Preview
Case Number: 14-000764-SC
***ELECTRONICALLY FILED 1/31/2014 5:24:38 PM: KEN BURKE, CLERK OF THE CIRCUIT COURT, PINELLAS COUNTY***
Filing # 9796997 Electronically Filed 01/31/2014 05:24:40 PM
IN THE COUNTY COURT OF THE SIXTH JUDICIAL CIRCUIT
IN AND FOR PINELLAS COUNTY, FLORIDA
SMALL CLAIMS
LR.C. INTEGRAL REHABILITATION
CENTER), LLC, as assignee of ROSA C
VALLE,
Plaintiff, CASE NO.:
vs.
STATE FARM MUTUAL AUTOMOBILE
INSURANCE COMPANY,
Defendant.
NOTICE OF SERVICE OF PLAINTIFF’S INTERRGATORIES
To: State Farm Mutual Automobile Insurance Company
C/o Insurance Commissioner
Department of Financial Services
200 East Gaines St.
Tallahassee, FL 32399
Plaintiff, Rosa C Valle, (hereinafter “Plaintiff’), by and through its undersigned attorney,
propounds to the Defendant, State Farm Mutual Automobile Insurance Company, (hereinafter
referred to as Defendant), pursuant to Rule 1.340 of the Florida Rules of Civil Procedure, the
attached written Interrogatories, answers to which will be due under oath within thirty (45) days
from the date of service hereof.EXPLANATION OF TERMS
As used in these Interrogatories, the following terms and definitions are intended to apply:
1. “You or Your” refers to the Defendant and its agents, employees, representatives and all
other persons acting on its behalf or at its request. Your response to these Interrogatories
must reflect and contain the knowledge of all persons embraced by the term “Defendant”
or the terms “you” or “your”.
2. “Person” refers to any corporation, individual, joint venture, partnership, group,
association, government agency, or any other identifiable entity.
3. “Communication” refers to the transmission, transfer or receipt of information in any
form, by any means, in any manner, at any time or place, under any circumstances
whatsoever.
4. “Document or Documents” refers to writings, letters, telegrams, memoranda, recorded
recollections of conferences or telephone conversations, reports, studies, lists, any written
compilation of data, papers, books, records, records, contracts, drawings, photographs,
mechanical or electronic recordings in any form, and all other identifiable objects upon
which any inscription, handwriting, typing, printing, drawing, representation by any
means, weather magnetic, electrical, photo static, or any other form of communication is
recorded, reproduced, perpetuated, maintained or preserved. These terms similarly
embrace the reproduction or copies of the foregoing.“Identify a Document” refers to the requirement that the identity of the person preparing
the document be disclosed, the identity of all persons signing, issuing and/or attesting to
such document be disclosed, the identity of addresses or distributes be disclosed with
sufficient particularity so as to enable identification. The date which the document was
prepared, released, or transmitted should be disclosed, and the physical location of the
document, together with the names and addresses of the custodian or custodians of the
documents should be disclosed.
“Identify a Person” when employed, with regard to a natural person, it refers to the name
of such person, the present or last known address of such person, the name and the
address of such person, the name and address of such person’s employer and the position
of employment held by such person. When the clause “identify person” is employed with
reference to a person that is not an individual, such term shall require the name and
principal office of such person, the date and place of incorporation, if applicable, and
such other information as necessary to identify, locate and/or communicate with such
person.
LR.C. INTEGRAL REHABILITATION CENTER), LLC refers to the above-named.
Plaintiff in this action.
“Insured” refers to “Insured”
“Injured Party” refers to Rosa C ValleCERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing was furnished by
service of process this 30th day of January, 2014, to the above-named addressee.
s/___ Kendrick J. Blackwell
KENDRICK J. BLACKWELL, ESQUIRE
FBN: 46019
R. STANLEY GIPE, P.A., ESQ.
FBN: 0187607
Attorneys for Plaintiff
PIP LAW GROUP OF FLORIDA, P.A.
