ORLANDO – A health care facility alleges that an insurer failed to pay a portion of a claim.
Sea Spine Orthopedic Institute LLC, as assignee off Michael James, filed a complaint on April 26 in the 9th Judicial Circuit Court of Florida - Orange County against USAA General Indemnity Co. alleging breach of contract of insurance.
According to the complaint, the plaintiff alleges that on March 14, 2014, James was involved in an auto accident and sought medical treatment with the plaintiff, to which he assigned Personal Independence Payment (PIP) benefits. However, the plaintiff alleges the defendant denied full payment for medically necessary treatment provided to James.
The plaintiff holds USAA General Indemnity Co. responsible because the defendant allegedly failed to pay all or a portion of plaintiff’s claim within 30 days of receipt and failed to establish that it is not responsible for payment of benefits.
The plaintiff seeks judgment against defendant, for benefits together with interest, costs, attorney’s fees, and further relief as the court deems just. It is represented by Richard Shuster and David Bender of Shuster & Saben LLC in Satellite Beach.
9th Judicial Circuit Court of Florida - Orange County Case number 17-CA-003748