Filing# 153647958 E-Filed 07/19/2022 04:42:54 PM
`
`IN THE COUNTY COURT, IN AND FOR
`BROWARD COUNTY, FLORIDA
`Case No: 22-013591 COINX 61
`
`PETER F. MERKLE, MD, PA,
`
`Plaintiff.
`
`VS.
`
`USAA CASUALTY INSURANCE
`COMPANY,
`
`Defendant.
`
`1
`
`PLAINTIFF'S MOTION FOR ENTITLEMENT OF ATTORNEY'S FEES AND
`COSTS. REOUEST FOR ENTRY OF FINAL JUDGMENT WITH RESERVATION
`OF JURISDICTION, AND REOUEST FOR EVIDENTIARY HEARING TO
`DETERMINE OUANTUM OF PLAINTIFF'S ATTORNEYS FEES AND COSTS
`
`Comes now, Plaintiff,PETER F. MERKLE, MD, PA, by and through the
`
`undersignedattorney and pursuant to F.S. §§627.428, and 627.736 and Florida R. Civ.P.
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`1.525, hereby moves for Entitlement of Attorney'sFees and Costs, Request for Entry of
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`Final Judgment with Reservation of Jurisdiction,and Request for Evidentiaryhearingto
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`Determine Quantum of Plaintiffs Attorney'sFees and costs pursuant to Defendant's post
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`suit payment of outstandingmedical benefits mailed on or about July 1,2022, constitutinga
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`confession ofjudgment,and in support thereof states:
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`STATEMENT OF FACTS
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`1. This is an action for failure to pay No-Fault and Medical Payments benefits in
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`accordance with Florida's No-Fault Statute and the policyat issue.
`
`*** FILED: BROWARD COUNTY, FL BRENDA D. FORMAN, CLERK 07/19/2022 04:42:54 PM.****
`
`

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`2. On March 12, 2022, the Plaintiff,Peter F. Merkle,MD, PA filed its Complaint
`
`aginst the Defendant, USAA Casualty Insurance Company, wherein it
`specificallysoughtpayment for overdue medical benefits,overdue medical
`
`payments benefits and statutoryinterestpursuantto Section 627.736,Fla. Stat.,
`as same was due and owing in connection with the amount demanded by the
`
`Plaintiffin it'sPre-suit demand letter dated January21, 2022. Please see copy of
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`Pre-suit demand letterattached hereto as Exhibit"A".
`
`3. On February19, 2022, a draft was received in the amount of $251.68 from the
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`Defendant representingoverdue penalty,postage and interest. Please see copy
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`ofDraft attached hereto as Exhibit"B".
`
`4. However, no Draft was received by the Plaintiff or it's counsel for the
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`outstandingmedical benefits due for services providedto the patientby the
`PlaintifffromNovember 5,2021 throughand includingDecember 13,2021.
`
`5. Plaintiffwas left with no choice but to file suit in the instant matter.
`
`It was not until after suit was filed that Defendant correctlymailed the Medicals
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`6.
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`draft to the proper address for the Plaintiff's attorney,Law Offices of Michele
`Muir, PA, 15673 Southern Blvd.,Suite 107-342,Loxahatchee,FL 33470.
`7. In particular,a draft in the amount of $2,731.06was received in an envelope
`postmarkedJuly 1, 2022, accompaniedby an insert indicatingthat,"The
`enclosed was returned to USAA by the post Office. If we've reached you at a
`new address,pleasecontact USAA and updateyour address. We cannot change
`your address unless we hear from you." The mailingaddress listedon the Insert
`is Peter F. Merkle,MD c/o Michele E. Muir PA Law, 7251 W Palmetto Park Rd
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`

`

`Ste 100, Boca Raton FL 33433-3487. Please see copy of draft,envelopeand
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`Insert attached hereto as Exhibit "C".
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`8. The Defendant failed to mail the medicals Draft to the correct address provided
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`in the Plaintiff'sdemand letter.
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`9. Despiteknowing it owes additional outstandingstatutoryinterest,Defendant
`refuses to comply with its obligationsunder Section 627.736, Fla. Stat.,and its
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`own policy,which incorporatesthe No-Fault Statute.
`
`10. After receiptof the Medicals Draft,counsel for the Plaintiffcontacted counsel
`for the Defendant regardingstipulatingthat its post-suitpayment was a
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`confession,that Plaintiffis entitled to attorney'sfees and that Plaintiffis entitled
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`to additional statutoryinterest. However, no agreementshave been reached.
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`MEMORANDUM OF LAW
`
`A. Post-suit payment of medicals
`The determination of whether attorney's fees are awardable in an action
`based upon Florida' s Motor Vehicle No-Fault Law is governed by Florida Statute
`627.736(8)(627.736(8)is a part of Florida's Motor Vehicle No-Fault law and
`specificallyincorporatedin all personalinjuryprotectionpoliciespursuant to
`Florida Statute 627.7407(2))and 627.428. These statutes state as follows:
`Upon the rendition of a judgment ["withrespect to any disputeunder the
`provisionsof ss. 627.730-627.7405 between the insured and the insurer,or
`between an assigneeof an insured's rightsand the insuref'Iby any of the
`courts of this state againstall insurer and in favor of any named or
`omnibus insured or the named beneficiaryunder a policyor contract
`executed by the insurer,the trial court or, in the event of an appealin
`which the insured or beneficiaryprevails,the appellatecourt shall adjudge
`or decree againstthe insurer and in favor of the insured or beneficiarya
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`

