Articles Posted in Personal Injury

There is a reason why the following inquiry is a standard interrogatory for personal injury cases in the Florida Rules of Civil Procedure:

Did you consume any alcoholic beverages or take any drugs or medications within twelve hours before the time of the incident described in the complaint? If so, state the type and amount of alcoholic beverage, drugs or medication which were consumed and when and where you consumed them.

While excessive alcohol consumption can support a claim for punitive damages — see this blog:, Special Considerations in Florida Motor Vehicle Crash Cases Involving Alcohol (DUI) — evidence of alcohol use, even short of “voluntary intoxication,” can be relevant to the issue of simple negligence. It’s application is not limited to vehicle accident cases.

The Florida Supreme Court decided long ago that evidence of a person being under the influence of intoxicants at the time of an automobile collision is admissible, on the theory that a driver so exhilarated is likely to be abnormally reckless. Taylor v. State, 46 So.2d 725 (Fla., 1950). It is valuable and useful to corroborate or render more likely, evidence that is doubtful or disputed. Smith v. State, 65 So.2d 303 (Fla., 1953).
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Every personal injury plaintiff must plead and prove that the defendant owed and breached a duty of care and that the breach proximately (i.e., foreseeably and substantially) contributed to the specific injury suffered. These are the prima facie elements of a personal injury case.

Whether a duty exists is a matter of law for the court (judge) to determine rather than a factual question for the jury. The duty element of negligence focuses on whether the defendant’s conduct foreseeably created a broader “zone of risk” that poses a general threat of harm to others. See Kaisner v. Kolb, 543 So.2d 732, 735 (Fla. 1989) (citing Stevens v. Jefferson, 436 So.2d 33, 35 (Fla. 1983)). It is a minimal threshold legal requirement for opening the courthouse doors. See McCain v. Florida Power Corporation, 593 So. 2d 500 (Fla. 1992) (In footnote number 1, the court qualified and explained the concept as follows: “Of course, to determine this legal question the court must make some inquiry into the factual allegations. The objective, however, is not to resolve the issues of comparative negligence or other specific factual matters relevant to proximate causation, but to determine whether a foreseeable, general zone of risk was created by the defendant’s conduct.”)

On the other hand, the proximate causation element is concerned with whether and to what extent the defendant’s conduct foreseeably and substantially caused the specific injury that actually occurred. Id. at 502. This is a “much more specific factual requirement that must be proved to win the case once the courthouse doors are open.” Id. at 502. Generally, issues of breach, proximate cause and foreseeability as related to proximate cause are fact questions for the jury, not resolved by summary judgment. McCain and See Springtree Properties, Inc. v. Hammond, 692 So.2d 164, 167 (Fla.1997). Importantly, it is immaterial that the defendant could not foresee the precise manner in which the injury occurred or its exact extent. Restatement (Second) of Torts § 435 (1965). In such instances, the true extent of the liability would remain questions for the jury to decide. McCain at 503.
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In a decision demonstrating strong support of confidentiality provisions, even at the expense of family dynamics, in Gulliver Schools, Inc. v. Snay, the Third District Court of Appeal punished a father (the Plaintiff) for informing his college-age daughter that a settlement was reached with the Defendant in an emotional case.

When his employment contract was not renewed, the Plaintiff sued the Defendant for age discrimination and retaliation under the Florida Civil Rights Act. Florida Statute Sections 760.01-760.11 and 509.092. Within days of the settlement, which included a confidentiality provision, the Plaintiff’s daughter posted the following message on her Facebook page.

Mama and Papa Snay won the case against Gulliver. Gulliver is now officially paying for my vacation to Europe this summer. SUCK IT.

As a result, the Defendant refused to pay the Plaintiff a large portion of the money promised under the settlement agreement. Plaintiff’s subsequent Motion to Enforce was granted by the trial court. However, the trial court order was reversed on appeal.
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A pedestrian struck and injured by a motor vehicle may be covered by some, all or none of the following types of motor vehicle insurance:

Personal Injury Protection (PIP). PIP is no-fault insurance, meaning that covered individuals receive the benefit without regard to fault. Put another way, at-fault individuals may recover under this type of insurance. This coverage does not compensate for non-economic damages like pain and suffering, and the limit for what it does cover — medical and lost wages — is typically capped at $10,000 combined. It is also subject to deductibles and does not pay 100% of the medical benefits or lost wages. It is not always easy figuring out whose insurance coverage applies.