3135 State Road 580, Ste 8
Safety Harbor, FL 34695
E-Mail: Service @ PIPLawGroup.com
Telephone: (727) 797-5298
Facsimile: (727) 897-5459PLAINTIFF’S FIRST INTERRROGATORIES TO DEFENDANT
State the name, social security number, title years of experience at current position, and
work address for the person answering these interrogatories on behalf of the Defendant,
and give the name and business address of anyone assisting you in answering these
interrogatories.
State the total amount of personal injury protection benefits and/or medical payment
benefits paid to date on the bills for this insured for the provider(s) this cause of action
addresses, listing the address and name of the person or organization which was paid, the
category of each payment, the date each bill was received, the date each payment was
made and the total amount of each payment and identify any charges that were unpaid
including reason for non-payment.
Please state the date you first received notice of a covered loss with regard to
the motor "vehicle accident as plead in Plaintiff's Complaint and the date you
received a PIP application, if so received and identify whether the application was
complete and if not, identify missing, incomplete, or objectionable items or any other
basis for which the Defendant is claiming a defense to payment on the basis that
Defendant was not on notice of a covered loss.4.
Please list the name, address, and telephone number of all persons (other than
medical witnesses or employees of the Defendant) believed or known by your, your
agents, or attorneys to have knowledge concerning any of the outstanding benefits
owed as plead in Plaintiff s Complaint or of the motor vehicle accident as plead in
Plaintiffs Complaint.
Please list the name, work address, and telephone numbers of all persons,
including your agent, representatives, and employees other than those identified in
question number one, above, believed or known by you, your agents, or attorneys to
have knowledge or to have handled any of the claim for personal injury
protection or medical payments coverage benefits as plead in Plaintiffs
Complaint.
State whether the above medical bills were reviewed for any reason whatsoever
by any person or organization. If said bills were reviewed, please state the name of
the person or organization that performed the review, their address, the dates of
review, the qualifications and/or licenses currently held by said person or
organization, and a detailed summary of the review, including, but not limited to,
explanations and/or conclusions of the review with facts supporting said
conclusions. Also state the substance of that person or organization's opinion and
identify any materials that were reviewed by said person or organization in
forming their opinion, including the date those materials were created.9.
Please identify, with enough specificity to allow for the drafting of a Request for
Production, any and all contracts the defendant has entered into with any person or
entity reflecting an agreed upon reimbursement rate for any of the CPT codes
submitted by the plaintiff in this case, specifically identifying the parties to the
contract, the CPT codes involved and the reimbursement level for each CPT code.
State the total amount of benefits available to the patient in this case including
PIP, Med Pay, and or any other supplemental coverage's that would cover injuries
sustained in the accident; include the amount of benefits, deductibles and co-
payments required by each coverage and state the insurance company name and
policy number for each coverage.
Identify with specificity each and every reason for non-payment of any portion of
any bill received by the defendant from the plaintiff, including identification of
person making decision to pay or not to pay.10.
11.
Please state with specificity each and every fact that you are relying on as
support for your reason to reduce or deny any bills as described in interrogatory
number seven (7) and specifically identify by name and precise location of any
documents or other information in existence which you believe supports the basis
for your reduction or denial and give a detailed summary of the contents of the
identified documents or other information.
Please provide corporate information on the named defendant to include the
official or legal corporate name, any fictitious names associated with the
corporation, the corporation's tax identification number, the owner or
shareholders of the corporation, the officers and directors of the corporation,
and if applicable the registration number with the Department of Insurance, and/or
any other licensing authority.
Please explain the defendant's claim handling procedures from the moment the
claim is received in the regular mail delivery until a payment or explanation of
benefits is mailed back to the provider, specifically identifying by name and
position each and every person who came into contact with any information related
to any of the claims submitted by this Plaintiff. This includes but is not limited to
mail room personnel and reviewing personnel and/or companies. For each person
that came into any contact with any information list the reason for the contact, the
person or organizations name, the persons position, the nature of the information
that the person or organization has come into contact with, and whether or not that
person or organization generated any documentation or report of any kind, including
the location of the report or documentation.13.
