Notice Of Class Action

MSPA Claims 1, LLC v. Ocean Harbor Cas. Ins. Co.,
Eleventh Judicial Circuit of Florida

Please read this notice carefully and in its entirety.
The Court said you should get this notice. This is not an advertisement from a lawyer.
You have not been sued.

There was a class action lawsuit about reimbursements for medical expenses related to motor vehicle accidents, where the medical expenses of persons injured in the accidents were paid for by Medicare Advantage Organizations, and where the injured persons may have also paid out of pocket costs towards the medical expenses. There is a settlement in this lawsuit that may entitle you to a reimbursement for amounts you paid towards qualifying motor vehicle accident related medical expenses.

Your legal rights are affected, and you could get a payment from this
class action settlement if:

  • You are a Medicare Advantage Organization (MAO) who paid or is financially liable for the medical care and treatment for persons injured in motor vehicle accidents who had a no-fault automobile policy with Ocean Harbor Casualty Insurance Company;

OR

  • You are registered with the NPI Registry and you have an arrangement with a MAO whereby you paid or are financially liable for the medical care and treatment for persons injured in motor vehicle accidents who had a no-fault automobile policy with Ocean Harbor Casualty Insurance Company;

OR

  • You have a valid assignment for a MAOs’ Medicare Secondary Payer recovery rights and that MAO paid or are financially liable for the medical care and treatment for persons injured in motor vehicle accidents who had a no-fault automobile policy with Ocean Harbor Casualty Insurance Company;

OR

  • You are a person who is enrolled in a Medicare Advantage Plan, who was injured in a motor vehicle accident, who had a no-fault automobile policy with Ocean Harbor Casualty Insurance Company, who received medical care and treatment for his or her accident-related injuries, and who paid out of pocket costs towards the medical expenses.

PLEASE READ THIS NOTICE CAREFULLY.
Your legal rights will be affected whether you act or don’t act.

Your Legal Rights and Options in This Settlement
Submit a Main Claim Form or Beneficiary Claim Form
(CLICK HERE)

The only way to get a payment.

The deadline to submit a claim form is October 1, 2018.

Exclude Yourself
(CLICK HERE)

Get no payment. This is the only option that allows you to ever be part of any other lawsuit against Ocean Harbor Casualty Insurance Company, about the legal claims in this case.

The deadline to exclude yourself is July 31, 2018.

Object

Write to the Court about why you don’t like the settlement.

The deadline to object is July 31, 2018.

Go to a Hearing

Ask to speak to the Court about the fairness of the settlement.

The deadline to tell the court you want to speak at the hearing is July 31, 2018.

Do Nothing

Get No payment. Give up rights.

  • These rights and options—and the deadlines to exercise them—are explained in this notice.
  • The Court in charge of this case still has to decide whether to approve thesettlement. Payments will be made if the Court approves the settlement and after all appeals are resolved. Please be patient.

Frequently Asked Questions?

See below or Call Class Counsel at (305) 398-0990

I. WHAT THIS NOTICE CONTAINS
II. BASIC INFORMATION
  1. Why did I get this notice package?
  2. What is this lawsuit about?
  3. Why is this a class action?
  4. Why is there a settlement?
  5. How is this notice being sent?
III. WHO IS IN THE SETTLEMENT.
  1. How do I know if I am part of the settlement?
  2. How is the Main Class, for MAOs and MAO Related Entities, defined?
  3. How is the Beneficiary Class defined?
  4. I’m still not sure if I am included.
IV. THE MAIN CLASS, MAOs AND MAO RELATED ENTITIES, THE SETTLEMENT BENEFITS—WHAT YOU GET
  1. What does the settlement provide to Main Class Members?
  2. What time period is applicable to the claims?
  3. What can Main Class Members get from the settlement?
  4. What should I do if I’m an MAO Entity but I did not pay for and I am not financially liable for any qualifying expenses because a MAO Related Entity is responsible for those expenses?
  5. Does the settlement cover Main Class Members’ future claims?
  6. How will Main Class Members’ future claims be presented, handled, processed and paid?
V. BENEFICIARY CLASS MEMBERS, THE SETTLEMENT BENEFITS—WHAT YOU GET
  1. What does the settlement provide for Beneficiary Class Members?
  2. What time period is applicable to the claims?
  3. What can a Beneficiary Class Member get from the settlement?
  4. Does the settlement cover Beneficiary Class Members’ future claims?
VI. ARE THERE ANY ADDITIONAL TERMS?
  1. Are there any additional terms applicable to Settlement Class Members?
VII. HOW TO GET A PAYMENT—SUBMITTING A CLAIM FORM
  1. How can I get a payment?
  2. What is the deadline for filing a claim?
  3. What does the claim form for Main Class Members require?
  4. What does the Beneficiary Class Member claim form require?
  5. What are the required attestations for all persons submitting Claim Forms?
  6. Can I dispute the decision about my claim?
  7. How can I dispute one of the above decisions?
  8. What happens if I don’t dispute a decision that my claim is untimely, deficient, or that it should be denied in part or in full?
  9. When would I get my payment?
  10. What am I giving up to stay in the Class?
  11. Do I have to sign a written release when I receive a payment?
VIII. EXCLUDING YOURSELF FROM THE SETTLEMENT
  1. How do I get out of the settlement?
  2. If I don’t exclude myself, can I sue Ocean Harbor Casualty Insurance Company for the same thing later?
  3. If I exclude myself, can I get money from this settlement?
IX. THE LAWYERS REPRESENTING YOU
  1. Do I have a lawyer in the case?
  2. How will the lawyers be paid?
X. OBJECTING TO THE SETTLEMENT
  1. How do I tell the Court that I don’t like the settlement?
  2. What’s the difference between objecting and excluding?
XI.THE COURT’S FAIRNESS HEARING
  1. When and where will the Court decide whether to approve the settlement?
  2. Do I have to come to the hearing?
  3. May I speak at the hearing?
XII. IF YOU DO NOTHING
  1. What happens if I do nothing at all?
XIII. GETTING MORE INFORMATION
  1. Are there more details about the settlement?
  2. How do I get more information?
II. BASIC INFORMATION

.

  1. Why did I get this notice package?

The Court sent you this notice because you have a right to know about a pending settlement of a class action lawsuit, and about your options, before the Court decides whether to approve the settlement.

The settlement relates to Medicare benefits provided by Medicare Advantage Organizations (and other related entities) to persons who reside in Florida who were enrolled in a Medicare Advantage Plan, who were injured in a motor vehicle accident, who received medical care and treatment for their injuries, and who were insured under a no-fault automobile policy with Ocean Harbor Casualty Insurance Company.

There is a settlement in this lawsuit that may entitle Medicare Advantage Organizations (and other related entities) to be reimbursed for amounts paid towards qualifying motor vehicle accident related medical expenses. The settlement may also entitle injured persons to be reimbursed for amounts paid for out of pocket costs towards those same medical expenses.

If the Court approves it and after objections and appeals are resolved a Settlement Administrator will make the payments that the settlement allows. You will be informed of the progress of the settlement.

This package explains the lawsuit, the settlement, your legal rights, what benefits are available, who is eligible for them, and how to get them.

The Court in charge of the case is:

The Honorable Judge Abby Cynamon
Circuit Court Judge,
Eleventh Judicial Circuit Miami-Dade County, Florida
73 West Flagler Street, DCC 817
Miami, Florida 33130

.

  1. What is this lawsuit about?

The company who sued is MSPA Claims 1, LLC and is called the Plaintiff, and it may be referred to as MSPA. The company it sued, Ocean Harbor Casualty Insurance Company, is called the Defendant and may be referred to as Ocean Harbor.

In the lawsuit, MSPA filed an amended class action complaint on January 27, 2016. MSPA is the assignee of Florida Healthcare Plus, Inc. (“FHCP”), a Medicare Advantage Organization, and MSPA sought to recover amounts allegedly paid by FHCP on behalf of its enrollee. MSPA also sought to certify a class on behalf of itself and a class of Medicare Advantage Organizations (“MAOs” or “MA Organizations”).

MSPA sought to recover from Ocean Harbor, a no-fault insurer, amounts paid by MAOs to providers as Medicare benefits for the medical care and treatment of enrollees who were injured in motor vehicle accidents and who were insured under auto policies issued by Ocean Harbor.

