Haage 4
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P.O.Box 512929
i s ;��:. :° °.p Los Angeles,CA 90051-0929
� '` ' � ' 'f:'?'�' Phone:(888)489-4214
Fax:(888)781-6947
1/22/2013 4:45:00 PM
SANDRA BODENSTEINER
CTI'Y OF ST.PUAL
651-266-8574
RE: Date Of Loss: 04-10-12
Our Insured: HAAGE,TRAVIS
Our Ctaim Number: 12-3316068
Your Insured: ST. PAUL REGIONAL WATER SERVICES
Your Claim Number: C12-0085
Dear SANDRA SODENSTEINER,
To date, Progressive Direct Insurance Co has paid $8,795.45 for Personal Injury Protection
("PIP") benefits resulting from a loss, which occurred on or about 04-10-12. Progressive Direct
Insurance Co is entitled to rights of recovery. We request CTTY OF ST. PUAL to notice,
aclrnowledge,protect and preserve these rights.
Our rights of recovery include, but are not limited to, indemnity or contribution created by the
payment of claims or benefits to insureds or qualified third parties under automobile accident
reparations statuses or common law.
For your reference,PIP benefits already paid, include:
Party Name PIP Total
MIRICK,TASHA-ROSE $8,795.45 OPEN
Please refer any inquires regarding our rights to recover to the attention of the InsPIP Team at
(888) 489-4214. Payment may be sent to Subrogation Payment Processing Center 24344
Network Place Chicago, IL 60673-1243.
Sincerely, I
i
InsPIP Team
Progressive Direct Insurance Co
PIP41.D(Rev.7/1/10)
Medical Payments/PIP- Print Preview Page 1 of 3
Medical Payments Details
Named Insured: Travis A Haage
Injured Party: Tasha-Rose Mirick
Cldim Number: 12-3316068
Date Of Loss: Oa-10-12
Total Billed: $1a,638.80
Total Paid: $8,795.45
------- - --- ---- -- ---- .__--- - ----- - - ----____ ____ _ _ _._.__ . .-- --------
Amount
Amount To Be Date Invoice Payment
_
r rv D -Biiled Paid Serv�ce-T e - - Received -L�en- Number Status
.
(Pr vi �E- - su e�Se �ce ffies _ ____.
o der xpo YP
i
ABBOTT NORTHWESTERN HOSP i
PIP MED 11-26-12/11-26- $187.30 $187.30 12-10-12 8375733 01-03-13 �
12 !
i
ABBOT NORTHWESTERN HOSP
PIP MED 10-01-12/10-01- $176.20 $0.00 12-14-12
12 !
ABBOT NORTHWESTERN HOSP i
PIP MED 10-01-12/10-01- $176.20 $88.10 11-07-12 8072857 11-27-12 !
