Articles Posted in Litigation

doctor.jpgAccident victims often require medical attention. Medical malpractice sometimes makes their medical conditions worse, compounding the initial injuries with additional medical expenses and pain and suffering.

When the initial injuries are caused by the negligence of a third party, the victim is entitled to be compensated by the third party for both the initial injuries and the enhanced injuries resulting from the medical negligence.

In Dungan v. Ford, 632 So. 2d 159 (Fla 1st DCA 1994), the trial court allowed the Defendant to present expert testimony that a surgeon should not have performed a percutaneous diskectomy which resulted in more pain, suffering and expenses. The trial judge’s ruling was appealed. The appellate court held that the trial judge was wrong:

“It is well-established that a wrongdoer is liable for the ultimate negligence on the part of a physician who has treated an injury in such a way that the treatment may have increased the damage which otherwise would have followed from the original wrong. Stuart v. Hertz Corp., 351 So.2d 703 (Fla. 1977); Davidson v. Gaillard, supra; Rucks v. Pushman, 541 So.2d 673 (Fla. 5th DCA), rev. denied, 549 So.2d 1014 (Fla. 1989); 57 Am.Jur.2d Negligence § 149, and Restatement (Second) of Torts § 457 (1965). Cf. Barrios v. Darrach, 629 So.2d 211 (Fla. 3d DCA 1993).”

surgery.jpgOne of the primary responsibilities of personal injury attorneys who represent Plaintiffs, those injured by the negligence of others, is to recover past and future medical expenses.

Recovering the past medical expenses requires proof that the charges are reasonable, related to the accident, and necessary. See Garrett v. Morris Kirschman & Co., Inc., 336 So.2d 566 (Fla. 1976).

Interestingly, while expert medical testimony is required to prove the relationship between the accident and the injuries, expert testimony is not always required to prove that the charges are reasonable and necessary. See, Id., and Albertson’s, Inc. v. Brady, 475 So.2d 986 (Fla. 2d DCA 1985), rev. denied, 486 So.2d 595 (Fla. 1986).

dollars.jpgIndividuals seriously injured through the negligence of others often require medical care and treatment long after the case is resolved. Settlements and jury verdicts must take these future medical expenses into account.

Some individuals harmed through the negligence of others are eligible for medical care through governmental or charitable services for a pre-existing disability unrelated to the tort claim. The most common of these services is Medicare.

Governmental and charitable reimbursements are always a fraction of a medical provider’s usual and customary charges. While the services may cover medical expenses related to the accident, there are no guarantees as to what will be covered and for how long. Given these factors, should juries be allowed to consider evidence of the reduced rates in calculating future medical expenses.

The answer in Florida appears to be Yes.

In State Farm v. Joerg, the trial court did not allow State Farm to introduce evidence that Joerg’s future medical expenses might be reduced under the Medicare program. The trial court’s decision was reversed on appeal.

Relying on Florida Physician’s Insurance Reciprocal v. Stanley, 452 So. 2d 514 (1984), a Florida Supreme Court case, Florida’s 2nd DCA held that since Joerg did not earn the Medicare benefit, the jury should be allowed to consider Medicare’s rates in calculating future medical expenses.
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scales.jpgFor-profit insurance companies enjoy privileges in Florida not afforded individuals and other commercial activities. It is little wonder they profit so handsomely. In turn, their wealth allows them to exercise ever greater control over politicians, the courts, and the psyche of the people. It’s an ugly picture.

Negligence
In the context of liability claims, an insurance company’s primary responsibility is to protect its insured from an excess judgment. An excess judgment is a judgment entered by the court in an amount greater than the insured’s policy coverage limits. The carrier can achieve this outcome in most cases simply by being conscientious and reasonable. Falling below this standard is generally considered negligence.

As a lawyer, I can be held accountable for negligence causing harm to a client. The same holds true for doctors, bankers, manufacturers, drivers and every other entity … except for insurance companies.

In DeLaune v. Liberty Mutual Ins. Co., 314 So.2d 601 (Fla. 4th DCA 1975), Liberty failed to settle a car crash claim for its insured’s policy limit of $10,000. A verdict was rendered against the insured for $360,000. The court disallowed the Plaintiff’s attempt to recover the difference in a separate lawsuit based on allegations of harm resulting from negligence. The court said that an insurance company cannot, unlike every other entity in Florida, be held liable for harming an insured based solely on negligence. (The insured assigned the Plaintiff his right to sue Liberty in exchange for the Plaintiff agreeing not to enforce the judgment against him. This is standard operating procedure in situations where insurance carriers expose their insureds to excess judgments.) See also Thomas v. Lumbermens Mutual, 424 So. 2d 36, 38 (Fla. 3rd DCA 1982).