Under the amended class action complaint, MSPA sought recovery under the following causes of action: private cause of action for double damages under the Medicare Secondary Payer Act (“MSP Act”) 42 U.S.C. § 1395y; a breach of contract action pursuant to a direct right of recovery under 42 C.F.R. 411.24(c); and three separate state law breach of contract actions for the failure to pay PIP benefits under theories of conventional subrogation, equitable subrogation and third-party beneficiary rights.

Generally,the lawsuit alleges that Ocean Harbor is a Primary Payer under Section 627.736, Florida Statutes and a Primary Plan under the MSP Act. It alleges that as a Primary Payer Ocean Harbor is required to reimburse or otherwise pay benefits up to the limits of its contractual responsibility, as required by Section 627.736, Florida Statutes. And it alleges that as a Primary Plan, Medicare and MA Organizations are entitled to reimbursement of their legitimate conditional payments (but not unlawful or unrelated payments) from primary payers.

In addition to its amended class action complaint, MSPA filed a motion for conditional class certification to which Ocean Harbor responded and MSPA replied. The parties engaged in discovery and motion practice. On June 2, 2016, the Court held a day-long evidentiary hearing on class certification. At the end of the day, the hearing was continued. The Court held four more days of an evidentiary hearing from September 12 through 15, 2016.

On September 23, 2016, Ocean Harbor filed a supplemental memorandum on the putative class representative’s standing on class certification, to which the Plaintiff filed a response on September 28, 2016. The Parties submitted to the Court their Joint Appendix on class certification as well as their respective proposed orders on certification. On February 2, 2017, the Court entered its order granting class certification (“Certification Order”).

On January 15, 2018, by agreement of the parties, MSPA filed its Second Amended Class Action Complaint to ensure that the allegations of the complaint conformed to the Settlement Agreement, including allegations relating to the Beneficiary Class. Ocean Harbor timely appealed the Certification Order to the Third District Court of Appeal in Ocean Harbor Casualty Insurance Co., Inc. v. MSPA Claims 1, LLC, 3D17-0392 (“Class Action Appeal”). The appeal has been fully briefed by the parties. Amicus Curiae Florida Justice Reform Institute and Amicus Curiae Property Casualty Insurers Association of America and Personal Insurance Federation of Florida filed amicus briefs in support of Ocean Harbor’s position on appeal. Oral argument is scheduled for 9:30 a.m. on June 11, 2018.

.

  1. Why is this a class action?

In a class action, one or more people, called Class Representatives (in this case MSPA), sue on behalf of people who have similar claims. All 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 Honorable Abby Cynamon is in charge of this class action.

.

  1. Why is there a settlement?

The Court did not decide in favor of MSPA or Ocean Harbor. Instead, both sides agreed to a settlement. After taking into account the uncertainty and risks inherent in any litigation, MSPA and Ocean Harbor agreed that further litigation of the Actions would be protracted, burdensome, and expensive, and that it is desirable and beneficial to them that the lawsuit be fully and finally settled and terminated in the manner and upon the terms and conditions set forth in the Settlement Agreement.

MSPA and Ocean Harbor reached this conclusion after considering the factual and legal issues in the lawsuit, the substantial benefits of a final resolution of the lawsuit, the expense that would be necessary to litigate the lawsuit throughout any trial and appellate proceedings, the benefits of disposing of protracted and complex litigation, and the desire to conduct its business unhampered by the distractions of continued litigation.

By agreeing to a settlement, MSPA and Ocean Harbor avoid the cost of a trial, and the people affected will get compensation. The Class Representative and the attorneys think the settlement is best for everyone who was injured or exposed.

.

  1. How is this notice being sent?

This notice is being sent via electronic mail, USPS Certified Mail and/or facsimile to individuals and entities identified in the Settlement Agreement, including Medicare Advantage Organizations, First Tier and Downstream entities, and Medicare Advantage Plan beneficiaries.

III. WHO IS IN THE SETTLEMENT

To see if you will get money from this settlement, you first have to decide if you are a Class Member.

.

  1. How do I know if I am part of the settlement?

Under the Settlement Agreement, which Judge Cynamon has preliminarily approved, the Settlement Class consists of a Main Class and a Beneficiary Class, which are further defined below.

.

  1. How is the Main Class, for MAOs and MAO Related Entities, defined?

The Main Class is defined as follows:

MAO Entities and MAO Related Entities, that (1) have paid or are financially liable for the payment of Qualifying Motor Vehicle Accident Related Expenses (2) for the Medical Care and Treatment of one or more Florida Beneficiaries (3) where the Beneficiary is also an Insured under an Ocean Harbor automobile policy (4) where the Medical Care and Treatment was provided pursuant to a Medicare Advantage Contract with CMS (5) where Ocean Harbor is responsible under its Policy to pay PIP benefits for the Medical Care and Treatment and (6) where Ocean Harbor is a Primary Plan.

Capitalized terms within the Main Class Definition are defined below:

“MAO Entity” means a Medicare Advantage Organization that contracts with Medicare to provide Medicare beneficiaries (under a Medicare Advantage Plan) with benefits under Medicare Part A, Medicare Part B and/or Medicare Part D.

“MAO Related Entities” means a MAO Entity’s First Tier Entities, Downstream Entities, and Assignees.

“First Tier Entity”means any person or entity registered with the NPPES NPI Registry that enters into a written arrangement with an MA Organization to provide administrative services or health care services for a Medicare eligible individual.

“Downstream Entity” means any person or entity registered with the NPPES NPI Registry that enters into an acceptable written arrangement below the level of an arrangement between an MA Organization and a First Tier Entity. These written arrangements continue down to the level of the ultimate provider of health and/or administrative services.

“Assignees” means any person or entity who has a valid assignment for the MAO’s Medicare Secondary Payer recovery rights.

First Tier and Downstream Entities may include: Clinically Integrated Networks (CINs); Independent Practice Associations (IPAs); Health Maintenance Organizations (HMOs); Management Services Organizations (MSOs); Preferred Provider Organizations (PPOs) and other eligible healthcare providers registered with the NPPES NPI Registry.

.

  1. How is the Beneficiary Class defined?

The Beneficiary Class is defined as follows:

Beneficiaries, and their heirs, executors, estates, administrators, or legal representatives, (1) who have paid or who are legally obligated to pay Out of Pocket Costs for the payment of Qualifying Motor Vehicle Accident Related Expenses (2) for their own Medical Care and Treatment (3) where the Beneficiary is also an Insured under an Ocean Harbor automobile policy (4) where the Medical Care and Treatment was provided pursuant to a Medicare Advantage Contract with CMS (5) where Ocean Harbor is responsible under its Policy to pay PIP benefits for the Medical Care and Treatment and (6) where Ocean Harbor is a Primary Plan. A Subrogor Beneficiary who has paid or who is legally obligated to pay Out of Pocket Costs towards the Reimbursed Medical Expenses of a Main Class Member falls within the definition of a Beneficiary Class Member.

Capitalized terms within the Beneficiary Class Definition are defined below:

“Coinsurance” is the amount a Beneficiary may be required to payas his or her share of the cost for services after any deductibles are paid. Coinsurance is usually a percentage (for example, 20%).

“Copayment” is the amount a Beneficiary may be required to pay as her or his share of the cost for a medical service or supply. A copayment is usually a set amount, rather than a percentage.

“Deductible” is the amount a Beneficiary must pay for health care or prescriptions before the MA Plan or Prescription Drug Plan is required to pay.

“Out of Pocket Costs” means amounts paid for any Deductible, Copayment, or Coinsurance. Out of Pocket Costs does not include Plan Premiums.

“Out of Pocket Maximum” is the maximum total costs a Beneficiary is required to pay for the total costs of certain medical services.

“Premium” is the amount a Beneficiary is required to pay to Medicare, a MA Plan, or a Prescription Drug Plan for health or prescription drug coverage. It includes any amounts paid toward Medicare Parts A, B, C and/or D.

“Reimbursed Medical Care and Treatment” means the Medical Care and Treatment for a specific Beneficiary for whom Ocean Harbor reimburses a Main Class Member under the Settlement Agreement.

“Subrogor Beneficiary” means the specific Beneficiary, for whom Ocean Harbor reimburses a Main Class Member under the Settlement Agreement and that specific Beneficiary’s heirs, executors, estates, administrators, or legal representatives.

.

  1. I’m still not sure if I am included.

If you are still not sure whether you are included please contact Class Counsel at the below address:

MSP Recovery Law Firm
5000 S.W. 75th Avenue, Suite 400
Miami, FL 33155
Telephone: (305) 614-2222

Attn:John H. Ruiz, Esq., Frank C. Quesada, Esq.

