Articles Posted in Litigation

Florida premises liability law is the body of law which makes the person who is in possession of land or premises responsible for certain injuries suffered by persons who are present on the premises. It is a negligence-based system, meaning that responsibility is apportioned in accordance with fault. This is known as the concept of comparative fault. See Florida Statute 768.81, entitled Comparative fault.

Under this system, the jury is charged with determing fault among the plaintiff, the defendant, and others who may not even be parties to the lawsuit. The jury must also place a monetary value on the damage sustained by the plaintiff. These two findings make up what is known as the [jury’s] verdict.

A jury verdict is not the same thing as a final judgment. Only judges render final judgments.

In rendering final judgments, judges consider a variety of factors. The jury’s findings regarding fault and damages are two of the most important factors.

A simple example, without consideration of any factors other than the jury verdict, will illustrate how the system works: Assume that Mr. Jones, a visitor to a friend’s condominium, trips on a large crack in a poorly lit underground parking lot while walking into the building. He falls hard to the ground, landing on his chin and head, sustaining a severe laceration and a concussion. Fire Rescue is summoned and he is transported to the hospital. The building and lot are controlled by a condominium association that has hired a management company to maintain the premises. It is learned that the large crack has existed for years and caused many other accidents. Unable to settle his case out of court, Mr. Jones sues the condo association and the management company for negligence. The jury returns a verdict in the amount of $500,000, but apportions fault at 75% (condo. association/management company)/25% (Mr. Jones). Based on the concept of comparative fault, the final judgment for Mr. Jones will be $375,000, or 75% of the total damages found by the jury.

Until 1973, Florida applied the law of contributory fault in all negligence cases. Under this concept, the plaintiff would be barred from any recovery if it was determined that he or she was at fault in any way, even only 1%. In our example, this would mean that Mr. Jones, although only 25% at fault, would receive nothing for his injuries.
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avis.jpgOur law firm (along with co-counsel firm Domnick & Shevin, LLP) is currently involved in litigation against the Enterprise car rental company.

In 2008, Enterprise rented a vehicle, in Miami, to a person whose Florida driver’s license was under suspension for failing to appear in court on a number of motor vehicle moving violations. After his credit card was rejected, forcing him to leave the rental agency to obtain cash, he returned with the cash and presented a facially valid (although unlawfully obtained) Texas driver’s license to the rental agent. Enterprise rented him the vehicle.

A few days later, the renter caused a high-speed rollover accident in the Enterprise vehicle on I-75 near Gainesville, Florida. Our client, a passenger in the vehicle, was airlifted to Shands Hospital with life-threatening injuries. She remains severely disabled, in great pain, and unable to work.

A quick and inexpensive (less than $1.00) Internet database search, based on name and birth date, performed by the Enterprise agent, would have disclosed the customer’s license suspension and traffic record. However, since the agent was not instructed or authorized by Enterprise to perform such a search, one was not done.

We sued Enterprise on the theory that it negligently entrusted its vehicle to the at-fault driver. Enterprise claims that it did nothing wrong.

What is Enterprise’s primary defense? Florida Statute 322.38(2).

322.38(2) provides as follows – No person shall rent a motor vehicle to another until he or she has inspected the driver’s license of the person to whom the vehicle is to be rented, and compared and verified the signature thereon with the signature of such person written in his or her presence.

Enterprise argues that 322.38(2) is a safe harbor provision providing it with absolute immunity from fault, that despite the ease and nominal cost of determining the prospective customer’s license status and driving record, its only responsibility to the public was to inspect the Texas driver’s license and compare and verify the signature thereon.

The Plaintiff’s (our client) position is that 322.38(2) is not a safe harbor provision extending absolute immunity to Enterprise or any other rental agency. Rather, it is a minimum standard established by the Florida Legislature to create some level of safety for those who travel on the streets and highways of the state, but it is not the only standard that can be considered by judges and juries to determine reasonable conduct under every circumstance.

