Category Archives: Uncategorized

Possible Changes to Florida Damages Statute: Florida Statute 768.042 in Personal Injury Cases

Jurys often time struggle with calculating future medical expenses to award or not to award during jury deliberations. Florida law restricts recovery of future medical expenses to those expenses “reasonably certain” to be incurred. [1] At trial, a jury must be offered evidence which reasonably supports that future medical services are reasonably certain to occur. Awarding damages for future medical expenses cannot be grounded on the mere possibility that certain treatment might be obtained in the future. [2]

Further, a jury must be provided evidence that is reasonably certain to allow a jury to determine the amount of those expenses. In proving special [past] medical damages for personal injuries, proof should be offered (1) that the medical services were rendered, (2) what the reasonable charges are therefor, (3) that the services for which they were rendered were necessary, and (4) that they were related to the trauma suffered in the accident. Florida law restricts recovery of future medical expenses to those expenses “reasonably certain” to be incurred. [3] At trial, a jury must be offered evidence which reasonably supports that future medical services are reasonably certain to occur. Awarding damages for future medical expenses cannot be grounded on the mere possibility that certain treatment might be obtained in the future. [4]

Florida Standard Jury Instruction 501.2(b) provides the basis of how a jury is to award damages for medical expenses. Specifically, Florida Standard Jury Instruction 501.2(b) states:

b. Medical expenses:

Care and treatment of claimant:

The reasonable [value] [or] [expense] of [hospitalization and] medical [in nursing] care and treatment necessarily or reasonably obtained by (claimant) in the past [or to be so obtained in the future].

Recently, House Bill 9/Senate Bill 1668 was offered to require certain medical expenses in personal injury claims be based on certain usual & customary amounts received. Should this bill become law, a jury will be allowed to rely upon usual and customary charges as evidence to be utilized as a way to calculate past, present, or future medical expenses. Currently, Florida Statute 768.042 states:

768.042 Damages-

(1) In any action brought in the Circuit Court to recover damages for personal injury or wrongful death, the amount of general damages shall not be stated in the complaint, but the amount of special damages, if any, may be specifically pleaded and the requisite jurisdictional amount established for filing in any court of competent jurisdiction.

However, should House Bill 9/Senate Bill 1668 become law, the following will be added as subsection 2 to Florida Statute 768.042:

(2) In any claim for damages related to personal injury to the claimant, evidence regarding the past, present, or future medical expenses must be based on the usual and customary charges of the community where the medical expenses are or are reasonably probable to be, incurred. With respect to past and present medical expenses, if the claimant is entitled to be reimbursed to any public or private health insurance or governmental health coverage, the amounts paid or payable under the insurance or governmental health coverage shall be presumed to be the usual and customary medical charges, unless the claimant shows that such amounts are inadequate under the circumstances. With respect to damages for future medical expenses, evidence of the availability of private or public health insurance coverage may be considered along with other relevant evidence. Usual and customary charges may not include increased or additional charges based on the outcome of the litigation.

As outlined in the January 28, 2020, Bill Analysis and Fiscal Impact Statement concerning Senate Bill 1668, this bill would require that in any claim for damages for personal injury to a claimant, evidence of past, present, or future medical expenses would have to be based on the usual and customary charges in the community where the medical expenses were incurred.

Currently, jury’s rely upon evidence of past expenses and testimony from experts as to reasonably certain procedures which are alleged needed as evidence of what future medical expenses it should award. This proposed new methodology of calculating future medical expenses is consistent with the current Florida methodology for calculating PIP reimbursement under Florida No-Fault Law, which also requires a determination of costs based on usual and customary charges in the community. This bill would prevent utilization of evidence of cost which had been inflated in anticipation of the jury award that may be larger than the amount insurers are typically willing to pay and larger than amounts healthcare providers typically accept. As a result, this will decrease the opportunity for plaintiffs to present evidence of inflated costs through the use of a letter of protection.

[1]Loftin v. Wilson, 67 So. 2d 185,188 (Fla 1953)

[2] White v. Westlund, 624 So. 2d 185, 188 (Fla. 4th DCA 1993)

[3] Loftin v. Wilson, 67 So. 2d 185,188 (Fla 1953)

[4] White v. Westlund, 624 So. 2d 185, 188 (Fla. 4th DCA 1993). Crowe v. Overland Hauling, Inc., 245 So. 2d 654, 656 (Fla. 4th DCA 1971) (quoting Ratay v. Yu Chen Liu, 260 A. 2d 484, 486 (Pa. Superior, 1969).

Filed under Legislation, Personal Injury Protection (PIP), Uncategorized

Tampa Bay Roofing Insurance Scammers Busted in Connecticut

Carlton DeWayne Dunko and Frank Martin Pureber, once known for using their former company NBRC Construction in a roofing insurance scam that cheated nearly 100 Tampa Bay residents out of at least $632,000 have taken their talents to Connecticut.

After serving two years in a Florida prison and being placed on probation, Dunko and Pureber fled to Connecticut to start a similar operation, CTST Construction. Dunko was leading a sales meeting in Milford, CT when Florida fraud agents busted him. They have been found guilty of larceny and sentenced to a year in a Connecticut prison.

When Dunko and Pureber finish their Connecticut prison time, they will face trial for the alleged fraud they committed in Missouri with another roofing company, American Shingle and Siding.

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Vero Beach Acupuncturist Charged with Insurance Fraud and Racketeering

Jill Jaynes of Absolute Integrated Medicine in Vero Beach has been arrested and charged with insurance fraud totaling nearly $1.5 million, racketeering and more. If Jaynes is convicted, she could face up to 135 years in prison and millions of dollars in fines.