Dorta Law
334 Minorca Avenue
Coral Gables, Florida 33134
Telephone: (305) 441-2299

Attn:Gonzalo Dorta. Esq.

You can also fill out the Claim Form described below and return it to the Settlement Administrator, to see if you qualify. (CLICK HERE)

IV. THE MAIN CLASS, MAOs AND MAO RELATED ENTITIES, THE SETTLEMENT BENEFITS—WHAT YOU GET

.

  1. What does the settlement provide to Main Class Members?

If you remain in the case, all claims under the lawsuit that may be owed to you by Ocean Harbor can be submitted for potential recovery through this litigation.

.

  1. What time period is applicable to the claims?

The Settlement Class Period is from January 1, 2010 through December 31, 2017.

.

  1. What can Main Class Members get from the settlement?

As a Settlement Payment, upon the timely and proper submission of a Claim Form, Ocean Harbor will reimburse, as personal injury protection (PIP) Benefits, a Main Class Member for the amount he, she or it paid, or is obligated to pay, for Qualifying Motor Vehicle Accident Related Expenses for the Medical Care and Treatment of a Florida Beneficiary who is also an Insured under an Ocean Harbor automobile policy in an amount calculated based on the terms fully set forth in the Settlement Agreement.

These terms include, but are not limited to, the following:

  1. Ocean Harbor will utilize its normal claims processing methods.
  2. Ocean Harbor will pay only reasonable, related and necessary medical expenses.
  3. Ocean Harbor will only approve claims where the Beneficiary received some Medical Care and Treatment related to the Qualifying Motor Vehicle Accident within at least 14 days of the date on which the motor vehicle accident took place (“Date of Loss”), without regard to whether that Medical Care and Treatment is the same Medical Care and Treatment for which reimbursement is sought under this Agreement.
  4. Medicare Part A claims for emergency services and care provided by a hospital licensed under Florida Statutes Chapter 395 shall be reimbursed at 3.5 times the Medicare Fee For Service Schedule Rate, less the amount of any applicable deductible for personal injury protection benefits under the Policy (“PIP Deductible Amount”), up to the Policy limit.
  5. Other than for emergency services and care, Medicare Part A claims for inpatient and outpatient services provided by a hospital licensed under Florida Statute Chapter 395 shall be reimbursed pursuant to Section 627.736, Florida Statutes, at 80% of 200% of the applicable Medicare Fee for Service Schedule Rate, less the PIP Deductible Amount, up to the Policy limit.
  6. All claims for MRI services shall be reimbursed pursuant to Section 627.736, Florida Statutes, at 80% of 200% of the applicable Medicare Fee Schedule, less the PIP Deductible Amount, up to the Policy limit.
  7. Medicare Part B claims shall be reimbursed pursuant to Section 627.736, Florida Statutes, at 80% of 200% of the applicable Medicare Fee for Service Schedule Rate, less the PIP Deductible Amount, up to the Policy limit.
  8. Medicare Part D claims shall be reimbursed pursuant to Section 627.736, Florida Statutes, at 3.5 times the Medicare Fee For Service Schedule Rate, less the PIP Deductible Amount, up to the Policy limit.
  9. Claims for chiropractic services shall be capped at a $2,500.00 total pay out amount, including prior paid claims, after the PIP Deductible Amount, up to the Policy limit.
  10. If the treatment on a submitted claim is found to have occurred after a beneficiary fails to appear at one (1) Independent Medical Examinations (“IME”), Ocean Harbor will not be required to reimburse any amounts whatsoever for medical expenses.
  11. Ocean Harbor is entitled to the application of the Beneficiary’s PIP Deductible Amount.
  12. Any amounts already paid as PIP Benefits for a Beneficiary under a Policy for the same Date of Loss shall be credited to Ocean Harbor and any amounts paid pursuant to the Settlement Agreement shall not exceed the difference between such creditand the Policy limit; however, Ocean Harbor shall provide the Class Member with the date, amount and payee whom Ocean Harbor paid the same benefits to which the Class Member maybe entitled.
  13. Additionally, for claims that are one or more years old, Ocean Harbor agrees to pay a total of 12 months of interest per claim at 6% per annum and, for claims that are less than a year old, Ocean Harbor agrees to pay 6% per annum for each month the claim is pending up to 12 months. Under no circumstances will Ocean Harbor be required to pay any more than 12 months of interest at 6% per annum.
  14. Ocean Harbor shall not be liable for any penalties, including statutory penalties under Section 627.736, Florida Statutes.
  15. The payment of attorneys’ fees, costs, and/or expenses isexclusively determined as set forth in Sections 10 and 11 of theSettlement Agreement.
  16. Ocean Harbor shall not be liable to pay any additional amounts whatsoever, including interest, costs, expenses, penalties, attorneys’ fees, benefits or other extra-contractual payments, unless expressly provided for in the Settlement Agreement and Main Class Members waive any claim to any such additional amounts.
  17. All Main Class Members who submit a Claim for reimbursement will be required to show reasonable proof of payment or proof of financial liability for the Claim as set forth in Section 19 of the Settlement Agreement and the Notice and Claims Supplement.
  18. As also set forth in Section 19 of the Settlement Agreement and the Notice and Claims Supplement, all Main Class Members who submit a Claim for reimbursement will also be required to establish that the Medical Care and Treatment was provided pursuant to a Medicare Advantage Contract with CMS. If the Class Member is a MAO Entity this may be established by evidence of the Class Member’s own MA contract with CMS. If the Class Member is a MAO Related Entity or Assignee this may be established by evidence of the MA contract between the related or assignor MA Organization and CMS. If the Class Member is a Beneficiary, this may be established by evidence of their membership in a Medicare Advantage Plan.
  19. Ocean Harbor will not be required to reimburse multiple Main Class Members for the same Qualifying Motor Vehicle Accident Related Expenses for a Beneficiary’s Medical Care and Treatment.
  20. Main Class Members will not be entitled to reimbursement for any Qualifying Motor Vehicle Accident Related Expenses for a Beneficiary’s Medical Care and Treatment (1) which Ocean Harbor has already paid to anyone; (2) for which the Class Member has already been paid or reimbursed; (3) for which the Class Member has released their right to payment or reimbursement under the No-Fault Act or the Medicare Secondary Payer Act.
  21. All coverage terms or payment limitations not specifically covered in this Agreement will be governed by the Policy, Florida’s No-Fault Act, the Medicare Secondary Payer Act, and other applicable law.
  22. To extent there is any conflict between the Settlement Agreement and Section 627.736, Florida Statutes, the No-Fault Act, the Medicare Secondary Payer Act and/or any other applicable law, the terms in the Settlement Agreement control.
  23. Decisions relating to Settlement Payment amounts shall be based on the following: information contained within the Main Class Claim Form; any supporting documents submitted with the Main Class Claim Form; Ocean Harbor’s records and information maintained in the ordinary course of business and any additional information which Ocean Harbor or the Settlement Administrator may obtain from the Main Class Member.
  24. With respect to MSPA’s claims in this lawsuit for medical expenses FHCP paid as Medicare benefits for enrollees R.G., I.S., S.D. and L.B., the amounts on those claims shall be calculated on the same basis described in this Section. Additionally, Ocean Harbor shall receive a credit for any and all amounts it previously paid to MSPA or its predecessor MSP Recovery, LLC for MSPA’s claims related to enrollees R.G., I.S., S.D., and L.B. This paragraph 7.30 only applies to MSPA’s claims in the Actions with respect to the Medicare benefits for the enrollees R.G., I.S., S.D., and L.B.
  25. It is agreed that prior to receipt of any recovery under the Settlement Agreement, each Main Class Member seeking recovery will be required to execute a written release in favor of Ocean Harbor as described in Sections 19 and 24 of the Settlement Agreement and the Notice and Claims Supplement.
  26. The Parties further agree that a Main Class Member shall not be entitled to a Settlement Payment under this Agreement if the Insured, Beneficiary, Health Care Provider, Main Class Member or Beneficiary Class Member has made material misrepresentations, pursuant to Section 627.409, Florida Statutes, the MSP Act or otherwise, pertaining to the Policy, a prior claim regarding the same no-fault benefits at issue in the Settlement Agreement, or pertaining to a claim under the Settlement Agreement.
  27. If Ocean Harbor fully or partially denies any Main Class Member’s claim under this Settlement Agreement and the Class Member disagrees with Ocean Harbor’s decision, the disagreement shall be resolved under the Dispute Resolution Process set forth in Section 20 of the Settlement Agreement and below. Any Class Member who fails to timely and properly follow the requirements of the Dispute Resolution Process is deemed to have waived and shall forever be foreclosed from asserting any claims arising out of, relating to, or based in whole or part on Ocean Harbor’s decisions relating to coverage and payment, including the full or partial denial of a claim, under this Settlement Agreement.
  28. All of Ocean Harbor’s decisions relating to coverage and payment are final unless disputed under the Dispute Resolution Process set forth in Section 20 of the Settlement Agreement and below. Any Class Member who fails to timely and properly follow the requirements of the Dispute Resolution Process is deemed to have waived and shall forever be foreclosed from asserting any claims arising out of, relating to, or based in whole or part on Ocean Harbor’s decisions relating to coverage and payment under this Settlement Agreement.
  29. In the event more than one Main Class Member submits a Claim for the Qualifying Motor Vehicle Accident Related Expenses for the Medical Care and Treatment of the same Beneficiary, any dispute regarding the priority of payment and the application of the PIP Deductible Amount and the Policy’s contractual limits shall be resolved under the Dispute Resolution Process set forth in Section 20 of the Settlement Agreement and below. Under no circumstance, however, will Ocean Harbor be required to pay any amounts in excess of the Policy’s contractual limits. Any Class Member who fails to timely and properly follow the requirements of the Dispute Resolution Process is deemed to have waived and shall be forever foreclosed from asserting any claims arising out of, relating to, or based in whole or part on the priority of payment and the application of the PIP deductible and the Policy’s contractual limits.
  30. Similarly, in the event a dispute arises between a Main Class Member and a Beneficiary Class Member regarding the priority of payment and the application of the PIP deductible and the Policy’s contractual limits, any such dispute shall be resolved under the Dispute Resolution Process set forth in Section 20 of the Settlement Agreement and below. Under no circumstance, however, will Ocean Harbor be required to pay any amounts in excess of the Policy’s limits. Any Class Member who fails to timely and properly follow the requirements of the Dispute Resolution Process is deemed to have waived and shall be forever foreclosed from asserting any claims arising out of, relating to, or based in whole or part on the priority of payment and the application of the PIP deductible and the Policy’s contractual limits.

