You, or a health care provider that you have been affiliated with, may have submitted a bill or bills to one or more of The GEICO Companies at amounts less than the schedule of maximum charges as defined by Section 627.736(5)(a)1, Florida Statutes (the PIP Statute), for medical charges arising from medical services provided to persons insured under PIP or other No-fault coverages provided in a Florida motor vehicle insurance policy issued by one of The GEICO Companies for which The GEICO Companies utilized the code “BA” when issuing payment and paid 80% of the amount charged for the claim. “BA” is a reason code The GEICO Companies utilized, and when used, it would appear with reference to certain charge line items on the Explanation of Benefits (EOB) or Explanation of Review (EOR) that you were sent associated with your billed charges. 

 The GEICO Companies' records indicate that you (or a health care provider with which you have been affiliated) may be in a position to contend that The GEICO Companies improperly interpreted the "Billed Amount" policy language when issuing payment in response to these charges. 

The Notice is provided because you have a right to know about a Settlement of the Lawsuit (as defined below), and about all of your options, before the Court decides whether to approve the Settlement. The Court approved the Settlement and any objections and appeals were resolved, claims allowed by the Settlement will be paid if you submitted a Settlement Claim Form (see FAQ 8).

The Court in charge of the Settlement of the Lawsuit is the court presiding over the case known as Randy Rosenberg, D.C., P.A. aao Danielle Russell v. GEICO General Insurance Company, et al, Case No. 19-61422-CIV-CANNON/Hunt (S.D. Fla.). This case is referred to in the Notice as the “Lawsuit.”  The health care provider who sued – Randy Rosenberg, D.C., P.A. – is called the “Plaintiff,” and the companies it sued –The GEICO Companies – are called the “Defendants.”
 

The Lawsuit claims that The GEICO Companies misinterpreted the “Billed Amount” or “BA” policy language applicable to medical charges submitted by health care providers arising from treatment to persons insured under PIP or other No-fault coverages contained in motor vehicle insurance policies issued by The GEICO Companies in Florida.  

The Policies included in the Settlement are the Florida Motor Vehicle Insurance policy underwritten by one of The GEICO Companies in Florida and which contains the No-Fault Policy Endorsement indicated by the acronyms, “FLPIP (01-13),” “FLPIP (07-15)” and “FLPIP (01-18)” and such later Endorsements containing the “BA” language. The “Billed Amount” or “BA” language referred to is the following sentence in the Policy: “A charge submitted by a provider, for an amount less than the amount allowed above, shall be paid in the amount of the charge submitted.”

In particular, the Lawsuit contends that The GEICO Companies misinterpreted the “Billed Amount” policy language when making payments in response to charges, resulting in underpayments to the charges. Plaintiff contends that based on the BA language in the Policy The GEICO Companies should have paid the full billed amounts (100% rather than 80% or more paid) on certain charges submitted by health care providers for medical charges arising from treatment to persons insured under PIP or other No-fault coverages issued by The GEICO Companies in Florida.  Plaintiff therefore asserts that The GEICO Companies underpaid PIP benefits for medical services by allegedly failing to properly pay the amount authorized under the “Billed Amount” or “BA” policy language.

You or a health care provider with which you have been affiliated may have submitted a bill or bills to The GEICO Companies at less than the schedule of maximum charges as defined by Section 627.736(5)(a)1, Florida Statutes, for medical charges arising from medical services provided to persons insured under PIP or other No-fault coverages provided in a Florida motor vehicle insurance policy issued by The GEICO Companies wherein The GEICO Companies utilized the code “BA” when issuing payment and paid 80% of the amount charged for the claim. Again, as stated above, “BA” is a reason code The GEICO Companies utilized, and when used, it would appear with reference to certain charge line items on the Explanation of Benefits (EOB) or Explanation of Review (EOR) that you were sent associated with your billed charges.

