Nation’s Largest Auto Insurer Sues South Florida Attorney and Two Local Hospitals

Geico claims Boca Raton lawyer Bobbie Celler of Emergency Recovery Inc. and Tenet Healthcare hospitals Delray Medical Center and St. Mary’s Medical Center schemed to bill the insurer for illegitimate claims. According to Geico, Celler, Emergency Recovery and the hospitals intentionally filed large volumes of misleading and confusing insurance claims in order to receive more payouts.

Click here to read the article. (Subscription required.)

Filed under Fraud

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)

Tampa Police Detective Under Fire for Alleged Insurance Fraud Scheme

Sergeant Shane Gadoury of the Tampa Police Department was arrested for allegedly insuring his boat after it had already capsized. Gadoury is charged with filing a false and fraudulent insurance claim for knowingly insuring his capsized boat and submitting a claim. The detective has been placed on administrative leave and faces an internal investigation by the police department as well.

Click here to read the article.

Filed under Fraud

Tallahassee Doctor Accused of Billing Insurers for Phony Medical Procedures

Dr. Moses D. Degraft-Johnson of the Heart and Vascular Institute of Northern Florida in Tallahassee is accused of taking $26 million from health insurance agencies for phony medical procedures. According to federal prosecutors, Dr. Degraft-Johnson allegedly went to hospitals, scheduled patients for unnecessary visits, and billed for the services that never occurred. In some cases, the doctor was traveling when he claims to have done procedures in his office.

Click here to read the article.

Filed under Fraud, Healthcare

FL Insurance Industry Pushes for Lawsuit Abuse Reform in 2020 Legislative Session

Florida’s insurance industry and consumer advocates are pushing lawmakers to consider reforms that would curb lawsuit abuses that clog the state’s legal system and hurt insurers’ bottom lines. During the last legislative session, lawmakers for passed AOB reform legislation that has led to lower rates for Citizens Property Insurance Corporation policyholders. Governor Ron DeSantis urged Florida lawmakers to target other lawsuit abuses.

Click here to read the article.

Filed under Legislation

Insurance Bills to Watch for the 2020 Legislative Session in Florida

Several key insurance-related bills were introduced in this year’s Legislative Session, including reform for auto glass (windshield), assignment of benefits (AOB) abuse, reforms to the state’s legal system, and changes to the Florida Hurricane Catastrophe Fund.

Here are a few more bills to keep an eye on:

  • CS/SB 292: Insurance Claims Data
  • SB 898/HB 529: Insurance Guaranty Associations
  • HB 329/SB 540: Insurance Guaranty Associations
  • HB 359: Insurance (General)
  • SB 378: Motor Vehicle Insurance (Personal Injury Protection)
  • HB 771: Motor Vehicle Insurance (Personal Injury Protection)
  • HB 895: Insurance
  • SB 904: Sinkhole and Catastrophic Ground Cover Collapse Insurance
  • HB 963/SB 1670: Consumer Data Privacy
  • HB 1137/SB 1492: Consumer Protection
  • SB 1204: Citizens Property Insurance Corporation
  • Senate Joint Resolution 1460: Commissioner of Insurance
  • SB 1494: Insurance Coverage for Condominium Unit Owners
  • HB359/SB 1334: Financial Services

Click here to read the article.

Filed under Legislation

Nelson Bellido Elected to Board of Directors of NAMWOLF

Nelson - NAMWOLF

Roig Lawyers is proud to announce that Nelson C. Bellido, Managing Partner of its Miami office, has been elected to the Board of Directors of the National Association of Minority and Women Owned Law Firms (NAMWOLF).

Nelson is also the Co-Chair of the Trial Practice Area Committee. He has served on the Financial Services Practice Area Committee and Development Committee in the past.

About NAMWOLF
The National Association of Minority & Women Owned Law Firms (NAMWOLF), founded in 2001, is a nonprofit trade association comprised of minority and women owned law firms and other interested parties throughout the United States.

Filed under Firm News

Farmers Insurance Now Covering Rideshare Drivers in 14 States

Farmers Insurance now provides commercial auto insurance to its Uber drivers in the District of Columbia, Delaware, Hawaii, Indiana, Iowa, Kansas, Maryland, Missouri, Nebraska, North Dakota, South Dakota, Virginia, and West Virginia. Ridesharing drivers in Pennsylvania and Georgia were already covered.

Farmers is the second insurer to announce the expansion of its relationship with Uber. Liberty Mutual started covering Uber drivers and passengers on December 31, 2019.

Click here to read the article.

Filed under Personal Injury Protection (PIP), Technology

Weston Doctor Sentenced for Conspiring to Illegally Distribute Oxycodone

Dr. Rodolfo Gonzalez Garcia was sentenced to eight years in prison for conspiring to dispense oxycodone, a charge to which he had previously pled guilty. Dr. Gonzalez Garcia and his co-defendants, including his wife Arlene Gonzalez, admitted to using a Hialeah medical office to provide prescriptions for the controlled substance, even though he did not conduct meaningful examinations to prescribe oxycodone appropriately. Dr. Gonzalez Garcia referred to himself as “El Chapo of Oxycodone.”

Co-defendants Arlene Gonzalez and Annie Suarez-Gonzalez pled guilty to conspiracy to pay and receive health care kickbacks. They were sentenced to 4 months in prison and one year of probation each. Co-defendant Fidel Marrero-Castellanos pled guilty to conspiracy to pay and receive health care kickbacks and conspiracy to distribute controlled substances. He was sentenced to 13 months in prison. The co-defendants were ordered to pay a total of $26,306 in restitution.

Click here to read the article.

Filed under Fraud, Healthcare

Roig Lawyers Complimentary Webinar – Insurance Bad Faith 101

We are pleased to announce our first CE Webinar for 2020!

Bad Faith 101 SM

Tampa attorneys Amanda Kidd and Stephanie McQueen-Zehm will present “Insurance Bad Faith 101” on Wednesday, February 12th, at 1:00 pm.  This course will provide an introduction to insurance bad faith claims and more.

This CE is approved for 1 credit for Florida adjusters.

REGISTER NOW!

Filed under Firm News