It is simply not the Legislature’s role to instruct companies how to conduct every aspect of their business. Those business decisions are left to the judgment of the companies, with the understanding, however, that poor decisions or worse can result in serious legal consequences.

Such is the scenario in our case. Enterprise did nothing more than the bare minimum. A judge and jury will now decide if this conduct was reasonable under the circumstances. We do not believe that it was, thus our claim for negligent entrustment. Clearly, Enterprise could have done more.
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Fault (or negligence) is always an issue in Florida motor vehicle accident personal injury cases. For an individual to be successful in claiming damages against another party, the claimant has the burden of proving that the other party caused the accident.

In some cases, proving fault is an easy matter. In others, the issue will be hotly contested. In those cases, the plaintiff – the party seeking damages – needs evidence to prove her or his case. One place to look (for evidence) is in the traffic court records.

In most Florida motor vehicle accidents, an investigating law enforcement officer will issue a traffic infraction/ticket to one or more of the involved parties. The ticket can be an expression of the investigating officer’s opinion with regard to fault. For example, a driver may be ticketed for following too closely or for failing to yield the right of way.

Although the traffic infraction itself is not admissable as evidence of guilt in a civil case arising out of the accident, the defendant’s response to the traffic charge may be.

With a few exceptions, Florida Statute Section 318.14(4)(a) allows any person charged with a noncriminal traffic infraction to pay the civil penalty by mail or in person without the effective admission of guilt being used as evidence in any other proceedings. “[O]ther proceedings” includes a civil action arising out of a traffic accident.

For purposes of motor vehicle accidents, the most important exceptions to 318.14(4)(a) are contained in Florida Statute 318.19, which contains a list of traffic infractions requiring a mandatory hearing. Those infractions are:

  1. Any infraction which results in a crash that causes the death of another;
  2. Any infraction which results in a crash that causes “serious bodily injury” of another as defined in s. 316.1933(1);
  3. Any infraction of s. 316.172(1)(b);
  4. Any infraction of s. 316.520(1) or (2); or
  5. Any infraction of s. 316.183(2), s. 316.187, or s. 316.189 of exceeding the speed limit by 30 m.p.h. or more.

Unlike the allowance contained in 318.14, a guilty plea in one of the 318.19 exceptions can be used as evidence in any other proceedings, including a civil case for damages. (The record of the plea is admitted, not as establishing the fact [of fault], but as a deliberate declaration or admission of the party himself that the fact is true. Boshnack v. World Wide Rent-A-Car, Inc., 195 So.2d 216, 218 (Fla., 1967).)
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In our firm’s continuing effort to inform the public of important legal issues, from time to time we will reproduce in our blog letters, articles, and papers written by other people. Today’s entry, published in the March, 2011 edition of The Florida Bar Journal, was written by Rutledge R. Liles, one of the most esteemed and accomplished lawyers in Florida, regarding, perhaps, the most important legal issue being debated in Florida today. Mr. Liles knows of what he speaks.

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Florida Insurance Bad Faith Law: Protecting Businesses and You
by Rutledge R. Liles

This article is offered as a response to a troubling presentation on insurance bad faith by authors Young and Clark that appeared in the February Florida Bar Journal (“The Good Faith, Bad Faith, and Ugly Set-up of Insurance Claims Settlement”). (Footnote 1.) It is intended to address various misunderstandings that may have been created by that earlier discussion, and to provide a more balanced discussion of this most topical subject. To accomplish this goal, this article explains what insurance bad faith is, how it protects insureds, and why the statutory amendment suggested in that article is unfair, unworkable, and unwise.

Eight years ago, my article, “Insurance Bad Faith: The Set Up Myth” was published in The Florida Bar Journal. (Footnote 2.) The premise of the article was that “generally speaking…insurance companies set themselves up for the fall in a fashion that could easily be avoided or remedied.” That statement remains as true today as it was eight years ago. Florida law remains consistently and appropriately focused upon the conduct of insurers when determining whether they have acted reasonably in the discharge of the fiduciary duty they owe their policy holders. If insurers acted reasonably in the discharge of the fiduciary duty they owe their policy holders, we would not be spilling ink over a contrived notion that claimants and insureds can somehow control the conduct of insurers in adjusting losses, thereby “setting up” bad faith claims. This contrivance is advanced as a justification for the passage of legislation to protect the insurance industry from its own failures at the cost of Florida’s insured businesses and individuals.

