Haage (2) .d�'��i�r�����i�`��.
R E C E I VE D Los Ange es?CA 90051-0929
Phone:(888)489-4214
MAY O1 2013 Fax:(888)781-6947
5/1/2013 9:48:00 AM
CITY CLERK
SANDRA BODENSTEINER
CTTY OF ST.PUAL
651-266-8574
RE: Date Of Loss: 04-10-12
Our Insured: HAAGE,TRAVIS
Our Claim Number: 12-3316068
Your Insured: ST. PAUL REGIONAL WATER SERVICES
Your Claim Number: C12-0085
Dear SANDRA BODENSTEINER,
To date, Progressive Direct Insurance Co has paid $8,883.55 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:
Partv Name PIP Total
MIRICK,TASHA-ROSE $8,883.55
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,
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
Claim Number: 12-3316068
Date Of Loss: 04-10-12
Total Billed: $14,815.00
Total Paid: $8,883.55
_------ - --._ ----- -------- __ __. ---- --- _ ----- ----- --- ____ . --- ----
Amo�nt
Amount To e Date Invo�ce Payment
�Pr vi r�E r ��S rvice Dates Biiled� Paid Ssrvice-T e Receroed Lien- Number Status
o de xposu e e Yq
ABBOT NORTHWESTERN HOSP
PIP MED 10-01-12/10-01- $176.20 $88.10 03-26-13 9179120 03-31-13
12 �
ABBOTT NORTHWESTERN HOSP
PIP MED 11-26-12/11-26- $187.30 $187.30 12-10-12 8375733 01-03-13
12
I
ABBOT NORTHWESTERN HOSP j
PIP MED 10-01-12/10-01- $176.20 $0.00 12"14"12 I
12 ;
ABBOT NORTHWESTERN HOSP I
PIP MED 10-01-12/10-01- $176.20 $88.10 11-07-12 8072857 11-27-12 i
12 '
ENTIRA FAMILY CLINICS I
PIPMED 06-28-12/06-28- $128.00 $128.00 11-05-12 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 !
12
ABBOT NORTHWESTERN HOSP
PIP MED 09-17-12/09-19- $484.90 $484.90 10-09-12 7776906 10-24-12 I
12
ABBOTT NORTHWESTERN HOSP I
PIP MED 08-23-12/08-23- $286.50 $286.50 09-10-12 7750508 10-22-12
�2 I
I
ST PAUL FlRE AND SAFETY
PIPMED 04-10-12/04-10- $1,478.00 $1,478.00 08-27-12 7406980 09-13-12
12 I
i
ABBOTT NORTHWESTERN HOSP ;
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 OS-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
PIPMED 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
http://medicalprocessing/Alpha/MedicalProcessingW eb/default.aspx?Page=S electedExpens... 5/1/2013
Medical Payments/PIP-Print Preview Page 2 of 3
UNIVERSITY OF MINNESOTA PHYS �
PIP MED 04-10-12/04-10- $97.00' $97.00 07-27-12 7099823 08-08-12
12 �
SELECT PHYSICAL THERAPY HOLDINGS j
PIP MED 04-17-12/04-30- $876.00' $876.00 07-27-12 7099820 08-08-12 i
12 ' I
UNIVERSITY OF MINNESOTA PHYS ' �
i
PIP MED 04-10-12/04-10- $111.00. $111.00 07-27-12 7099796:08-08-12 j
12
i
REGIONS HOSPITAL �
PIPMED 04-11-12/04-11- $767.05 $767.05 07-27-12 7099788',08-08-12 �
12 (
FAIRVIEW HEALTH SERVICES ' !
PIP MED 04-10-12/04-10- $258.00' $258.00 07-27-12 7099781 08-08-12 �
12 i
SELECT PHYSICAL THERAPY HOLDINGS ' �
i
PIP MED 05-08-12/OS-08- $310.00, $310.00 07-27-12 7099754;08-OS-12 i
12 , i
REGIONS HOSPITAL
PIP MED 04-11-12/04-11- $362.00 $362.00 07-27-12 7099741 08-08-12 I
12
i
ALLINA HEALTH SYSTEM �
PIP MED 04-30-12/04-30- $211.00 $0.00 07-03-12 �
12 ' I
ALLINA HEALTH SYSTEM ' �
PIP MED 04-30-12/04-30- $211.00 $0.00 06-15-12 i
12 ' ;
ALLINA HEALTH SYSTEM �
�
PIP MED 04-30-12/04-30- $211.00 $0.00 OS-15-12 �
�
12 i
SELECT PHYSICAL THERAPY HOLDINGS �
PIP MED OS-08-12/05-08- $310.00' $0.00 05-21-12 '
12 i
�
GROUP HEALTH PLAN
PIP MED 04-20-12/04-20- $503.00 $0.00 05-07-12 �
�
12 ' ' i
SELECT PHYSICAL THERAPY HOLDINGS �
PIP MED 04-17-12/04-30- $876.00', $0.00 OS-07-12 I
12 i
;
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
PIP MED 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
http://medicalprocessing/Alpha/MedicalProcessingW eb/default.aspx?Page=S electedExpens... 5/1/2013
Medical Payments/PIP- Print Preview Page 3 of 3
PIP MED 04-10-12/04-10- $1,662.00 $0.00 04-25-12 ' '
12 '
FAIRVIEW HEALTH SERVICES ' '
PIP MED 04-10-12/04-10- $258.00 $0.00 04-27-12 '
12
http://medicalprocessing/Alpha/MedicalProcessingW eb/default.aspx?Page=S electedExpens... 5/1/2013