Please identify each and every person who is known or reasonably believed by
you, your agents, or attorneys to have any knowledge concerning any of the
issues raised by the pleadings or any other reason for nonpayment, reduction, or
denial of any bill and specify their name, address, phone number, employer (if
known) and the subject matter about which each witness has knowledge.
Please state the identity or identify any and all documents, materials, and other
physical evidence you rely upon to support your contention that:
(a) That the injuries to the Defendant's insured were not related to the subject
accident;
(b) That the Plaintiff's charges are not "usual", "customary" and/or "reasonable" for
the services provided.
(c) That the medical services provided were not medically necessary.15.
16.
17.
State in specific detail each and every reason that you believe that the facts do not
support the charges assigned with each of the CPT codes and give a detailed
explanation as to why you believe that any dates of service for this patient were not
"medically necessary" (section 627.736 of the Florida Statutes states: "Medically
necessary" refers to a medical service or supply that a prudent physician would
provide for the purpose of preventing, diagnosing, or treating an illness, injury,
disease, or symptom in a manner that is: (a) In accordance with generally accepted
standards of medical practice; (b) Not primarily for the convenience of the patient,
physician, or other health care provider for the treatment and care provided to the
Defendant's insured).
Please state the names, addresses and the extent of the education, (giving names
and
addresses of all schools, colleges, universities, vocational schools, or other
institutions attended and the years attended, as well as stating any degrees,
certifications, or licenses (other than driver's license) of all persons who
participated in setting your reimbursement level for the CPT codes billed by the
plaintiff in this cause.
Please set forth any and all information relied upon by you, your staff, or business to
include but not limited to all documents, reports, surveys, databases, writings,
memoranda etc in the development of your reimbursement levels for charges
submitted by this plaintiff.18.
19,
20.
Does the Defendant have a contract agreement with any company that reviewed any
of the claims submitted by this provider? If so, please state the nature of the
contract, and the identity and address of the parties to the contract, the identity
of the person who has possession of the contract, the terms and conditions of the
contract, and identify any person whose name appears on the contract (you may
attach the contract in response to this interrogatory).
Please state whether or not, during the past three years, you have even been involved
in any other litigation involving the same CPT codes that are at issue in this case. If
so, please set forth the name of the case, the jurisdiction where the case was
pending, the case number (you may, in the alternative, simply attach a copy of the
pleadings related to those claims) and the names and address of the attorneys
involved for both the Plaintiff and Defendant and the ultimate resolution of the case.
Please set forth any and all information relied upon, including identification of
documents 'that you intend to introduce at trial as support for the development of your
reimbursement levels for the charges submitted by this Plaintiff with regard to
the motor vehicle accident as plead in Plaintiff's Complaint, including all
documents, reports, surveys, databases, writings, memoranda and alike with such
specificity as to draft an appropriate request to produce.21.
22.
23.
24.
Do you intend to call any expert witnesses at the trial of this case? If so, state as
to each such witness the name and business address of the witness, the witness's
qualifications as an expert, the subject matter upon which the witness is expected to
testify, the substance of the facts and opinions to which the witness is expected to
testify, and a summary of the grounds for each opinion.
For each and any policy defense which you reasonably believe is available with
regard to the Plaintiff's claim in this action, please describe and detail the factual and
legal basis for any such defense including identification of any documents relied upon
in such defense that you intend to use at trial in this matter.
For each and any affirmative defense which you have asserted in this matter, kindly
provide the factual legal basis for any such defense, specificity of the facts of the
defense itself, and any documents upon which you intend to rely on at trial in this
matter to prove such a defense.