Initially, it should be noted that the February article never mentions the common law duty of good faith, which the authors’ proposed statutory amendment would largely eliminate. Moreover, the article ignores the well-established principle, recognized by both the courts and the legislature, that insurers owe a fiduciary duty to their insureds. These long-established tenets of insurance law are the cornerstones that ensure that businesses and individuals receive the benefit of the protection for which they bargained and paid in their insurance contract. Otherwise, insurance companies are without accountability and Florida’s businesses, professionals, homeowners, and other insureds are left to pay the cost of careless and improper claims practices by insurers. The article makes absolutely no showing that the remedies crafted by the courts (common law) and by the legislature in F.S. §624.155 (statutory law) require the drastic revisions proposed.

The Florida Supreme Court recognized a common law action for third-party bad faith as early as 1938. (Footnote 3). Its decision to do so grew out of the realization that insurance contracts had come to “occupy a unique institutional role” in modern society, as they became an economic necessity for businesses and individuals. (Footnote 4.) Additionally, as liability policies replaced indemnity policies, the insurer’s power over the insured’s situation became greater, requiring a remedy for when that power was abused.

Under a liability policy, the insured’s role is essentially limited to selecting the type and desired level of coverage and paying the corresponding premium. Insurance coverage, theoretically, offers security and peace of mind against unforeseeable losses. As part of the contract, the insured surrenders to the insurer all control over the negotiations and decisionmaking as to claims. The insured’s role is relegated to the obligation to cooperate with the insurer’s efforts to adjust the loss. The insurer makes all the decisions with regard to claims handling and thereby has the power to settle and foreclose an insured’s exposure to liability, or to refuse to settle and leave the insured exposed to liability in excess of the policy limits. (Footnote 5.) As a result, “the relationship between the parties arising from the bodily injury liability provisions of the policy is fiduciary in nature, much akin to that of attorney and client,” because the insurer owes a duty to refrain from acting solely on the basis of its own interests in the settlement of claims. (Footnote 6.) Accordingly, and because of this relationship, the insurer owes a duty to the insured to “exercise the utmost good faith and reasonable discretion in evaluating the claim” and negotiating for a settlement within the policy limits. (Footnote 7.) When the insurer fails to act in the best interests of the insured in settling a claim, an injured insured is entitled to hold the insurer accountable for its “bad faith.”

Although Florida courts recognized a bad faith cause of action in the context of liability policies, they did not impose the same obligation in the context of first-party insurance contracts, when the injured party was also the insured under the insurance policy. At common law, first-party insurance policies were enforced solely through traditional contract remedies. However, in 1982, the legislature recognized that due to the same disparity in power between the insurer and the insured in first-party contracts, there was a need for a bad faith remedy in that context as well. (Footnote 8.) As a result, the legislature enacted F.S. §624.155, which established, inter alia, a first-party bad faith cause of action. It should be noted, however, that in F.S. §624.155(8), the legislature made it abundantly clear that the statute did not preempt the common law remedy. The standard for bad faith in settlement was the same as the common law standard: “Bad faith on the part of an insurance company is failing to settle a claim when, under all the circumstances, it could and should have done so, had it acted fairly and honestly towards its insured and with due regard for the insured’s interest.” (Footnote 9.)

The measure of whether an insurer has acted in good faith is, necessarily, determined by an assessment of the lengths to which the carrier went in an effort to provide the insured with the protection afforded by the insurance policy. It is for this reason that the focus in a bad faith case is upon the conduct of the insurer and not the person making the claims or presenting any opportunity for settlement. If the liability insurer undertakes a prompt investigation of the loss, timely evaluation of the legal liability of the insured, communicates to the insured the material events of the adjustment process, and acts reasonably with regard to opportunities to settle the loss and protect the assets of the insured, then it has no fear from Florida’s bad faith laws.