12 �
ENTIRA FAMILY CLINICS
PIP MED 06-28•12/06-28- $128.00 $128.00 11-OS-12 8059737 11-26-12
12
�
ENTIRA FAMILY CLINICS
PIP MED 11-01-12/11-01- $124.00 $124.00 11-20-12 8039711 11-22-12 i
12
�
ABBOT NORTHWESTERN HOSP '
PIP MED 09-17-12/09-19- $484.90 $484.90 10-09-12 7776906 10-24-12 �
12
ABBOTT NORTHWESTERN HOSP
PIP MED 08-23-12/08-23- $286.50 $286.50 09-10-12 7750508 10-22-12 i
12
ST PAUL FlRE AND SAFETY '
PIP MED 04-10-12/04-10- $1,478.00 $1,478.00 08-27-12 7406980 09-13-12 ;
12
ABBOTT NORTHWESTERN HOSP �
i
PIPMED 07-12-12/07-19- $579.60 $579.60 08-11-12 7233541 08-23-12 �
12
ABBOTT NORTHWESTERN HOSP '
�
PIP MED 07-26-12/07-26- $282.00 $282.00 08-13-12 7218393 08-21-12 �
12 �
GROUP HEALTH PLAN INC
�
PIP MED 04-20-12/04-20- $503.00 $503.00 07-27-12 7105575 08-08-12
12
U MN MEDICAL CENTER FAIRVIEW
PIP MED 04-10-12/04-10- $1,662.00 $1,662.00 07-27-12 7099883 08-08-12
12
ALLINA HEALTH SYSTEM
PIP MED 04-30-12/04-30- $211.00 $211.00 07-27-12 7099876 08-08-12
12
UNIVERSITY OF MINNESOTA PHYS
PIP MED 04-10-12/04-10- $97.00 $97.00 07-27-12 7099823 08-08-12
12
http://medicalprocessingweb/Alpha/MedicalProcessingWeb/default.aspx?Page=SelectedE... 1/22/2013
Medical Payments/PIP- Print Preview Page 2 of 3
SELECT PHYSICAL THERAPY HOLDINGS
PIP MED 04-17-12/04-30- $876.00 i $876.00 07-27-12 7099820 08-08-12 ,
12 '
UNIVERSITY OF MINNESOTA PHYS i
PIP MED 04-10-12/04-10- $111.00 $111.00 07•27-12 7099796 08-08-12 i
12
REGIONS HOSPITAL '
PIP MED 04-11-12/04-11- $767.05 $767.05 07-27-12 7099788 08-08-12
12 i
FAIRVIEW HEALTH SERVICES
PIPMED 04•10-12/04-10- $258.00' $258.00 07-27-12 7099781 08-08-12
12
SELECT PHYSICAL THERAPY HOLDINGS
PIPMED 05-08-12/05-08- $310.00 $310.00 07-27-12 7099754'08-08-12
12 (
REGIONS HOSPITAL
PIPMED 04-11-12/04-11- $362.00 $362.00 07-27-12 7099741 ;08-08-12
12
ALLINA HEALTH SYSTEM �
PIPMED 04•30-12/04-30- $211.00' $0.00 07-03-12 '
12 ,
ALLINA HEALTH SYSTEM '
PIP MED 04-30-12/04-30- $211.00' $0.00 06-15-12
12
ALLINA HEALTH SYSTEM '
PIP MED 04-30-12/04-30- $211.00 $0.00 05-15-12
12
' I
SELECT PHYSICAL THERAPY HOLDINGS
PIP MED OS-08-12/05-08- $310.00; $0.00 OS-21-12 , ,
12
GROUP HEALTH PLAN
PIP MED 04-20-12/04-20- $503.00' $0.00 05-07-12
12
SELECT PHYSICAL THERAPY HOLDINGS ' '
PIP MED 04-17-12/04-30- $876.00 $0.00 05-07-12
12
UNIVERSITY OF MINNESOTA PHYSICIANS
PIP MED 04-10-12/04-10- $111.00 $0.00 04-30-12 ', ,
12
UNIVERSITY OF MINNESOTA PHYSICIANS
PIP MED 04-10-12/04-10- $97.00 $0.00 04-30-12
12
REGIONS HOSPITAL
PIPMED 04-11-12/04-11- $767.05 $0.00 04-30-12
12
REGIONS HOSPITAL
PIPMED 04-11-12/04-11- $362.00 $0.00 04-30-12
12
UNIVERSITY OF MINNESOTA MEDICAL CENTER FAIRVIEW
PIP MED 04-10-12/04-10- $1,662.00 $0.00 04-25-12
12
FAIRVIEW HEALTH SERVICES
http://medicalprocessingweb/Alpha/MedicalProcessingWeb/default.aspx?Page=SelectedE... 1/22/2013
Medical Payments/PIP- Print Preview Page 3 of 3
PIPMED 04-10-12/04-10- $258.00'': $0.00 04-27-12 �
12 �
http://medicalprocessingweb/Alpha/MedicalProcessingWeb/default.aspx?Page=SelectedE... 1/22/2013