IN THE CIRCUIT COURT OF THE

ELEVENTH JUDICIAL CIRCUIT, IN

AND FOR MIAMI-DADE COUNTY,
FLORIDA

CIVIL DIVISION

CASE NO.

Case No.:
FLORIDA SPINE AND JOINT
INSTITUTE, a Florida limited liability
company,

Plaintiff,

v.

GEICO GENERAL INSURANCE

COMPANY, a Maryland corporation,

Defendant.
__________________________________/

COMPLAINT AND DEMAND FOR JURY TRIAL

Plaintiff, Florida Spine and Joint Institute (“FSJI”), by and through its undersigned

counsel, hereby files this Complaint and Demand for Jury Trial against Defendant, Geico

General Insurance Company (“Geico”), and alleges as follows:

THE PARTIES, JURISDICTION, AND VENUE

1. This is an action for damages in excess of $750,000, exclusive of attorneys’ fees,

interests, and costs, and for declaratory relief, tortious interference with a contractual or

business relationship, and defamation arising out of Geico’s refusal to reimburse FSJI for PIP

benefits coverage and dissemination of false statements concerning FSJI’s business practices.

FSJI seeks damages in this action in excess of $750,000 (exclusive of attorneys’ fees, interest,

and costs), the threshold for this circuit’s Complex Business Litigation Division, and the subject
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matter in controversy and the amount in dispute meet the requirements of the Court’s

Administrative Order No. 17-11 §§ 3(B)(ii) and conform to the Complex Business Litigation

Rules.

2. FSJI is a limited liability company organized under the laws of the State of

Florida doing business in Florida through operation of its facilities in Florida.

3. Geico is a corporation organized under the laws of Maryland with its principal

place of business in Maryland. The Court has personal jurisdiction over Geico because Geico

engages in substantial and not isolated in activity in Florida, is registered to do business in

Florida, carries on its business in Florida, and has entered into insurance contracts with patients

in Florida. Geico has sufficient contacts with this state such that the Court’s exercise of

jurisdiction comports with traditional notions of fair play and substantial justice.

4. Jurisdiction and venue are proper in Miami-Dade County, Florida because the

causes of action herein accrued in Miami-Dade County, Florida.

FACTUAL ALLEGATIONS

Florida’s Motor Vehicle No-Fault Law and FSJI

5. Florida’s Motor Vehicle No-Fault Law (“Florida’s PIP Statute”), Fla. Stat. §

627.730 et seq., requires motor vehicle owners to maintain personal injury protection (“PIP”)

coverage, and it requires insurers to provide PIP coverage to its insureds for injury, sickness,

disease, or death arising out of the ownership or maintenance of a motor vehicle.

6. FSJI is a healthcare provider that offers medical services, including to patients

who have sustained personal injuries in motor vehicle accidents. This includes various

treatments, procedures and diagnostic testing for various conditions.

7. FSJI’s patients assign their PIP benefits to FSJI, and FSJI accordingly submits

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claims for reimbursement to its patients’ insurers for PIP benefits pursuant to Florida’s PIP

Statute.

Geico’s Refusal to Provide PIP Benefits Reimbursement

8. Geico is an automobile insurer required to provide PIP benefits to its insureds as

set forth under Florida’s PIP Statute.

9. Geico issued insurance policies, including PIP benefits coverage, to a number of

FSJI’s patients (“FSJI’s Geico Patients”) who in turn assigned their PIP benefits to FSJI.

10. For a significant period of time, FSJI has submitted numerous claims for

reimbursement of PIP benefits to Geico for FSJI’s Geico Patients that Geico has denied (the

“Denied Claims”).

11. Geico has wrongfully denied FSJI’s Denied Claims.

12. Geico alleges that it is not required to pay for the Denied Claims for reasons

which may differ among certain claims, but which include: (1) FSJI’s medical directors are not

fulfilling their duties as set forth in Section 400.9935, Florida Statutes; (2) FSJI is

inappropriately billing Geico under Florida’s PIP statute for services rendered through the

participation of FSJI’s licensed massage therapists (“LMTs”);1 (3) FSJI is engaging in

“upcoding”, or charging its patients for higher level medical services in lieu of more inexpensive,

conservative treatment; and (4) FSJI’s billing for timed codes is not matching its hours of

1 FSJI has informed Geico that the law permits FSJI to receive PIP reimbursement for therapy
services rendered by an LMT so long as such services were rendered under the direct supervision
of an FSJI doctor and billed as incidental to the doctor’s lawful practice of medicine, which is the
case here. Geico has taken the position that this is not true, despite the fact that Geico has
recently lost this argument twice in Florida state courts. Therapeutic Rehab Ctr. v. Geico
Indemnity Co., Case No. 14-9299-cc-26(3), (Fla. Cir. Ct. Dec. 3, 2015) (Order Granting
Plaintiff’s Motion for Final Summary Judgment on Count 1 of the Complaint); North Miami
Therapy Ctr. Inc., v. Geico Indemnity Co., Case No. 14-001899 (Fla. Cir. Ct. May 18, 2018)
(Order on Geico’s Motion for Summary Judgment).
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operation.