It is within this framework that common law bad faith actions have been allowed in Florida for over 70 years without substantial change in the governing principles, with statutory bad faith claims being allowed for almost 30 years. The previous Journal article proposes a dramatic and unwarranted change to bad faith law for which no empirical justification is offered, and its anecdotal reliance on cases it cites actually undermines its basic premise. That is, an analysis of the relevant case law demonstrates that the courts have properly and consistently defeated attempts to allow “set-up” bad faith claims which were premised on the two tactics the article identifies: 1) arbitrary and unrealistic time deadlines for acceptance imposed by claimants, and 2) settlement offers containing unreasonable terms that cannot be complied with (and will not be negotiated).

With respect to the arbitrary and unrealistic time deadlines, the authors look for support in DeLaune v. Liberty Mutual Insurance Co., 314 So. 2d 601 (Fla. 4th DCA 1975), where no support is to be found. There, the claimant made a demand for policy limits, but required payment in 10 days. Neither the court nor the jury was impressed by that unreasonable time limit, and the bad faith claim was lost at trial and affirmed on appeal. In affirming, the Fourth District specifically noted that the 10-day time limit was “totally unreasonable under these circumstances,” and that it was a charade designed to “set-up” a bad faith suit. (Footnote 10.) Subsequent cases have expanded on that and even determined that attempts to limit insurers to 30 days to verify a claim and pay limits cannot establish bad faith, as a matter of law, resulting in summary judgments against the claimants on their bad faith claims. (Footnote 11.) Thus, it is clear that the legal system has properly responded to unreasonable time demands to establish bad faith, and clearly determined it to be an ineffective tactic. Thus, established case law again completely undermines the article’s premise that any amendment to Florida’s bad faith law is needed to address a contrived concern, much less the dramatic and unwarranted amendment proposed by the authors.

The second set-up tactic that the authors rely upon involves settlement demands incapable of an insurer’s reasonable acceptance. Examples advanced include demands that contain confusing or ambiguous terms that the claimant’s attorney refuses to clarify or to otherwise cooperate with the insurer’s efforts to negotiate a settlement. Again, existing Florida law completely undermines the authors’ assertion that any amendment in bad faith law is needed to address the ability of an insurer to defend its conduct by showing that it did not have a reasonable opportunity to settle the claims. The authors suggest that insurers are hamstrung by being prevented from even presenting evidence that such offers were not made in good faith.

The article states: “Imposing the duty of good faith during settlement on only the insurer, as some courts appear to have done in light of the narrow language of the bad faith statute, is inconsistent with Florida’s strong public policy encouraging settlement of claims.” However, the authors do not cite a single case for the proposition that any court has suggested that the totality of the circumstances bearing on the ability of the insurer to settle the claims are irrelevant in a failure to settle setting. In fact, the only cases cited in the footnote to that passage relate to public policy encouraging settlement of claims. Therefore, the authors have no support for the contention that any court has precluded an insurer from showing that despite its reasonable efforts, it could not settle the claims. In fact, the courts have consistently applied existing Florida law to allow for consideration of the facts surrounding the settlement negotiations that bear on whether the insurer “could” settle.

In Barry v. Geico General Insurance Co., 938 So. 2d 613 (Fla. 4th DCA 2006), the jury ruled in favor of the insurance company on a third-party bad faith claim. On appeal, the claimant argued, inter alia, that the insurance company was improperly permitted to present evidence as to the claimant’s motives and her attorney’s conduct in declining to settle. That argument was rejected, with the court clearly holding that such evidence was relevant and admissible, even though the focus of an insurance bad faith case is primarily on whether the insurer fulfilled its duty to the insured. (Footnote 12.) The court stated that inquiries into the prior conduct and motives of the claimant were relevant and admissible because the insurer can defend on the ground that there was no realistic possibility of settlement within the policy limits, based on the claimant’s intransigence. The Barry court stated:

The jury could have concluded that the failure of [the claimant’s] attorney to notify GEICO of his representation coupled with her refusal to meet with Stone on the settlement, among other incidents, showed that she did not want to settle with GEICO for the policy limits. Thus, GEICO did not inject irrelevant information into the case. (Footnote 13.)