The GEICO Companies contend that they complied with their obligations in interpreting the “Billed Amount” policy language and issuing payment for reasonable medical expenses submitted pursuant to the applicable insurance policy and the No-Fault Law.  The Court has made no ruling on the merits of the claims or defenses asserted in the Lawsuit.

The Lawsuit and Settlement concern only claims submitted for coverage under applicable insurance Policies identified above and as set forth in the definition of the Settlement Class defined below.  

The Court has approved the Lawsuit to proceed as a class action against The GEICO Companies for settlement purposes only.  If the Settlement is not finally approved, then the case will return to its prior status, and the case will proceed to trial on the merits of Plaintiff’s claims. 
 

(“PIP” refers to the personal injury protection insurance as defined by and required under Section 627.736, Florida Statutes.)

(The Court in this case previously certified a contested class of providers according to a narrower class definition and only against one of the Defendants.  The Settlement expands the Class definition and includes more GEICO entities than originally named in the Lawsuit.) 

In a class action, one or more people called Class Representatives sue on behalf of people who they believe have similar claims.  All of these people are a class or class members.  One court resolves the issues for all class members, except for those who exclude themselves from the class.  The “Class Representative” in the Lawsuit is the named Plaintiff, Randy Rosenberg, D.C., P.A.  

The Court has not decided in favor of the Plaintiff or Defendants. Instead, both sides agreed to a Settlement. That way, they and the affected health care providers avoid the risk, delay, and expense of continuing the Lawsuit, and the Settlement Class Members, as described in the Notice, will be eligible to get compensation. The Class Representatives and Class Counsel, as described in the Notice, think the Settlement is best for all affected health care providers who will be Settlement Class Members as described in the Notice.
 

Not if you remain a Settlement Class Member. The Court has approved the Settlement. Because Settlement Class Members will be eligible to receive compensation through the Settlement instead of having to bring their own lawsuits, the Court has tolled the time for The GEICO Companies to respond to demands and civil remedy notices and has tolled the statute of limitations while Settlement Class Members decide whether or not they will stay in the class.

The tolling provision contained in the Order of Preliminary Approval issued on May 31, 2022 states:

"The statute of limitations and all other presuit time limits, including without limitation any time limits to pay or otherwise respond to notices of intent to initiate litigation under Chapter 627 of the Florida Statutes or notices of violation under Chapter 624 of the Florida Statutes, shall be tolled until the Court either grants or denies final approval of the proposed Settlement and such order or judgment becomes final, provided that the tolling shall terminate ten (10) business days after submission of an Opt Out Request, as indicated by the postmark date of such request submitted to the Claims Administrator, with respect to any Settlement Class Member that submits a timely, written Opt Out Request that has not been challenged by The GEICO Companies as provided in this Order or that is otherwise approved by the Court. Upon receipt of any such notices of intent to initiate litigation under Chapter 627 of the Florida Statutes or notices of violation under Chapter 624 of the Florida Statutes, The GEICO Companies shall send a response to the Settlement Class Member that encloses copies of the Class Notice and this Order, and advises of the proposed Settlement and this tolling provision, as well as how the Settlement Class Member can obtain further information regarding the Settlement."

The tolling order applies to all Settlement Class Member claims covered by the Settlement.  Accordingly, deadlines or response time limits applicable to The GEICO Companies with respect to any covered Settlement Class Member claim shall only begin to run as provided in the tolling provision above.

You may not file a new lawsuit without complying with, or obtaining relief from, the Court’s tolling provision, or excluding yourself (i.e., opting out) from the Settlement.

The Settlement was given final approval by the Court, all Settlement Class Members who are not recognized by the Court as excluded from the Settlement Class are barred from making a demand, or filing or prosecuting a lawsuit or other proceeding, or otherwise pursuing claims released by the settlement.
 