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  1. What should I do if I’m an MAO Entity but I did not pay for and I am not financially liable for any qualifying expenses because a MAO Related Entity is responsible for those expenses?

If a MAO Entity knows that a MAO Related Entity paid or is financially liable, rather than the MAO Entity, for the Qualifying Motor Vehicle Accident Expenses for the Beneficiary’s Medical Care and Treatment, then the MAO Entity should forward this notice to that MAO Related Entity and the MAO Entity should return the claim form indicating that the identified MAO Related Entity, not the MAO Entity, paid or is financially liable for the medical expenses.

.

  1. Does the settlement cover Main Class Members’ future claims?

Yes, the settlement also includes certain future claims during the Prospective Claims Period, which is from January 1, 2018 until five (5) years from the date of the Final Judgment approving the Settlement Agreement

The claims that will be covered are all claims during the Prospective Class Period under the No-Fault Act for PIP Benefits for which reimbursement is sought by a Person based on its status as a secondary payer and Ocean Harbor’s status as a primary payer or Primary Plan under the Medicare Secondary Payer Act. These claims will be referred to as “Prospective Claims.”

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  1. How will Main Class Members’ future claims be presented, handled, processed and paid?

All Prospective Claims shall be presented, handled, processed, and granted relief as set forth below:

  1. The Class Member must first present the Prospective Claim to Ocean Harbor through Class Counsel, MSP Recovery Law Firm. The Prospective Claim must be in the form of a billing invoice as outlined by the No-Fault Act.
  2. Ocean Harbor will process and pay a Prospective Claim, if it otherwise meets the requirements of the Settlement Agreement, pursuant to the terms of the Settlement Agreement.
  3. Class Counsel will receive the Prospective Claims from all Class Members and will work with Ocean Harbor in an effort to resolve those claims within 30 days as required by the Florida No-Fault Act.
  4. To the extent that the resolution of any Prospective Claim is not agreed upon, the claims will be resolved under the Dispute Resolution Process set forth above, in the same manner as any disputed claim in the Settlement Agreement.
  5. If the claim is approved, the claim payment shall be made to the Class Member by making payment through Class Counsel. Class Counsel shall be entitled to a 50% fee on any claim paid which shall be the amount charged by class counsel for processing such claims. In consideration for the claim payment, the Class Member shall be required to execute a written general release with respect to the Prospective Claim at issue.
  6. Additionally, any amounts paid on Prospective Claims under this Section are in addition to any amounts paid under the Settlement Agreement to Class Members for claims within the Class Period.
  7. All Class Members, who (1) received Notice (2) who had actual notice of the Settlement Agreement
    will be bound by the provisions therein relating to the submission of Prospective Claims that fall within the Prospective Claims Period. This remains so even if the Class Member did not request relief under the Settlement Agreement for any claim falling within the Class Period.
V. BENEFICIARY CLASS MEMBERS, THE SETTLEMENT BENEFITS—WHAT YOU GET

.

  1. What does the settlement provide for Beneficiary Class Members?

If you remain in the case, all claims under the lawsuit that may be owed to you by Ocean Harbor can be submitted for potential recovery through this litigation.

.

  1. What time period is applicable to the claims?

The Settlement Class Period is from January 1, 2010 through December 31, 2017.

.

  1. What can a Beneficiary Class Member get from the settlement?

As a Settlement Payment, upon the timely and proper submission of a Beneficiary Claim Form, as a Settlement Payment, Ocean Harbor will reimburse, as PIP benefits, a Beneficiary Class Member for the amount he or she paid, or is obligated to pay, for Out of Pocket Costs for Qualifying Motor Vehicle Accident Related Expenses for his or her Medical Care and Treatment (Reimbursed Medical Expenses in the case of a Subrogor Beneficiary) where the Beneficiary is also an Insured under an Ocean Harbor automobile policy in an amount calculated based on the terms fully set forth in the Settlement Agreement.

These terms include, but are not limited to, the following:

  1. Ocean Harbor agrees to pay 80% of the amount a Beneficiary Class Member has paid, or is obligated to pay, for Out of Pocket Costs for the Qualifying Motor Vehicle Accident Related Expenses for his or her Medical Care and Treatment (Reimbursed Motor Vehicle Expenses in the case of a Subrogor Beneficiary), less any applicable PIP Deductible Amount, up to the Policy limit.
  2. Additionally, for claims that are one or more years old, Ocean Harbor agrees to pay a total of 12 months of interest per claim at 6% per annum and, for claims that are less than a year old, Ocean Harbor agrees to pay 6% per annum for each month the claim is pending up to 12 months. Under no circumstances will Ocean Harbor be required to pay any more than 12 months of interest at 6% per annum.
  3. Ocean Harbor shall not be liable for any penalties under Section 627.736, Florida Statutes.
  4. The payment of attorneys’ fees, costs, and/or expenses is exclusively determined as set forth in Sections 10 and 11 of the Settlement Agreement.
  5. Ocean Harbor shall not be liable to pay any additional amounts whatsoever, including interest, costs, expenses, penalties, attorneys’ fees, benefits or other extra-contractual payments, unless expressly provided for in the Settlement Agreement and Beneficiary Class Members waive any claim to any such additional amounts.
  6. Beneficiary Class Members who submit a claim(s) for reimbursement will be required to show reasonable proof of payment or proof of financial liability for the claim(s) as set forth in Section 19 Sections 10 and 11 of the Settlement Agreement and the Notice and Claims Supplement.
  7. Beneficiary Class Members will not be entitled to reimbursement for any Out of Pockets for the Reimbursed Medical Expenses (1) for which the Class Member has already been paid or reimbursed or (2) for which the Class Member has released their right to payment or reimbursement for the medical expense under the No-Fault Act or the Medicare Secondary Payer Act.
  8. Decisions relating to coverage or payment not specifically covered in this Agreement will be governed by Section 627.736, Florida’s No-Fault Act, the Medicare Secondary Payer Act, and other applicable law.
  9. To extent there is any conflict between the Settlement Agreement and Section 627.736, Florida Statutes, the No-Fault Act, the Medicare Secondary Payer Act and/or any other applicable law, the terms in the Settlement Agreement control.
  10. Decisions relating to Settlement Payment amounts shall be based on the following: information contained within the Beneficiary Claim Form; any supporting documents submitted with the Beneficiary Claim Form; Ocean Harbor’s records and information maintained in the ordinary course of business and any additional information which Ocean Harbor or the Settlement Administrator may obtain from the Beneficiary Class Member.
  11. It is agreed that prior to receipt of any recovery under the Settlement Agreement, each Beneficiary Class Member seeking recovery will be required to execute a written release in favor of Ocean Harbor as described in Sections 19 and 24 of the Settlement Agreement and the Notice and Claims Supplement.
  12. The Parties further agree that a Beneficiary Class Member shall not be entitled to a Settlement Payment under this Agreement if the Insured, Beneficiary, Health Care Provider, Main Class Member or Beneficiary Class Member has made material misrepresentations, pursuant to Section 627.409, Florida Statutes, the MSP Act or otherwise, pertaining to the Policy, a prior claim regarding the same no-fault benefits at issue in the Settlement Agreement, or pertaining to a claim under the Settlement Agreement.
  13. If Ocean Harbor fully or partially denies any Beneficiary Class Member’s claim under this Settlement Agreement and the Class Member disagrees with Ocean Harbor’s decision, the disagreement shall be resolved under the Dispute Resolution Process set forth in Section 20 of the Settlement Agreement and below. Any Class Member who fails to timely and properly follow the requirements of the Dispute Resolution Process is deemed to have waived and shall forever be foreclosed from asserting any claims arising out of, relating to, or based in whole or part on Ocean Harbor’s decisions relating to coverage and payment, including the full or partial denial of a claim, under this Settlement Agreement.
  14. Further all of Ocean Harbor’s decisions relating to coverage and payment are final unless disputed under the Dispute Resolution Process set forth in Section 20 of the Settlement Agreement and below. Any Class Member who fails to timely and properly follow the requirements of the Dispute Resolution Process is deemed to have waived and shall forever be foreclosed from asserting any claims arising out of, relating to, or based in whole or part on Ocean Harbor’s decisions relating to coverage and payment under this Settlement Agreement.
  15. In the event a dispute arises between a Main Class Member and Beneficiary Class Member regarding the priority of payment and the application of the PIP deductible and the Policy’s contractual limits, any such dispute shall be resolved under the procedures described in Section 20 of the Settlement Agreement and below. Under no circumstance, however, will Ocean Harbor be required to pay any amounts in excess of the Policy’s limits. Any Class Member who fails to timely and properly follow the requirements of the Dispute Resolution Process is deemed to have waived and shall be forever foreclosed from asserting any claims arising out of, relating to, or based in whole or part on the priority of payment and the application of the PIP deductible and the Policy’s contractual limits.

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  1. Does the settlement cover Beneficiary Class Members’ future claims?

No, the settlement does not include any future claims for Beneficiary Class Members.

VI. ARE THERE ANY ADDITIONAL TERMS?

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  1. Are there any additional terms applicable to Settlement Class Members?

Yes. The following additional terms are applicable to all Settlement Class Members:

  1. The Parties agree that nothing contained herein shall prevent Ocean Harbor from pursuing affirmative relief pursuant to Florida Statutes, Chapter 772, or any other legal remedy including but not limited to recovery of funds paid in connection with this Settlement Agreement from any Insured, Beneficiary, Health Care Provider, Main Class Member or Beneficiary Class Member whose conduct in connection with insurance claim(s) against Ocean Harbor and/or claim(s) under this Settlement Agreement constitutes fraud, misrepresentation, conversion, or a violation of state or federal law.
  2. The Parties specifically agree that neither the contents of this Settlement Agreement nor Ocean Harbor’s obligations under this Settlement Agreement, including the payment of any amounts, constitutes a waiver of any past, present, or future rights it might have to challenge the payee’s entitlement to benefits under Florida’s No-Fault Act and the MSP Act and/or to recover any such benefits already paid, in all cases where the Settlement Class Member committed fraud, misrepresentation, conversion, or a violation of state or federal law in connection with that Class Member’s Claim.
  3. The Parties acknowledge that Ocean Harbor has an affirmative duty to maintain procedures for investigating fraud and reporting fraud to the Florida Department of Insurance, and that Ocean Harbor has an affirmative duty to report suspected insurance fraud to the Florida Department of Insurance, pursuant to Sections 626.989 & 626.9891, Florida Statutes.
  4. Ocean Harbor reserves all rights to bring affirmative actions or defenses based on fraud, isrepresentation, conversion, or a violation of state or federal law, including violations of Sections 817.234, 766.111, and/or 817.505, Florida Statutes, in future claims or litigation under Florida’s No-Fault Act or the MSP Act, and nothing in this Agreement shall affect those rights.
  5. The Parties agree that Ocean Harbor reserves all rights to assert any available defenses under Florida’s No-Fault Act, the Medicare Secondary Payer Act, the Policy, and other applicable law as well as defenses based on fraud, misrepresentation, conversion, or a violation of state or federal law in future claims or litigation under Florida’s No-Fault Act or the MSP Act and that neither the contents of this Settlement Agreement nor Ocean Harbor’s obligations under this Settlement Agreement, including the payment of any amounts, abrogate, abridge, preclude, estop, waive, or otherwise affect Ocean Harbor’s rights to assert any available defenses under Florida’s No-Fault Act, the Medicare Secondary Payer Act, the Policy, and other applicable law as well as defenses based on fraud, misrepresentation, conversion, or a violation of state or federal law in future claims or litigation under Florida’s No-Fault Act or the MSP Act.
VII. HOW TO GET A PAYMENT—SUBMITTING A CLAIM FORM

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  1. How can I get a payment?

To qualify for payment, you must send in a claim form. Claim forms for both Main Class Members and Beneficiary Class Members are attached to this notice. You can also get a claim form by (CLICKING HERE).

Read the instructions carefully, fill out the form, include all the documents the form asks for, sign it, and mail it by the Claims Deadline.

The Parties agree to work cooperatively and fairly together to arrive at a fair and equitable determination of any Class Member’s claim.

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  1. What is the deadline for filing a claim?

Main Class Member claim forms must be postmarked or submitted no later than the Claims Deadline. Any Main Class Member claim form that is untimely shall be invalid and the Main Class Member will be barred from recovering any Settlement Payments.

Beneficiary Class Member claim forms must be postmarked or submitted no later than Claims Deadline, except in the case of Subrogor Beneficiaries whose claims must be postmarked or submitted no later than thirty (30) days following Notice to the Subrogor Beneficiary. Any Beneficiary Claim Form that is untimely shall be invalid and the Beneficiary Class Member will be barred from recovering any Settlement Payments.

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  1. What does the claim form for Main Class Members require?

A Main Class Claim Form submission must identify the Main Class Member’s name, federal tax identification number (if an entity) or the last four digits of the Social Security Number (if a person), NPPES NPI Registry number, and a current address for sending settlement related communications and payment.

A Main Class Claim Form submission must also provide the following information: Beneficiary’s Name, Date of Birth and HICN or SSN, if their HICN is not available, and a description, including CPT Code and any DX Codes, and date of service of the Medical Care and Treatment.

A Main Class Claim Form may encompass multiple bills or services arising under an insurance claim (i.e. a claim arising under the same accident, and typically having a unique claim number).

A Main Class Claim Form will also require that the Main Class Member sufficiently establish the following requisites of Main Class Membership including but not limited to the following: (a) status as a MAO Entity or a MAO Related Entity; (b) proof that the expenses for which reimbursement is sought are Qualifying Motor Vehicle Accident Related Expenses; (c) proof that the Medical Care and Treatment was provided to the Beneficiary; (d) proof that the Medical Care and Treatment was provided pursuant to a Medicare Advantage Contract with CMS; and (e) reasonable proof of payment or proof of financial liability for the Medical Care and Treatment.

A Main Class Claim Form will also require the signature of the person submitting the form, a description of that persons’ relationship to the Main Class Member, an attestation to the statements described in paragraph 19.10 of the Settlement Agreement and below, and the execution of a written release.

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  1. What does the Beneficiary Class Member claim form require?

A Beneficiary Class Member claim form submission must identify the Settlement Class Member’s name; the settlement class member’s federal tax identification number (if an entity), or the last four digits of the Social Security Number (if a person); and a current address for sending settlement related communications and payment.

A Beneficiary Claim Form must also provide the following types of information from Beneficiary Class Members: Beneficiary’s Name, Date of Birth, amount and type of Out of Pocket Costs, and proof of payment or financial liability for the Out of Pocket Costs.