Additionally, in a published federal decision, it was specifically noted that a claimant’s unwillingness to settle was “not completely ignored under Florida law,” but was a relevant factor when the insurer is attempting to prove the defense that the claimant was actually unwilling to settle for the policy limits. (Footnote 14.)

In accordance with those cases, decisions have consistently addressed the likelihood that intransigence or a failure to cooperate by a claimant in settlement negotiations will fatally undermine a bad faith claim. When a claimant failed to provide medical information to the insurer regarding his injuries, a court has ruled that there was no bad faith, as a matter of law, arising from the insurer’s failure to settle. (Footnote 15.) Additionally, when claimants have failed to respond to insurer’s attempts to settle claims within the policy limits, courts have determined that there was no bad faith claim, as a matter of law. (Footnote 16.)

Thus, the courts have properly, effectively, and firmly rejected attempts to justify bad faith claims based on either arbitrary or unrealistic time deadlines, or in response to settlement offers, with which compliance is impossible, or which were not made in a good faith attempt to reach a resolution of the claim.

The article does not cite a single case in which the tactics of unreasonable deadlines or intransigence in negotiations has resulted in a successful bad faith recovery. Instead, the authors rely on statements contained in the dissenting opinions in Berges v. Infinity Insurance Co., 896 So. 2d 665 (Fla. 2004), but the facts of that case do not support its contention that the decision encourages or allows insureds or claimants to set up bad faith claims.

In Berges, James Taylor’s wife was killed and his daughter seriously injured by a drunk driver. The insurance policy providing coverage to the drunk driver had limits of $10,000 per claimant. Mr. Taylor did not impose unreasonable deadlines in his offer and, in fact, did not even make an offer to settle until more than two months after the accident, when he hand-delivered an offer to settle for the $20,000 policy limits. At that time, the insurer had already conducted an investigation and issued a report concluding that its insured was completely at fault, and confirmed that Mrs. Taylor had died and that the daughter’s medical bills already exceeded $30,000. Although initially there was a coverage issue, six days after Mr. Taylor’s offer, the insurer concluded its coverage investigation and decided to extend coverage.
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Language in documents used to absolve parties from liability for their own negligence is disfavored by the courts. Nevertheless, under certain circumstances, such exculpatory clauses or pre-injury releases/waivers are enforceable in Florida.

Pre-injury releases are used frequently in connection with activities considered risky, such as go-cart and off-road racing, high school football, horseback riding, and cheerleading, but are also used for commonplace activities such as Disney World rides and school outings.

Because of their disfavor with the courts, exculpatory clauses will be strictly construed against the party seeking to avoid liability. Requirements for enforceability include:

  • The language must be clear and unambiguous.
  • The intent to limit liability must be expressed in clear and unequivocal terms.
  • The waiver must clearly state that it releases the party from liability for his own negligence (although this requirement is not strictly followed by Florida’s 5th DCA).

Other factors weighing on enforceability include:

  • Does the release give the plaintiff the option to purchase insurance or pay additional fees to cover loss, injury or damage?
  • Is exculpatory language in different color or typeset than other provisions of the agreement?
  • Is the release signed, dated, and witnessed?

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The newspaper article reproduced below, written in 2003, does an excellent job of illustrating the importance of having strong bad faith insurance laws designed to persuade insurance companies to settle cases for fair value rather force every case to trial.

Florida’s bad faith laws impose a duty on insurance companies to act in the best interests of their insureds (customers). If an insurance company can and should settle a case within its insured’s policy limits, it should. If the insurance company refuses and a final judgment in excess of the limits is then entered against the insured, the company may be forced to pay the full judgment, not just the policy limits.

Whether or not the carrier must pay the full judgment depends on the manner in which it handled the claim. If, based on all available information, the carrier could have and should have settled the case within the policy limits, it may very well be required to pay the full judgment … as it should for needlessly exposing its insured to a significant money judgment.

