Filing # 112769739 E-Filed 09/02/2020 11:39:36 AM
`
`IN THE SMALL CLAIMS COURT OF THE NINTH
`JUDICIAL CIRCUIT, AND IN AND FOR ORANGE
`COUNTY, FLORIDA
`
`CASE NO.:
`
`DIV. NO.:
`
`10858891
`
`GLOVER CHIROPRACTIC CLINIC, LLC. a/a/o
`KAYLA WRIGHT,
`
` Plaintiff,
`vs.
`
`ALLSTATE PROPERTY AND CASUALTY
`INSURANCE COMPANY,
`
` Defendant.
`___________________________________/
`
`
`
`
`COMPLAINT
`
`GLOVER CHIROPRACTIC CLINIC LLC, (hereinafter "Plaintiff"), as assignee of Kayla Wright,
`
`(hereinafter "Insured"), sues the Defendant, ALLSTATE PROPERTY AND CASUALTY INSURANCE
`
`COMPANY, (hereinafter "Defendant"), and alleges:
`
`1.
`
`This is an action for damages in the amount range of $500.01 to $2,500.00 dollars
`
`exclusive of interest, costs, and attorney’s fees.
`
`2.
`
`At all times material hereto, Defendant was a corporation duly licensed to transact
`
`insurance in the State of Florida and maintained agents for transaction of its customary business in
`
`Orange County, Florida.
`
`3.
`
`On or about August 30, 2019, the Insured was involved in a motor vehicle accident.
`
`The Insured sustained personal injuries in, or as a result of, said accident.
`
`4.
`
`As a direct and proximate result of the personal injuries the Insured sustained in
`
`the accident, the Insured incurred reasonable expenses for related and necessary medical and
`
`rehabilitative treatment and therapy, supplies, diagnostic testing, nursing and remedial care
`
`performed or provided by the Plaintiff in the State of Florida.
`
`5.
`
`Defendant issued an insurance policy that provided personal injury protection (PIP)
`
`benefits required by law to comply with Section 627.730 - 627.7405, Florida Statutes, and/or
`
`
`
`
`
`

`

`medical payment coverage. A copy of the policy is not available, but it is in the possession of the
`
`Defendant. Plaintiff is not in possession of the policy and Defendant is not prejudiced by the
`
`policy not being attached to this complaint.
`
`6.
`
`The above described policy was in full force and effect on the date of the accident
`
`and provided PIP and/or medical payment coverage for the Insured for bodily injuries sustained in
`
`said accident.
`
`7.
`
`Pursuant to all or a combination of the following, Plaintiff has standing to pursue
`
`this action directly against the Defendant, and to collect all reasonable attorney's fees pursuant
`
`to Sections 627.733 et seq., 627.736(4)(c), 627.736(8), and 627.428, Florida Statutes:
`
`A.
`
`a written assignment of benefits wherein the Insured assigned to Plaintiff the
`
`rights to any potential benefits under the PIP policy of insurance issued by the
`
`Defendant (A copy of said assignment of benefits is contained in Exhibit "A");
`
`B.
`
`an equitable or implied assignment (hereinafter "equitable assignment"), that
`
`exists between the patient and Plaintiff wherein the patient assigned the rights to
`
`any potential benefits under the PIP policy of insurance issued by the Defendant;
`
`and/or
`
`C.
`
`as the real party in interest as Plaintiff has a sufficient stake in the controversy
`
`addressed in this count, will be effected by the outcome of this matter and is the
`
`actual party that stands to lose or gain.
`
`Defendant received notice of the covered losses.
`
`Defendant failed to make proper payment of said PIP benefits within thirty (30)
`
`8.
`
`9.
`
`days as required by Section 627.736(4)(b), Florida Statutes.
`
`10.
`
`A demand for PIP and/or medical payment benefits was made for all reasonable
`
`charges that were for necessary medical and rehabilitative treatment and therapy, supplies,
`
`
`
`
`
`