You are member of the “Settlement Class” covered by the Settlement if you fall within the following class definition adopted by the Court:

All health care providers who hold an assignment of benefits of the Policy¹ from an individual insured by one of The GEICO Companies and, pursuant to that assignment, submitted a claim for reimbursement of no-fault benefits to one of The GEICO Companies during the Class Period for a charge in an amount less than the schedule of maximum charges as defined by Section 627.736(5)(a)1., Florida Statutes, where the applicable GEICO Company utilized the reason code “BA” to issue payment to the provider for 80% of the amount charged for the claim.

Excluded from the Settlement Class are: (1) The GEICO Companies, any entities in which The GEICO Companies have a controlling interest, and all of their legal representatives, heirs and successors; and (2) members of the judiciary for the United States District Courts of Florida.   

The "Class Period" for each of the specific included GEICO COMPANIES means;

• GEICO indemnity Company - June 15, 2017 through May 31, 2022.
• GEICO General Insurance Company - May 7, 2014 through May 31, 2022.
• GEICO Casualty Company - June 15, 2017 through May 31, 2022.
• Government Employees Insurance Company  -June 15, 2017 through May 31, 2022.

The following claims of Settlement Class Members shall be outside of the scope of the Settlement Agreement and the Released Claims, but shall not otherwise affect membership in the Settlement Class:

    (1) any claims resolved by separate settlement, dismissal with prejudice, or full payment in response to a demand letter;  

    (2) any claims that are the subject of an individual (not on behalf of a proposed class) lawsuit that has been filed and remains pending as of the Court’s Preliminary Approval Order;

    (3) any claims where insurance benefits exhausted prior to the Effective Date or the date a timely Settlement Claim Form is deemed submitted, whichever is later; and

    (4) any claims that are denied during the settlement claims process on the grounds that the claim is outside the scope of the Settlement Agreement. When a PIP or other No-fault claim includes both medical services within the scope of the Settlement Agreement and others outside the scope of the Settlement Agreement, the Settlement Agreement and Release will apply, but only to those medical services within the scope of the Settlement Agreement.

Members of the Settlement Class are referred to as “Class Members” or “Settlement Class Members.” If you are a member of the Settlement Class, unless you excluded yourself from the Settlement Class, you will be deemed to be a Settlement Class Member and a participant in the Settlement.

( The “Policy” refers to the Florida Motor Vehicle Insurance policy underwritten by one of The GEICO Companies in Florida and which contains the No-Fault Policy Endorsement indicated by the acronyms, “FLPIP (01-13),” “FLPIP (07-15)” and “FLPIP (01-18)” and such later Endorsements containing the “BA” language. )

Payments (“Settlement Relief”) will be made to Settlement Class Members who timely submitted Valid Settlement Claim Forms. Settlement Relief includes the Readjustment Payment, Enhanced Relief, Interest, and Submission Compensation as explained in FAQ 8.

Settlement Class Members who did not exclude themselves from the Settlement and who timely submitted a Valid Settlement Claim Form will be eligible to receive Settlement Relief from The GEICO Companies, subject to the requirements and terms of the Settlement. The Settlement Relief includes Readjustment of Claims, Enhanced Relief (Interest), and Submission Compensation, determined as follows:

Readjustment of PIP Claims

The GEICO Companies will readjust settlement claims as follows: For each qualifying claim number/line item charge on a PIP insurance claim, The GEICO Companies will reimburse each Settlement Class Member that submits a Valid Settlement Claim an amount calculated at 20% of the amount billed by the Settlement Class Member for each claim where GEICO utilized the code “BA” with respect to the payment of the claim where the billing provider billed at less than 100% of the schedule of maximum charges as defined by Section 627.736(5)(a)1., Florida Statutes and The GEICO Companies paid the provider 80% of the amount billed on the claim. 

Enhanced Relief

Settlement Class Members who submit a Valid Settlement Claim will also receive an enhanced relief amount calculated as ten percent (10%) of the additional amount paid on a Valid Settlement Claim.  