A Beneficiary Claim Form will also require that the Beneficiary Class Member sufficiently establish the following: (a) proof that the expenses for which reimbursement is sought are Qualifying Motor Vehicle Accident Related Expenses; (c) proof that the Medical Care and Treatment was provided to the Beneficiary; (d) proof that the Medical Care and Treatment was provided pursuant to a Medicare Advantage Contract with CMS; and (e) reasonable proof of payment or proof of financial liability for the Medical Care and Treatment. However, if the Beneficiary Class Member is also a Subrogor Beneficiary, she or he does not need to abide by this requirement since the Main Class Member’s Claim has already been approved.

A Beneficiary Claim Form will additionally require the signature of the person submitting the form, a description of that persons’ relationship to the Beneficiary Class Member, an attestation to the statements described in paragraph 19.10 of the Settlement Agreement and below, and the execution of a written release.

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  1. What are the required attestations for all persons submitting Claim Forms?

All persons submitting claim forms must attest and affirm the following:

  1. The person submitting the Claim Form has reviewed the Class Notice and reasonably believes that the submitter, or the person or entity on whose behalf the submitter is acting, is a Settlement Class Member entitled to relief under the proposed settlement;
  2. The Settlement Class Member holds the legal right to receive PIP Benefits under the subject insurance claim; which right has not been otherwise assigned or transferred by the Class Member to another person or entity;
  3. No rights or claims asserted by the Claim Form have been otherwise resolved, discharged, settled, or released;
  4. No payments have been made by or on behalf of the Beneficiary for any amounts other than Out of Pocket Expenses;
  5. The Settlement Class Member has provided reasonably available documents relating to the Claim Form submission;
  6. The Settlement Class Member agrees to reasonably cooperate in verifying and quantifying any amounts for which reimbursement is sought under the Settlement Agreement and in providing additional supporting documentation upon reasonable request from the Settlement Administrator or Ocean Harbor; and,
  7. The Settlement Class Member agrees that, he, she or it is releasing all claims against Ocean Harbor and the Released Parties in accordance with the Settlement Agreement and the Court’s orders approving this Settlement.

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  1. Can I dispute the decision about my claim?

Settlement Class Members shall have the right to dispute or challenge the following:

  1. The Settlement Administrator’s or Ocean Harbor’s determination that a claim is deficient or untimely;
  2. Ocean Harbor’s coverage or payment decisions including the partial or full denial of any claim, the amount of the Settlement Payment, as well as any decision relating to the priority of payment and the application of the PIP Deductible and the Policy’s contractual limits; and,
  3. Any dispute between a Main Class Member and a Beneficiary Class Member regarding the priority of payment and the application of the PIP deductible and the Policy’s contractual limits.

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  1. How can I dispute one of the above decisions?

If a Settlement Class Member desires to challenge or dispute any of the above decisions, the Class Member must follow the below procedures:

  1. The Settlement Class Member must deliver a written notice briefly describing the nature of the dispute (Dispute Notice) to Class Counsel and Ocean Harbor’s Counsel, via U.S. mail or electronic mail, at the addresses set forth at the end of this notice;
  2. The Dispute Notice must be sent within thirty (30) days of being notified that the claim is being denied as untimely or deficient or being notified that the claim was being denied in part or in full; and,
  3. If the Settlement Class Member will be challenging or disputing a claim for which he, she or it received a Settlement Payment, then that Class Member must include the uncashed Settlement Payment with their Dispute Notice.

Within ten (10) days of receipt of a Dispute Notice, Class Counsel and Ocean Harbor’s Counsel will review and attempt to resolve the dispute. Any agreement reached by Class Counsel and Ocean Harbor’s Counsel is final and shall not be appealable. If an agreement cannot be reached, however, the dispute shall be resolved by the Court. The Court’s decision will be final and shall not be appealable.

A copy of the dispute resolution procedures will be given in writing to Settlement Class Members in conjunction with delivery of the Settlement Payment or other notice of claim determination.

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  1. What happens if I don’t dispute a decision that my claim is untimely, deficient, or that it should be denied in part or in full?

Settlement Class Members who fail to timely and properly follow the requirements of the Dispute Resolution Process set forth in this Section and/or Settlement Class Members who cash their Settlement Payment are deemed to have waived and shall forever be foreclosed from asserting any claims or seeking any remedies arising out of, relating to, or based in whole or part on the Settlement Administrator’s or Ocean Harbor’s decisions described above.

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  1. When would I get my payment?

The Court will hold a hearing on June 28, 2018 to determine the reasonableness, adequacy, and fairness of the Settlement Agreement and whether it should be approved. Following this hearing, Judge Cynamon will enter an order approving or disproving the settlement. After that Judge Cynamon will enter any other orders necessary and then she will enter final judgment, after that there may be appeals.

It’s always uncertain how long this process will take and resolving any appeals or other issues can take time, perhaps more than a year. Everyone who sends in a claim form will be informed of the progress of the settlement. Please be patient.

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  1. What am I giving up to stay in the Class?

Unless you exclude yourself, you are staying in the Class, and that means that you can’t sue, continue to sue, or be part of any other lawsuit against Ocean Harbor Casualty Insurance Company about the legal issues in this case. It also means that all of the Court’s orders will apply to you and legally bind you. If you sign the claim form, you will agree to a Release, which describes exactly the legal claims that you give up if you do not exclude yourself from the Class.

The terms of this Release are defined in Section 24 of the Settlement Agreement, which are re-printed below:

The term “Release” means the release and waiver set forth below:

The performance by Ocean Harbor of all obligations pursuant to this Agreement shall constitute a full and final disposition and settlement of the Actions and any and all “Released Claims” and “Unknown Claims” as against all Released Parties for the Settlement Class. Upon the Settlement Effective Date, for the consideration provided for herein and by operation of the Final Judgment, the Class Representative, each Settlement Class Member, and all Releasing Parties shall be deemed to have, covenanted and agreed that: they shall be barred from asserting any Released Claims and Unknown Claims against Ocean Harbor and the Released Parties; shall have forever released and fully and finally discharged any and all Released Claims and Unknown Claims against Ocean Harbor and the Released Parties; and shall not at any time, institute, cause to be instituted, assist in instituting or permit to be instituted on his, her or its behalf any proceeding in any state or federal court, in or before any administrative agency, or any other proceeding or otherwise allege or assert any of the Released Claims or Unknown Claims against Ocean Harbor and the Released Parties.

The definitions for the terms “Released Claims”, “Released Parties”, “Releasing Parties”, and “Unknown Claims” are set forth below:

“Released Claims” means:

Any and all actual, potential, filed, known or unknown, fixed or contingent, claimed or unclaimed, suspected or unsuspected, claims, demands, liabilities, rights, causes of action, contracts or agreements, extra contractual claims, damages, punitive, exemplary or multiplied damages, expenses, costs, attorneys’ fees and or obligations, whether in law or in equity, accrued or unaccrued, direct, individual or representative, of every nature and description whatsoever, including Unknown Claims, arising out or discharged from all claims, actions, suits, obligations, debts, demands, rights, causes of action, damages, extra-contractual claims, statutory or common law bad faith claims, contribution claims, contractual or common law indemnity claims, RICO, conspiracy, oranti-trust claims, or liabilities of any nature whatsoever, controversies, costs, court costs, expenses, prejudgment and post-judgment interest, and attorneys’ fees whatsoever, at law or in equity, in any state or federal court, regardless of legal theory, which arise out of or are related to the medical care and treatment of Beneficiaries who were injured in motor vehicle accidents during the Class Period. , which have been asserted, or could have been asserted in these Actions or in other lawsuits, including but not limited to all claims under Florida’s No-Fault Act, of any kind whatsoever, all breaches of contract related to the payment of PIP benefits, of any kind whatsoever, all claims under the Medicare Secondary Payer Act, of any kind whatsoever, including all claims related in any way to the Released Parties’ reporting requirements and obligations under the Medicare Secondary Payer Act and its accompanying rules and regulations, and all claims related in any way whatsoever to the payment or reimbursement of Medicare benefits including those relating to the denial of benefits under the Medicare Act or the Social Security Act, which Releasing Parties ever had, now have or hereinafter can, shall or may have against one or more of said Released Parties, arising out of, contained in, or related to those claims and causes of action asserted or that could have been asserted in connection with any damages suffered by Releasing Parties as a result of, related to, or arising out of Releasing Parties claims against Ocean Harbor and the Released Parties related to the medical care and treatment of Beneficiaries who were injured in motor vehicle accidents during the Class Period.

