Complaint: CONDITION OF COSTS I agree to pay Hill & Ponton, P.A. for the following costs: a. In the event that my claim is approved, I will be responsible for all costs.Hill & Ponton, P.A. agrees to advance payment for costs which may be charged by the doctors, hospitals, or any other entity for medical records or information necessary in the preparation of the claim. b. In the event that my claim is approved, I will also be responsible for a$300.00 administrative cost for other expenses incurred, including the copying of my file at the Social Security office, travel expenses, certified mail, postage, fax, and long distance telephone charges. The fee is in addition to any responsibility for the costs outlined in paragraph (a) and representative’s fees. I accept responsibility for these costs and will reimburse Hill & Ponton, P.A. prior to the close of my claim. If the case is not approved, I will not be responsible for these costs. I have read and understood all ofthe above. Date This is a form I received from Hill and Pondon. Sounds like a setup for disaster.
Address: DAYTONA, Florida USA