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Williams v. Heckler

October 2, 2019, Arbitration, left wrist fracture, residual scarring right leg.

Style: Anesia Williams v. Bronson James Heckler.

Venue: Circuit Court, Hillsborough County, Florida.

On July 10, 2018, Plaintiff, Anesia Sharine Williams, had been the driver of a 2000 Dodge Neon accompanied by minor son and unrestrained passenger, Kyree Chapman, which had been traveling southbound on Florida Avenue, Tampa, Hillsborough County, Florida, at approximately 50 mph.

Defendant, Bronson James Heckler, had been the driver of a 2015 Ford F150 pickup truck traveling eastbound on West Shore Drive and at stop for stop sign at intersection of Florida Avenue. After oncoming traffic had cleared Mr. Heckler attempted to make a left hand turn to proceed northbound on Florida Avenue at which time collision between the two vehicles occurred.

Plaintiff, Anesia Sharine Williams, alleged injuries to include fracture to left wrist, scarring to right leg and sprain/strain of the cervical, thoracic, and lumbar spine.

The claims of minor child Kyree Chapman were settled through negotiation. The claims of Plaintiff, Anesia Sharine Williams, proceeded to arbitration.

Medical specials were in excess of $20,000.00 with future loss of earning capacity claim estimated at $9,000.00.

No collateral sources were available.

Treating physicians providing expert opinion on behalf of Plaintiff included Christopher MacLaren, D.O.

No witnesses were called on behalf of the Defendant. Plaintiff sought damages in the amount of $100,000.00.

The defense placed a range of settlement value on the matter between $45,000.00 and $50,000.00.

Arbitration resulted in an award of $47,051.22.
The parties were responsible for their respective attorneys’ fees and cost.

Demoura v. Travelers

September 16, 2019, PIP, discontinuation of benefits, directed verdict, failure to show conditions precedent.

Style: Nimo Demoura v. The Travelers Home & Marine Insurance Company.

Venue: County Court, Orange County, Florida.

Plaintiff, Nimo Demoura, had been the restrained driver of a vehicle traveling on I-4 and at a stop for traffic at the on ramp for Lee Road, Orlando, Orange County, Florida, when his vehicle was struck from the rear.

Plaintiff alleged multiple injuries to include headaches, TMJ, neck and low back pain.

Plaintiff initiated medical care with Eric Feiter, D.C., three times per week and ongoing for an extended period of time. Approximately four months post accident Travelers requested a compulsory medical examination which was performed by Fred VanderSchaaf, D.C. who determined that further treatment would not be reasonable, necessary, or related to the accident.

Plaintiff filed suit seeking PIP benefits subsequent to the compulsory medical exam.

Witnesses called on behalf of Plaintiff included Eric Feiter, D.C., treating physician, Nimo Demoura, insured, Ruben Infinger, Corporate Representative for Travelers and Jeffrey Diab, claims adjuster for Travelers.

No witnesses were called on behalf of Defendant.

During his case in chief Plaintiff attempted to introduce, over Defendant’s objection, a copy of the pre-suit demand letter which included an assignment of benefits not included or produced in the original. The Court did not admit the document as evidence as a result.

Plaintiff then attempted to publish the deposition transcript of Ruben Infinger, Corporate Representative of Travelers Insurance however the Court sustained Defendant’s objection to same as the Plaintiff had not listed the Corporate Representative as a witness for trial and due to the fact that upon review of the transcript the demand letter and assignment of benefits at issue had not been discussed.

Finally, Plaintiff called Travelers claim adjuster, Jeffery Diab, who was unable to provide sufficient testimony for introduction of the demand letter or assignment of benefits as he had no knowledge as to the specific document at issue.

At the close of Plaintiff’s case in chief, the Court granted Defendant’s motion directed verdict on Plaintiff’s failure to satisfy conditions precedent.

No damages were awarded as a result.

Defendant is entitled to seek attorneys’ fees and cost.

Ramey & Kampf, P.A. and The Great American Teach In 2019

Associate attorneys, Joe Monte and Amber Inman, participated in The Great American Teach In on November 21, 2019 as a part of the celebration of American Education Week in Hillsborough County, Florida.