“Released Parties” means:

Defendant Ocean Harbor Casualty Insurance Company, Policy Services Company, LLC d/b/a Pearl Holding (“Pearl Holding”), HGGC LLC. (“HGGC”), and all of Ocean Harbor’s, Pearl Holding’s and HGGC’s acquired entities, predecessors, successors, affiliates, parent companies and subsidiaries (collectively “Affiliates”) and all of Ocean Harbor’s, Pearl Holding’s and HGGC’s Defendant’s Affiliates’ past or present heirs, executors, estates, administrators, predecessors, successors, assigns, parents, affiliates, subsidiaries, associates, employers, employees, agents, consultants, independent contractors, insurers, directors, managing directors, officers, partners, principals, members, attorneys, accountants, financial and other advisors, investment bankers, underwriters, shareholders, lenders, auditors, investment advisors, legal representatives, successors in interest, assigns and Persons, firms, trusts, corporations, officers, directors, other individuals or entities in which Ocean Harbor, Pearl Holding and HGGC or their Affiliates have or had a controlling interest or which are or were affiliated with any of them, or any other representatives of any of these Persons and entities.

“Releasing Parties” means:

The Settlement Class Members, as defined in Sections 5 and 6, and: (a) with respect to any Settlement Class Member that is not an individual, all of its present, former, and future direct and indirect parent companies, affiliates, subsidiaries, divisions, agents, franchisees, successors, predecessors-in-interest, and all of the aforementioned’s present, former, and future officers, directors, employees, shareholders, attorneys, agents, independent contractors; and, (b) with respect to any Settlement Class Member who is an individual, any present, former, and future spouses, as well as the present, former, and future heirs, executors, administrators, representatives, agents, attorneys, partners, successors, predecessors-in-interest, and assigns of each of them.

“Unknown Claims” means:

Claims that could have been raised in the Actions and that the Plaintiffs, Class Representatives, Settlement Class Members, or any or all other Persons and entities whose claims are being released, or any of them, do not know or suspect to exist, which, if known by him, her or it, might affect his, her or its agreement to release the Released Parties or the Released Claims or might affect his, her or its decision to agree, object or not to object to the Settlement Agreement. Upon the Settlement Effective Date, the Plaintiff(s), Class Representative(s), Settlement Class Members, and all other Persons and entities whose claims are being released shall be deemed to have, and shall have, expressly waived and relinquished, to the fullest extent permitted by law, the provisions, rights and benefits of § 1542 of the California Civil Code and/or the provisions, rights and benefits conferred by any law of any state or territory of the United States, or principle of common law, or legal doctrine, or the law of any jurisdiction outside of the United States, which is similar, comparable or equivalent to § 1542 of the California Civil Code

California Civil Code § 1542 provides that:

A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS OR HER FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM OR HER MUST HAVE MATERIALLY AFFECTED HIS OR HER SETTLEMENT WITH THE DEBTOR.

To the extent thatanyone might argue that these principles of law are applicable—notwithstanding that the Parties have chosen Florida law to govern the Settlement Agreement—the Plaintiff(s) and Class Representative(s) hereby agree, and each Settlement Class Member will be deemed to agree, that the provisions of all such principles of law or similar federal or state laws, rights, rules, or legal principles, to the extent they are found to be applicable herein, are hereby knowingly and voluntarily waived, relinquished, and released. The Plaintiffs and Class Representative recognize, and each Settlement Class Member will be deemed to recognize, that, even if they may later discover facts in addition to or different from those which they now know or believe to be true, they nevertheless agree that, upon the Settlement Effective Date, they fully, finally, and forever settle and release any and all Released Claims.

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  1. Do I have to sign a written release when I receive a payment?

Yes, before receiving any payment under the Settlement Agreement, each Settlement Class Member seeking recovery will be required to execute a written release in favor of Ocean Harbor and the Released Parties of all Released Claims.

If a Class Member accepts a Settlement Payment, this written release will remain valid even if the Final Judgment is later reversed and/or vacated on appeal.

VIII. EXCLUDING YOURSELF FROM THE SETTLEMENT

If you don’t want a payment from this settlement, but you want keep the right to sue or continue to sue Ocean Harbor Casualty Insurance Company, on your own, about the legal issues in this case, then you must take steps to get out. This is called excluding yourself—or is sometimes referred to as opting out of the Settlement Class.

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  1. How do I get out of the settlement?

If you want to exclude yourself you must strictly comply with the procedures outlined below. You can’t exclude yourself on the phone or by e-mail. If you ask to be excluded, you will not get any settlement payment, and you cannot object to the settlement. You will not be legally bound by anything that happens in this lawsuit. You may be able to sue (or continue to sue) Ocean Harbor Casualty Insurance Company in the future.

Any request to be excluded from the Settlement Agreement will apply to the entire Settlement Agreement. Settlement Class Members may not opt-out specific claims or bills submitted for payment while still participating for other claims or bills. Neither may Class Members opt-out of provisions relating to Prospective or Future Claims while participating in the settlement for claims within the Class Period.

To validly exclude yourself or “Opt-Out” from the settlement, you must strictly comply with the following procedures:

  1. A Class Member must personally sign and submit a written request to be excluded from the Settlement Agreement (Request for Exclusion).
  2. The Request for Exclusion must be personally signed by the Class Member requesting exclusion. So called “mass” or “class” opt-outs shall not be allowed.
  3. If the Request for Exclusion is submitted by someone other than the Settlement Class Member, or an officer or authorized employee of the Settlement Class Member, then the third party signor (e.g., attorney, billing agent, or other third party) must include the following attestation on the Request for Exclusion: “I certify and attest to the Court that the Settlement Class Member on whose behalf this Request for Exclusion is submitted, has been provided a copy of and an opportunity to read the Class Notice and thereafter specifically requested to be excluded from this Settlement Class.”
  4. The Request for Exclusion shall be in writing and it must (1) state the Class Member’full name, telephone number, and current address; (2) refer to the Actions as follows: MSPA Claims 1, LLC v. Ocean Harbor Casualty Ins. Co., Case No. 2015-1946-CA-01 (11th Jud. Cir. Miami-Dade County);(3) describe in express and clear terms the Class Member’s desire to opt-out from the Settlement Agreement and from the Class; and (4) expressly acknowledge that by requesting exclusion from the Settlement and the Class the Class Member is foreclosed forever from raising any objections to the Settlement Agreement.
  5. Any Request for Exclusion must be served on Class Counsel and Ocean Harbor’s Counsel via electronic mail to the addresses set out at the end of this notice, by July 31, 2018.
  6. Failure to strictly comply with these requirements and to timely submit the Request for Exclusion shall result in the Settlement Class Member being bound by all the terms of the Settlement Agreement, the Approval Order, and the Final Judgment. Any Settlement Class Member who elects to Opt Out pursuant to this Section shall be deemed to have waived any rights or benefits under the Settlement Agreement.

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  1. If I don’t exclude myself, can I sue Ocean Harbor Casualty Insurance Company for the same thing later?

No. Unless you exclude yourself, you give up the right to sue Ocean Harbor Casualty Insurance Company for the claims that this settlement resolves. If you have a pending lawsuit, speak to your lawyer in that lawsuit immediately. You must exclude yourself from this Class to continue your own lawsuit. Remember, the exclusion deadline is July 31, 2018.

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  1. If I exclude myself, can I get money from this settlement?

No. If you exclude yourself, do not send in a claim form to ask for any money. But, you may sue, continue to sue, or be part of a different lawsuit against Ocean Harbor Casualty Insurance Company.

IX. THE LAWYERS REPRESENTING YOU

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  1. Do I have a lawyer in the case?

The Court certified the following attorneys as Settlement Class Counsel to represent you and other Class Members: John H. Ruiz, Esq., Frank C. Quesada, Esq., and Gonzalo Dorta, Esq. (collectively “Class Counsel”). Class Counsel are experienced in litigating class action claims of the type involved in this Settlement. Class Counsel also has vast experience in certifying, litigating, and processing millions of health care claims through proprietary systems. Class Counsel have the necessary experience to settle the Actions and represent the interests of the Class Members. Mr. Ruiz has certified, affirmed on appeal, administered, and otherwise handled No-Fault Act class actions through final judgment. These attorneys will represent you as part of the Settlement Class, unless you choose to hire your own attorney, which you have a right to do, at your own expense.

