Filing # 44082467 E-Filed 07/18/2016 04:36:37 PM
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`ALLIANCE SPINE & JOINT III, INC (AAO
`STEVEN ANDERSON),
`
`Plaintiff(s),
`
`VS.
`
`USAA CASUALTY INSURANCE COMPANY,
`
`Defendant(s).
`
`IN THE COUNTY COURT IN AND
`FOR MIAMI DADE COUNTY,
`FLORIDA
`
`CASE NO.: 2016-008137-SP-23
`
`PLANTIFF'S FIRST REQUEST TO PRODUCE
`
`INC (AAO STEVEN
`COMES NOW,Plaintiff, ALLIANCE SPINE & JOINT Ill,
`ANDERSON), by and through the undersigned attorney, and pursuant to Rule 1.350,
`Florida Rules of Civil Procedure, hereby requests the Defendant, USAA CASUALTY
`INSURANCE COMPANYproducethe items and matters hereinafter set forth.
`YOUR ATTENTION IS INVITED TO THE REQUIREMENT OF RULE 1.350 (b)
`WHEREIN THE PARTY TO WHOM THIS REQUESTIS DIRECTED IS REQUIRED TO
`SERVE A WRITTEN RESPONSE HERETO WITHIN FOURTY-FIVE (45) DAYS AFTER
`THE SERVICE HEREOF SUBJECT TO THE ALLOWANCE OF A SHORTER OR
`LONGER TIME BY COURT.
`
`The items to produceare asfollows:
`
`1.
`
`The original or a true copy of the insurance policy, including PIP coverage that is
`the subject of this lawsuit, and any Amendments and/or Endorsements thereto.
`
`The original or a true copy of the Declaration sheet form the Defendant showing
`all insurance coverage (s) that were in force and effect at the time of the auto
`accident set forth in the Complaint.
`
`The original or a true copy of the documents evidencing the Defendant is receipt
`of the claimant’s PIP application regarding the auto accident set forth in the
`Complaint.
`
`The original or a true copy of the documents requested and received from the
`Florida Department of Motor Vehicles regarding the claimant.
`
`The original or true copy of the police report and/or Long Firm Florida Traffic
`Crash Report.
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`[PP-16-12740/591062/1]
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`The original or true copy of the documents evidencing the Defendant's receipt of
`the claimant’s medical expenses incurred as result of the auto accident set forth
`in the Complaint.
`
`The original or a true copy of documents evidencing the Defendant’s receipt of
`the claimant’s lost wage claim resulting from the auto accident set forth in the
`Complaint.
`
`The original or a true copy of documents evidencing payment by the Defendant
`of the claimant's medical expenses incurred and/or lost earnings suffered as a
`result of the subject auto accident set forth in the Complaint.
`
`The original or a true copy of any written or recorded statements the Defendant
`obtained from the claimant pertaining to the subject accident set forth in the
`Complaint.
`
`The original or true copy of any written or recorded statements the Defendant
`obtained from any other person pertaining to the subject auto accident.
`
`The original or a true copy of any reports from physicians who conducted a
`compulsory physical
`examination, peer
`review, or “independent” medical
`examination at the request of the Defendant with regard to the injuries claimed by
`the claimant as a result of the auto accident set forth in the Complaint.
`
`The original or a true copy of documents evidencing payment, compensation,
`and/or credit application to any and all physicians and/or third party vendors who
`conducted a compulsory physical examination, peer review, or “independent”
`medical examination at the request of the Defendant with regard to the injuries
`claimed by the claimant as a result of
`the auto accident set forth in the
`Complaint.
`
`The original or true copy of any surveillancefilms of the claimant.
`
`The original or true copy of any reports from experts who are expectedto testify
`at trial.
`
`The original or true copies of all other correspondence between the claimant,
`claimant's attorney and the Defendant.
`
`The original or true copies of all other correspondence between the Defendant
`and/or Defendant’s attorney to claimant, claimant's attorney and the insured,
`omni-bus insured, claimant, Plaintiff's assignor, Plaintiff, and/or the attorney/s for
`any of these respective
`recipients.
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`10.
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`11.
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`12.
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`13.
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`14.
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`15,
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`16.
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`17.
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`The original or true copy of all correspondence between medical providers of the
`claimant and the Defendant.
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`[PP-16-12740/591062/1]
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`18.
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`19.
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`20.
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`21.
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`22.
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`23.
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`24.
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`20.
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`26.
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`2/.
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`28.
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`29.
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`30.
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`The original or true copy of all correspondence not included above, between the
`Plaintiff's counsel and the Defendant.
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`The original or a true copy of all documents evidencing peer review of the
`medical bills submitted by the claimant as result of the auto accident as set forth
`in the complaint.
`
`The original or a true copy of all documents evidencing the final relationship
`between the Defendant and the entity that set the peer review and or IME.
`
`All reports created in the last three years that you have received from the IME
`and or Peer review vendor that reviewed or examined the patient assignor for the
`exams (peer reviews or in person exam) by that doctor or other insureds. You
`make redact the name of the insureds or claimants to maintain confidentiality.
`
`regarding the
`Any manuals, pamphlets, or any other documents that exist
`database/auditing system used to reduce the billing submitted by the medical
`provider describing,
`the contents of the database, explaining how to use the
`database, discussing how the database wascreated.
`
`The original or a true copy of all documents evidencing the Defendant's request
`for an independent medical examination of the claimant.
`
`The original or true copies of all documents evidencing the Defendant's request
`for a statement/examination under oath of the claimant.