Without meaningful bad faith laws, insurance companies would never settle cases within policy limits. Knowing that the most they will ever have to pay is what they should pay anyway, i.e., the policy limits, they will force every case to trial. Their purpose in taking every case to trial will be to put plaintiffs’ lawyers on notice that to avoid trial, every case must be settled for less than policy limits, even cases worth much more than policy limits.

Without strong bad faith insurance laws, the only parties that will be exposed to excess judgments will be the insureds, those who purchase the insurance coverage to avoid such a scenario.

Under Governor Rick Scott, the Florida Legislature will attempt to gut Florida’s bad faith laws. From their point of view, insurance company profits are more important than protecting individuals.

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Bad faith in the law

By MARTIN DYCKMAN Published December 21, 2003
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TALLAHASSEE – The malpractice debate last summer was an emotional roller coaster ending in bitter disappointment for Florida physicians whose leaders had convinced them that there would be no relief from high insurance premiums without a flat $250,000 ceiling on pain and suffering awards. That line came straight from the insurance lobby, which actually wanted something else a lot more, and got it.

To the insurers, the more important goal was to erode Florida’s bad-faith law, which they blame for forcing them to settle cases they say they shouldn’t. That premise is partly true; the law is intended to encourage settlements and avoid costly trials. But legislators heard only opinion, not evidence, as to whether there are really too many before agreeing to make the doctors the guinea pigs in a dangerous experiment.

To illustrate what’s at stake, let’s look at the outcome of an important trial at Clearwater earlier this month. It involved an automobile accident, not medical malpractice, but the principles are the same. My colleague William R. Levesque reported the story in the Dec. 5 St. Petersburg Times.

The plaintiff was Xiao-Cao Sha, a 41-year-old violinist who suffered severe shoulder and neck injuries in a collision that the defense conceded to be the fault of the driver who had run a red light and hit the car in which Sha was a passenger. Sha, who had left the Florida Orchestra to seek opportunities in major orchestras, can no longer play without severe pain and can practice only 15 minutes a day. The defense didn’t question that either.

The other driver was unusually well insured – for $1.75-million, says Sha’s lawyer, Tom Carey – and Carey offered to settle for that. He might have settled for even less, I gathered, but not for as little as the defendant’s carrier, Liberty Mutual, was willing to pay.

According to Carey, “they never made it to $200,000.”

So the case went to trial, where Liberty Mutual’s lawyer contended that Sha should be awarded no more than $189,000 because there was no guarantee she could have fulfilled her dreams and might never have earned more than $30,000 a year, her former salary with the Florida Orchestra. She could still have earned that, the lawyer said, by teaching and performing solos.

Imagine for a moment that the victim had been a young doctor about to start practice as a neurosurgeon and an insurance company had proposed that he or she settle for pediatrics or some other specialty that earns much less. Any red-blooded jury would have socked that company at least as hard as Sha’s did.

The jury took less than hour to award her $5-million, which included some $1,375,000 for lost future wages and $3,456,000 for pain and suffering. More than twice, all told, the limits of the policy that the defendant and her husband had paid for and Sha would have accepted.
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In Greenfield v. Daniels (November 24, 2010), the Florida Supreme Court decided that paternity of a child could be determined in the course of a wrongful death proceeding under Chapter 768, Fla. Statutes rather than in a paternity proceeding under Ch. 742, Fla. Stat. The Court’s decision disapproved the conflicting decision of a lower appellate court in Achumba v. Neustein, 793 So.2d 1013 (Fla. 5th DCA 2001).

In Greenfield, the bioligical father of a minor child committed suicide. A wrongful death action was brought by the estate of the decedent against a psychiartist (and a hospital) for allegedly negligently discharging him. A claim was made for the minor as a “survivor” under the statute. However, the doctor challenged the child’s status as a “survivor,” claiming that the child’s status could not be established after the purported father’s death.

