PIP Injunction. Affidavit and/or Donations Needed Now! Florida PIP Defense Fund.

PIP Injunction. Affidavit and/or Donations Needed Now!  Florida PIP Defense Fund.

Help Save Florida PIP

Dr. Alan Himmel

As you are aware by now, the Mr. Lirot and Mr. Levine have been fighting to keep the Florida No-Fault Law in place for Florida residents and providers.  click:  FLORIDA PIP DEFENSE  They need these affidavits filled out and sent in.  They also need money.  But, if you cant send money, you can at least file an affidavit explaining how the changes in PIP will affect your livelihood.  Below are the Affidavits. There are instructions below as well, including where to send your donation and affidavit.

Below is the affidavit for Florida Providers: Print this form out. Follow the instructions (below) on how to fill it out properly and where to mail it. Here is the link to the PDF: 

Click here for the Affidavit if you are a Florida Provider

UNITED STATES DISTRICT COURT

MIDDLE DISTRICT OF FLORIDA

TAMPA DIVISION

ROBIN A. MYERS, A.P., an individual
person and Acupuncture Physician,

GREGORY S. ZWIRN, D.C., an individual
persona and Chiropractic Physician,

SHERRY L. SMITH, L.M.T., an individual
person and Licensed Massage Therapist, Case No. 8:12-cv-2660-T-26TBM

CARRIE C. DAMASKA, L.M.T., an individual
person and Licensed Massage Therapist,

“JOHN DOE,” on behalf of all similary
situated health care providers,

“JANE DOE,” on behalf of all those injured
by motor vehicle collisions,

Plaintiffs,

v.

KEVIN N. McCARTY, in his Official Capacity as
Commissioner of the Florida Office of Insurance
Regulation,

Defendant.
__________________________________________/

AFFIDAVIT OF  ______________[INSERT YOUR NAME HERE]_______________

STATE OF FLORIDA )
COUNTY OF [FILL IN COUNTY] )

Before me, the undersigned authority, appeared    [YOUR NAME HERE], having been duly identified and who states under oath the following:

1. I am over the age of 18 years and otherwise competent to make this affidavit;
2. I have personal knowledge of the facts set forth herein;
3. I am a resident of  [FILL IN COUNTY] County;
4. I am a [INSERT TYPE OF HEALTH CARE PROVIDER OR PATIENT];
5. I own [OR WORK IN OR WHATEVER - INSERT THE BUSINESS NAME];
6. My business is located in [INSERT COUNTY HERE] County;
7. I possess license number [INSERT LICENSE NUMBER HERE] issued by the State of Florida to practice [INSERT TYPE OF LICENSE HERE];
8. I read the 2012 Motor Vehicle Personal Injury Protection Insurance Act;
9. Although I [UNDERSTAND, AM CONFUSED BY ETC.] the aforementioned Act, I believe that the Act will [what you think the Act will do in your own words. Generally injunctions are granted for things that will cause you irreparable harm – i.e. even if they could give you money, you would still be harmed because your business was destroyed etc.  With an injunction, you are asking the Court to provide you with an extraordinary remedy – something that will potentially cause you such harm that you will be permanently damaged.];
10. At this time, this Act has already  [what was the impact of the act on your business?];
11. Further, I have the following comments:
12. I am requesting that this Court maintain the status quo so that I am not irreparably harmed until the Court can proceed with a full hearing or trial regarding this matter.

FURTHER AFFIANT SAYETH NAUGHT.
_______________________________________________
[INSERT YOUR NAME AND SIGN ABOVE]

NOTARY ACKNOWLEDGMENT

The foregoing Affidavit was sworn and acknowledged before me on this ___th day of _____________________ 2012 by  [INSERT NAME HERE], ___who is personally known to me, or ___ who produced the following identification: __________________________________________.

Notary signature: ________________________________
Notary name: ________________________________
Notary Expiration Date: ____________________________
Notary Seal:

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

Below is the Affidavit of you are a Florida Consumer: Copy and print this form out. Follow the instructions on where to mail it. Here is the link to the PDF:  

Click here for the Affidavit if you are a Florida Consumer

IN THE CIRCUIT COURT OF THE SECOND JUDICIAL CIRCUIT

IN AND FOR LEON COUNTY, STATE OF FLORIDA

CIVIL DIVISION

ROBIN A. MYERS, A.P., an individual person 

and Acupuncture Physician, GREGORY S. 