Submission Compensation

Settlement Class Members who submit a Valid Claim Form by U.S. Mail shall also receive a payment to offset postage and time in the flat amount of nine dollars ($9.00) per separate Valid Claim Form that has been submitted by U.S. Mail (i.e. if a provider has treated three separate insureds and thereby must submit 3 separate Settlement Claim Forms, that provider will be entitled to $27.00 in Submission Compensation upon submission of the three Valid Claim Forms).  Settlement Claim Forms submitted by U.S. Mail that are otherwise qualifying, but for which no other payment will be made due to exhaustion of benefits, will nonetheless receive the Submission Compensation.

Additional Terms Applicable to Calculation of Settlement Relief

All coverage terms or payment limitations provided under the applicable insurance policy and the Florida Motor Vehicle No-Fault Law shall continue to apply. The GEICO Companies waive the defenses of reasonableness, relatedness, and medical necessity for purposes of this Settlement only. The GEICO Companies shall further continue to apply any defenses arising from GEICO claims that were adjusted and paid under an applicable out of state policy; the GEICO insurance claim having been previously resolved, discharged, settled, or released; or where the BA code was not actually applied to the qualifying patient/line item charge on the GEICO insurance claim. 

The coverage benefits remaining under the applicable policy limits as of the date the Settlement Claim Form is deemed submitted shall be applied and shall be the maximum amount of recovery available under the Settlement. Exhaustion of benefits and other limits on the amounts payable under the applicable policy on claims arising after the Settlement Claim Form is deemed submitted shall not be applied as a further limitation on the amount of a Settlement Relief payment, but in no event shall The GEICO Companies be responsible for paying greater than the applicable policy limits on the claim for Settlement Relief, or greater than the coverage benefits applicable to that claim remaining under the applicable insurance policy in response to a claim for Settlement Relief. Settlement Claim Forms shall be deemed submitted based upon their postmark date or online submission date, plus 30 days for purposes of determining the PIP benefits that remain under the applicable insurance policy. 

No interest, costs, attorneys’ fees or other extra-contractual payments, except as expressly provided in the Settlement Agreement, shall be payable with respect to any Settlement Relief, and Settlement Class Members waive any claim to such interest, costs, attorneys’ fees, or other extra-contractual payments.  

The Settlement does not waive or impair The GEICO Companies’ right at any time, during or after the Class Period, to challenge a Settlement Class Member’s claim for entitlement to Settlement Relief or other insurance benefits on the basis of the Settlement Class Member’s violation of Section 817.234, Florida Statutes, in connection with the claim for insurance benefits underlying the Settlement Claim Form submission.
 

To qualify for Settlement Relief, you needed to timely submit a complete Settlement Claim Form via First Class Mail, postage prepaid or via the Settlement Website. The deadline was November 28, 2022 and has passed.

The Court granted final approval of the settlement on December 22, 2022. Everyone who sent in a Settlement Claim Form will be informed of the status of the Settlement and their Settlement Claim. The website will also be updated as more information becomes available. Please be patient. 

If you do not agree with the amount of your Settlement Relief payment, you will be provided an opportunity to have your Settlement Relief payment reviewed and re-determined by the Claims Administrator, in consultation with Class Counsel and counsel for The GEICO Companies.  

The Court has appointed the following lawyers to represent you and the other Class Members:  Edward Zebersky, Michael T. Lewenz, and Mark S. Fistos of Zebersky Payne Shaw Lewenz, LLP, and Alec Schultz of Hilgers Graben, PLLC. These lawyers are called “Class Counsel.”  You will not be charged for these lawyers.

 If you want to be represented by your own lawyer, you may hire one at your own expense.

You will not be charged for the services of Class Counsel. The Court will decide how much Class Counsel will be paid for their time and effort.  Thus far, Class Counsel have received no fees or costs for working on this case. Any payment of attorney’s fees and costs awarded by the Court will be paid solely by The GEICO Companies.

As part of the Settlement, Class Counsel will ask the Court to approve a total collective payment to them and their firms of attorneys' fees and expenses up to Four Million Nine Hundred Fifty Thousand Dollars ($4,950,000.00).  