The legal question at issue was whether or not paternity could be established in the wrongful death proceeding.
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law books.jpgIn my opinion, the most important Florida workers’ compensation case of all time is Aguilera v. Inservices, Inc., 905 So.2d 84 (Fla., 2005). Aguilera made it clear that workers’ compensation insurance carriers and adjusters are not immune from being sued for the tort of intentional infliction of emotional distress where their conduct in handling a claim is more than simply bad faith or a breach of contract, but where the conduct is intentional and outrageous. What this means is that carriers and adjusters can be sued in circuit court for damages caused by outrageous conduct.

The Aguilera decision reinstated a lawsuit, which had been dismissed by a lower appellate court, the 3rd DCA, brought by an injured worker against the workers’ compensation carrier and claims adjuster. Although a confidential settlement was reached in the case, word on the street is that the case settled for in excess of one million dollars. Given the damage caused by their outrageous conduct, this was a small price to pay.

This Florida Supreme Court decision has gotten the attention of workers’ compensation insurance companies and their claims adjusters. No longer can claims be handled with complete indifference and a lack of regard for the health, safety, and welfare of injured workers without consequence. This is not to say that injured workers get everything they want. This is far from the case. There is still room for legitimate disputes. What the decision does mean is that there is no place in the workers’ compensation system for mean-spirited claims handling.

UNDERLYING FACTS:

  • On April 21, 1999, Aguilera was struck by a forklift and pushed against a pallet. He suffered immediate injuries and was rushed to the emergency room. Testing performed in the ER showed blood in Aguilera’s urine.
  • Subsequently, Aguilera began to complain of kidney and bladder pain.
  • On May 24, after two physicians examined him and concluded that he could not return to work, Aguilera’s attorney requested that he be examined by a board certified urologist.
  • The workers’ compensation insurance carrier denied authorization of the urologist, asserting that Aguilera’s injury was not work related.
  • On June 17, 1999, the insurance carrier was again notified that urological care was now needed on an emergency basis because Aguilera’s urine had begun to smell like feces.
  • On June 21, Aguilera was advised that his workers’ compensation benefits were being terminated as of July 9, 1999, notwithstanding the report of two doctors, including the opinion of the insurance carrier’s own doctor, that he should not return to work.
  • On June 25, 1999, the insurance company intervened and blocked Aguilera’s receipt of medication prescribed by the hospital emergency room doctor for his urinary condition.
  • On June 30, the carrier again denied authorization of emergency medical care for the urinary problems, claims it was not medically necessary.
  • On July 7, 1999, Aguilera’s treating doctor advised the carrier that his need for medical care was urgent and that his condition was deteriorating.
  • On July 9, 1999, the carrier’s own doctor issued prescriptions for various urinary tests.
  • On July 30, 2009, the adjuster intervened and simply unilaterally cancelled some of the medical testing.
  • Testing that was ultimately done revealed that Aguilera had a fistula, a hole in his bladder.
  • On August 6, 1999, Mippy Heath became the new insurance company case manager. She was specifically told by Aguilera’s attorney that she should have no direct contact with Aguilera. She also agreed that no intervention with Aguilera’s care would be attempted.
  • On August 19, Aguilera’s attorney alerted the insurance carrier that the injured employee was in need of emergency care for the fistula. Heath refused the authorization and insisted on a second opinion.
  • On August 25, Heath secretly appeared at the physician’s office for Aguilera’s appointment. She urged Aguilera to lie to his attorney that she has not appeared at his doctor’s appointment.
  • Subsequently, Heath insisted that Aguilera submit to the administration of invasive tests that were not only painful but also contraindicated by his then-present medical condition. The insurance company then proceeded to use Aguilera’s refusal to submit to the tests as a basis to justify a refusal and denial of his then needed critical, surgical treatment.
  • By November 4, 1999, Heath, the case manager, and a nurse practitioner also employed by the insurance carrier had changed positions and agreed that Aguilera needed immediate hospitalization for surgery. However, the insurance carrier’s adjuster again intervened and overruled the decision of medical personnel simply because he wanted a second opinion from a general surgeon. Notwithstanding this intervention, the insurance carrier did not follow its own position and authorize Aguilera to consult with a general surgeon, but instead again changed course and sent Aguilera to a gastroenterologist. At this point in time, Aguilera had allegedly been urinating feces and blood for over six months.
  • Aguilera’s ultimate surgery, the need for which had been diagnosed as an emergency as early as June of 1999, was not finally authorized or approved until March 22, 2000. By this time, according to the allegations, Aguilera had been urinating feces and blood for over ten months.

