CLEARCARE LLC -VS- OCEAN HARBOR CASUALTY INSURANCE C (2025)

alternative Jacob Soley was entitled to PIP benefits belonging to the motor vehicle involved in the accident on 04/07/ 2021 . Plaintiff does not have a copy of said policy to attach; however, Defendant does have a copy of policy. A copy of said policy has been requested through discovery.

4. Assignor sought treatment from Assignee and assigned their PIP benefits over to said medical provider. A valid assignment of benefits has been provided to the medical provider by the assignee which will be made available to Defendant upon request. Additional evidence of an assignment can be established by the health insurance claim form previously provided to the Defendant by the medical provider (i.e. the HCFA/CMS- 1500 Health Insurance Claim Form). If for some reason the Court determines that a valid written assignment does not exist, an equitable assignment can be found by the actions of the Defendant and Plaintiff in that the Defendant has made payment(s) directly to the medical provider. See Giles V. Sun Bank, 450 So.2d 258 (Fla. 5th DCA 1994 ).

5. On or about 04/07/ 2021 , Jacob Soley was involved in an automobile accident in the state of Florida.

6. Following said accident, Jacob Soley underwent medical treatment with Plaintiff for injuries sustained as a direct result of said accident on 04/07/ 2021 .

7. At all times material hereto, said policy of insurance was in full force and effect.

8. Plaintiff has performed all conditions precedent to entitle it to recover benefits, including compliance with F.S. 627.736(10).

9. Jacob Soley furnished Defendant with a properly executed application for PIP benefits together with medical authorization for the Defendant to obtain the information needed to process the claim.

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Plaintiff re-alleges the allegations contained in paragraphs 1 to 9 above and further states:

10. On or about 04/07/ 2021 , Jacob Soley was involved in a motor vehicle accident in the state of Florida and sustained personal injuries as a direct causal result of said accident.

11. As a direct and proximate result of the injuries Assignor sustained in the accident, Jacob Soley incurred expenses for medical care that was reasonable and medically necessary.

12. Defendant denied full payment for medically necessary treatment provided to Jacob Soley by Plaintiff. Defendant has denied coverage for, or did not make full payment of Assignor's PIP benefits for medical expenses provided by the Plaintiff within 30 days as required by Florida Statute, 627.736 (1). Specifically, the Defendant received medical bills from the Plaintiff for medical services rendered to the Assignor. A copy of the HCFAs and/or itemized ledger was previously provided to the insurer and will be made available to Defendant (again) upon request.

13. Despite prior demand by Plaintiff, to date, Defendant has yet to pay all or a portion of Plaintiff's claim and continues to refuse to issue payment of all sums due, including benefits, interest, penalty and postage in violation of 667.736 and in breach of its insurance policy.

14. At no time did Defendant assert that Plaintiff's medical bills were untimely or otherwise defective in form or content.

15. As a result of Defendant's breach and failure to pay all or a portion of Plaintiff's claim, the Defendant has breached the contract of insurance with the Plaintiff.

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SYLVIA GRUNOR

Party Details

CLEARCARE LLC

JACOB SOLEY

OCEAN HARBOR CASUALTY INSURANCE COMPANY

VALERIE ZEPPILLI

THOMAS WENZEL

CHRISTINA GLEMAUD

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