Not good.

Silent (Dominant) Partner
When its insured is sued, the insurance company calls the shots on every aspect of defending the case. The carrier chooses the lawyers, hires the experts (or not), requires the insured’s cooperation, and decides on settlement (or not). Florida juries are not allowed to know any of this. See Sec. 627.4136, Fla. Stat.; Beta Eta House Corp. v. Gregory, 237 So. 2d 163, 165 (Fla. 1970) (The Florida Supreme Court said this information is not relevant to issues of fault and damages.)

Not good.
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cemetery1.jpgAny cause of action, or lawsuit, arising in Florida from the death of an individual caused by the wrongful act or negligence of any person or entity is controlled by the “Florida Wrongful Death Act” (Sections 768.16-768.26). This blog describes some key wrongful death claim considerations.

  • Statute of Limitations: Florida Statute Section 95.11(4)(d) instructs that an action for wrongful death must commence within two years of death. Section 95.11(4)(b) describes when the SOL can be extended beyond 2 years where the WD resulted from medical negligence. (Read this blog: The Statute of Limitations (SOL) Under Florida’s Wrongful Death Act.)
  • Court of Competent Jurisdiction: Typically, WD claims are brought in state circuit courts. Regarding venue, Florida Statue, 47.011 provides that “Actions shall be brought only in the county where the defendant resides, where the cause of action accrued…. This section shall not apply to actions against nonresidents.” If none of the defendants reside in or have a principal place of business in Florida, the action must be brought in federal court.
  • Parties to the Lawsuit (Plaintiff): Florida WD actions are prosecuted by court appointed personal representative(s) on behalf of the decedent’s statutorily defined “survivors.” Link to this blog (for an outline of the “survivors” list.) The court appointed PR is often a survivor, like an adult child or a parent. The court may also appoint a guardian ad-litem for minors and incompetent adults.
  • Parties to the Lawsuit (Defendant): Defendants in WD actions are the individuals and entities who are alleged to be at-fault.
  • Damages: Making defendants pay monetary compensation to the survivors for their loss is how defendants are punished under our civil justice system. The amount of compensation, or damages, is determined by examining such elements as mental pain & suffering, loss of the decedent’s companionship and protection, past and future loss of support and services, and medical and funeral expenses. (Read this blog to see an outline of the damages available under the Act.)
  • Pretrial Procedure: Florida Wrongful Death Act claims can be settled by the parties at any time, even pre-suit. Some are settled after the lawsuit has been filed, but before or during trial. Some are dismiised by the court. The remainder go to final verdict.
  • Trial: Wrongful death cases are typically tried to juries, although judges can be chosen to act as the finder of fact. Judges make legal rulings, juries make factual determinations.
  • Post-trial: All rulings by judges and juries can be challenged on appeal. The threat of appeal sometimes precipitates settlement.

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While personal injury litigation in Florida courts is not supposed to be a game of “gotcha,” or trial by ambush, Surf Drugs, Inc. v. Vermette, 236 So.108, 111 Fla.1970,” unless attorneys pay careful attention, it can happen in their cases. One of the ripest areas for this gamesmanship to occur is in the use of accident videotape.

Premise liability defendants often have videotape of the accident. Rarely is it produced presuit, even when doing so might head off a lawsuit. Proof that tried and true policies aren’t always the best. Even during suit, defendants resist turning over the tape. In the hope of catching Plaintiffs giving testimony inconsistent with the events captured on tape, even if the inconsistencies are based on a lack of clear memory or a lack of knowledge, rather than untruthfulness, they want to question plaintiffs before producing the accident footage.
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scales of justice.jpgExpert testimony plays a major role in almost every civil and criminal legal case. In Florida state courts expert testimony is governed by sections 90.702-90.706, Florida Statutes. The goal of the statutes is to insure fairness and impartiality in the trial of cases. The standard for when expert testimony is allowed is set forth in

pregnant.jpgFederal law, Title VII of the Civil Rights Act of 1964 (Title VII) — see 42 U.S.C. Section 2000e et seq.; 42 U.S.C. Section 2000e-2 — expressly forbids sex discrimination on the basis of pregnancy. Florida’s discrimination statute, the Florida Civil Rights Act of 1992, does not. See Fla. Stat. Section 760.10.