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`reasonable sum as fees or compensationfor the insured's or beneficiary's
`attorney prosecutingthe suit in which the recovery is had.
`
`Florida Statute 627.428 and [FloridaStatute 627.736(8)is cited in the brackets].
`"Dispute,"as contemplatedby Florida Statute 627.736(8),is very broad and includes
`"any dispute."There is no limitation on the type of disputesor the type of recovery that
`must be had. The onlyrequirementis the rendition of a judgment.The Florida Supreme
`Court in Ivey v. Allstate Ins. Co., 774 So. 2d 679,684 (Fla.2000) acknowledgedthe
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`breadth ofthis statute when it held:
`
`Florida law is clear that in any dispute" which leads to judgment
`againstthe insurer and in favor of the insured, attorney'sfees shall be
`awarded to the insured. See §§ 627.736(8),627.428(1);see also
`Dunmore, 301 So.2d at 503. That is,under PIP law,the focus is outcome-
`oriented. If a dispute arises between an insurer and an insured,and
`judgment is entered in favor of the insured, he or she is entitled to
`attorney'sfees. ... It is clear to us that the purpose of this provisionis to
`level the playingfield so that the economic power of insurance companies
`is not so overwhelmingthat injusticemay be encouragedbecause people
`will not have the necessary means to seek redress in the courts.
`The Third District Court of Appeals in Amador v. Latin Am. Prop. & Cas. Ins.
`rd DCA 1989) held:
`
`Co., 552 So. 2d 1132, 1133 (Fla.3
`
`The trial court has no discretion to deny a reasonable attorney'sfee to the
`prevailingplaintiffwhere the insurance company first disputesthe claim
`and then settles the case after a lawsuit is filed. § 627.428(1),Fla.Stat.
`(1987) (upon rendition ofjudgmentagainstan insurer the trial court shall
`adjudgeagainstthe insurer and in favor of the insured or beneficiarya
`reasonable sum as attorney fees).
`
`and the Fourth District Court of Appealsin State Farm Florida Ins. Co. v. Lime
`Bay Condominium, Inc., 187 So.3d 932 (Fla.4th DCA 2016) held:
`When an insured moves for attorney'sfees under statute entitlinginsured
`to reasonable attorneyfees upon rendition ofjudgmentagainstinsurer,the
`underlyingissue is whether the suit was filed for a legitimatepurpose, and
`whether the filingacted as a necessary catalystto resolve the disputeand
`force the insurer to satisfyits obligationsunder the insurance contract.
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`

`

`"The purpose of Section 627.428 is not one of punishmentbut to
`encourage the prompt payment of valid claims." Universal Underwriters Ins. Co:
`v. Gorgei Enterprises,Inc.. App., 345 So.2d 412 (1977)."The purpose behind
`section 627.428 is plainlyto place the insured or beneficiaryin the place she
`would have been if the carrier had seasonablypaid the claim or benefits without
`
`..
`
`causing the payee to engage counsel and incur obligationsfor attorney fees.
`Travelers of Florida v. Stormont, 43 So.3d 941 (Fla.3d DCA 2010) and Federated
`Nat. Ins. Co. v. Esposito,937 So.2d 199 (Fla.4thDCA 2006). See also the 17t,th
`circuit appellateopinionin USAA General Indemnityv. Cohen Chiropractic,23
`Fla. L. Weekly Supp. 522e, (Fla.Cir. Ct. AppellateDivision,17th Cir. 2015)
`wherein the court awarded appellateattorney'sfees to the medical providerwho
`
`successfullydefended a trialcourt's award of unpaidpenalty:
`Sections 627.736(d)and 627.736(c),Florida Statutes,entitle Cohen to
`statutorypenaltyand postage. See 627.736(10)(d),Fla. Stat. (2008);
`627.736(10)(c),Fla. Stat. (2008).These provisionscontemplatea scenario
`where the insurer partiallypays a claim upon receiptof a pre-suitdemand
`letter. In that instance,the insurer is obligatedto pay "a penaltyof 10
`percentof the overdue amount paid by the insurer,subjectto a maximum
`penalty of $250" and "postalcosts if requestedby the claimant in the
`Id. Giving the statue its plainand obvious meaning,USAA is
`obligatedto pay the statutory penaltyand postage costs related to USAA S
`pre-suitpartialpayment of benefits. ... The county court ultimatelyruled
`in favor of Cohen and awarded Cohen the statutorypenaltyand postage
`related to USAA's pre-suitpartialpayment of benefits. ... Appellee's
`Motion for AppellateAttorney'sFees is hereby GRANTED with the
`amount to be determined by the county court upon remand.
`
`notice."
`
`It is well settled that the payment of a previouslydenied claim followingthe
`
`initiationof an action for recovery, but priorto the issuance of a finaljudgment,constitutes
`the functional equivalentof a confession ofjudgment.Johnson v. Omega Ins.Cq.200 So.3d
`1207, 1215 (Fla.2016).When an insurance company has agreedto settlea disputedcase, it
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`