You may contact Class Counsel for further information regarding the nature and/or scope of this litigation, questions regarding Class Certification, or to discuss pertinent data for the lawsuit, please contact Class Counsel:

MSP Recovery Law Firm, 5000 S.W. 75th Avenue, Suite 400 Miami, FL 33155, Telephone: (305)614-2222
Attn: John H. Ruiz, Esq. and Frank C. Quesada,
Dorta Law, 334 Minorca Avenue, Coral Gables, Florida 33134, Telephone: (305) 441-2299
Attn: Gonzalo Dorta. Esq.

Email: info@oceanharborclassaction.com

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  1. How will the lawyers be paid?

Class Counsel will ask the Court to approve the amount of attorneys’ fees and expenses agreed upon by the Parties in the Settlement Agreement. These amounts will not come out of the funds for payments to Class Members. Ocean Harbor Casualty Insurance Company will also separately pay the costs to administer the settlement.

X. OBJECTING TO THE SETTLEMENT

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  1. How do I tell the Court that I don’t like the settlement?

If you’re a Class Member, you can object to the settlement if you don’t like any part of it. You can give reasons why you think the Court should not approve it. You can also file a petition to intervene in the settlement. The Court will consider your views.

You cannot object or file a petition to intervene if you requested to exclude yourself from the settlement.

If you want to object or file a petition to intervene you must strictly comply with the below procedures:

  1. Any Objection or Petition to Intervene shall be in writing, personally signed, and include the following information: (1) full name, current address, current electronic mail address, and current telephone number; (2) sworn proof that the objector or intervenor is a Class Member as defined in the Settlement Agreement; (3) a statement of each objection being made and/or each ground for intervention; (4) a detailed description of the facts underlying each objection and/or ground(s) for intervention; (5) a detailed description of the legal authorities underlying each objection and/or ground for intervention; (6) a list of witnesses, including impeachment witnesses, who may be called to testify at the Fairness Hearing, either live or by deposition or by affidavit, and a summary of the testimony to be presented at the hearing; (7) a list of exhibits, including impeachment exhibits, along with copies of the exhibits, that the objector and/or intervenor may offer during the Fairness Hearing; and (8) a detailed statement comparing the benefits recoverable by the class member pursuant to the settlement agreement with the benefits recoverable by the class member if he/she/it were to pursue the benefits on an individual basis.
  2. Any Objection or Petition to Intervene must also identify any previous objections to or petition to intervene in any class actions whatsoever filed by the Class Member and his/her/its counsel in any state or federal court. This listing must contain (1) the name of the case; (2) the case number; (3) the court in which the objection or petition to intervene was filed; and (4) the outcome of the objection or petition to intervene.
  3. Any Objection or Petition to Intervene and all of the documents described in this Section must be filed with the Court and served on Class Counsel and Ocean Harbor’s Counsel via electronic mail to the addresses set out at the end of this notice, by July 31, 2018.
  4. In addition, any Class Member who files an Objection or Petition to Intervene must also file with the Court and serve Class Counsel and Ocean Harbor’s Counsel via electronic mail to the addresses set out at the end of this notice, a Notice of Intention to Appear at the Fairness Hearing by July 31, 2018.
  5. Any Class Member who does not file and serve an Objection or Petition to Intervene and a Notice of Intention to Appear at the Fairness Hearing in strict accordance with the deadlines and other specifications set forth in this section will be deemed to have waived any objections to the settlement and may be barred from speaking or otherwise presenting any views at the Fairness Hearing.
  6. Any Class Member who fails to timely and properly make an Objection or Petition to Intervene as set forth in this section shall be deemed to have waived and forfeited any and all rights he or she may have to object to or intervene in the Settlement Agreement and/or to appear and be heard on said objection at the Fairness Hearing; shall be deemed to have waived any right to appeal the Final Judgment; shall not be entitled in any way to contest the approval of the terms and conditions of the Settlement Agreement, the Approval Order, or the Final Judgment; and shall be foreclosed forever from raising any objections to and/or intervening in the Settlement Agreement; asserting claims arising out of, relating to, or based in whole or part on any of the facts or matters alleged, or which could have been alleged, or which were otherwise at issue in the Actions; or raising any Released Claims.
  7. Any Class Member who timely and properly makes an Objection or Petition to Intervene as set forth in this section and whose Objection or Petition to Intervene does not result in the denial of the Approval Order remains a member of the Settlement Class.
  8. The procedures and requirements set forth in this section for objecting to or petitioning to intervene in the Settlement Agreement are intended to ensure the fair and efficient administration of justice and the orderly presentation of any objections or petitions to intervene by any Class Members consistent with their right to Due Process.
  9. Opting Out as set forth above and making an Objection or Petition to Intervene as set forth in this section are mutually exclusive options. Any Class Member who elects to make an Objection or Petition to Intervene pursuant to this Section may not also Opt Out of the Settlement Agreement and any Class Member who elects to Opt Out may also not make and Objection or Petition to Intervene pursuant to this Section.

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  1. What’s the difference between objecting and excluding?

Objecting is simply telling the Court that you don’t like something about the settlement. You can object only if you stay in the Class. Excluding yourself is telling the Court that you don’t want to be part of the Class. If you exclude yourself, you have no basis to object because the case no longer affects you.

XI. THE COURT’S FAIRNESS HEARING

The Court will hold a hearing to decide whether to approve the settlement. You may attend and you may ask to speak, but you don’t have to.

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  1. When and where will the Court decide whether to approve the settlement?

The Court will hold a Fairness Hearing at June 26, 2018 at 1:30 p.m. The hearing will be held before the Honorable Abby Cynamon, Circuit Court Judge, at the following location:

Eleventh Judicial Circuit Courthouse
73 West Flagler Street, DCC 817
Miami, Florida 33130

At this hearing the Court will consider whether the settlement is fair, reasonable, and adequate and whether it should be approved. If there are objections, the Court will consider them. Judge Cynamon will listen to people who have asked to speak at the hearing. After the hearing, the Court will decide whether to approve the settlement. We do not know how long these decisions will take.

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  1. Do I have to come to the hearing?

No. Class Counsel will answer questions Judge Cynamon may have. But, you are welcome to come at your own expense. If you send an objection, you don’t have to come to Court to talk about it. As long as you mailed your written objection on time, the Court will consider it. You may also pay your own lawyer to attend, but it’s not necessary.

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  1. May I speak at the hearing?

You may ask the Court for permission to speak at the Fairness Hearing. To do so, you must send a Notice of Intention to Appear at the Fairness Hearing by July 31, 2018. You must file this notice with the Court and serve Class Counsel and Ocean Harbor’s Counsel via electronic mail to the addresses set out at the end of this notice.

You cannot speak at the hearing if you excluded yourself.

XII. IF YOU DO NOTHING

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  1. What happens if I do nothing at all?

If you do nothing, you’ll get no money from this settlement. But, unless you exclude yourself, you won’t be able to start a lawsuit, continue with a lawsuit, or be part of any other lawsuit against Ocean Harbor Casualty Insurance Company about the legal issues in this case, ever again.

XIII. GETTING MORE INFORMATION

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  1. Are there more details about the settlement?

This notice summarizes the proposed settlement. More details are in a Settlement Agreement. You can get a copy of the Settlement Agreement by (CLICKING HERE), or by contacting Class Counsel at the below address:

MSP Recovery Law Firm
5000 S.W. 75th Avenue, Suite 400
Miami, FL 33155
Telephone: (305) 614-2222

Attn:John H. Ruiz, Esq., Frank C. Quesada, Esq.

Dorta Law
334 Minorca Avenue
Coral Gables, Florida 33134
Telephone: (305) 441-2299

Attn:Gonzalo Dorta. Esq.

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  1. How do I get more information?

You may contact Class Counsel for further information regarding the nature and/or scope of this litigation, questions regarding Class Certification, or to discuss pertinent data for the lawsuit:

MSP Recovery Law Firm
5000 S.W. 75th Avenue, Suite 400
Miami, FL 33155
Telephone: (305) 614-2222

Attn:John H. Ruiz, Esq., Frank C. Quesada, Esq.

Dorta Law
334 Minorca Avenue
Coral Gables, Florida 33134
Telephone: (305) 441-2299

Attn:Gonzalo Dorta. Esq.

Email: info@oceanharborclassaction.com

Instructions to access

Court Website

To access

Material Court Pleadings