`

`diagnostic testing, nursing, and remedial care related to the subject accident. (The medical bills,
`
`charges, and items that are the subject of this claim are attached hereto as Exhibit “A”).
`
`11.
`
`The Plaintiff has performed all conditions precedent to entitle Plaintiff to recover PIP
`
`and medical payment benefits for reasonable, related and necessary medical and rehabilitative
`
`treatment and therapy, supplies, diagnostic testing, nursing and remedial treatment regarding the
`
`above-described policy, or those conditions have been waived.
`
`12.
`
`Despite the fact that Defendant had no reasonable proof to establish that it was not
`
`responsible for the payment, Defendant has failed to pay Plaintiff for covered losses.
`
`13.
`
`Due to Defendant’s failure to pay PIP benefits in accordance with Florida law,
`
`Plaintiff has been required to retain the undersigned law firm for the prosecution of this lawsuit.
`
`The Plaintiff has agreed to pay, and the attorneys have agreed to accept, any Court-awarded
`
`attorneys’ fee.
`
`14.
`
`Defendant has failed to pay the applicable statutory interest, postage, penalties,
`
`and the statutory attorney fees required by law.
`
`15.
`
`The determination of the reasonableness of charges is subject to Section,
`
`627.736(5), Florida Statutes and Defendant’s policy language. To the extent Defendant has
`
`made a legally sufficient election allowing it limit payment pursuant to the schedule of
`
`maximum charges legally permitted by Section 627.736(5)(a)(1), Florida Statutes (2012)(or
`
`Section 627.736(5)(a)(2), Florida Statutes (2008)), Plaintiff’s claim or claims do not exceed
`
`those legally permitted limits.
`
`16.
`
`Plaintiff would derive a direct benefit from the Court ordering the Defendant to pay
`
`benefits, interest, postage, penalty and attorney fees, even if Defendant pays all or some of the
`
`disputed benefits before judgment is entered.
`
`17.
`
`Plaintiff is entitled to an award of reasonable attorneys' fees pursuant to Sections
`
`57.041, 57.104, 627.428 and 627.736(8), Florida Statutes.
`
`
`
`
`
`

`

`18.
`
`Plaintiff is entitled to simple interest on the amount of said medical bills or charges
`
`pursuant to Section 627.736(4)(c), Florida Statutes.
`
`WHEREFORE, Plaintiff, GLOVER CHIROPRACTIC CLINIC LLC, as assignee of Kayla Wright,
`
`demands judgment against Defendant, ALLSTATE PROPERTY AND CASUALTY INSURANCE
`
`COMPANY, for damages in the amount range of $500.01 to $2,500.00 dollars exclusive of
`
`interest, costs, and attorney’s fees.
`
`PLAINTIFF HEREBY DEMANDS A JURY TRIAL ON ALL ISSUES SO TRIABLE.
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`Respectfully submitted this 2nd day of September, 2020.
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`/s/ JESSICA PICKERAL
`JESSICA PICKERAL, ESQUIRE
`Florida Bar No. 1003101
`
`MORGAN & MORGAN, P.A.
`20 N. Orange Avenue, 4th Floor
`Orlando, FL 32801
`(407) 428-6243 – Phone
`(407) 204-2102 – Fax
`Primary Email: jpickeral@forthepeople.com
`Secondary Email: vcolon@forthepeople.com
`NCascio@forthepeople.com
`Attorneys for Plaintiff
`
`
`
`###EFMESES###
`
`