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`has,in effect,declined to defend itspositionin the pendingsuit. Thus, the payment of the
`claim is,indeed,the functionalequivalentof a confession ofjudgmentor a verdict in favor
`
`of the insured. Wollard v. Lloyd'sand Companies of Lloyd's,439 So.2d 217,218 (Fla.
`
`1983).
`The Fourth DCA has held that when an insurer pays an amount claimed by an
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`insured after suit was filed but before the rendition of a judgment,the payment is a
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`confession ofjudgmententitlingthe insurer to an award of attorneys'fees pursuant to F.S.
`
`Section 627.428:
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`Where an insured prevailsin litigationagainstan insurance company, the
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`insured is generallyentitled to reasonable attorney'sfees. Section 627.428(1),Fla. Stat.
`
`(2009). Likewise,where an insurance company pays on a claim after the insured files suit
`but before judgment is rendered, the payment constitutes a confession of judgment or
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`verdict in favor of the insured,therebyentitlingthe insured to attorney'sfees. Florida Ins.
`
`ith DCA 2011),rev. denied,88 So.3d 148
`Guar. Ass'n v. Ehrlich,82 So.3d 849,850 (Fla.4L
`
`(Fla.2012).
`
`Trial courts have no discretion to deny fee entitlement where an insurer confessed
`judgment;it is mandatory.Losiscco v. Aetna Cas. & Sur. Co., 588 So.2d 681. 682 (Fla.3d
`DCA 1991);Avila v. Latin Am. Prop.& Cas. Ins. Co., 548 So.2d 894, 895 (Fla.3d DCA
`
`1989).
`
`B. Payment/MailboxRule
`The Plaintiff anticipatesthat the Defendant will allegethat "paymenf' of the
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`outstandingmedicals was made on or about February11, 2022 and that it properlymailed
`the medicals draft. However, it is unclear as to what address the draft was allegedlymailed
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`

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`to. The address listed on the draft is "Peter F Merkle MD C/O Michele E Muir PA Law,
`15673 Southern Blvd.,Ste 107-34,Loxahatchee Groves FL 33470-9218. This address lacks
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`the correct suitenumber for the Counsel's office.
`
`Payment is defined as "The performanceof a duty,promise,or obligation,or
`dischargeof a debt or liability,by the deliveryof money or other value." Black's Law
`nd Ed. It is the transfer of money, goods,or services in exchange for goods
`Dictionary,2?
`and services in acceptableproportionsthat have been previouslyagreed upon by all
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`partiesinvolved. https://www.Investopedia.com.
`In this matter, there was no "payment"until after the medieals draft was received
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`in July,2022. Mailinga check to an incorrect address for the debtor does not constitute
`payment simplybecause the Post Office might have been able to deliver the draft. In this
`case, it is clear there was no payment in February,2022 as the USPS returned the Draft to
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`the Defendant,USAA, due to the mailingaddress error.
`
`It is clear that the draft was never received by the Plaintiff or it'scounsel until after
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`This is evidenced by the fact that USAA acknowledgedin its July 1,2022
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`July 1,2022.
`mailingthat the check was returned to USAA by the post office. The insert included in the
`July 1,2022 envelopefurther listsan address of: Peter F. Merkle,MD c/o Michele E. Muir
`PA Law, 7251 W Palmetto Park Rd Ste 100,Boca Raton FL 33433-3487.
`Regardlessof which address USAA used, neither of these addresses are the correct
`mailingaddress,per the pre-suitdemand letter. The Plaintiff should not be punishedfor the
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`Defendant's failure to properlyaddress and mail the Draft.
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`

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`The Defendant should not be permittedto utilize the "Mailbox Rule.
`
`"
`
`It appears
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`that whatever documents USAA allegedlymailed on or about February 11, 2022 where
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`not correctlyaddressed and were returned to USAA by the USPS.
`
`Pursuant to Florida law, there exists a presumptionthat "a letter properly
`addressed,stamped and mailed is presumed to have been received by the addressee."
`Brown v. Griffen Industries. Inc.,281 So.2d 897 (Fla. 1973); Home Insurance Co. V. C
`& G SportingGoods, Inc.,453 So.2d 121 (Fla.1StDCA 1984) and Berwick v. Prudential
`,rd DCA 1983).
`Property& CasualtyAssurance Co.,436 So.2d 239 (Fla.3'
`
`USAA is not entitled to a presumptionin this case because the letter was not
`properlyaddressed and, as a result,was returned to USAA by the USPS.
`
`The mailbox rule is a rebuttable presumptionstatingthat "when somethingis
`mailed by a business,it is presumed that the ordinarycourse of business was followed in
`mailingit and that the mail was received by the addressee. Camerota v. Kaufman, 666
`So.2d 1042, 1044 (Fla.4.th DCA 1996). The key is that the presumptionis rebuttable
`and, in the instant case, it is rebutted by the incorrect address listed on the draft and the
`Insert accompanying the July 1, 2022 envelope showing that the USPS was not able to
`deliver the mail and it was returned to USAA since the address was incorrect.
`
`Bare testimony as to the Defendant's practiceof its mailing out to each
`insurer's amending the uninsured liabilitylimit
`policyholdera notice of the
`instant action
`additional evidence that the plaintiffin the
`of...policy...without
`specificallyreceived such notification,does not constitute sufficient proof of notice. For
`proof of practice,habit. or custom, alone, does not constitute proof of performanceof an
`act on a specificoccasion;there must also be some proofthat the practicewas followed
`in the particularinstance in issue. Bernstein v. LibertyMutual Ins. Co., 294 So.2d 2d 63
`(Fla.3d DCA 1974.
`
`