• If the pedestrian owns a vehicle and has PIP coverage on the vehicle, a requirement under Florida law for operational vehicles registered in the state, the pedestrian’s own policy applies. F.S. 627.736(4)(e)1.
• If the pedestrian does not own a vehicle that must be insured, but resides with a relative who does, the resident relative’s policy provides coverage. F.S. 627.736(4)(e)3. (If there is more than one resident relative with coverage, each carrier must pay its pro-rata share. Regardless of the number of carriers, PIP coverage is limited to $10,000 unless a policy has a higher coverage limit. F.S. 627.736(f)).
• If neither the pedestrian nor a resident relative has PIP, the at-fault vehicle owner’s and/or operator’s carrier provides coverage. F.S. 627.736(4)(e)4.

CAVEAT: None of these PIP provisions apply if the accident occurs outside of Florida.
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The Medicare Secondary Payer Act of 1980 (“MSP”) — Link to the MSP Manual — was enacted to limit the financial burden on taxpayers for the medical expenses of Medicare beneficiaries whose medical needs are the primary responsibility of some other source.

Until 2010, the MSP’s main focus was on workers’ compensation cases. (Florida’s workers’ compensation laws are contained in Chapter 440 of Florida’s statutes.) Injured workers who receive a lump sum settlement in a workers’ compensation case are required to pay all or a portion of those proceeds for the medical care related to their job accident injuries before Medicare will pay penny-one. While third-party civil liability plaintiffs have always been expected to reimburse Medicare for benefits paid in the past, the same regulations with regard to future coverage was never applied. In other words, Medicare was not expecting these Medicare beneficiaries to cover the expenses of future medical care resulting from their accidents from settlement proceeds.

For some time, The Centers for Medicare and Medicaid Services (“CMS”), the federal agency responsible for administering Medicare and Medicaid (as well as a host of other federal programs ) within the Department of Health and Human Services, has been hinting that the Medicare Secondary Payer Act applied to future medical services in third party liability cases, pointing out that the statutory language is the same for workers’ compensation and liability cases. With regard to liability cases, Barbara Wright of CMS stated: “So where future medicals are a consideration in arriving at the settlement, appropriate arrangements should be made for appropriate exhaustion of the settlement before Medicare is billed for related services.”

One consequence of this new thinking is that insurers and self-insured entities are currently required to report claims made by Medicare-eligible claimant/plaintiffs to the Centers for Medicare and Medicaid Services (“CMS”). This suggests that “appropriate exhaustion of the settlement before Medicare is billed for related services” is required “before Medicare is billed for related services” in personal injury cases. Interestingly, as of the posting of this blog, Medicare has not taken the next step of denying the payment of bills where the care is related to injuries sustained in an accident for which future medicals were considered in arriving at a settlement.
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Medicaid will sometimes pay the medical expenses incurred by a person injured in an accident, albeit at rates substantially below the medical provider’s usual and customary charges. When Medicaid does pay, beneficiaries must reimburse Medicaid from third party payments for medical care. See section 409.910(11)(f), Florida Statutes (2013). The goal of the statute is to protect tax dollars while preventing Medicaid beneficiaries from receiving a windfall. Tristani v. Richman, 652 F.3d 360, 370, at 372 (3d Cir. 2011).

In Arkansas Department of Health & Human Services v. Ahlborn, 547 U.S. 268 (2006), the U.S. Supreme Court confirmed that the Medicaid lien was limited to payments for medical care. Id. at 284. At issue in Ahlborn was a North Carolina Medicaid lien statute similar to Florida’s.

In spite of Ahlborn, AHCA, which administers Florida’s Medicaid system, insisted that its payments could be recovered from the entire settlement without regard to the various other damage elements typically constituting the basis of a settlement. (In addition to incurred medical expenses, personal injury cases usually also involve claims for lost wages, future medical expenses, mental anguish, and pain. According to Ahlborn, Medicaid’s lien only attaches to the payments made for medical care.) Moreover, ACHA refused to negotiate or even concede that any court had a say in the matter. AHCA’s brazenness was challenged.

In Roberts v. Albertson’s Inc., 37 Fla. L. Weekly D2515 (Fla. 4th DCA Oct. 24, 2012), reh’g and reh’g en banc denied, modified on reh’g, No. 4D10-2313 (Fla. 4th DCA June 26, 2013), the Fourth District Court of Appeal issued a decision authorizing the trial court to conduct a hearing to determine the Medicaid lien. The court could consider evidence of payments for such other damages as lost wages, pain, and mental anguish, as well as determine how much less the case settled for than its full value. (Cases are often settled for less than full actual damages due to a variety of factors including comparative fault and limited insurance coverage.)
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