ZWIRN, D.C., an individual person and

Chiropractic Physician, SHERRY L . SMITH, L.M.T.,

an individual person and Licensed Massage Therapist,

CARRIE C. DAMASKA, L.M.T., an individual 

person and Licensed Massage Therapist, “John Doe,”

on behalf of all similarly situated health care providers, 

and “Jane Doe,” on behalf of all those individuals 

injured by motor vehicle collisions,

Plaintiffs,

Case: 2013-CA-000073

v.

KEVIN N. McCARTY, in his Official Capacity as

Commissioner of the Florida Office of Insurance 

Regulation,

Defendant.

_____________________________________________/

AFFIDAVIT OF: ___________________________________

STATE OF FLORIDA

COUNTY OF _____________________

Before me, the undersigned authority, appeared ______________________________, having 

been duly identified and who states under oath the following:

1. I am over the age of 18 years and otherwise competent to make this affidavit;

2. I have personal knowledge of the facts set forth herein;

3. I am a resident of ______________ County;

4. I am a resident of Florida that owns a motor vehicle and is required to purchase 

$10,000.00 (ten thousand dollars) in Personal Injury Protection Insurance. My address:

_____________________________________________________________________.

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

Here are the instructions to fill out the Affidavits and here is the PDF:

Click Here to view the Affidavit Instructions in PDF

AFFIDAVIT INSTRUCTIONS: 1. Tell the truth. 2. Add your name to the title: Affidavit of: Your Name. 3. Add your current County 4. Add your name to the first line, Before me…. 5. Fill in line #4 with your county of residence (where you live) 6. Fill in line #4 with your licensure: DC, LMT, AP, Consumer 7. Fill in line #5 with your business name 8. Fill in line #6 with the county your business is located in. 9. Fill in lines #7 and #8 with the impact of the 2012 PIP Act on you and your business – be as detailed as possible. An injunction is an extraordinary remedy – it is hard to get. We have to show that you and your business are being irreparably harmed – irreparable harms occur when you cannot receive mere money to make things right – things like loss of referrals, loss of patient relationship etc. Also list financial harms – all of them. 10. Fill in #10 – the state alleged that eliminating acupuncture and massage were ok because they are of no benefit. 11. Fill in #12 with any statement you wish to make. 12. If you have any accident victims that were injured before or after 1/1/13 and have been limited in their coverage, please have them fill out an affidavit too and discuss how they have been impacted by this Act. INSTRUCCIONES EN COMO LLENAR EL AFIDAVIT: (Favor de Leer todo, antes de llenar el Affidávit.) 1. Diga la verdad. 2. Agregue su nombre al título: Declaración Jurada de: Su Nombre. 3. Añada su condado actual 4. Añade tu nombre a la primera línea, delante de mí .... 5. Introduzca la línea # 4 con su condado de residencia (donde vive) 6. Introduzca la línea # 4 con su licencia: DC, LMT, AP, Consumer 7. Introduzca la línea # 5 con su nombre comercial 8. Introduzca la línea # 6 con el condado de su negocio se encuentra en 9. Llene las líneas # 7 y # 8 con el impacto de la Ley de 2012 sobre PIP de usted y su negocio - sea lo más detallado posible. Una orden judicial es un recurso extraordinario - es difícil de conseguir. Tenemos que demostrar que usted y su negocio se están irreparablemente dañados - daños irreparables ocurren cuando no se puede recibir dinero solo hacer las cosas bien - cosas como la pérdida de referencias, la pérdida de la relación médico-paciente, etc. también una lista de los daños financieros - todos ellos. 10. Rellene # 10 - el Estado alega que eliminando la acupuntura y el masaje esta bien porque ellos no son beneficiosos al accidentado. 11. Rellene # 12 con cualquier declaración que usted desea hacer. 12. Si tiene alguna víctimas de accidentes que resultaron heridos antes o después de 1/1/13 y se han limitado en su cobertura, por favor haga que llenar una declaración jurada también y discutir la forma en que se han visto afectadas por esta ley.