`

`Further,a presumptionestablishedprimarilyto facilitatethe determination of an
`See
`action isa rebuttable presumptionaffectingthe burden of producingevidence.
`Stat. (1981). Such a presumptionrequires the trier of fact to
`Section 90.303 Fla.
`assume the existence of the presumed fact unless credible evidence sufficient to sustain
`a findingof the non-existence ofthe presumedfact is introduced. See Section 90.302(1),
`Fla. Stat. (1981);C. Erhardt,supra, at Section 302.1; see generallyLadd, Presumptions
`in Civil Actions, 1977 Ariz St. L.J,275 (1977).
`The July 1, 2022 documents sent by the Defendant show that the Defendant's
`Mailbox Rule "presumption"is not applicableand has been rebutted due to the
`insufficientaddress on the mailingenvelope.
`
`C. Additional Interest due
`
`Pursuant to F.S. Section 627.736(10(d),USAA was requiredto pay overdue
`Interest when it issued the payment in response to the Plaintiffs pre-suitdemand letter.
`On or about February11, 2022, after receiptof the Plaintiff s pre-suitdemand
`letter,USAA issued a draft in the amount of $251.68 representingpenaltyof $220.80,
`This draft was not cashed/depositedas the
`postage of $7.73 and interest of $23.15.
`medicals draft was not received at the time. The postage, penalty and interest draft
`remains outstanding.Please see copy attached hereto as Exhibit "B".
`The medicals draft was not received by the Plaintiffuntilafter July 1,2022. As a
`In particular,the Defendant owes statutory
`result,additional statutoryinterest is due.
`interestof $44.52 ($0.31800dailyrate at 140 days from 2-11-22 to 7-1-22).
`In this matter, the Plaintiff,as assigneeof the subjectinsured's rights,disputesthat
`
`the Defendant paid the correct amount of interest. The Defendant owes additional interest
`
`for the periodofFebruary11, 2022 throughJuly 1,2022.
`To date,USAA has made no attempt(s)to issue additional interest due in response
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`to the Plaintiff'spre-suitdemand letter and the additional overdue interest payment
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`remains outstanding.
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`

`

`D. Attorney'sfees and costs due for overdue Statutoryinterest
`
`In this matter, the Plaintiff,as assigneeof the subjectinsured's rights,disputesthat
`
`the Defendant paidthe correct amount of interest. The Defendant owes additional interest
`for the periodfrom February11,2022 throughand includingJuly1,2022. As a resultofthe
`Defendant's failure/refusalto timelypay the overdue interest during the statutorygrace
`
`period,the Defendant also owes Attorney'sfees and costs to the Plaintiff.
`
`The purpose of Section 627.428 is not one ofpunishmentbut to encourage
`Universal Underwriters Ins. Co. v. Gorgei
`
`the prompt payment of "valid claims."
`Enterprises.Inc., App., 345 So.2d 412 (1977). "The purpose behind section 627.428 is
`plainlyto placethe insured or beneficiaryin the placeshe would have been if the carrier
`had seasonablypaid the claim or benefits without causingthe payee to engage counsel
`and incur obligationsfor attorneyfees." Travelers of Florida v. Stormont,43 So.3d 941
`(Fla.3d DCA 2010) and -FederatedNat. Ins. Co. v. Esposito,937 So.2d 199 (Fla.4?
`DCA 2006).
`The Plaintiff is entitledto attorney'sfees and costs for litigatingPlaintiffsrightto
`
`,th
`
`interest under F.S. Section 627.736. See MagneticImagingSys.,I,Inc. v. Prudential Prop.
`& Cas. Ins. Co., 847 So.2d 987 (Fl.3dDCA 2003) (Insurer'stender of interest payment
`post-suitentitled the assigneemedical providerto attorney fees under section 627.428,
`
`Florida Statutes (2002).).
`
`The Court must look at the plainlanguageof the applicableFlorida Statutes.
`
`Section 627.736(8),Florida Statutes (2021),provides:
`APPLICABILITY OF PROVISION REGULATINO ATTORNEY FEES.-With
`respect to any disputeunder the provisionsof ss.627.730-627.7405 between the
`insured and the insurer,or between an assigneeof an insured'srightsand the insurer,
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`