13. FSJI has repeatedly requested that Geico provide FSJI with information to

substantiate its allegations so that FSJI may investigate those allegations appropriately. As of the

date of filing this Complaint, Geico has refused to provide any data or information substantiating

its allegations as set forth in Paragraph 12.

Geico’s Dissemination of False Information

14. In addition to wrongfully denying claims, Geico has also sent letters to FSJI’s

patients claiming that FSJI is engaging in fraudulent billing for medical services that it has

rendered (the “Defamatory Letters”). An exemplar of a Defamatory Letter is attached hereto as

Exhibit A.

15. The Defamatory Letters state, in part, that “GEICO has a reasonable belief that a

fraudulent insurance act under Section 626.989 or 817.234, Fla. Stat., has been committed with

respect to [your] Claim. GEICO is therefore investigating [your] Claim for suspected fraud.”

Ex. A at 1.

16. Notably, however, Geico’s Defamatory Letters to FSJI’s patients do not contain

any information or data substantiating the allegations therein. See Ex. A.

17. In fact, several Geico representatives were recently asked during depositions what

information Geico had to substantiate its allegations of fraud against FSJI, as set forth in its

Defamatory Letters. Geico’s representatives were unable to provide any information supporting

those allegations. See Deposition Transcript of Lafaydra Neal, attached hereto as Exhibit B, at

34:4–35:12 (“Q: And at the time that the letter was physically sent out … did you have any

documentation or information within the claims file that a fraudulent insurance act under Section

626.989 or 817.234 had been committed with respect to this claim? A: Again, [] the letter was

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sent because I needed additional time to investigate the file. … Q: But just so we’re clear … the

only reason as to why these particular letters was sent out is because GEICO wanted more time

to investigate the claim. A: On this particular claim, yes, I wanted more time to investigate it … I

did not know if a fraudulent act ha[d] been committed and that was the reason [] for sending the

letter, to get more time [] to investigate.”); Deposition Transcript of Shannon Studt, attached

hereto as Exhibit C, at 29:2–5 (“Q: [W]hat reasonable belief did they have that there was some

type of fraudulent insurance act that was being committed by Florida Spine and Joint? A: And

that I do not know.”); Deposition Transcript of Brittany West, attached hereto as Exhibit D, at

14:5–16 (“Q: And at the time that you sent out the letter … what documentation or information

did you have in your file that Geico had a reasonable belief that a fraudulent insurance act under

Section 626.989 or 817.234 had been committed with respect to this claim? A: I – I don’t recall.

Q: So as you sit here today, do you have any documentation or information within your file as to

what the reasonable belief that a fraudulent insurance act had occurred in respect to this claim?

A: No, sir.”).

18. Indeed, Geico is engaging in systematic fraud by denying coverage to their

customers by refusing to pay for legitimate medical services covered under the applicable

policies and governed by Florida’s PIP Statute.

19. At various points in time, Geico has contacted FSJI and offered to pay the Denied

Claims, if FSJI excludes any interests costs on those claims. Geico’s after-denial offers to pay

the Denied claims, at a reduced price, make clear that Geico’s denials were not made in good

faith.

20. FSJI has retained the undersigned law firm and has agreed to pay its reasonable

attorneys’ fees and costs.

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 21. All conditions precedent for maintaining this action, if any, have occurred, been

performed, or otherwise been waived.

COUNT I – DECLARATORY JUDGMENT

22. FSJI incorporates into this Count Paragraphs 1 through 21 as if fully set forth

herein.

23. This is an action for declaratory judgment pursuant Section 86.011, Florida

Statutes.

24. A bona fide, actual, concrete, and continuing justiciable controversy exists

between FSJI on one hand, and Geico on the other, regarding whether, among other things,

Florida law permits FSJI to receive PIP reimbursement for therapy services rendered by an LMT

so long as such services were rendered under the direct supervision of an FSJI doctor and billed

as incidental to the doctor’s lawful practice of medicine.

25. The resolution of this live controversy requires a determination of whether Geico

is obligated to pay the Denied Claims pursuant to Florida’s PIP Statute and whether FSJI has a

right to collect on the Denied Claims from Geico pursuant to Florida’s PIP Statute.