Has your SIU department investigated the Plaintiff or this claimant in the past 5 years?Print Name:
STATE OF FLORIDA
COUNTY OF
SWORN TO AND SUBSCRIBED BEFORE ME, this day of. .2011,
by. who personally appeared, deposes and says
that the foregoing Answers to Interrogatories are true and correct to the best of his/her
knowledge and belief, and who is either personally known to me or has produced
as identification.
Print Name:
NOTARY PUBLIC
My Commission Expires:
(Notarial Seal)
Preview
Case Number: 14-000764-SC ***ELECTRONICALLY FILED 1/31/2014 5:24:38 PM: KEN BURKE, CLERK OF THE CIRCUIT COURT, PINELLAS COUNTY*** Filing # 9796997 Electronically Filed 01/31/2014 05:24:40 PM IN THE COUNTY COURT OF THE SIXTH JUDICIAL CIRCUIT IN AND FOR PINELLAS COUNTY, FLORIDA SMALL CLAIMS LR.C. INTEGRAL REHABILITATION CENTER), LLC, as assignee of ROSA C VALLE, Plaintiff, CASE NO.: vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. NOTICE OF SERVICE OF PLAINTIFF’S INTERRGATORIES To: State Farm Mutual Automobile Insurance Company C/o Insurance Commissioner Department of Financial Services 200 East Gaines St. Tallahassee, FL 32399 Plaintiff, Rosa C Valle, (hereinafter “Plaintiff’), by and through its undersigned attorney, propounds to the Defendant, State Farm Mutual Automobile Insurance Company, (hereinafter referred to as Defendant), pursuant to Rule 1.340 of the Florida Rules of Civil Procedure, the attached written Interrogatories, answers to which will be due under oath within thirty (45) days from the date of service hereof.EXPLANATION OF TERMS As used in these Interrogatories, the following terms and definitions are intended to apply: 1. “You or Your” refers to the Defendant and its agents, employees, representatives and all other persons acting on its behalf or at its request. Your response to these Interrogatories must reflect and contain the knowledge of all persons embraced by the term “Defendant” or the terms “you” or “your”. 2. “Person” refers to any corporation, individual, joint venture, partnership, group, association, government agency, or any other identifiable entity. 3. “Communication” refers to the transmission, transfer or receipt of information in any form, by any means, in any manner, at any time or place, under any circumstances whatsoever. 4. “Document or Documents” refers to writings, letters, telegrams, memoranda, recorded recollections of conferences or telephone conversations, reports, studies, lists, any written compilation of data, papers, books, records, records, contracts, drawings, photographs, mechanical or electronic recordings in any form, and all other identifiable objects upon which any inscription, handwriting, typing, printing, drawing, representation by any means, weather magnetic, electrical, photo static, or any other form of communication is recorded, reproduced, perpetuated, maintained or preserved. These terms similarly embrace the reproduction or copies of the foregoing.“Identify a Document” refers to the requirement that the identity of the person preparing the document be disclosed, the identity of all persons signing, issuing and/or attesting to such document be disclosed, the identity of addresses or distributes be disclosed with sufficient particularity so as to enable identification. The date which the document was prepared, released, or transmitted should be disclosed, and the physical location of the document, together with the names and addresses of the custodian or custodians of the documents should be disclosed. “Identify a Person” when employed, with regard to a natural person, it refers to the name of such person, the present or last known address of such person, the name and the address of such person, the name and address of such person’s employer and the position of employment held by such person. When the clause “identify person” is employed with reference to a person that is not an individual, such term shall require the name and principal office of such person, the date and place of incorporation, if applicable, and such other information as necessary to identify, locate and/or communicate with such person. LR.C. INTEGRAL REHABILITATION CENTER), LLC refers to the above-named. Plaintiff in this action. “Insured” refers to “Insured” “Injured Party” refers to Rosa C ValleCERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing was furnished by service of process this 30th day of January, 2014, to the above-named addressee. s/___ Kendrick J. Blackwell KENDRICK J. BLACKWELL, ESQUIRE FBN: 46019 R. STANLEY GIPE, P.A., ESQ. FBN: 0187607 Attorneys for Plaintiff PIP LAW GROUP OF FLORIDA, P.A. 3135 State Road 580, Ste 8 Safety Harbor, FL 34695 E-Mail: Service @ PIPLawGroup.com Telephone: (727) 797-5298 Facsimile: (727) 897-5459PLAINTIFF’S FIRST INTERRROGATORIES TO DEFENDANT State the name, social security number, title years of experience at current position, and work address for the person answering these interrogatories on behalf of the Defendant, and give the name and business address of anyone assisting you in answering these interrogatories. State the total amount of personal injury