`

`the provisionsof ss.627.428 and 768.79 apply,except as providedin subsections
`
`(10)and (15),and except that any attorneyfees recovered must:
`
`(a)Comply with prevailingprofessionalstandards;
`(b) Not overstate or inflate the number of hours reasonablynecessary for a case of
`
`comparableskill or complexity;and
`(c) Representlegalservices that are reasonable and necessary to achieve the result
`
`obtained.
`
`Under the plainlanguageof this section on attorney'sfees,the section appliesto
`
`"any dispute"under section 627.736,and the provisionsof 627.428,Florida Statutes (2021),
`
`govern.
`
`Section 627.736(10)(d),Florida Statutes (2021),providesa statutoryrightto interest
`
`on any overdue claim:
`If,within 30 days after receiptof notice by the insurer,the overdue claim specified
`in the notice is paidby the insurer togetherwith applicableinterest and a penaltyof
`10 percent of the overdue amount paidby the insurer,subjectto a maximum penalty
`
`of $250,no action may be broughtagainstthe insurer. Id.
`
`In this matter, the Plaintiffasserts that the overdue claim for services rendered to the
`patientfrom November 5, 2021 throughDecember 13,2021 was not paidby the Defendant
`until July 1, 2022. The payment was not issued "togetherwith" applicableinterest. The
`failureto pay applicableinterestconstitutesa disputeunder F.S. Section 627.736(8).
`A post-suitpayment of a claim in an insurance case is the functional equivalentof a
`
`confession of judgment or verdict entitlingthe claimant to attorney'sfees.
`
`Wollard v.
`
`

`

`Lloyd's& Cos. OfLloyd's,439 So.2d 217 (Fla.1983);Losicco v. Aema Cas. And Sur. Co.,
`588 So.2d 681 (Fla.3dDCA 1991).
`
`It is clear from the language of F.S. Section 627.736(10)(d)that the legislature
`
`intended for providersto be permittedto sue insurers if theydo not pay the PIP claim
`togetherwith the applicableinterest. The statute does not stop with failure to pay the claim
`and does not requirethat the insurance contract contain a provisionallowingfees for
`
`interest.
`
`Courts must not interpreta statute that would lead to an absurd or unreasonable
`
`result. Dep't of Highway Safetyand Motor Vehicles v. Patrick,895 So.2d 1131 (Fla.5'
`DCA 2005). Words also many not be excised from the statute and must be enforced. See
`Haworth v. Chapman, 113 Fla. 591,595 (Fla.1933) (A Statute must be read to take all parts
`
`.th
`
`into consideration and givethem all effect.).The legislaturedid not intend to authorize
`insurers to withhold applicableinterest and a penaltywith impunity;an action may be
`broughtif they do not pay them. Angelsl)iagnosticGroup, Inc., v. United Auto. Ins. Co.,
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`Case No. 2021-001220 SP 25 (Fla.Miami-Dade County Ct. July 13,2021).
`
`E.
`
`Conclusion
`
`For the foregoingreasons, the Plaintiffis entitledto recover statutoryinterest,and
`
`attorney'sfees and costs pursuant to Sections 627.428 and 627.736, Fla. Stat.
`
`WHEREFOR.E, the Plaintiff,Peter F. Merkle, MD, PA, respectfullyrequests this
`Honorable Court enter an Order grantingFinal Judgment in favor of the Plaintiff,enter an
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`Order grantingPlaintiff'sentitlement to attorney'sfees and costs, set an evidentiaryhearing
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`

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`to determine the amount of same, and any such other relief as this Court deems justand
`
`proper.
`
`Certificate of Service
`
`I HEREBY CERTIFY that a true and correct copy of foregoingdocument was
`served upon the followingby electronic deliverythis 19 day of July,2022.
`
`MFPero@MI)WCG.com;
`FtLaudPIPService@mdwcg.com
`
`LAW OFFICES OF MICHELE E. MUIR, PA
`15673 Southern Blvd., Suite 107-342
`Loxahatchee Groves, Florida,33470
`Phone (561)368-6360
`micheleemuj,@yahoo.com
`
`BY: ,-- .
`
`Michele Muir, Esq.
`Florida Bar No. 0028150
`
`