The attorneys' fees and expenses will be separate and apart from any Settlement Relief that may be payable to the Settlement Class Members under the terms of this Settlement Agreement. The foregoing attorneys' fees and expenses were negotiated only after relief to Class Members was agreed. This amount and its payment does not and will not reduce or otherwise affect the amount of Settlement Relief payable to the Settlement Class Members.  

The GEICO Companies have agreed not to oppose these requests. The fees and payments would pay Class Counsel and the Class Representatives for investigating the facts and litigating the Lawsuit, as well as negotiating the Settlement and monitoring your rights during approval and administration of the Settlement.  The Court may award less than the amounts requested.
 

If you did not want Settlement Relief from this Settlement, but you wanted to keep the right to sue The GEICO Companies, on your own, about the legal issues released and dismissed by this Settlement, then you needed to take steps to get out of the Lawsuit. This is called excluding yourself -- or is also sometimes referred to as "opting out" of the Settlement Class.

The deadline to request exclusion from the Settlement was August 15, 2022 and has passed.

No. If you asked to be excluded, you will not be eligible for any Settlement Relief, and you cannot object to the settlement. You will not be legally bound by the Settlement or anything that happens in this Lawsuit.

No. If you did not exclude yourself, you gave up the right to bring or continue claims or lawsuits resolved by this Settlement. If you have a pending lawsuit against The GEICO Companies, you should speak to your lawyer in that case immediately about the Notice.  

The deadline to object to the Settlement was August 15, 2022 and has passed.

Objecting is simply telling the Court that you do not like something about the Settlement.  You can object only if you stay in the Settlement Class, and you will be bound as a Class Member if the Court approves the Settlement despite any objections.  Excluding yourself from the Settlement Class means that the Settlement no longer applies to you, so you cannot receive Settlement Relief or object to the Settlement.

The Court held the Final Approval Hearing at 10:00 am on December 2, 2022, at the Alto Lee Adams, Sr. United States Courthouse, 101 South U.S. Highway 1, Fort Pierce, Florida 34950. At this hearing, the Court considered whether the Settlement was fair, reasonable, and adequate.  If there were objections, the Court considered them. The Court also decided how much to award Class Counsel. After the hearing, the Court granted final approval of the Settlement on December 22, 2022.

No. Class Counsel answered any questions the Court may have had. You were welcome to come at your own expense. If you sent a timely and proper objection, the Court considered it whether or not you attended the hearing. You could have also paid your own lawyer to attend or appear for you in the case, but it was not necessary.

The Final Approval Hearing was held on December 2, 2022.

If you do nothing, you will get no money from the Settlement.  But, unless you excluded yourself, you won’t be able to start a lawsuit, continue with a lawsuit, or be part of any other lawsuit against the Released Parties concerning the Released Claims as set forth in the Release, attached to the Notice as Appendix A, ever again. 

The Settlement Relief described above could have tax consequences for you. Those tax consequences may vary, depending upon your individual circumstances. You should consult your own tax advisor regarding any tax consequences of the Settlement, including any payments or benefits provided under the Settlement, and any tax reporting obligations you may have with respect thereto. The Parties make no representations, and assume no responsibility, with respect to any tax consequences that may occur.  

The Notice summarizes the Settlement, but does not purport to be a comprehensive description of the Lawsuit, the allegations related thereto, or the terms of the Settlement Agreement. To the extent, if any, that the Notice is inconsistent with the terms of the Settlement Agreement, the terms of the Settlement Agreement shall control.  More details are in the Settlement Agreement, which is on file and may be reviewed at the Court or can be found on the Important Documents page, together with other information about the Settlement.

 You can also write to the Claims Administrator at the address below, call at 1-855-606-0783 or email at info@FLBilledAmountSettlement.com.

Rosenberg v GEICO General Insurance Company
c/o JND Legal Administration
PO Box 91222
Seattle, WA. 98111