checklist.jpgFrom our experience, most Florida motor vehicle owners are not familiar with the many different types of coverages that are available, for the asking and at a price, under a standard vehicle insurance policy.

Preliminarily, it should be understood that, in Florida, for a vehicle to be lawfully registered, the only mandatory coverages are PIP (limited medical and lost wages) and Property Damage – Liability (covers damage to the other person’s property caused by the at-fault party). (Florida, a state with, in my opinion, primitive notions of right and wrong, is in the minority with regard to mandatory coverages. Other states, by making Bodily Injury – Liability mandatory, seemingly value life and limb more than property. Not so Florida, whose motor vehicle insurance vehicle laws create an environment the equivalent of the Wild West, where each man is responsible for his own safety and welfare without protection from the authorities.) Since these are the minimum requirements, a policy that covers nothing more is also the least expensive policy that can be purchased.* It is also the policy of choice for a large percentage of Florida motorists.
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barricade.jpgEffective October 1, 2011, individuals seeking redress for injuries caused by medical errors face yet another obstacle placed in their path by Florida’s Republican-dominated legislature. The new legislation applies to cases that arise on or after October 1, 2011.

The new legislation, Florida Statute 766.1065, forces claimants to provide target defendants with a medical authorization form along with the notice of intent to initiate litigation. The problem is that the authorization requirements of 766.1065 appear to abrogate the privacy rights of patients under Florida Statute section 456.057(7)(a) and the Federal Health Insurance Portability and Accountability Act at 42 USC Section 201 et seq. (commonly referred to as HIPAA) and 45 CFR Section 164.512.

It is too early to tell how the conflict will be resolved. One would like to believe that privacy rights will hold sway, but the forces seeking to insulate medical providers and their malpractice insurance companies hold an inordinate amount of influence in this state, so the outcome is anything but predictable.

The consequences of failing to comply with 766.1065 could be fatal to the case, so it is best not to play with that fire. We recommend providing the required authorization form, but include a statement in the notice of intent to initiate litigation, in bold large face type, that the authorization does not abrogate or supersede the doctor-patient privacy/confidentiality rights deliniated in the aforementioned citations.

Perhaps even more problematic to the pursuit of due process than the authorization, is the further hurdle created by the new law that for physicians licensed in other states to provide expert testimony in Florida about the prevailing professional standard of care or to execute and submit presuit verified written expert medical opinions, they must obtain certain certificates. Florida Statute Sections 766.102(12) and 458.3175. This is an onerous requirement designed to make it more difficult for those harmed by malpractice to pursue just compensation.
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maze2.jpgUninsured/Underinsured vehicle insurance, described in Florida Statute 627.727, is first party insurance that covers non-economic damages (e.g., pain & suffering), economic losses (e.g., lost wages) and medical expenses realized by insureds through the negligence of uninsured or underinsured (i.e., losses exceed policy limits) owners and operators of motor vehicles. In Florida, where a high percentage of vehicle owners do not maintain bodily injury (BI) coverage or, if they do, only carry it up to a limit of $10,000, having UM/UIM is the only sure way of providing some degree of economic protection against the catastrophic losses a serious motor vehicle accident can cause.

UM/UIM can be stacked or non-stacked. The most well known function of stacked coverage is to increase policy limits for owners of multiple vehicles insured under the same insurance policy. For example, the owner of three vehicles insured under the same policy, with stacked UM/UIM coverage with limits of $100,000 per vehicle, really has $300,000 worth of coverage for the the types of losses described in the paragraph above.

Stacked coverage serves another valuable function.

It is not unusual for owners of multiple vehicles to have some or all of their vehicles covered under separate policies. This can be problematic because most insurance policies issued in Florida exclude the extension of UM/UIM when the accident happens in a vehicle “owned by an insured but not insured under this policy.” In other words, the UM/UIM on one vehicle does not transfer to another vehicle owned by the same person.

Having stacked UM/UIM on even one of the insured vehicles overcomes the exclusion. In the example above, $100,000 is available to the insured no matter which vehicle the insured was occupying during the accident. Another way of thinking of it is that stacked UM/UIM follows the insured everywhere. Non-stacked coverage does not.

Florida insurance law can be a puzzle. It is best to seek the advice of legal counsel before and after an accident to learn your rights.
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calculator.jpgEmployees injured while working in accidents caused by third parties may be entitled to compensation through Florida’s workers’ compensation system and its personal injury laws. In the context of this blog, a third party is a person or company other than an injured worker’s employer. Examples include manufacturers of defective machinery and negligent operators of motor vehicles.