`

`LAW OFFICES OF MICHELE E. MUIR,P.A.
`
`15673 Southern Blvd.,Suite 107-342
`Loxahatchee Groves, Florida 33470
`Office: (561)368-6360
`
`Date mailed:January21,2022
`
`USAA CasualtyInsurance Company
`Attn.: Vivian Jones
`9800 FredericksburgRoad
`San Antonio,TX 78288
`VIA certified Mail-Return ReceiptRequested-70192970 0000 7403 4148
`
`Dear Ms. Jones:
`
`DEMANI) LETTER
`
`This is a demand letterpursuant to Fl. Statute Section 627.736(10)
`
`HEALTHCARE PROVIDER: Peter F. Merkle,MD, PA.
`INSURED: Sedat Celik
`CLAIMANT: Sedat Celik
`CLAIM NUMBER/POLICY NUMBER: 011027634-006-000
`ITEMIZED STATEMENT: See attached HCFA 1500 Form and/or ledger.Demand is
`herebymade for each and every billnot paid.
`Exact amount: $5,640.00billed,$2,019,42paid.Amount appliedto a deductible is
`unknown. If policyprovidesfor payment at 80%, exact amount due is $2492.58 plus
`BA amount of $19,83 for a total of $25].2.41 plusall applicableinterest,penaltyand
`postage if 80% policy, Ifpolicyprovidesfor payment at 100%, exact amount due is
`$3,620.58plusall applicableinterest,penaltyand postage.
`Provider does not know if the policyprovidesfor payment at 80% or 100% (exceptfor
`BA codes)and does not know if there is an applicabledeductible.
`
`In particular:
`
`Billed $5,640.00for 11-5-21 to 12-13-21, $2,019.42paid, If the policypayment
`provisionsare for 80% (exceptfor BA codes)and the policydoes not have an applicable
`deductible: lf payment is at 80%, then amount due is as follows: $5,640.00less $0.00
`appliedto a deductible is $5,640.00@ 80% = $4512.001ess $2019.42 paidis $2492,58
`plusatl applicableinterest,penaltyand postage due.
`Additionally:Billed $200.00 for 11-8-21,and 11-10-21 CPT Code 97163. Provider
`If payment is at 80% of Allowable amount,
`believes the allowable amount is $206,88.
`then amount due is as follows: $413.76 less $0.OOappliedtoadeductibleis $413.76 less
`
`Exh,5,+A
`
`

`

`$400.00 allowed is $13,76@ 80%==$11,01 less $0.00 paidis $11.01 (BA difference
`amount) plusall applicableinterest,penaltyand postage due.
`
`Additionally:Billed $180.00 for 12-2-21, CPT Code 99213. Provider believes the
`allowable amount is $191,02. If payment is at 80% of allowable amount, then amount
`due igag follows: $191.02legg$180,00is$11.02@ 80%=$8.821esspaidof $0.OOis
`$8.82 (BA difference amount) plus all applicableinterest,penaltyand postage due.
`
`Billed $5,640.00 for 11-5-21 to 1 2-13-21, $2,019,42paid. If the policypayment
`provisionsare for 100% and the policydoes not have an applicabledeductible:
`If
`payment is at 100%, then amount due is as follows: $5,640.00 less $0.00 appliedto a
`deductible is $5,640.00 @ 100% = $5640.00 less $2019.42 paid is $3620.58 plus all
`applicableinterest,penaltyand postage due.
`
`Additionally,statutory interest is overdue.
`A copy of the patient'sreport for DOS 11-5-21 was previouslyprovided to USAA.
`Another copy is attached hereto.
`
`Dates of Treatment at issue: 11-5-21 to 12-13-21
`
`Services or Accommodation: See attached HCFA 1500 Form and/or ledgerand/or
`explanationof benefits.
`Type of benefit claimed: PIP-See above, attached HCFA 1500 Form and/or ledgerand/or
`explanationof benefits,
`
`REQUEST FOR REIMBURSEMENT: 'I?his is a demand letter under F. S. Section
`for the-crtofIt?lifitftf}t?and
`627.736(10).Thisis areq-Igst?o?
`reimburseme?
`letter in the ainount of $ 7 -1'1 , to be made payableto Law offices of Michele E.
`Muir, PA, only.A copy of the agkignmentof benefits is attached.
`
`NOTICE OF ASSIGNMENT: Please be advised that the medical providerhas assigned
`and Law offices of Michele E. Muir, PA has acceptedan Assignment ofthe Statutory
`Interest,StatutoryPenaltyand postage from the medical provider.Any and all interest,
`penaltyand postage payments shall be made payableto Law Offices of Michele E. Muir,
`PA.
`
`Please be advised that Law Offices of Michele E. Muir, PA has been retained by the
`above-listed providerin their claim for overdue PIP benefits. Please refrain from any
`further contact with our client regardingthis matter.
`
`The Health care providerasserts standingpursuant to the attached copy o f the
`Assignment of Benefits, pursuant to F.S. Section 627.736(10),
`
`Demand is hereby made for payment of medical services provided to the above-named
`patientfor dates of service listed on the attached HCFA 1500 Form. Payment for these
`services is overdue as of the date ofthis letter,
`
`