26. The adverse position taken by Geico, that Florida law does not permit FSJI to

receive PIP reimbursement for therapy services rendered by an LMT in any case, has

substantially injured FSJI, who is owed in excess of the jurisdictional amount in unpaid Denied

Claims. This issue touches directly on the legal rights of the parties, and there is a bona fide,

actual, and practical need for a declaration.

27. The relief sought herein is not a mere advisory opinion, legal advice, or an answer

to a question propounded for curiosity, and does not have an abstract disagreement.

WHEREFORE, as to Count I of this Complaint, FSJI respectfully requests the following

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relief:

a. A declaratory judgment pursuant to Section 86.011, Florida Statutes, that

Florida law permits FSJI to receive PIP reimbursement for therapy
services rendered by an LMT so long as such services were rendered
under the direct supervision of an FSJI doctor and billed as incidental to
the doctor’s lawful practice of medicine;
b. A declaratory judgment pursuant to Section 86.011, Florida Statutes, that
Geico is required to pay FSJI for the unpaid Denied Claims;
c. Attorneys’ fees and costs incurred as a result of this action pursuant to
Section 627.736(8), Florida Statutes and Section 627.428, Florida Statutes;
and,
d. Such other and further relief that the Court deems just and proper.

COUNT II – TORTIOUS INTERFERENCE WITH FSJI’S

CONTRACTUAL OR BUSINESS RELATIONSHIPS

28. FSJI incorporates into this Count Paragraphs 1 through 21 as if fully set forth

herein.

29. FSJI has ongoing contractual and/or business relationships with its Geico Patients

who have received medical services at one of FSJI’s facilities and entered into contracts with

FSJI.

30. Geico, as the insurer for FSJI’s Geico Patients, knows of and is aware of FSJI’s

contractual and business relationships with its Geico Patients.

31. Geico, having knowledge of FSJI’s existing contractual and business relationships

with its patients, intentionally and unjustifiably interfered with those contracts and relationships

by sending the Defamatory Letters to FSJI’s Geico Patients, which contained false allegations of

fraud against FSJI.

32. As a direct and proximate result of Geico’s actions, FSJI has suffered and will

continue to suffer significant damages including, without limitation, loss in good will, damages

to its reputation, and damages in amount to be proven at trial.

WHEREFORE, as to Count II of this Complaint, FSJI respectfully requests the following

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relief:

a. Monetary relief in an amount to be determined at trial; and,

b. Such other and further relief that the Court deems just and proper.

COUNT III – DEFAMATION

33. FSJI incorporates into this Count Paragraphs 1 through 21 as if fully set forth

herein.

34. Geico sent the Defamatory Letters to several of FSJI’s patients.

35. The Defamatory Letters contain false and defamatory statements that FSJI

engaged in, and engages in, fraudulent behavior.

36. The defamatory and false statements made by Geico in its Defamatory Letters

prejudiced FSJI’s business and deterred FSJI’s patients from continuing to seek medical services

at FSJI.

37. Geico made the defamatory and false statements in the Defamatory Letters with

knowledge of the falsity of such statements and/or negligent disregard as to the falsity of such

statements. See Ex. B at 34:4–35:12; Ex. C at 29:2–5; Ex. D at 14:5–16.

38. As a direct and proximate result of Geico’s defamatory and false statements, FSJI

has suffered and will continue to suffer a loss in good will, loss of clients, damages to its

reputation, and damages in amount to be proven at trial. FSJI reserves its right to seek leave

from the Court to seek punitive damages.

WHEREFORE, as to Count III of this Complaint, FSJI respectfully requests the

following relief:

a. Monetary relief in an amount to be determined at trial; and,

b. Such other and further relief that the Court deems just and proper.

JURY TRIAL DEMAND

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 FSJI seeks trial by jury on all counts so triable.

Dated: April 2, 2020 Respectfully submitted,

/s/ Avi Benayoun

AVI BENAYOUN
Florida Bar No. 151696
benayouna@gtlaw.com
GREENBERG TRAURIG, P.A.
401 East Las Olas Boulevard, Suite 2000
Fort Lauderdale, FL 33301
Telephone: (954) 768-8254
Facsimile: (954) 765-0500

MICHAEL N. KREITZER
Florida Bar No. 705561
kreitzerm@gtlaw.com
STEPHANIE PERAL
Florida Bar No. 119324
perals@gtlaw.com
GREENBERG TRAURIG, P.A.
333 S.E. 2nd Avenue, Suite 4400
Miami, Florida 33131
Telephone: (305) 579-0500
Facsimile: (305) 579-0717

Attorneys for Plaintiff