TRI-County Diagnostic & Imaging Centers LLC Plaintiff vs. State Farm Mutual Automobile Insurance Company Defendant, COCE17001893, 01-31-2017_Statement of Claim (eFiled) (Fla. Broward Cty. Ct. Jan. 31, (2024)

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`On or about January 6, 2015, Pierrela Joseph (hereinafter “Claimant”)
`5.
`was involved in a motor vehicle accident.
`
`As a result of that motor vehicle accident, Plaintiff provided Claimant
`6.
`with medical services and/or treatment.
`
`As a direct and proximate result of the injuries sustained by Claimant
`7.
`in the accident, Claimant incurred reasonable expenses for necessary medical and
`rehabilitative care by the Plaintiff. To date, Defendant refuses to pay the full
`amount due.
`
`Defendant issued a policy of insurance to Pierrela Joseph and/or the
`8.
`named insured, which provided personal
`injury protection benefits coverage
`required by law to comply with Florida Statutes Sections 627.730 thru 627.7405.
`Plaintiff does not have a copy of the policy to attach; however, Plaintiff believes
`that the Defendant has a copy of said policy.
`
`The above described policy was in full force and effect on the date of
`9.
`the accident and provided PIP coverage for Pierrela Joseph for bodily injuries
`sustained in said accident.
`
`Plaintiff and Claimant have performed the statutorily required
`10.
`conditions precedent to entitle Plaintiff to recover benefits for said necessary
`medical,
`rehabilitative and remedial
`treatment regarding the above—described
`policy and statutory conditions precedent to instituting this action.
`
`Claimant equitably assigned to Plaintiff and also executed a written
`11.
`assignment of benefits, assigning to Plaintiff certain benefits payable pursuant to
`the policy of insurance issued by Defendant.
`
`Pursuant to said Assignment, Plaintiff gave notice of the covered
`12
`losses and Plaintiff made demand for PIP benefits for reasonable, necessary and
`related medical treatment. A copy of the Assignment of Rights is attached hereto
`and incorporated by reference.
`
`13. Defendant has denied coverage for, withheld or reduced the medical
`bills that were submitted by Plaintiff for date of service February 10, 2015 and/or
`misapplied the application of the deductible. A copy of the HCFA/Bill(s) is
`attached hereto and incorporated by reference. Due to the failure of Defendant to
`
`1 250 EAST HALLANDALE BEACH BLVD.. Sum: 703. HALLANDALE BEACH. FL 33009
`(305) 932-91 99 — TELEPHONE- (305) 932-9191 - FACSIMILE
`
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`pay these PIP benefits in accordance with the law, Plaintiff has been required to
`retain the undersigned law firm to act on their behalf in this suit. Plaintiff has
`agreed to pay, and the attorneys for Plaintiff have agreed to accept, any court
`awarded fee.
`
`COUNT I: BREACH OF CONTRACT FOR FAILURE TO PAY
`
`AMOUNTS OWED.
`
`14.
`complaint.
`
`Plaintiff reavers and realleges paragraphs
`
`1
`
`through 13 of this
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`15. Despite prior demand by Plaintiff, Defendant has refused and
`continues to refuse to issue payment of all sums due Plaintiff,
`in violation of
`Section 627.736, Florida Statutes, and in breach of its contact with claimant.
`
`Plaintiff has retained the undersigned firms to represent it in this
`16.
`action and has agreed to pay a reasonable fee for said services.
`
`Pursuant to Section 627.428, Florida Statutes, Plaintiff is entitled to
`17.
`recover from Defendant reasonable attorney’s fees and costs for the necessity of
`this action.
`
`WHEREFORE, Plaintiff requests:
`
`a.
`
`That
`
`this Honorable Court declare that Defendant
`
`is overdue in
`
`payment of all sums due to Plaintiff;
`
`b.
`
`c.
`
`d.
`
`e.
`
`That Defendant pay all sums due to Plaintiff under Claimant’s policy
`of Insurance with Defendant, including Medpay if applicable;
`
`That Defendant pay interest on all unpaid sums in accordance with
`Section 627.736(4), Florida Statutes;
`
`That Defendant pay Plaintiff pro-suit penalty, postage, and interest in
`accordance with Section 627.736(10), Florida Statutes.
`
`That Defendant pay Plaintiff reasonable attorney’s fees and costs
`pursuant to Sections 627.428, Florida Statutes, and/or 627.736(5),
`Florida Statutes, for the necessity of this action;
`
`1250 EAST HALLANDALE BEACH BLVD.. SUITE 703. HALLANDALE BEACH. FL 33009
`(305) 93 2-91 99 — TELEPHONE - (305) 932-9191 — FACSIMILE
`
`

