`
`IN THE COUNTY COURT OF THE
`NINTH JUDICIAL CIRCUIT IN AND
`FOR ORANGE COUNTY, FLORIDA
`
`CASE NO.: 2018-SC-025282-O
`
`MACK INJURY & SPINE CARE A/A/O JOSE
`ZAPATA,
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`Plaintiff,
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`VS.
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`GEICO GENERAL INSURANCE COMPANY,
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`Defendant.
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`_____________________________________/
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`DEFENDANT GEICO GENERAL INSURANCE COMPANY'S
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`RESPONSE TO PLAINTIFF'S SUPPLEMENTAL REQUEST FOR ADMISSIONS
`REGARDING FEE SCHEDULE
`
`
`COMES NOW the Defendant, Geico General Insurance Company, by and through the
`
`undersigned attorney, and responds to Plaintiff's Supplemental Request for Admissions Regarding
`Fee Schedule as follows:
`1.
`Admit that Geico General Insurance Company never adopted 80% of the
`maximum reimbursable allowance under workers compensation in its policy.
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`RESPONSE: Denied.
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`
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`Admit that the deductible does not apply to any medical bills submitted by
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`2.
`plaintiff.
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`RESPONSE: The Plaintiff has failed to specify the medical bills it is referring to,
`therefore the Defendant is unable to admit or deny this request.
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`
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`3.
`Admit that the term “workers compensation” does not appear in the underlying
`insurance policy.
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`RESPONSE: Denied.
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`4.
`Admit that the insurance policy does not reflect a premium reduction as a result of
`cost savings from paying medical expenses pursuant to the so-called statutory fee schedules.
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`RESPONSE: Denied as phrased.
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`Admit that PIP insurance is not Medicare.
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`5.
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`RESPONSE: Admitted.
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`6.
`Admit that PIP insurance is not regulated by the Centers for Medicare &
`Medicaid Services.
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`RESPONSE: Denied as phrased.
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`7.
`Admit that the underlying insurance policy states it will pay 80% of reasonable
`expenses for medically necessary treatment related to auto accident.
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`RESPONSE: Admitted that personal injury protection benefits were issued by the
`Defendant to the Plaintiff for the claimed medical expenses, based on the terms, conditions,
`and limitations of the Policy and Sections 627.730-627.7405 of the Florida Statutes.
`Otherwise denied.
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`
`8.
`Admit that the insurer did not inform the patient, named insured or claimant that
`reimbursement would be limited to 80% of the maximum reimbursable allowance under workers
`compensation.
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`RESPONSE: Denied.
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`Admit that the insurance policy contains medical payments coverage.
`
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`9.
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`RESPONSE: Denied.
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`10.
`Admit that a PIP insurer is permitted to use one of two payment methodologies
`found at Fla. Stat. 627.736 et seq.
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`RESPONSE: Admitted that personal injury protection benefits were issued by the
`Defendant to the Plaintiff for the claimed medical expenses, based on the terms, conditions,
`and limitations of the Policy and Sections 627.730-627.7405 of the Florida Statutes.
`Otherwise denied.
`
`
`11.
`Admit that that amounts charged by the Plaintiff for the medical services in this
`case were not unreasonable.
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`RESPONSE: Denied.
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`12.
`Admit that the insurance policy does not explicitly state that Defendant shall limit
`reimbursement to 80 percent of the maximum reimbursable allowance under workers’
`compensation, as determined under s 440.13 and rules adopted thereunder which are in effect at
`the time such services, supplies, or care is provided for codes not reimbursable under Medicare
`Part B.
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`RESPONSE: Admitted that personal injury protection benefits were issued by the
`Defendant to the Plaintiff for the claimed medical expenses, based on the terms, conditions,
`and limitations of the Policy and Sections 627.730-627.7405 of the Florida Statutes.
`Otherwise denied.
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`CERTIFICATE OF SERVICE
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`I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by
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`Electronic Mail on this the 7th day of March, 2019 to the following designated service email
`address(es): Todd Landau, Esq., Landau and Associates, P.A., efilings@pip-lawyers.com.
`
`Law Office of Kelly L. Wilson
`
`
`
` /s/ Ronalda Stevens
`Ronalda Stevens, Esq.
`Florida Bar No.: 85461
`1000 Legion Place, Suite 850
`Orlando, FL 32801
`Phone: (407) 648-8236
`Facsimile: (407) 648-2650
`Attorney for Defendant(s): Geico General Insurance
`Company
`Service Email: orlandopipgeico@geico.com
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