While Florida’s statute does not expressly prohibit discrimination on the basis of pregnancy, one Florida appellate court, the Fourth District Court of Appeals has decided that a cause of action does exist under Section 760.10 for discrimination in employment based on pregnancy. See Carsillo v. City of Lake Worth, 995 So.2d 1118 (Fla. 4th DCA 2008).

Florida has five District Courts of Appeals. While the Fourth has decided that a cause of action does exist under 760.10, the First, in

law books.jpgIndividuals in Florida under 18 years of age, considered minors, do not have the legal capacity to settle personal injury claims or control the settlement proceeds. Minors are typically represented in their cases by one or both parents, who, by operation of law, are their legal guardians. In the absence of a parent or where the suitability of a parent is in question, a court can appoint someone else. In some instances, another person, like a grandparent, has already been appointed legal guardian by a court. The legal guardian chooses the lawyer who will handle the personal injury case.

Whether and to what extent further court involvement is required, depends on for how much money the case is settled. In some instances the legal guardian can settle the case without court intervention, while, in others, the court becomes deeply involved. Court involvement adds delay and costs. What follows is a chart setting forth the requirements:

Court Approval of Settlement Required:

  • Gross Settlement is $15,000 or less – No, unless a lawsuit has been filed, then yes. Sections 744.301(2) & 744.387(3)(a) Florida Statutes.

    Court approval is obtained by filing a Petition for Approval of Minor’s Settlement with the Court. The Petition must contain details of the case regarding the issues of liability and damages, the amount of the settlement, and the amount of attorneys’ fees and costs. In many instances, the Court will approve the settlement without a hearing.

  • Gross Settlement is greater than $15,000, but less than $50,000 – Yes. Section 744.387(3)(a).
  • Gross Settlement in excess of $50,000 – Yes. Section 744.387.

Need Legal Guardianship/Guardian of the Property Appointed:

  • Gross Settlement is $15,000 or less – No.
  • Gross Settlement is greater than $15,000, but less than $50,000 – Yes, but only if the Net settlement (after gross settlement is reduced by attorney’s fees and costs) exceeds $15,000. Section 744.387(2).
  • Gross Settlement in excess of $50,000 – Yes, but only if the Net settlement exceeds $15,000. Section 744.387(2).

The guardian of the property, usually the legal guardian, is responsible for signing releases and collecting the net settlement proceeds. However, the court retains sole jurisdiction to determine the allocation and use of the minor’s money, including as to how it should be invested for safekeeping until the minor reaches the age of majority. Until majority, the legal guardian needs court approval to touch the minor’s money. The Court is supposed to consider what is in the best interest of the minor when determining if or how the proceeds can be used.
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maze.jpgMedical bills are a strong measure of injuries and future expenses. However, due to insurance and governmental (e.g., Medicare) discounts, bills are rarely paid in full. Where the medical provider is prohibited, by contract or law, from balance billing, Plaintiffs and Defendants contest which medical expenses, the full charges or the reduced payments, may be presented to the jury.

Plaintiffs argue that total charges give a full picture of their bodily injuries and future medical expenses. Defendants endeavor to limit admissibility to the discounted amounts. The outcome depends on who pays the bills.

Where the discounts are contractual write-downs from private insurance, the trial court should allow evidence of the total charges. In other words, Plaintiff may “board” all billed charges.

If a jury, in the face of discounted medical expenses, awards the Plaintiff the full medical expenses, doesn’t the Plaintiff derive a windfall? No. In Goble v. Frohman, 901 So.2d 830 (Fla. 2005), the Florida Supreme Court decided that such verdicts are to be reduced post-trial by the contractual discounts between the providers and private insurance company. Here is an example of how it works: if the discounted payment is $35,000 on total charges of $100,000, and the jury awards $ 100,000 for incurred medical expenses, the verdict will be reduced post-trial by $ 65,000 for a final judgment of $ 35,000.

This is fair. The jury, which does not hear about the discounted payment, is allowed to render its verdict based on relevant, probative evidence, while the judge, post-trial, adjusts the verdict so that the Defendant pays no more than was received by the medical providers.

This raises another question. If insurance has paid and the patient therefor owes the provider nothing, what is fair about a final judgment which awards the Plaintiff the amount paid by the insurance company? Simple. The Plaintiff must repay the money to the insurance company.

In essence, then, the most important aspect of boarding full medicals is for the jury to award the correct amount for pain and suffering damages and future medical expenses.
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