The Simoes Law Group is an unusual firm – small and intimate with a narrow scope of specialized practice. At SLG, representing the rights of insurance policyholders and the medical professionals that provide them with valuable medical care is all that we do. We work in state and federal courtrooms across Florida, moving cases forward and making sure that our clients are treated fairly. Our reputation is such that other lawyers have been kind enough to ask us to assist their personal injury clients when the insurance carrier denies coverage or refuses to pay medical expenses that are due. We have also had the honor to co-counsel with other lawyers in the defense of their physician clients during an aggressive onslaught by an insurance company. It is always a privilege to assist with any case where the outcome can change the face of the law in the State of Florida.
A Brief Look at Some of Our Current Cases:
Johnny Johnson v. GEICO Casualty Insurance Company and Orlando Health, Inc.,
On the evening of November 9, 2006, Johnny Johnson was sitting in his vehicle when he was approached by two armed assailants. One of the assailants shot Mr. Johnson in the chest and fled. Mr. Johnson was transported to Orlando Health's trauma center for emergency medical care. After undergoing multiple surgeries and being hospitalized for several weeks, Mr. Johnson sought lost wages under the car policy issued by GEICO. GEICO delayed all payment of Mr. Johnson's claim asserting that there was insufficient evidence that Mr. Johnson was injured during the shooting. Unable to satisfy GEICO, Johnny Johnson retained Kimberly Simoes. Fortunately for Johnny, in the state of Florida the law allows an injured policyholder to reserve his available benefits to compensate him for lost wages. Simoes demanded that GEICO reserve Johnny's $10,000.00 in benefits to pay his forthcoming lost wage claims. After Mr. Johnson retained Kimberly Simoes, GEICO made some payments to Mr. Johnson. However, rather than reserving Mr. Johnson's limited benefits as requested, GEICO exhausted Mr. Johnson's remaining benefits by paying Orlando Health. Kimberly Simoes filed suit on behalf of Mr. Johnson alleging that GEICO had breached the insurance contract and failed to act in good faith and in the best interests of Mr. Johnson by improperly paying his remaining benefits to Orlando Health. A lawsuit was also filed against Orlando Health for fraud, violation of the Fair Debt Collection Practices Act and civil theft. The suit filed on behalf of Mr. Johnson alleges that Orlando Health asserted an invalid lien against Mr. Johnson's benefits because the hospital bill was completely satisfied by payment from Victims' Compensation. Trial will be set for late 2010.
Raul F. Nodal, M.D. vs. Infinity Insurance Company,
Infinity Insurance Company sold a policy of insurance to Ariel Felipe, which provided Mr. Felipe with $10,000.00 in medical benefits for treatment related to injuries received in a motor vehicle accident. Following a covered accident, Mr. Felipe sought medical care and treatment from Dr. Nodal at Perez Personal Injury Clinic. Dr. Nodal performed medical services for Mr. Felipe and submitted the medical bills and medical records to Infinity. Infinity received the bills and medical records and then made payments for Mr. Felipe's medical treatment. Approximately one year after paying Mr. Felipe's medical bills, Infinity filed a lawsuit in Hillsborough Circuit Court against Dr. Nodal and Perez Personal Injury Clinic. Infinity asserted claims for fraud and civil theft against Dr. Nodal contending that the medical records submitted to Infinity were insufficient to support the CPT coding selected by the doctor. Infinity identified provisions of Florida's No Fault Law (§627.736) as the predicate basis for its fraud and civil theft claims. Kimberly Simoes represented Dr. Nodal and moved to dismiss Infinity's Complaint based upon the economic loss rule as well as other legal theories. In general, parties to a contract can only seek redress as provided by the contract. Therefore, Nodal contended that Infinity could only sue for breach of contract and not under common law fraud. The Circuit Court agreed with the Nodal’s economic rule argument, dismissed the Complaint, and allowed Infinity an opportunity to amend it. Infinity amended the Complaint and Dr. Nodal moved to dismiss the amended Complaint with prejudice. Prior to the hearing on Dr. Nodal's motion, Infinity dismissed the amended Complaint without prejudice. Dr. Nodal sought attorney fees under §772.11 (civil theft) asserting that Infinity's claim did not have substantial factual or legal basis, and also sought fees pursuant to §627.428. The trial court denied Dr. Nodal's motion for attorney fees finding that due to the short duration of the case, the Court was unable to determine if the lawsuit had any sufficient basis. Dr. Nodal and the co-defendant, Perez Personal Injury Clinic, appealed to the Second District Court of Appeals seeking a substantive ruling on the viability of Infinity's causes of action. Oral argument was held on April 14, 2010 [click here for video of the oral argument]. While the appellate panel voiced concern over Infinity’s conduct and appeared to agree with Nodal’s position, an opinion of the appellate court is still pending.