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Former NFL Player & Coach arrested for Insurance Fraud

Marlon McCree, former Jacksonville Jaguar football player and assistant coach, has been arrested for an insurance fraud scheme totaling nearly $78,000. McCree allegedly submitted fraudulent invoices from a dental office he’d never been a patient of to his Health Reimbursement Account (HRA) with intentions of defrauding the fund. He could be facing a prison sentence up 30 years and a hefty fine if found guilty.

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Owner of Medical Billing Company Pleads Guilty to Healthcare Fraud Scheme

According to the report, Billings USA received or created fabricated bills for its clinic customers. The clinics would then bill insurance companies for allowable amounts and create records to back up the charges.  Billings USA collected a 6% fee on the reimbursement from insurers. Palma’s company filed $5.7 million in fraudulent claims to Blue Cross Blue Shield with one clinic and then an additional $5.9 million in fraudulent claims to Blue Cross and Cigna with another clinic.

Mauricio Palma, the owner of medical billing office Billing USA in Miami, pleaded guilty to conspiracy to commit healthcare fraud and was sentenced to eight years in prison. Palma faces $2.1 million in restitution lost $1.8 million in forfeiture.

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Roig Lawyers Orlando Managing Partner to Present at DRI Marijuana Law Seminar

If you’ve never attended a DRI seminar, you don’t know what you’re missing in terms of networking and education!

Roig Lawyers’ Orlando Managing Partner, Scharome Wolfe, will present “How High? Insurance and MedicalMarijuana” at the 3rd Annual DRI Marijuana Law Seminar in Chicago from June 26-27. It’s a fascinating area of rapidly-changing law. We encourage you to attend!

Click here for more information.

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Two Miami Medical Clinics Raided for Staged Accidents & Insurance Fraud

Florida’s Department of Investigative and Forensic Services Bureau of Insurance Fraud and the Miami Police Department raided two South Florida medical clinics accused of paying for patients and fraudulent billing. Both clinics have been under investigation since early 2017 for recruiting people for staged accidents and billing insurance companies for thousands of dollars in treatments that they were not providing.

According to Captain Emissael Díaz of Florida’s Bureau of Insurance Fraud “Just in South Florida alone, most of your rates are going to go up 20 to 25 percent just because of the insurance fraud.” The captain stated that schemes of this kind are the reason insurance rates are going in South Florida.

The suspects taken into custody are facing several charges, including patient brokering, insurance fraud and grand theft.

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Former Dade City Police Officer and Two Others Charged in Insurance Fraud Scheme

According to the Florida Department of Law Enforcement, former Dade City police officer Jonathan Lance Hobby and two others, Bruce Dewayne Wilson Jr. and Carl “Chuck” Roach Jr. were arrested for insurance fraud among other charges.

Hobby, Wilson and Roach were charged with combinations of conspiracy to commit insurance fraud, filing a false police report, conspiracy to deal in stolen property and operating a chop shop. According to detectives, Hobby filed a police report and auto theft claim in May 2017 claiming his 2015 Dodge Ram 1500 truck was stolen from Rancho Bonito in Lakeland. The insurance company paid a claim to Hobby in the amount of $24,712.72.

Hobby’s truck was located at Wilson’s business, After Hours Diesel Service. Investigators say Wilson and Hobby orchestrated a scheme to falsely report the truck as stolen and sell most of its parts, which Roach knew about and actually participated in dismantling the truck.

All three suspects were arrested and booked into the Pasco County Jail.

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Palm Beach Post Receives National Recognition for Insurance Fraud Coverage

Washington-based policy and research group, Coalition Against Insurance Fraud, has awarded its inaugural journalism award for fraud reporting to The Palm Beach Post for its work on fraud in the sober-home industry. The award honored Post coverage dating back to 2015 when Post investigators Christine Stapleton and Pat Beall first wrote about how sober-home operators were defrauding insurers of millions of dollars for urine drug tests.

Sober homes were requiring residents to be tested every day, creating multimillion-dollar business empires. Palm Beach County treatment centers and affiliated labs were charging as much as $2,000 for urine tests that can be purchased for $25 at a drug store.

In 2016, a team of Post reporters and editors, including Stapleton, Beall, Lawrence Mower, Joe Capozzi, John Pacenti, Barbara Marshall and Mike Stuck produced “Heroin: Killer of a Generation,” a 12-page special section of stories about 216 men, women and teenagers who died of a heroin-related overdoses in Palm Beach County in 2015. One in 10 had died in a sober home.

The Post’s reporting played a role in the prosecution of sober-home operators Kenneth Chatman and Eric Snyder as well as the successful push to tighten state laws which have resulted in more than 40 people on charges related to brokering patients.

Congratulations to the Palm Beach Post on this national recognition for their work in fighting insurance fraud.

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Florida Man Arrested for False Insurance Claim

Insurance Journal has reported that a Florida man, Claude Milhomme, was arrested for attempting to file a false insurance claim for his vehicle. According to the Department of Financial Services’ Disaster Fraud Action Strike Team (DFAST), Milhomme filed a claim in September stating water damage to his vehicle caused by Hurricane Irma in the amount of $225 for a diagnosis, after hours fee and storage fee.

DFAST received a suspected fraud tip about one month later. After an inspection by state investigators, it was revealed that Milhomme’s vehicle was mechanically inoperable prior to Hurricane Irma’s landfall in September of 2017.

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