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`f.
`
`Any other relief this Court deems just and appropriate.
`
`injury
`for personal
`WHEREFORE, Plaintiff demands judgment
`protection benefits including Medpay if applicable together with pre—
`judgment
`interest, costs and attorneys fees pursuant
`to Florida Statute
`627.428 and Florida Statute sections 627.736(5) and any other relief this
`Court deems proper and just.
`
`Plaintiff demands trial by jury on all issues triable as of right.
`
`TODD LANDAU, P.A.
`
`Plaintiff‘s Counsel
`
`1250 East Hallandale Beach Blvd.
`
`Suite 703
`
`Hallandale Beach, Fl. 33009
`
`Telephone (305) 932-9199
`Facsimile (305) 932-9191
`
`Pleadin rsfcfltoddlandaulaw
`
`
`*
`i
`,
`By:
`N
`TODD A. LANDAU, ESQ.
`0633333 WV
`Florida Bar No. 0489433
`
`1250 EAST HALLANDALE BEACH BLVD. SUITE 703. HALLANDALE BEACH. FL 33009
`(305) 932-9199 -» TELEPHONE . (305) 93291 91 - FACSMLE
`
`

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`Tri-Coungy D & I Centers
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`I hereby authorize and direct you. my insurance company and/or my attorney, to pay directly to Trl-Cogmy Q & 1 nggrg
`(“Assignee”). such sums as may be due and owing Assignee for the services rendered to me. both by reason of accident or illness. and
`by reason of any other bills that are due Assignee, and to withhold such sum from any disability benefits. medical payment benefits.
`No-Fault benefits. or any other insurance benefits obligated to reimburse me or from any settlement, judgment or verdict on my behalf
`as may be necessary to adequately protect said Assignee. la the event that I do not have insurance coverage. I understand that I rennin
`personally responsible for payment of services rendered. I hereby further give an irrevocable lien to said assignee against any and all
`insurance benefits named herein and any and all proceeds of any settlement, judgment or verdict which may be paid to me as a result
`ofthe injuries or illness for which I have been treated by the Assignec. This is to act as an assignment ofmy rights and benefits to the
`extent of the Assignec‘s services provided. In the event my insurance company is obligated to make payments to me upon charges
`made by the Assignee for its services refuses to make such payments, upon demand by me or Assignee. I hereby assign and transfer to
`Assignee any and all causes of action, and proceeds from such causes of actioa. that I might have or that might exist in my favor
`against such company and authorize Assignee to prosecute said cause of action either in my name or Assignee's name and timber!
`authorize Assignce to prosecute said cause of action either in my name or Assignec’s 'name and ihrthcr I authorize Assiguee to
`compromise. settle or otherwise resolve said claim of action as they see fit.
`
`D1315Q! [OE OF EAXMEEI
`
`I hereby authorize any insurance company or attorney to pay directly to Assignee the amount of this and/or any future bills for
`services rendered to me. I also agree to pay in a current manner any difference between the total charges and the amount paid by the
`insurance company directly to Assignee.
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`sic er
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`I hereby authorize Assignee to release any information requested that is pertinent to my case to my insurance company or attorney
`involved in this case. Pursuant to §627.4137 Florida Statutes (2001). I hereby request a copy of the pip log and declaration sheet.
`which reflects the policy limits available at the time of this accident, to be provided to this Assignee. I hereby authorize this Assignee
`to request and receive a copy of my pip log periodically as they deem to be necessary. If any .term or provision of this Assignment.
`Lien and Authorization or the application thereof to any person or circ*mstances shell to any extent be invalid or unenforceable the
`remainder of this Assignment, Lion and Authorization. or the application of such term or provision to persons or circumtanccs other
`than those as to which it is held invalid or unenforceable. shall not be affected thereby. and each term and provision of this
`Assignment. Lien and Authorization shall be valid and enforced to the fullest extent ofthe law.
`
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`to Florida case law that should you (the insurance
`I am hereby placing you on notice pursuant
`Be thrthcr advised that
`company/carrier) deny. reduce or fail to pay any part of. or an entire bilehich was submitted on my behalf from this health care
`provider, I (the assignor) and well as the assignee (health care provider) are requesting in advance that you reserve. or “set-aside.” the
`amount you reduce for deny until the dispute is resolved. Should you submit a check to this health care provider which rs less that the
`correct contractual amount, and contains any language referring to payment as “Full and Final Payment.“ I have instructed this health
`care provider to return the check to you (the carrier) and consider the bill still due and owing (i.e. a late payment as defined in ES.
`627.736). Additionally should the remaining amount of my benefits approach an amount where there would be insufficient funds to
`pay the amount you reduced. denied or failed to pay. please notify me (the assignor) and the assignee (this health care provider) ofthis
`fact. Lastly. should my benefits become exhausted; please notify me (the assignor) and this health care provider (the assignee).
`.
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