`

`Exhibit 1
`Exhibit 1
`
`

`

`
`
`
`
`
`
`
`
`
`
`July 16, 2020
`
`SENT VIA CERTIFIED MAIL
`
`*10858891*
`Mr. Damian De Padua
`Allstate Property & Casualty Insurance Company
`8333 Bryan Dairy Road
`Largo, FL 33777
`
`
`
`
`
`
`
`
`
`
`Written Notice of Intent to Initiate Litigation
`
`
`
`This is a demand letter under §627.736(10) as required by Florida Statute (effective date - January
`1, 2008) and/or §627.736(11)(prior statute), or under any policy of insurance
`
`
`RE: [10858891] Glover Chiropractic a/a/o Wright, Kayla vs Allstate
`
`
`
`Insured:
`
`Patient:
`Claim/Policy#:
`Date of Loss:
`
`Our File#:
`
`
`Kimberly K. Wright
`Kayla Wright
`0563107630
`August 30, 2019
`10858891
`
`
`
`
`
`
`Dear Sir/Madam:
`
`This is a demand letter under section 627.736 (10), Florida Statutes, and under any policy of insurance.
`The personal injury protection (PIP) benefits (and medpay benefits if applicable), claimed are for payment
`of reasonable charges for related and necessary treatment, services, accommodations or supplies to the
`above-referenced patient. The below-identified provider has not been properly paid.
`
`Name of medical provider rendering treatment, services, accommodations or supplies that form the basis
`of this claim: Glover Chiropractic Clinic LLC.
`
`Specifically, this demand is for payment of the below listed amounts for the listed dates of service at the
`reasonable amount billed minus any payments received by Glover Chiropractic Clinic LLC from said
`PIP insurer. (Please note that if this policy contains medpay coverage, the amount demanded is at 100%
`of the reasonable billed amount minus any payments received from said PIP insurer). If the insurer has
`information supporting that a lesser amount is owed and/or this demand is not payable due to deductible,
`co-payment, exhaustion, Florida Statute §627.736(1)(a), §627.736(2), §627.736(4), §627.736(5),
`§627.736(6), §627.736(7), or for any other reason, please provide the appropriate explanation pursuant to
`§627.736(4)(b).
`
`
`
`
`
`
`
`20 North Orange Ave, Suite 1600, Orlando, FL 32801 | (407) 420-1414 | ForThePeople.com
`
`

`

`
`If the insurer has made an unambiguous election in its insurance policy pursuant to Fla. Stat. Section
`627.736(5)(a)(1)(2012), permitting the insurer to limit payment to 80% of 200% of the allowable amount
`under the Medicare Part B Physicians Fee Schedule and/or the 80% of the maximum reimbursable
`allowance under workers’ compensation, then the amounts demanded herein are subject to those legally
`permitted amounts. The policy of insurance is in the insurer’s possession, and the insured and/or its
`assignee is unable to determine the specific amount owed without this documentation.
`
`If the insurer contends that it has made an election to limit payment subject to the schedule of maximum
`charges noted above, please recite to us or provide us with the portion of the insurance policy that
`provides for limiting payment to the schedule of maximum charges.
`
`Please provide a copy of the PIP payout log and/or copies of all explanation of benefits/reimbursements
`that have been made on behalf of the above-referenced patient/claimant.
`
`We dispute the payments made by the insurer and request the insurer to notify us that the policy limits
`under this section have been reached within 15 days after the limits have been reached as required by
`§627.736(6)(f).
`
`The following is demanded:
`
`
`1. Amount of $1,806.00 or @ 80% $1,444.80, subject to applicable policy limits, and any
`proper election under §627.736(5)(a)(5) to limit payment to the schedule of maximum
`charges legally permitted under §627.736(5)(a)(1)-(4), pending verification of medical
`benefits for date(s) of service 09/17/2019 - 12/02/2019 made payable to Glover
`Chiropractic Clinic LLC and mailed to our office.
`Interest on the amount due, at the statutory rate, commencing 30 days after the date the
`bill for services (CMS 1500) was received by the carrier and up to the date payment
`made make payable to Morgan & Morgan P.A.
`3. Penalty of 10% of amount due (Maximum penalty $250.00) and certified or registered
`mail, return receipt requested, cost made payable to Morgan & Morgan P.A. our tax
`identification number is 59-2920684.
`4. The demand response must reference file number 10858891
`
`Also, enclosed please find the following:
`
`
`2.
`
`1. Assignment of Benefits
`2.
`Itemized Statement
`
`
`Further, in the event the carrier decides to not honor this claim and/or demand, we hereby request or
`demand the carrier reserve or escrow sufficient benefits to satisfy this outstanding claim prior to any
`exhaustion of benefits, pending resolution of any action reasonably filed after this letter. We seek to
`preserve and pursue all rights as provided by law and to minimize or avoid litigation if possible.
`Additionally, we request any reply further denying or not satisfying this claim/demand to outline the exact
`reasons why the carrier denies this claim/demand for denied or overdue benefits and other damages.
`
`Failure to fully and completely comply with this demand letter within 30 days will result in suit being filed
`for all amounts legally due, including applicable costs and attorney’s fees.
`
`Govern yourselves accordingly.
`
`Sincerely,
`
`
`Jessica Pickeral, Esquire
`
`JP/sg
`Enclosure(s)
`
`
`

