HERRERA ALONSO v. GEICO General Insurance Company

CourtDistrict Court, S.D. Florida
DecidedApril 25, 2024
Docket1:23-cv-20852
StatusUnknown

This text of HERRERA ALONSO v. GEICO General Insurance Company (HERRERA ALONSO v. GEICO General Insurance Company) is published on Counsel Stack Legal Research, covering District Court, S.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
HERRERA ALONSO v. GEICO General Insurance Company, (S.D. Fla. 2024).

Opinion

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF FLORIDA CASE NO. 23-20852-CV-WILLIAMS

ALLAN HERRERA ALONSO, et al.,

Plaintiffs,

v.

GEICO GENERAL INSURANCE COMPANY,

Defendant. / ORDER THIS MATTER is before the Court on the Motion for Summary Judgment (DE 29) (“Motion”) filed by Defendant GEICO General Insurance Company (“Defendant” or “GEICO”) to which Plaintiffs Allan Herrera Alonso (“Mr. Herrera”) and Lourdes Herrera (“Mrs. Herrera”), assignees of Roger A. Garcia (“Mr. Garcia Sr.”) and Roger S. Garcia (“Mr. Garcia Jr.”), assignors (collectively, “Plaintiffs”) filed a Response (DE 47) (“Response”), and GEICO filed a Reply (DE 49) (“Reply”).1 For the reasons set forth below, GEICO’s Motion is GRANTED IN PART AND DENIED IN PART. I. BACKGROUND On the morning of February 28, 2018,2 at or around the intersection of NW 36th Avenue and NW 82nd Street in Miami-Dade County, Florida, an automobile insured by

1 In accordance with Southern District of Florida Local Rule 56.1, the Parties appropriately filed separate and contemporaneous Statements of Material Facts. See S.D. Fla. L.R. 56.1(a). The Court will cite to the GEICO’s Statement of Material Facts (DE 28), Plaintiffs’ Statement of Material Facts (DE 46), and GEICO’s Reply Statement of Material Facts (DE 49).

2 All dates, unless otherwise stated, occurred in the annual year of 2018. GEICO and operated by Mr. Garcia Sr. was involved in a motor vehicle accident with a motorcycle operated by Mr. Herrera (“Accident”). (DE 28 at 1; DE 28-2 at 1, 4.) As a result of the Accident, Mr. Herrera sustained serious injuries, requiring him to be immediately transported to the trauma unit at Jackson Memorial Hospital (“JMH”). (DE

28-2 at 4–5.) At JMH, Mr. Herrera underwent numerous surgeries, including the amputation of his right leg. (DE 46 at 6; DE 47 at 2.) That same day, GEICO received a notification of the Accident. (DE 28-3 at 55.) The next day, GEICO called and left a voicemail on Mr. Garcia Sr.’s phone in hopes to obtain additional information. (DE 28-3 at 55.) On March 7, after multiple unsuccessful calls to Mr. Garcia Sr., GEICO spoke to Ms. Margarita Ibarra (“Ms. Ibarra”), one of the named co-insureds under the GEICO auto-insurance policy (“Auto Policy”), who advised

GEICO of the property loss and personal injury to Mr. Herrera. (DE 28-3 at 53–54.) After requesting and reviewing the corresponding State of Florida Traffic Crash Report (“Crash Report”) memorializing the details of the Accident, GEICO advised Ms. Ibarra and Mr. Garcia Jr., the other co-insured under the Auto Policy, that GEICO found Mr. Garcia Sr. at fault for the Accident.3 (DE 28-3 at 50–53.) On March 16, GEICO initiated its first contact with Mr. Herrera by leaving a

voicemail on his cell phone. (DE 28-3 at 45–47.) Three (3) days later, GEICO followed up with Mr. Herrera via mail correspondence delivered to his registered address with enclosed copies of a HIPPA Authorization and a Medicare Eligibility Form. (DE 28-6.) On March 20, Mrs. Herrera returned GEICO’s initial phone call but was unable to reach a

3 Mr. Garcia Sr. is not a named insured on the Auto Policy, but he was a permissive driver of the insured vehicle. representative. (DE 28-3 at 44.) She left a voicemail explaining that Mr. Herrera was scheduled to begin a second surgery and that she and Mr. Herrera had been unable to speak with GEICO sooner. (DE 28-3 at 44.) Mrs. Herrera did not share her name or contact information in her voicemail. (DE 28-3 at 44.) By the end of that day, however,