`
`The entire claim file (by this we main the collection of records and documents
`which you have accumulated as a result of your receiving notice that the medical
`provider made or intended to make a claim for benefits under the insurance
`policy whichis the subject of this lawsuit; this file should contain medical records,
`correspondence with plaintiff, etc.) minus any privileged materials and/or
`documents.
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`Underwriting file, minus any privileged materials and/or documents.
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`All medical bills received by you from claimant or his medical providers.
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`Most recent PIP payout sheet/log free and clear of any redaction of names and
`payments done to other providers.
`
`All assignments of benefits Defendant received from any and all providers
`regarding this subject accident.
`
`All statutory demand letters the Defendant
`claimant's medical providers.
`
`received from claimant and/or
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`[PP-16-12740/591062/1]
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`31.
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`32.
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`33.
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`34.
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`35.
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`36.
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`37.
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`38.
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`39.
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`40.
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`41.
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`42.
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`43.
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`All HCFA/CM1500or other bills received by the Defendant from claimant and/or
`claimant's medical providers.
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`Any documents, computer printouts, books, reference materials Defendant used
`to determine what a reasonable fee was for the medical services rendered to the
`claimant as a result of the auto accident set forth in the Complaint.
`
`All proof of mailing/ green cards for any notices for IME and/or EUO.
`
`reports, papers, or other materials used by the
`Any and all documents,
`Defendant to determine the status of the “emergency medical condition” of the
`patient/claimant/assignors’ condition for which he/she sought medical treatment.
`
`letters, papers, or notices submitted by the Defendant to the
`All documents,
`insured, claimant, and/or assignor stating that the claim is being investigated for
`suspected fraud.
`
`letters, papers, or notices submitted by the Defendant to the
`All documents,
`insured, claimant, and/or assignor notifying that the PIP insurance policy limits
`have been reached and that the benefits are exhausted.
`
`All documents, letters, papers, or notices in the Defendant’s possession granting
`them the authority to use Medicare coding policies and payment methodologies
`(i.e., OPPs, NCCI, etc.).
`
`All documents in the Defendant’s possession evidencing that the claimant did not
`present
`for medical
`treatment within fourteen (14) days of
`the date of
`loss/accident.
`
`to Florida
`Injury Protection Benefits” pursuant
`The “Notification of Personal
`Statute 627.7401, that was furnished to the insured, omnibus insured, medical
`provider, and/or any other assignor or assignee in this case.
`
`All documents in the Defendant’s possession evidencing notification and/or
`notice at the time of the policy of insurance issuance and/or renewal that the
`insurer may limit payment pursuant to the schedule of charges via the Medicare
`Part B fee schedule and/or Workers’ Compensation fee schedule.
`
`All documents in the Defendant’s possession evidencing that the claimant did or
`did not report for their initial services within fourteen (14) days of the subject
`accident.
`
`All documents in the Defendant's possession evidencing what the Defendant
`uses to make their determination as to whether or not the claimant’s injuries
`claimed were an “emergency medical condition.”
`
`itemized specifications (i.e., explanation of
`The original or true copies of all
`benefits/review) as provided to the insured, omni-bus insured, claimant, Plaintiff's
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`[PP-16-12740/591062/1]
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`44.
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`45.
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`46.
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`47.
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`48.
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`49.
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`50.
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`51.
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`assignor, and/or Plaintiff for any and all medical treatment or services rendered
`and billed for the subject accident.
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`All documents in the Defendant’s possession evidencing that the Defendant has
`furnished the insured, omni-bus insured, claimant, Plaintiff's assignor, and/or
`Plaintiff with any notification, correspondence, letter, document, and/or electronic
`transmission of any nature stating that PIP benefits will not be forthcoming until
`there is compliance with an “examination under oath” and/or “independent
`medical examination” attendance.
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`Any and all documentation or evidence (in whatever form) of cancellation or
`voiding of the policy at
`issue in this cause (including, without
`limitation, all
`cancellation letters, all evidence of premium refund, and all documentation
`showing calculation of additional premium).
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`Any and all contracts or agreement by and/or between the Defendant and the
`companythat reviewed any of the medical bills in this case.
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`Any and all photographs taken by Defendant showing the extent of damage to
`any of the vehicles involved in the accident as were taken prior to the filing of
`suit.
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`Any and all estimates of repair or statements concerning the nature and extent of
`damage to anyof the vehicles involved in the accident.
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`Copies of all correspondence to and from any medical review company that
`reviewed any of the bills including any printouts or explanations or supporting
`documentsfor any reductions.
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`Any and all contracts or agreements by and/or between the Defendant and the
`company that furnished, maintains or programs the computer or computer
`software used to review any of the medical bills in this case.
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`Copies of any and all documentation of the education and training of the
`adjuster,
`to use the computer software that reviewed any of the bills including
`any seminars attended and certificates earned by the adjuster to properly use
`suchsoftware.
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`[PP-16-12740/591062/1]
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`CERTIFICATE OF SERVICE
`
`| HEREBY CERTIFYthat a true and correct copy of the foregoing was served
`
`via e-mail to Roig Lawyers at pleadings@roiglawyers.com , on the 18 day of July, 2016.
`
`The Madalon Law Firm
`100 North Federal Hwy
`Suite CU-5, 4th Floor
`Fort Lauderdale, FL 33301
`Telephone:
`(954) 923-0072
`Facsimile:
`(954) 923-0074
`Email: siopieacings@madaloniaw car
`
`
`
`By: /s/ Leandro Carvalho
`
`Leandro Carvalho, Esq.
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`[PP-16-12740/591062/1]
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