protection benefits and/or medical payment benefits paid to date on the bills for this insured for the provider(s) this cause of action addresses, listing the address and name of the person or organization which was paid, the category of each payment, the date each bill was received, the date each payment was made and the total amount of each payment and identify any charges that were unpaid including reason for non-payment. Please state the date you first received notice of a covered loss with regard to the motor "vehicle accident as plead in Plaintiff's Complaint and the date you received a PIP application, if so received and identify whether the application was complete and if not, identify missing, incomplete, or objectionable items or any other basis for which the Defendant is claiming a defense to payment on the basis that Defendant was not on notice of a covered loss.4. Please list the name, address, and telephone number of all persons (other than medical witnesses or employees of the Defendant) believed or known by your, your agents, or attorneys to have knowledge concerning any of the outstanding benefits owed as plead in Plaintiff s Complaint or of the motor vehicle accident as plead in Plaintiffs Complaint. Please list the name, work address, and telephone numbers of all persons, including your agent, representatives, and employees other than those identified in question number one, above, believed or known by you, your agents, or attorneys to have knowledge or to have handled any of the claim for personal injury protection or medical payments coverage benefits as plead in Plaintiffs Complaint. State whether the above medical bills were reviewed for any reason whatsoever by any person or organization. If said bills were reviewed, please state the name of the person or organization that performed the review, their address, the dates of review, the qualifications and/or licenses currently held by said person or organization, and a detailed summary of the review, including, but not limited to, explanations and/or conclusions of the review with facts supporting said conclusions. Also state the substance of that person or organization's opinion and identify any materials that were reviewed by said person or organization in forming their opinion, including the date those materials were created.9. Please identify, with enough specificity to allow for the drafting of a Request for Production, any and all contracts the defendant has entered into with any person or entity reflecting an agreed upon reimbursement rate for any of the CPT codes submitted by the plaintiff in this case, specifically identifying the parties to the contract, the CPT codes involved and the reimbursement level for each CPT code. State the total amount of benefits available to the patient in this case including PIP, Med Pay, and or any other supplemental coverage's that would cover injuries sustained in the accident; include the amount of benefits, deductibles and co- payments required by each coverage and state the insurance company name and policy number for each coverage. Identify with specificity each and every reason for non-payment of any portion of any bill received by the defendant from the plaintiff, including identification of person making decision to pay or not to pay.10. 11. Please state with specificity each and every fact that you are relying on as support for your reason to reduce or deny any bills as described in interrogatory number seven (7) and specifically identify by name and precise location of any documents or other information in existence which you believe supports the basis for your reduction or denial and give a detailed summary of the contents of the identified documents or other information. Please provide corporate information on the named defendant to include the official or legal corporate name, any fictitious names associated with the corporation, the corporation's tax identification number, the owner or shareholders of the corporation, the officers and directors of the corporation, and if applicable the registration number with the Department of Insurance, and/or any other licensing authority. Please explain the defendant's claim handling procedures from the moment the claim is received in the regular mail delivery until a payment or explanation of benefits is mailed back to the provider, specifically identifying by name and position each and every person who came into contact with any information related to any of the claims submitted by this Plaintiff. This includes but is not limited to mail room personnel and reviewing personnel and/or companies. For each person that came into any contact with any information list the reason for the contact, the person or organizations name, the persons position, the nature of the information that the person or organization has come into contact with, and whether or not that person or organization generated any documentation or report of any kind, including the location of the report or documentation.13. Please identify each and every person who is known or reasonably believed by you, your agents, or attorneys to have any knowledge concerning any of the issues raised by the pleadings or any other reason for nonpayment, reduction, or denial of any bill and specify their name, address, phone number, employer (if known) and the subject matter about which each witness has knowledge. Please state the identity or identify any and all documents, materials, and other physical evidence you rely upon to support your contention that: (a) That the injuries to the Defendant's insured were not related to the subject accident; (b) That the Plaintiff's charges are not "usual", "customary" and/or "reasonable" for the services provided. (c) That the medical services provided were not medically necessary.15. 