Source: http://www.roiglawyers.com/flpipguide/author/johnfregeolle/
Timestamp: 2019-01-20 03:10:36
Document Index: 731478981

Matched Legal Cases: ['§ 627', '§ 627', '§ 627', '§ 627', '§ 627', '§ 627', '§ 627', '§ 627', '§ 627']

John A. Fregeolle, Esq. | Florida PIP Guide Blog
Author Archives: John A. Fregeolle, Esq.
by John A. Fregeolle, Esq. | November 1, 2016 · 4:27 pm
Miami Woman Arrested and Charged in Insurance Fraud Scheme
According to the Palm Beach Post, Carmen Montalvo-Rivera of Miami was arrested and charged in Lake Worth, FL on Thursday, October 27th after investigators say she defrauded SUNZ Insurance Company. The arrest report states that Montalvo-Rivera’s shell company, Enterprises Remodeling Group Inc., used uninsured employers to do construction work. Once the job was finished, she would then cash the checks made out to the shell company in order to pay the workers in cash and severely underreport her company’s wages to the insurance company.
Montalvo-Rivera reported Enterprise Remodeling Group’s wages at $26,665 when they were actually $4,307,092.48. Her insurance premium should have been between $327,000 and $525,000 instead of the $1,796 premium she had been paying due to her fraudulent reporting.
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Filed under Florida, Insurance, Insurance Fraud, Miami-Dade County, Uninsured
Tagged as insurance, Insurance Fraud, Uninsured
by John A. Fregeolle, Esq. | July 21, 2016 · 3:35 pm
GEICO Wins Sanctions Against Law Firm, Auto Repair Shop
GEICO won a sanctions request in Florida federal court against a Mississippi auto repair shop and its law firm. U.S. Senior District Judge Gregory A. Presnell ruled that GEICO’s Motion for Attorney Fees was “meritorious” and ordered the insurance company to prepare a specific fees request.
Clinton Body Shop and its law firm, John Arthur Eaves Attorneys, lost a summary judgment in a related suit charging GEICO with unjust enrichment and tortious interference with business relations. GEICO said that the summary judgment victory in that previous case barred the body shop from reasserting those same claims. The federal judge in the Middle District of Florida agreed.
“Any reasonable attorney or claimant would have known what is one of the most fundamental principles of our legal system: that a claim or issue, once litigated to a final adjudication, cannot be relitigated,” GEICO said in its motion. “(R)efiling of the same claims they lost to GEICO three months earlier in another case is automatically bad faith, warranting sanctions.”
Clinton’s argument was that the two suits involved separate entities: the first against GEICO Insurance Co., the latter against GEICO General Insurance.
The case is part of multidistrict litigation in which repair shops in 10 states are accusing several insurance companies of violating the Sherman Antitrust Act by colluding to keep reimbursement rates low for auto body repair work.
Presnell had dismissed Clinton’s claims against GEICO in May before granting sanctions on July 19.
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Filed under Florida, Insurance, Insurance Defense, Middle District of Florida
Tagged as body shops, MDL, Presnell, sanctions
by John A. Fregeolle, Esq. | June 24, 2016 · 9:52 am
by John A. Fregeolle, Esq. | May 20, 2016 · 2:36 pm
by John A. Fregeolle, Esq. | April 11, 2016 · 12:15 pm
Pinellas County Court on Application of Deductible
In Bayfront Health Education & Research Organization Inc. v. Progressive American Insurance Co., the Plaintiff billed the Defendant for services. The Defendant reduced the bills, subtracted the insured’s deductible, and paid eighty percent of the difference. Under Florida Statute § 627.736, the Defendant pled that only reasonable, related, and necessary “medical expenses are reimbursable and likewise applicable to any deductible.” The Plaintiff moved for summary judgment claiming that the Defendant misapplied the deductible. The Plaintiff claimed that the deductible should be applied to the amount billed.
The Court held that Florida Statute § 627.739(2) “requires the deductible be applied to 100 percent of the reasonable expenses.”
The Court construed Florida Statute § 627.739(2) and Florida Statute § 627.736. Under Florida Statute § 627.739(2), “[t]he deductible amount must be applied to 100 percent of the expenses and losses described in s. 627.736.” The Court looked to Florida Statute § 627.736 “to determine the expenses and losses described.” The Court said that Florida Statute § 627.736 “describes the payable expenses as ‘reasonable expenses.’”
The Court also found that “the deductible is applied to 100% of all reasonable expenses” under the insurance contract.
The Court interpreted the insurance contract. Under the insurance contract, “the deductible will be applied to 100% of the expenses and losses covered under Personal Injury Protection Coverage.” The Court said that “[m]edical benefits are part of the Personal Injury Protection Coverage and defined as 80% of all reasonable expenses.”
In sum, under Florida Statute § 627.739(2), Florida Statute § 627.736, and the insurance contract, the Court held that “the deductible is applied to 100% of the provider’s reasonable expenses.”
Order Denying Plaintiff’s Motion for Summary Judgment, in Part, and Granting, in Part, Bayfront Health Educ. & Research Org. Inc. v. Progressive Am. Ins. Co., No. 12-5556-SC (Fla. Pinellas Cty. Ct. 2015).
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Filed under Fla. Stat. 627.736 (2012), FLA. Stat. 627.739(2), Florida, Insurance, Insurance Defense
Tagged as Bayfront Health Education & Research Organization Inc., insurance, Insurance Fraud, Insurance Policies, Progressive American Insurance