Florida’s workers’ compensation laws provide employees limited medical and wage loss benefits, without regard to fault, for losses resulting from accidental workplace injuries. The carrier’s failure to provide benefits in a timely manner or at all may result in the assessment of minor monetary penalites and interest. However, the workers’ compensation system does not have a mechanism for making carriers/adjusters accountable for serious injuries caused by outrageous claims handling.

In exchange for not having to prove fault for losses resulting from accidental injuries, employees have relinquished their right to seek common law recovery from the employer for those injuries. This concept is commonly known as “workers’ compensation immunity.” (See Florida Statute 440.11.)
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doctor.jpgUnder no circumstances may a civil action alleging medical malpractice/negligence be started in Florida more than seven years from the date of the incident or occurrence out of which the action accrued. This 7-year limitation is imposed by what is called a statute of repose, set forth in Florida Statute 95.11(4)(b). This is not to say that every medical negligence claim can be instituted up to seven years from the date of the incident or occurrence out of which the action accrued. Most cannot.

The time limit for starting most medical malpractice cases is controlled by the section of 95.11(4)(b) that provides as follows: “An action for medical malpractice shall be commenced within 2 years from the time the incident giving rise to the action occurred or within 2 years from the time the incident is discovered, or should have been discovered with the exercise of due diligence; however, in no event shall the action be commenced later than 4 years from the date of the incident or occurrence out of which the cause of action accrued….” This is Florida’s medical negligence statute of limitations. It is not the same thing as the statute of repose.

How is the 4 year sol limit stretched to 7 years? By showing that “fraud, concealment, or intentional misrepresentation of fact prevented the discovery of the injury….” id. When the burden is met, “the period of limitations is extended forward 2 years from the time that the injury is discovered or should have been discovered with the exercise of due diligence, but in no event to exceed 7 years from the date the incident giving rise to the injury occurred.” Hence, the 7 year cap.

(IMPORTANT NOTE: Nothing shall bar an action brought on behalf of a minor on or before the child’s eighth birthday. 95.11(4)(b))
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law books.jpgA statute of limitation is an enactment in a common law legal system that sets forth the maximum time after an event that legal proceedings based on that event may be initiated. Most people are familiar with the concept.

Far less familiar to the general public, and even to some lawyers, is the legal concept known as statute of repose. Like a statute of limitation, a statute of repose (sometimes called a nonclaim statute) limits the time period in which a civil action may be instituted.

A products liability case is a legal action for injuries founded on the defective design, manufacture, distribution, or sale of personal property. Examples of products found to be defective are tires, motor vehicles, drugs, and surgical hardware. In Florida, defective products cases are subject to a statute of limitation and a statute of repose.

The statute of limitation in Florida with regard to injuries caused by defective products is four years. (Florida Statute 95.11(3)(e)). (Caveat: When death results from a defective product, Florida’s Wrongful Death Act imposes a two year statute of limitations.) This means that a lawsuit founded on a defective product must be filed within four years or two years of when it is known or should have reasonably known what caused the accident.

Sometimes, however, the statute of repose effectively limits the time allowed under the statute of limitation and, in some instances, bars altogether a claim from being brought.

An actual case example will help illustrate this point:

Our law firm was recently hired by a gentleman who was severely injured by a defective forklift. Through discovery conducted in his workers’ compensation case, we learned that the manufacturer originally sold the forklift in 1996, more than fourteen years before the accident.

Even though we were prepared to file a products liability complaint well within the two year statute of limitation period, we were prevented from doing so by the statute of repose.
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