Florida orthopedic practice files complaint against insurance company for underpayment: 5 key notes

Laura Dyrda -   Print  |

SeaSpine Orthopedic Institute, based in Orlando, filed a complaint against USAA General Indemnity Co. for breach of contract, according to a Florida Record report.

Here are five things to know:


1. The practice filed the complaint as an assignee of Michael James, a patient who received care at the practice after an auto accident injury. Mr. James was assigned Personal Independence Payment benefits, but the USAA General Indemnity Co. did not pay in full for the treatment deemed medically necessary.


2. SeaSpine Orthopedic now holds the payer responsible because USAA General Indemnity Co. didn't pay the claim in full within 30 days of receipt.


3. The insurer did not establish a lack of responsibility for paying the benefits, according to the report.


4. SeaSpine Orthopedic is seeking payment for the benefits with interest, costs, attorney's fees and "further relief as the court deems just."


5. Shuster & Saben LLC in Satellite Beach is representing the practice.


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