Florida’s workers’ compensation system is a no-fault system, meaning that for an injured worker to be eligible for benefits, the fault of another in bringing about the accident need not be proved. This is one of the biggest differences between the workers’ compensation system and the personal injury system, which is fault based.

To prevent the person harmed from receiving a windfall recovery, some or all of the money received from the third party must be repaid to the employer or the workers’ compensation carrier in rough proportion to value of the benefits they furnished. In other words, employers and workers’ compensation carriers have subrogation rights against the third party proceeds. This right is commonly referred to as the workers’ compensation lien.

Workers compensaiton is a creature of statute – see Chapter 440 of Florida’s statutes – and the right of subrogation is derived, in particular, from Section 440.39(2).

The employer or carrier can agree to waive the lien. However, the waiver may come at a cost, typically a reduction in the amount of money the employer/carrier are willing to pay to settle the workers’ compensation case.

More often, employers and carriers do not agree to waive liens. Fortunately, very rarely does the amount paid to satisfy a workers’ compensation lien equal the full amount of the lien.

440.39 describes the formula for satisfying the lien. The formula has been explained in clearer terms in the Florida Supreme Court case Manfredo v. Employer’s Casualty Insurance Company, 560 So.2d 1162 (Fla 1990).

This is the formula: Third party settlement amount less (-) attorney fees and costs divided by (/) full case value = the % value of the wc lien.; and here is the formula by way of an example:

  • WC lien (medical, indemnity, settlement, etc.): $ 100,000
  • $ 250,000 third party settlement less fees (40%) and costs = $ 135,000
  • Full case value: $ 1,000,000. (Settled for less due to tough liability, coverage limits, etc.)
  • $ 135,000 divided by $ 1,000,000 = 13.5%
  • 13.5% of $ 100,000 = $ 13,500.
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    scales of justice.jpgMost Florida accident cases involving personal injuries – e.g., motor vehicle; premises liability; medical malpractice – include an element of monetary compensation for pain and suffering damages sustained by victims through the fault of others. Workers’ compensation claimants are not entitled to compensation for pain & suffering.

    Florida’s workers’ compensation system was established more than 75 years ago to provide basic benefits (medical and indeminty) to injured workers without regard to fault. In theory, the entitlement to benefits is supposed to be as simple as establishing that the claimed injuries have resulted from an accident occurring in the course and scope of the employment. As long as the accident was not caused by horseplay or intentionally by the person injured, workers’ compensation benefits are supposed to be provided. This is so even if the accident was the fault of the injured worker.
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    worker2.jpgFor the past twenty years I have witnessed the steady and sometimes precipitous decline of rights and benefits available to injured workers under Florida’s workers’ compensation system (Chapter 440 Florida Statutes). The losses have come through legislative, rather than court, action, mostly by the hand of Republican legislators. Not surprisingly, the most damaging losses occurred during Jeb Bush’s eight-year (1999-2007) mean-spirited reign as Florida’s Governor.

    MEDICAL
    No longer may injured workers select their own treating doctors. Sadly, the Florida Legislature has turned this most important decision over to the workers’ compensation insurance companies. (See Florida Statute 440.13.) The doctors they select understand who is feeding them and why. Fearing that they will lose business if they side with injured workers, these doctors too often put the insurance companies’ best interests before those of their patients.

    Prior to the changes, patterned after laws instituted in Texas by George Bush, who was the Governor of that state, Florida’s injured workers were allowed to select the initial treating doctor and a second treater if desired, and have an independent medical evaluation performed at the carrier’s expense. No longer. The right to select treating doctors has been eliminated and the IME, which can cost in excess of $1,000, must now be paid out-of-pocket by injured workers, who often have barely enough money to buy food.

    LOST WAGES
    Like medical benefits, lost wages have taken a big hit from Jeb Bush and Republican legislators. Including for the problems associated with partial doctors, as described above, it has become more difficult to qualify for temporary lost wage benefits (TPD and TTD) and nearly impossible to qualify for permanent lost wage benefits (PTD). Additionally, a limit of 104 weeks, without regard to an injured workers actual medical statuts, has been placed on the right to receive temporary benefits. (F.S. 440.15 addresses the various types of lost wage benefits.)
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    wet floor sign.jpgUnder Florida law, the duty owed by landowners and/or those in control of properties to individuals other than employees – injuries to employees are governed by Florida’s workers’ compensation system (see Chapter 440 of the Florida’s Statutes) – depends in part on the individual’s purpose for being on the property.

    Florida divides the status of individuals on property into five categories. This blog lists the categories and the duties owed under each category.
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    doctor.jpgMedical providers (doctors, hospitals, nurses), aligned, for the most part, with Republican politicians, believing them to be covering their backs, will be surprised to learn that, in a battle between them and medical malpractice insurance companies, they have been stabbed in the back.