`

`Statutoryinterestand penaltypayment as permittedby Florida law is herebydemanded to
`be made payableto Law Offices of Michele E. Muir, PA only,
`
`Provider is not in possessionof an IME/Peer review report,
`
`Demand is also hereby made for a copy of the unredacted PIP payout sheet, explanation
`of benefits for each bill which has not been paidand/or reduced,insurance declaration
`sheet and the policyof insurance. If you have a good faith basis for non-
`payment/reduction,pleaseexplainwhy the billswere not paid,and/or reduced. Failure to
`respond to this letter shall result in a count for breach of contract, declaratoryrelief
`and/or specificperformance.
`
`Demand is further requestedfor El listingor other record that comprisesthe following:
`a. Date of receiptof each and every claim presentedto the insurer with respect to the
`subjectclaimant and this motor vehicle accident;
`b. The amount claimed (withoutreduction for any reason);
`c, The amount shown as billed (whetheror not reduced for some reason);
`d, The amount allowed for each claim;
`e. The date ofpayment of each claim;
`The completedispositionofeach claim;
`f
`g. The remainingavailable undistributed benefits and;
`h. The identityof the claimant or assignee.
`
`If there is no substantial compliance with the requestand if there is an underpaymentof
`anythingwithout a rational basis we will file an action seekingthe documents and
`determination of our rights.
`
`As you know, Florida Statutes requirethat ifpaymentof the overdue amount is made
`within thirty(30)days after receiptof notice by the insurer,the insurer must include the
`applicableinterest and a 10% penaltyof the overdue amount paid,subjectto a maximum
`penaltyof $250.00. Failure to make payment within the allocated 30-day periodmay
`result in the immediate institution o f a civil suit for damages, attorney's fees and costs
`that were incurred unnecessarilyas a result of the failure to respond to this demand letter
`may result in further litigationfor which we would seek payment of our attorney'sfees
`and costs.
`
`Law Offices of Michele E, Muir, PA has an interest in any pre suit payment. Please
`make all checks payable for the medical expenses to the providerand for the interest,
`postage and penaltyto Law Offices of Michele E. Muir, PA. The tax ID number is
`264395171. Mail directlyto: Law Offices of Michele E. Muir, PA, 15673 Southern
`Blvd., Suite 107-342, Loxahatchee,FL 33470.
`
`Any contact regardingthis demand letter with the Health care providerlisted above shal]
`be considered a tortuous interference with a contractual agreement between Law Offices
`of Michele E. Muir, PA and the Health Care providerlisted above. Please do not contact
`
`

`

`the Health Care Provider regarding this demand letter. Do not mail any drafts for
`medical benefits, postage, statutory penaltyand statutory interest to the Health Care
`Provider as they are representedby Law Offices of Michele E. Muir, PA. Thank you for
`your immediate response,
`
`VeryTrulyYojrg,
`
`Michele Muir, Esq.
`Enc.
`
`

