Filing # 142476076 E-Filed 01/24/2022 09:06:42 AM
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`16-2022-SC-001756-INSX-MA Div: CC-B
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`IN THE COUNTY COURT IN AND FOR
`DUVAL COUNTY, FLORIDA
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`CASE NO.::
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`JAX SPINE & PAIN CENTER
`A/A/O RHONDA TAYLOR,
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`VS.
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`Plaintiff,
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`GARRISON PROPERTY AND CASUALTY
`INSURANCE COMPANY,
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`Defendant.
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`/
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`COMPLAINT
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`COMES NOW,the Plaintiff, JAX SPINE & PAIN CENTER,as (Assignee) for RHONDA
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`TAYLOR (Assignor), by and through the undersigned counsel, and sues the Defendant,
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`GARRISON PROPERTY AND CASUALTY INSURANCE COMPANY,andalleges:
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`1.
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`2.
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`3.
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`4.
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`5.
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`6.
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`This is an action for damages that upon information andbelief is under $99.99 exclusive of
`interest, costs and attorney's fees.
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`At all times material hereto, Defendant was a corporation duly licensed to transact business
`in the State of Florida and maintained agents for the transaction of its customary business in
`DUVALCounty, Florida.
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`Assignor sought treatment from Assignee and assigned their PIP benefits over to said
`medical provider. A valid assignment of benefits has been provided to the medical provider
`by the assignee. Additional evidence of an assignment can be established by the health
`insurance claim form previously provided to the Defendant by the medical provider(i.e. the
`HCFA/CMS-1500 Health Insurance Claim Form). If for some reason the Court determines
`that a valid written assignment does not exist, an equitable assignment can be found by the
`actions of the Defendant and Plaintiff in that the Defendant has made payment(s) directly to the
`medical provider. See Giles v. Sun Bank, 450 So.2d 258 (Fla. 5" DCA 1994).
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`On January 22, 2017, Rhonda Taylor was involved in an automobile accidentin the state of
`Florida.
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`Following said accident, Rhonda Taylor underwent medical treatment with Jax Spine &
`Pain Center for injuries sustained as a direct result of said accident on January 22, 2017.
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`Defendant issued a policy of insurance to Rhonda Taylor, which insured patient Rhonda
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`ACCEPTED: DUVAL COUNTY, JODY PHILLIPS, CLERK, 01/24/2022 09:42:37 AM
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`Taylor, or in the alternative Rhonda Taylor was the name insured on the policy, or in the
`alternative Rhonda Taylor was a dependentresidentrelative of the named insured,or in the
`alternative Rhonda Taylor was entitled to PIP benefits belonging to the motor vehicle
`involved in the accident on January 22, 2017. Plaintiff does not have a copy ofsaid policy
`to attach; however, Defendant does have a copy of policy. A copy of said policy has been
`requested through discovery.
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`Atall times material hereto, said policy of insurance was in full force andeffect.
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`Plaintiff has performedall conditions precedentto entitle it to recover benefits, including
`compliance with F.S. §627.736(10).
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`Rhonda Taylor furnished Defendant with a properly executed application for PIP benefits
`together with medical authorization for the Defendant to obtain the information needed to
`process the claim.
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`10.
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`11.
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`12.
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`On or about January 22, 2017, Rhonda Taylor was involved in a motor vehicle accident in
`the state of Florida and sustained personalinjuries as a direct causalresult of said accident.
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`Asa direct and proximate result of the injuries Assignor sustained in the accident, Rhonda
`Taylor incurred reasonable expenses for necessary medicalcare.
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`Defendant denied full payment for medically necessary treatment provided to Rhonda
`Taylor by Jax Spine & Pain Center. Defendant did not makefull payment of Assignor’s PIP
`benefits for the following medical expenses provided by the Plaintiff within 30 days as
`required by Florida Statute, §627.736 (1), plus interest on late payment. Specifically, the
`Defendant recetved the following medical bills from the Plaintiff for medical services
`renderedto the assignor: dates of service 3/8/2017 through 4/24/2018 totaling $10,983.50,at
`80% equals $8,786.80, less prior payment of $4,837.32, leaves a balance of $4,959.48; plus
`applicable interest. If the policy at issue provides medical payments coverage, then the
`balanceis the difference between the total amount billed at 100% less any prior payments,
`plus applicable interest.