Tina Swindell (“Ms. Swindell”), a GEICO supervisor, directed the handing claims adjuster to verify Mr. Herrera’s hospital room at JMH and to tender the Auto Policy’s maximum $10,000 bodily injury limit to Mr. Herrera. (DE 28-3 at 42.) On March 21, Peter Mixon (“Mr. Mixon”), the GEICO claims handler assigned to Mr. Herrera’s claim, called Ms. Ibarra to update her on GEICO’s decision to tender the maximum limit. (DE 28-3 at 35, 38.) Afterwards, Mr. Mixon also called and left a voicemail on Mr. Herrera’s phone, stating that GEICO would pay him $10,000 and explaining the

subsequent lien process GEICO must adhere to in order to ensure there were no outstanding medical bills for the services Mr. Herrera received at JMH. (DE 28-3 at 35, 38.) On March 22, a GEICO field representative visited JMH, attempting to deliver a $10,000 check to Mr. Herrera. (DE 28-3 at 34.) However, Mr. and Mrs. Herrera did not accept the $10,000 check because Mr. Herrera, at the time, believed that he and his wife had retained counsel to represent them on issues pertaining to the Accident. (DE 28-3 at 34.)4 In this encounter with the Herreras, the GEICO field representative discovered that Mr. Herrera’s right leg had been amputated. (DE 28-3 at 33–34.) Accordingly, Mr. Mixon

4 Upon information that Plaintiffs may have retained counsel, Mr. Mixon contacted Plaintiffs’ purported counsel who informed Mr. Mixon that he and his law office had not agreed to represent Mr. and Mrs. Herrera as of March 22. (DE 28-3 at 34.) informed Ms. Ibarra of the increasing value of the claim and the lengthy settlement process that may ensue when hospital liens apply. (DE 28-3 at 33–34.)

After the first failed attempt to deliver the $10,000 check to Mr. Herrera, on March 23, the GEICO field representative returned to JMH and successfully delivered a proposed release form and the $10,000 check made co-payable to Mr. Herrera and JMH. (DE 28-3 at 33.) Later, following a conversation with Mr. Garcia Sr., GEICO amended the proposed release to include Mr. Garcia Jr. as an additional released party and subsequently delivered the amended proposed release to Mr. Herrera at his residence on March 27. (DE 28-3 at 26–27, 31–32.) By April 7, Mrs. Herrera mailed GEICO a letter explaining that she and her husband received the $10,000 check payable to Mr. Herrera and JMH but because Mr. Herrera’s medical bills were covered by Medicaid, she would

like for GEICO to re-issue the check without JMH’s name on it. (DE 28-12.) In response, Mr. Mixon advised Mrs. Herrera that “Medicare” can hold liens based on medical services rendered at JMH and in order for GEICO to amend the check, the Herreras would need to provide documentation showing a lien satisfaction or a zero balance from JMH. (DE 28-3 at 23.) Notably, however, records indicate that Mr. Mixon redialed Mrs. Herrera thirty (30) minutes after initially speaking with her and left a voicemail clarifying his earlier statement to mean that a zero balance from Jackson “will be fine but [GEICO] will still need [a] Medicaid lien amount to reissue check.” (DE 28-3 at 23.)

On April 17, Mrs. Herrera faxed GEICO a JMH Charge Summary for the purpose of proving that Mr. Herrera had a zero balance for the medical services rendered at JMH. (DE 28-12.) Mrs. Herrera did not enclose a release or any information about a lien satisfaction. Mr. Mixon followed up with Mrs. Herrera on May 14, leaving a voicemail on Mrs. Herrera’s phone and requesting the Herreras to call GEICO regarding the status of the Medicaid lien amount. (DE 28-3 at 23.) Four (4) days later, on May 18, Ms. Swindell directed Mr. Mixon to “send the [M]edicare notice letter to Medicaid please so [GEICO] can get them moving on pulling a Medicaid lien amount.” (DE 28-3 at 22.) The Medicare

letter was not sent to Medicaid, however, until June 11, twenty-four (24) days after Ms. Swindell’s directive. (DE 28-3 at 22.) That same day, GEICO sent Mr. Herrera a Consent to Release (“CTR”) Form designated for Medicare beneficiaries for the purpose of “prevent[ing] any undue delay in the settlement of the claim.”5 (DE 1-6 at 1; DE 28-3 at 22.) On June 27, Mrs. Herrera purportedly sent a fourteen (14) paged fax to GEICO, including a handwritten letter that confirmed the Herreras received GEICO’s June 12

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HERRERA ALONSO v. GEICO General Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/herrera-alonso-v-geico-general-insurance-company-flsd-2024.