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IN THE CIRCUIT COURT, IN AND FOR
ST. LUCIE COUNTY, FLpRIDA.
CASE NO. 79-197 CA
JAMES METCALF and YVONNE NOTICE OF PAYMENT
METCALF, his wife, ~ ) OF
' WORKMEN'S COMPENSATION
Plaintiffs, ) AND
MEDICAL BENEFITS
vs. _ ) AND
CLAIM OF LIEN THEREFOR
LEE BROCK and PHILLIP M. )
BAKER,
Defendants. )
PENINSULAR LIFE INSURANCE COMPANY, employer, and COMMERCIAL _
UNION ASSURANCE COMPANIES, workmen's compensation carrier for the
said employer of YVONNE METCALF, plaintiff in the above-styled
cause, by and through their undersigned attorney and pursuant to
Section 440.39(3), Florida Statutes, file their notice of payment
of compensation and medical benefits paid and/or to be paid to or on
behalf of~said employee and/or plaintiff.
WHEREFORE, PENINSULAR LIFE INSURANCE COMPANY and OOMMERCIAL
UNION ASSURANCE COMPANIES hereby affirm and assert their lien upon
any judgment or settlement recovered by the above-named plaintiff
against the above-named defendants to the extent that the Court
5
( may determine as their pro rata share of said judgment or settlement
~ for compensation and medical benefits paid and/or to be paid under
the provisions of Chapter 440., Florida Statutes.
I HEREBY CERTIFY that a copy of the foregoing has been mailed
this 11th day of June, 1979 to: C.R. McDonald, Esquire and Hugh
Lindsey, Esquire, attorneys for Plaintiffs and Robin Blanton, Esquire,
attorney for Defendants.
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Attorney for Employer/Carrier
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