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`A. In the alternative, should the Court deem Defendant’s policy to be “properly
`amended”to allow for payments at the “Medicare Fee Schedule”, Defendant did not
`properly reimburse Plaintiff's charges pursuant to the PIP Statute with respect to
`the Non-Facility Limiting Charge(s).
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`B. Additionally, in the alternative, Defendant did not properly rermburse Plaintiff's
`charges pursuant to the PIP Statute with respect to CPT Codesbilled at less than
`200% of the “Medicare Fee Schedule”.
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`13.
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`issue, after any applicable deductible,
`the amount at
`Upon information and belief,
`application of fee schedule (if applicable), and limitation for the amountof available PIP (if
`applicable) is believed to be less than $99.99 plus applicable interest.
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`14,
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`15.
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`16.
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`17.
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`18.
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`To date, Defendant has yet to pay all or a portion of Plaintiffs clatm including applicable
`postage, penalty and interest for payments made over 30 days from the date Defendant
`receivedsaidbills.
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`As a result of Defendant’s breach and failure to pay all or a portion of Plaintiffs claim, the
`Defendant, Garrison Property and Casualty Insurance Company, has breached the contract
`of insurance with the Plaintiff.
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`The Defendant is in violation of §627.736(1)(b), Florida Statutes, for failing to pay the
`Assignor’s medical bills within 30 days of receipt plus applicable interest despite the fact
`that Defendant had no reasonable proof to establish that it is not responsible for said
`payments within thirty (30) days from the date the Defendant received the bills and for
`postage , penalty and interest on payments madeoutside of the statutory 30 days of received
`of saidbills.
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`Due to the Defendant’s breach and failure to pay PIP benefits and interest in accordance
`with the law, Plaintiff has suffered damages and has been required to retain the undersigned
`law firm for the prosecution of this PIP suit. The Plaintiff has agreed to pay and the attorney
`of this firm has agreed to accept any Court awardedfee.
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`Plaintiff would derive a direct benefit from the Court's Judgmentordering the Defendant to
`pay the applicable Personal Injury Protection benefits to the Plaintiff, together with interest
`postage, and penalty and attorney's fees pursuantto Florida Statute §627.736 and §627.428.
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`WHEREFORE,the Plaintiff, JAX SPINE & PAIN CENTER,as (Assignee) for RHONDA
`TAYLOR(Assignor) demands judgment for Personal Injury Protection benefits, postage, penalty,
`interest, cost and attorney’s fees pursuant to Florida Statutes, §§627.736 and 627.428,
`legal
`assistants’ fees pursuant to §57.104 Florida Statutes, and costs pursuant to §92.231, Florida Statutes
`and §57-041, Florida Statutes, and any andall furtherrelief as this Court deems just and proper, and
`further demandsa trial by Jury on all issues.
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`CERTIFICATE OF SERVICE
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`I HEREBY CERTIFY that a copy of the foregoing has been furnished to the Defendant
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`herein through service of process.
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`SHUSTER & SABEN, LLC
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`/s/ Adam Saben, Esq.
`ADAM SABEN,ESQ.
`Fla. Bar No.: 0958697
`E-mail: Adam@piplaw.com
`MELISSA R. WINER, ESQ.
`Fla. Bar No.: 084594
`E-Mail: Melissa@piplaw.com
`JULIA E. GAZECKA, ESQ.
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`
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`Fla. Bar No.: 1011317
`E-Mail: JuliaG@piplaw.com
`10245 Centurion Parkway N., Suite 305
`Jacksonville, Florida 32256
`Pleading E-mail: Jaxpleadings@piplaw.com
`Telephone:
`904-999-4000
`Fax Number: 904-374-9644
`Attorney for Plaintiff
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