    Florida Statute 766.1185 (2003) is a safe-harbor statute for medical mapractice insurers. It gives them 210 days after a formal Complaint is served on one of its insureds to avoid having to satisfy an excess (of the policy limits) judgment. If the insurance carrier tenders the policy limits within the 210 days, it is safe from having to pay the excess portion of any judgment.

    Although the insurance carrier may be safe, the insured is not. For the carrier to benefit from the safe-harbor statute, it is the tender alone, rather than a tender and acceptance, and thus a release of liability, that matters. The statute does not make acceptance of the tender mandatory. The operative act for carrier protection is the tender.
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    greed2.jpgAs a Plaintiffs’ personal injury law firm, we deal with insurance companies every day. Thanks to current Florida law, insurance companies are duty bound to act in the best interests of their insureds, the individuals and companies who pay for insurance coverage. Acting in the best interests of an insured sometimes means that an insurance company should tender its insured’s policy limits to the injured party. If done timely, the tender will keep the insured from being exposed to a court judgment in excess of his/her or its policy limits.

    When an insurance company fails to tender the policy limits at a time when it could have and should have based on the information at hand, it exposes its insured to an excess judgment. This is considered bad faith. When an insurance company has been found to have acted in bad faith, a determination made by a jury based on evidence, it, rather than its insured, will be required to satisfy the excess judgment. Given that its bad faith created the exposure, this outcome is fair.

    Insurance companies do not like being told how to behave, including towards their own customers.

    The insurance industry has tried for years to eliminate through legislation and court decisions the duty to act in good faith towards their own customers. However, because the duty is so solidly grounded on reasonableness and good sense, their efforts to date have proved unsuccessful. Unfortunately, they do not give up.

    With Governor Scott and a solid majority of right-wing Republicans, in the Florida House and Senate, in control of lawmaking in Florida, during the upcoming legislative session, scheduled to begin in January, 2012, the insurance industry will be proposing legislation to end their duty to act in good faith. In fact, one bill, HB 427 has already been proposed, by Rep. Kathleen Passidomo (R-Naples).

    This is a serious topic, about which I have and will continue to blog at length, with far reaching ramifications. Ironically, those who are the most at risk by the proposed legislation are the very same constitutents who generally support right-wing policies, wealthy individuals and corporations.

    Reproduced here is a well written article on the subject by Steven Marino, a prominent South Florida “bad faith” attorney, which was published in the Sunday (10/23/11) Miami Herald.
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    By Stephen A. Marino Jr.
    Special to The Miami Herald
    You’re in good hands. Your insurer is on your side, because it’s like a good neighbor. Some companies live up to their slogans, but some use promises to induce Floridians to entrust their livelihoods and businesses to companies offering liability insurance.

    When the paperwork is signed and the premiums are paid, it’s all smiles and handshakes. But if the small business owner is a few days late on a premium payment, or makes a mistake on the policy application, coverage is terminated. But what happens if the insurance company makes a mistake?

    Florida law has long recognized an insurance company’s fiduciary obligation to protect its policyholder from a judgment exceeding the limits of the policy. Since at least 1938, Florida courts have clearly expressed that an insurer must act honestly and in good faith toward the insured. The reasoning is simple: An insurance company writes a contract that gives it complete control over the defense and settlement of a claim against the policyholder, and must therefore use “the same degree of diligence as a person of ordinary care and prudence should exercise in the management of his own business.”

    The insurance company insists that it make the decisions, so Florida law requires that it do so while acting in the best interest of its insured. If the insurance company makes a mistake, and the result is a liability judgment against the policyholder, the law places the responsibility for the judgment on the insurance company, not the small business.
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    maze.jpgFlorida’s motor vehicle insurance laws can be hard to comprehend.

    A case in point: Personal Injury Protection (PIP) and Property Damage – Liability are the only required coverages for an owner to lawfully operate a vehicle on Florida’s streets and highways. (PIP pays 80% of medical bills and 60% of lost wages for the insured up to $10,000, while Property Damage – Liability pays to repair or replace the other owner’s motor vehicle.) With these coverages, the owner is able to register a vehicle and purchase a license plate.

    Surprisingly, however, in the event of a motor vehicle accident involving injury or death, having the minimum mandatory coverages will not prevent the at-fault party from having her drivers license and all vehicle registrations suspended. Sections 316.066(3)(a)1 and 324.051(2)(a) Florida Statutes.

    The only type of coverage that will prevent these suspensions is Bodily Injury liability (a/k/a BI). Section 324.021 (7) Florida Statutes.
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