIRCUIT COURT, PINELLAS COUNTY*** Assignment of Benefits from Defendant’s insured. Page 1 of 310. 11. 12. 13, 14. This is an action for damages whose amount in controversy is less than five thousand dollars ($5,000.00) and is in the jurisdiction of this Honorable Court. COUNT I- BREACH OF CONTRACT FOR THE RECOVERY OF PIP BENEFITS UNDER ELA. STAT. 627.736 ON BEHALF OF PATIENT Plaintiff re-alleges Paragraphs 1 through 5, as if fully set herein. Defendant is the insurer for JENNIFER KNUTSON under policy number 686543659C, for which John Knutson paid valuable consideration. Said policy, by its terms, provided inter alia personal injury coverage (otherwise known as PIP), in the amount of $10,000.00. Defendant’s insurance policy with JENNIFER KNUTSON was in full force and effect at the time treatment and/or services were rendered. . On or about April 7, 2011, JENNIFER KNUTSON was involved in a motor vehicle accident, sustained bodily injuries, and subsequently incurred medical expenses for treatment, including but not limited to chiropractic care and modalities, MRI and other radiological imaging services, and medical doctor services. JENNIFER KNUTSON came under the care and treatment of Plaintiff on or about October 2, 2013 and voluntarily executed an Assignment of Benefits with Plaintiff. Plaintiff provided reasonable and necessary care and treatment to Defendant’s insured, for the injuries resulting from the motor vehicle accident. . Plaintiff timely submitted reasonable and necessary medical charges, relating to JENNIFER KNUTSON’s treatment, to Defendant for payment under PIP. Defendant has since refused to pay Plaintiff’s charges in the amount of $1,952.00 for date(s) of service October 2, 2013, which is 80% of the total charges of 2,440.00. Page 2 of 315. Plaintiff has complied with all prerequisites prior to filing this action by submitting a demand letter for payment of overdue benefits, pursuant to Fla. Stat. 627.736(10). See Exhibit “B”. 16. As a result of Defendant’s refusal to pay Plaintiff, Defendant has heretofore breached the contract with its insured; and also the Plaintiff by virtue of the assignment of benefits. 17. Consequently, it has become necessary for Plaintiff to hire the undersigned counsel, to whom. Plaintiff is now obligated for the payment of attorney’s fees and costs. WHEREFORE, Plaintiff, MRI ASSOCIATES OF PALM HARBOR, INC. D/B/A PALM HARBOR MRI demands judgment against the Defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, for the payment of overdue PIP beneiits of $1,952.00 less any deductible, together with interest, costs, and attorney’s fees pursuant to Fla. Stat. 627.736(8) and Fla. Stat. 627.428(1). Dated this 23 day of January, 201 Stephen Farkas, Esquire FBN: 84160 Matthew A. Dolman\ Esquire FBN: 0729221 J DOLMAN LAW GROUP 800 North Belcher Road Telephone: (727) 451-6900 Facsimile: (727) 451-6907 service@dolmanlaw.com Attorneys for Plaintiff Page 3 of 3