`

`01/14/22
`
`PATIENT FINANCIAL HISTORY BY DT SERVICE
`PETER F. MERKLE, M.D.,P.A.
`Accounts 170020 - 170020
`All DateS
`
`Page
`
`1
`
`Acct
`
`Date
`
`Dep Il Name
`
`170020 CELIK,SEDAT
`
`CELIK, SEDAT
`
`OELIK,SEDAT
`
`CELIK, SEDAT
`CELIK, SEDAT
`
`CELIK,SEDAT
`CELIK,SEDAT
`
`11/05/21
`
`11/06/91
`
`11/05/21
`
`11/05/21
`
`11/05/21
`
`11/05/21
`
`11/08/21
`11/OB/21
`
`11/08/21
`
`11/08/21
`
`O
`
`6
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`11/08/21
`
`0
`
`Dr#
`
`Procedure
`
`Ref Dt
`
`Diag
`
`Units
`
`AmOUn t
`
`4
`
`4
`
`4
`
`4
`
`4
`
`4
`
`6
`
`G
`
`G
`
`6
`
`6
`
`99204
`
`72050
`
`73030
`
`73030
`
`80215
`
`E0860
`
`97163
`
`94760
`
`97010
`
`97140
`
`G0283
`
`Previous Balance :
`
`NEW PATIENT (45 MIN)
`
`4 VIEWS -CERVICAL -
`
`X-RAY, SHOULDER - CO
`X-RAYr SHOULDER - CO
`
`CERVICAL TRACTION -
`PHYSICAL THERAPY EVA
`PULSE OXYGEN READING
`THERAPY - HOT/COLD P
`
`ELECTRICAL STIM--UNA
`
`213.4XXA
`
`S13.4XXA
`
`843.491A
`
`S43,492A
`843.492A
`S13.4XXA
`
`S46.01LA
`
`S46.011A
`SSG.011A
`S46,011A
`S46,011A
`
`1.00
`
`1,00
`
`1.00
`
`1.00
`
`1,00
`
`1.00
`
`1,00
`
`1.00
`
`1,00
`
`1.00
`
`1.00
`
`0.0.
`
`450.00
`
`250,00
`
`200.00
`
`200.00
`
`150,00
`150.00
`
`200.00
`
`40.00
`75.0
`
`75.00
`
`75.00
`
`CELIK,SEDAT
`CELIK, SEDAT
`CELIK,SEDAT
`CELIK,SEDAT
`CELIK,SEDAT
`CELIK,SEDAT
`
`CELIK,SEDAT
`CELIK, SEDAT
`CELIK,SEDAT
`CGLIK, SEDAT
`CELIK, SEDAT
`CELIK,SEDAT
`CELIK,SEDAT
`CELIK,SEDAT
`
`11/08/21
`
`11/10/21
`
`ll/10/21
`
`.l/10/21
`
`ll/la/21
`
`11/10/21
`
`11/10/21
`11/15/21
`
`11/15/21
`
`11/15/21
`
`11/15/21
`
`11/15/21
`
`11/15/21
`
`11/15/21
`
`11/17/21
`
`0
`
`0
`
`0
`
`0
`
`0
`
`Q
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`6
`
`6
`
`6
`
`G
`
`6
`
`6
`
`6
`
`G
`
`?
`
`6
`
`6
`
`6
`
`6
`
`6
`
`6
`
`97112
`
`97163
`
`94760
`
`97010
`
`97140
`G0283
`
`97112
`94760
`
`97010
`
`97110
`
`97140
`
`G0283
`
`97112
`
`97035
`
`94760
`
`PHYSICAL THERAPY EVA
`PULSE OXYGEN READING
`THERAPY - HOT/COLD P
`
`ELECTRICAL STIM--UNA
`
`PULSE OXYGEN READING
`THERAPY - HOT/COLD P
`THERAPY-THERAPEUTIC
`
`ELECTRICAL STIM--UNA
`
`S46.011A
`S 13.4XXA
`
`S13.4XXA
`
`S13.4XXA
`Sll,4XXA
`S13.4XXA
`S13,4XXA
`Slj,4XXD
`S 13.4XXD
`
`S13,4XXD
`S13.4XXD
`Sl].4XXD
`313.4XXD
`
`S13.4XXD
`
`S13,4XXD
`
`1.00
`
`1,00
`
`1.00
`
`1.00
`
`1.00
`
`1.00
`
`1.00
`
`1,00
`
`1.00
`
`1,00
`
`1.00
`
`1.00
`
`1.00
`
`1.00
`
`1.00
`
`7S.00
`
`200,00
`
`40.00
`
`75.00
`75.00
`
`75.00
`
`75.00
`
`40 00
`7500
`75,00
`
`75.00
`75.00
`
`75.00
`
`CELIK,SEDAT
`CELIK,SEDAT
`CELIX,SEDAT
`CELIK,SEDAT
`CELIK, SEDAT
`CELIK, SEDAT
`CEI,IK, SEDAT
`CELIA, SEDAT
`CELIK,SEDAT
`CELIK, SEDAT
`
`CWLIK,SEDAT
`
`CELIK,SEDAT
`
`CELIK,SEDAT
`CELIK, SEDAT
`
`CELIX,SEDAT
`
`CELIK,SEDAT
`CELIK, SEDAT
`CELIK,SEDAQ'
`CELIK,SEDAT
`
`11/17/21
`
`11/17/21
`11/17/21
`
`1L/17/21
`
`11/17/21
`
`11/18/21
`
`11/18/21
`
`11/18/21
`
`11/18/21
`
`11/18/21
`
`11/18/21
`
`ll,/22/21
`
`11/22/21
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`6
`
`6
`
`?
`
`6
`
`6
`
`6
`
`6
`
`6
`
`G
`
`6
`
`6
`
`6
`
`6
`
`97010
`
`97110
`
`97140
`G0283
`
`97112
`
`94760
`
`97010
`
`97110
`
`97140
`
`00283
`
`97112
`
`94760
`
`97010
`
`ULTRASOUND--15 MIN
`PULSE OXYGEN READING
`THERAPY - HOT/COLD P
`TLIERAPY-TJIERAPEUTIC
`
`MOBILIZATION/MAN:IPUL
`ELECTRICAL STIM--UNA
`
`PULSE OXYGEN READING
`THERAPY - HOT/COLD P
`
`ELECTRICAL STIM--UNA
`
`PULSE OXYGEN READING
`THERAPY - HOT/COLD P
`
`S 13,4XXD
`913.4XXD
`
`S 13.4XXD
`
`S13,4XXD
`S 13,4XXD
`
`S 13.4XXD
`
`S13.4XXD
`
`S13.4XXD
`
`813,4XXD
`Sll.4XXD
`
`S13.4XXD
`
`1.CO
`
`1,00
`
`1,00
`
`1,00
`
`1,00
`
`1,00
`
`1.00
`
`1.00
`
`1,00
`
`1,00
`
`1.00
`
`1.00
`
`1,00
`
`75,00
`40.00
`
`75.00
`
`75.00
`
`75.00
`
`75.00
`
`75.00
`
`40,00
`
`75,00
`7500
`75.00
`
`75.00
`
`75.00
`
`40.00
`
`11/22/21
`
`11/22/21
`
`11/22/21
`
`11/22/21
`
`12/02/21
`
`12/06/21
`
`12/06/21
`
`12/06/21
`12/06/21
`
`12/06/21
`
`12/06/21
`12/08/21
`
`12/08/21
`
`12/08/21
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`0
`
`CELIK,SEDAT
`
`CELIK,SEDAT
`
`CELIK,SRDAT
`CELIK,SEDAT
`
`CELIK,SEDAT
`CELIK,SEDAT
`
`CELIK,SEDAT
`CELIX,SEDAT
`CELIK,SEDAT
`CELIK,SEDAT
`
`CELIK,BEDAT
`CELIK,SEDAT
`
`CELIK, SEDAT
`CELIK, SEDAT
`
`6
`
`6
`
`6
`
`6
`
`4
`
`6
`
`6
`
`6
`
`G
`
`6
`
`6
`
`6
`
`6
`
`6
`
`97110
`
`G0283
`
`97140
`
`97035
`
`99213
`
`94760
`
`97010
`
`97110
`97140
`
`G0283
`
`97112
`
`947G0
`
`9701