`

`
`
`Dr. Jeffrey N. Glover
`
`Assignment of Benefits and Direction to Pay
`
`|, hereby irrevocably assign to Jeffrey N. Glover (Glover Chiropractic Clinic, 312 N 14‘ Street, Leesburg, FL 34748)
`(hereinafter “Provider”), all benefits from my insurance carrier(s) due to me under No Fault, Medical Payments or any
`other applicable insurance coverage under anypolicy of insurance, for products, services and/or accommodations
`rendered by Provider as consideration for those products, services and/or accommodations rendered.
`
`| hereby authorize and unequivocally instruct and direct my insurance companyto issue payment directly to Provider for
`any and all products, services and/or accommodations rendered by Provider.
`
`| have read the information herein and it is accurate to the best of my knowledge and belief.
`
`PrintedPatient Name
`
`
`
`Patiént Name(Signature)
`
`Date ofBirth
`
`(417 |e
`
`Date
`
`Witness (Signature)
`
`Date
`
`He
`
`(
`Insurance Carrier
`
`Policy Number
`
`O19) \
`
`Date of Accident
`
`Do you have an attorney?
`If YES, WHO?
`
`re
`YE
`
`NO
`
`AN
`
`Claim Number
`
`312 N 14th St., Leesburg, FL 34784
`T: (352) 787 - 9995 « F: (352) 787 - 9997
`
`
`
`

`

`CP#10858891 Wright, Kayla
`
`DATE
`
`CPT
`CODE
`99203
`9/17/2019
`72050
`9/17/2019
`98940
`9/17/2019
`97535
`9/17/2019
`9/17/2019 G0283
`9/17/2019
`97039
`9/23/2019
`98940
`9/23/2019 G0283
`9/23/2019
`97039
`9/23/2019
`97010
`9/23/2019
`97110
`9/26/2019
`98940
`9/26/2019 G0283
`9/26/2019
`97039
`9/26/2019
`97010
`9/26/2019
`97110
`9/30/2019
`98940
`9/30/2019 G0283
`9/30/2019
`97039
`9/30/2019
`97010
`9/30/2019
`97110
`10/3/2019
`98940
`10/3/2019 G0283
`10/3/2019
`97039
`10/3/2019
`97010
`10/3/2019
`97110
`10/7/2019
`98940
`10/7/2019 G0283
`10/7/2019
`97039
`10/7/2019
`97010
`10/7/2019
`97110
`10/16/2019 98940
`10/16/2019 G0283
`10/16/2019 97039
`10/16/2019 97010
`10/16/2019 97110
`11/1/2019
`98940
`11/1/2019 G0283
`11/1/2019
`97039
`11/1/2019
`97010
`11/1/2019
`97110
`
`TOTAL
`BILLED
`AMOUNT
`$213.00
`$108.00
`$51.00
`$66.00
`$6.00
`$30.00
`$51.00
`$6.00
`$30.00
`$0.00
`$61.00
`$51.00
`$6.00
`$30.00
`$0.00
`$61.00
`$51.00
`$6.00
`$30.00
`$0.00
`$61.00
`$51.00
`$6.00
`$30.00
`$0.00
`$61.00
`$51.00
`$6.00
`$30.00
`$0.00
`$61.00
`$51.00
`$6.00
`$30.00
`$0.00
`$61.00
`$51.00
`$6.00
`$30.00
`$0.00
`$61.00
`
`Page 1 of 2
`
`

`

`CP#10858891 Wright, Kayla
`
`11/26/2019 98940
`11/26/2019 G0283
`11/26/2019 97039
`11/26/2019 97010
`11/26/2019 97110
`12/2/2019
`98940
`12/2/2019 G0283
`12/2/2019
`97039
`12/2/2019
`97010
`12/2/2019
`97110
`TOTAL
`
`$51.00
`$6.00
`$30.00
`$0.00
`$61.00
`$51.00
`$6.00
`$30.00
`$0.00
`$61.00
`$1,806.00
`
`Page 2 of 2
`
`