Tag Archives: insurance defense

Roig Lawyers Partner Keith Hernandez Publishes Article in CLM Magazine on Autonomous Vehicle Technologies and its Impact on Insurance

ROIG Lawyers Deerfield Partner Keith Hernandez has published an article in CLM Magazine entitled “Keep Your Eyes Off the Road.” In the article, Keith discusses the emergence of autonomous vehicle technologies and its impact on traditional insurance.

Click here to read the entire article.

CLM Magazine is the premier source for content that addresses trends, topics of interest, and industry challenges for those in the claims and litigation management industry.

Filed under Autonomous Vehicles

Another DCA Sides With Insurers on Fee Schedule Language

The Third District Court of Appeal recently ruled in favor of Allstate in a dispute over personal injury protection (PIP) reimbursements for medical services following an auto accident.

The Third DCA now agrees with two other appellate courts: the First in Tallahassee and the Second in Lakeland. However, as a result of a contrary ruling from the Fourth DCA in West Palm Beach, the dispute is set for oral argument before the Florida Supreme Court in September.

The dispute focuses on language in auto insurance policies that spells out if the insurer properly elected to pay medical bills based upon the Medicare fee schedules enumerated in the PIP statute. Florida courts have said the insurance policies must unambiguously elect the use of the statutory fee schedules in limiting reimbursement for PIP claims.

The Third DCA case came from five consolidated appeals. All five concerned a medical provider, as assignee of a person insured by Allstate, suing Allstate for payment of medical bills under the PIP statute. In each case the policy had identical policy language stating: “Any amounts payable under this coverage shall be subject to any and all limitations, authorized by section 627.736 … including but not limited to, all fee schedules.”

Third DCA Judge Thomas Logue, who wrote the opinion, agreed with the opinions in the other two appellate courts finding for Allstate and noted that he agreed with Judge Melanie May’s dissent in the Fourth DCA ruling. Logue disagreed with medical providers, who insisted the words “subject to” were ambiguous.

“A decision that the term ‘subject to’ is ambiguous would mean that the Judicial Code and many provisions of Florida Statutes were legally meaningless and in need of redrafting,” Logue wrote. “We decline to adopt such a counter-intuitive interpretation of a common and well-understood legal expression. The use of the phrase ‘subject to’ in the policy places the insured on notice of the limitations elected by Allstate.”

Click here for full story.

Filed under Personal Injury Protection (PIP)

Federal Appeals Court Reinstates PIP Claims Suit Against HCA

A federal appeals court has revived a lawsuit against HCA Holdings charging that HCA and three of its Florida hospitals violated Florida’s Deceptive and Unfair Practices Act.

The U.S. Court of Appeals for the Eleventh Circuit’s April 26 ruling overturned a February 2015 federal court decision in the Middle District of Florida that dismissed the class action. That suit accused three HCA hospitals—Memorial Hospital Jacksonville, North Florida Regional Medical Center of Gainesville and JFK Medical Center in Atlantis—of charging unreasonably high fees for emergency radiological services covered by Florida’s Personal Injury Protection (PIP) insurance.

The four Florida residents who filed the complaint received emergency radiological services after motor vehicle accidents. They said they were billed more than other patients who received the same services. “In fact, these fees are up to 65 times higher than the usual and customary fees charged to non-PIP patients for similar radiological services,” according to the complaint.

In one example, the court’s opinion said the hospitals charged between $5,900 and $6,965 for spinal CT scans on the plaintiffs. The ruling said Medicare rates for spinal CT scans are between $213 and $220, and rates for uninsured patients go up to $3,454.

The complaint said the exorbitant rates caused the residents’ $10,000 PIP coverage to be exhausted prematurely. The complaint also accuses HCA of breach of contract as the four Floridians entered into a Condition of Admission contract that required their accounts to be paid at the hospitals’ price lists. All four plaintiffs said they weren’t provided such a price list at the time of their treatments.

Only one of the four plaintiffs was allowed to go forward with a suit against a single hospital in the 2015 ruling by U.S. District Judge James Moody in the Middle District of Florida. Moody’s ruling was overturned by a unanimous Eleventh Circuit panel consisting of Judges Beverly B. Martin, Julie E. Carnes and Senior Judge R. Lanier Anderson III. The suit was originally filed July 2014 in the Southern District of Florida.

 

Filed under Uncategorized

Roig Lawyers Attorneys Present on Regulatory Compliance

Roig Lawyers, a minority-owned, multi-practice litigation law firm dedicated to serving clients across six offices throughout Florida, is pleased to announce that Jessica Z. Martin, Partner (Deerfield Beach), and Dennis LaRosa, Healthcare Policy Advisor (Tallahassee), will present a program on August 11, 2015 to a national insurance carrier’s SIU Team in Orlando covering regulatory compliance as it relates to insurance defense.

“At Roig Lawyers we believe that continually updating and educating our lawyers is one of the most important aspects of a comprehensive PIP defense.  It is even more important that SIU’s stay on the cutting edge of new and innovative issues so that cases that come to defense counsel utilize the most current thought in the industry,” said Martin.

The presentation will cover specific topics such as medical director responsibilities and the implications of clinic licensing, and exemptions under current and newly enacted legislation together with innovative ideas in defending insurance law suits.  In recent years, regulatory compliance has become a significant tool for auto insurers in fighting personal injury protection fraud and abuse. It will also cover recent case law regarding Section 627.736(6)(b) requests for pre-suit discovery, and other investigative tools to obtain information regarding whether a clinic is operating lawfully.

Martin has been practicing since 2006 defending Personal Injury Protection (PIP)/No-Fault, bodily injury and uninsured/underinsured litigation and aiding insurance carriers with fraud (SIU) investigations, through Examinations Under Oath (EUO), Section 627.736(6)(c) Petitions/Motions for Discovery, and leading affirmative litigation against fraudulent medical providers. Martin is a skilled trial attorney and is also experienced in the use of alternative dispute resolution techniques, including mediation and arbitration, as a means of litigation avoidance. Martin joined the firm in 2002, became a licensed attorney in 2006, and the first female partner in the firm in 2009.

LaRosa has over 40 years experience in state licensing, including 10 years as a supervisor at the Agency for Health Care Administration implementing and overseeing health care clinic licensure and exemptions. LaRosa is a sought after speaker in discussing the relationship between state licensing and automobile insurance having made presentations to the Florida Bar, National Insurance Crime Bureau, the International Association of Special Investigative Units, attorneys and judges and has been a witness in numerous federal criminal and civil cases dealing with this subject.  While a practicing attorney, he prosecuted scores of administrative law cases, appeals, and represented the State of Florida in both state and federal courts on diverse issues ranging from taxation, state licensing, and environmental law to admiralty.  He has been a healthcare policy advisor with Roig Lawyers for the past two years.

About Roig Lawyers

Roig Lawyers is a multi-practice Florida Litigation firm with an unfaltering growing presence in the legal market celebrating 15 years of service, with more than 100 attorneys in 6 offices in Deerfield Beach, Miami, Orlando, West Palm Beach, Tampa, and Tallahassee. Roig Lawyers offers unparalleled legal representation in the areas of commercial litigation, construction, community association law, corporate law, real estate, banking and finance, immigration, labor and employment, and all phases of insurance defense litigation.

For more information about Roig Lawyers, visit www.roiglawyers.com.

Filed under Healthcare