16. 17. State in specific detail each and every reason that you believe that the facts do not support the charges assigned with each of the CPT codes and give a detailed explanation as to why you believe that any dates of service for this patient were not "medically necessary" (section 627.736 of the Florida Statutes states: "Medically necessary" refers to a medical service or supply that a prudent physician would provide for the purpose of preventing, diagnosing, or treating an illness, injury, disease, or symptom in a manner that is: (a) In accordance with generally accepted standards of medical practice; (b) Not primarily for the convenience of the patient, physician, or other health care provider for the treatment and care provided to the Defendant's insured). Please state the names, addresses and the extent of the education, (giving names and addresses of all schools, colleges, universities, vocational schools, or other institutions attended and the years attended, as well as stating any degrees, certifications, or licenses (other than driver's license) of all persons who participated in setting your reimbursement level for the CPT codes billed by the plaintiff in this cause. Please set forth any and all information relied upon by you, your staff, or business to include but not limited to all documents, reports, surveys, databases, writings, memoranda etc in the development of your reimbursement levels for charges submitted by this plaintiff.18. 19, 20. Does the Defendant have a contract agreement with any company that reviewed any of the claims submitted by this provider? If so, please state the nature of the contract, and the identity and address of the parties to the contract, the identity of the person who has possession of the contract, the terms and conditions of the contract, and identify any person whose name appears on the contract (you may attach the contract in response to this interrogatory). Please state whether or not, during the past three years, you have even been involved in any other litigation involving the same CPT codes that are at issue in this case. If so, please set forth the name of the case, the jurisdiction where the case was pending, the case number (you may, in the alternative, simply attach a copy of the pleadings related to those claims) and the names and address of the attorneys involved for both the Plaintiff and Defendant and the ultimate resolution of the case. Please set forth any and all information relied upon, including identification of documents 'that you intend to introduce at trial as support for the development of your reimbursement levels for the charges submitted by this Plaintiff with regard to the motor vehicle accident as plead in Plaintiff's Complaint, including all documents, reports, surveys, databases, writings, memoranda and alike with such specificity as to draft an appropriate request to produce.21. 22. 23. 24. Do you intend to call any expert witnesses at the trial of this case? If so, state as to each such witness the name and business address of the witness, the witness's qualifications as an expert, the subject matter upon which the witness is expected to testify, the substance of the facts and opinions to which the witness is expected to testify, and a summary of the grounds for each opinion. For each and any policy defense which you reasonably believe is available with regard to the Plaintiff's claim in this action, please describe and detail the factual and legal basis for any such defense including identification of any documents relied upon in such defense that you intend to use at trial in this matter. For each and any affirmative defense which you have asserted in this matter, kindly provide the factual legal basis for any such defense, specificity of the facts of the defense itself, and any documents upon which you intend to rely on at trial in this matter to prove such a defense. Has your SIU department investigated the Plaintiff or this claimant in the past 5 years?Print Name: STATE OF FLORIDA COUNTY OF SWORN TO AND SUBSCRIBED BEFORE ME, this day of. .2011, by. who personally appeared, deposes and says that the foregoing Answers to Interrogatories are true and correct to the best of his/her knowledge and belief, and who is either personally known to me or has produced as identification. Print Name: NOTARY PUBLIC My Commission Expires: (Notarial Seal)