Mr. Monte visited Booker T. Washington Elementary School in Ybor City to speak to Ms. Burley’s Fourth Grade students. Mr. Monte shared his educational background and professional experiences with the students who were excited to learn about the types of cases and clients Mr. Monte has represented throughout his career as a practicing attorney.

Ms. Inman visited Broward Elementary School in Seminole Heights to speak to Ms. Arfsten’s Fourth Grade students. The students learned about the role of any attorney in a courtroom, rules of professionalism, and the requirements for an attorney to practice law in the state of Florida.

Ramey & Kampf, P.A. is dedicated to mentorship and “paying it forward” in our community with the Great American Teach In providing a rewarding experience for our attorneys to share their professional journey with students who may be interested in a future legal career.

PIP Ruling

The firm recently obtained a ruling on a matter without precedence when the Second District Court of Appeal, after oral argument, agreed with Ramey & Kampf, P.A.’s managing partner, David Kampf, whom also successfully argued for our client at the trial level, that the insurer was entitled to a commercial right of reimbursement under Florida No-law including recovery from a governmental entity.  The Agency argued that sovereign immunity precluded suit since a PIP action is not an action in tort; and the government may only be sued based on a tort action.  However, the Second District agreed sovereign immunity was waived by the legislature per the language in F.S. 627.732(3), in conjunction with Florida Statute § 627.7405.

The Court determined that the legislature specifically excluded motor vehicles used for public school transportation from the definition of what is not a commercial moto vehicle.  Thus, the legislature expressly included certain government vehicles as being commercial motor vehicles under the No-fault statute which means the statute unequivocally waived sovereign immunity.  The Court determined the Lee County School Board was responsible to reimburse our client notwithstanding exclusions under their policy with Safety National.  The Second District agreed with Mr. Kampf that the statute does not limit the obligation to pay to a no-fault insurer.  Any type insurer of the vehicle is required to extend reimbursement to the PIP insurer.  Further, the Court found the insurer, Safety National, and the Board are not liable to reimburse based on the specific terms of the policy, but is liable based on the statute.   Thus, policy exclusions may not apply.

Mr. Kampf’s knowledge and legal expertise were crucial in obtaining a favorable ruling for our client on a novel area of law.

FIFEC Presentations

Ramey & Kampf, P.A. was honored to present in the 27th Annual Florida Insurance Fraud Education Committee (FIFEC) Conference in Orlando, FL for not one, but two presentations that provided CEU and CLE credits for adjusters and attorneys. FIFEC provides education and training for the insurance fraud investigative community, promotes a coordinated effort within the insurance industry and law enforcement to combat insurance fraud, and educates local communities on ways to combat insurance fraud.FIFEC

Managing partner, Mark Ramey, and associate attorney, Amber L. Inman, presented a course entitled, “Recommendations for Handling Florida BI/UM Pre-Suit Claims and the Impact of the Supreme Court Decision in Harvey v. GEICO.” The course focused on identification of Florida bad faith setups and provided advice to claim representatives, adjusters, and attorneys to avoid a bad faith claim related to the handling of BI/UM pre-suit matters following the recent Florida Supreme Court decision of Harvey v. GEICO using real-life examples from our everyday practice.

Associate attorneys Joseph Monte and Allen Gaffney presented the course titled, “Pre-Suit Examinations Under Oath on Coverage Issues: Residency and Operability of a Motor Vehicle”.  The course focused on the unique and multifaceted factual and legal issues involving claimants as to their residence, family, ownership of a vehicle, and operability of a vehicle.  The course was highly interactive and engaging with the audience with the factual and legal backdrop of EUOs undertaken by Ramey & Kampf, P.A. attorneys in providing advice to claim representatives and adjusters in performing their good faith obligations in investigating claims.

Ambrose v. Ferro & State Farm

March 22, 2019, Low back injury, radiofrequency ablations

Style: Jamie Ambrose v. James J. Ferro & State Farm Mutual Automobile Insurance Company

Venue: Circuit Court, Pasco County, Florida.

Plaintiff, Jamie Ambrose, had been a restrained driver in a vehicle stopped at a red light at the
intersection of U.S. 19 and Moog Road, New Port Richey, Pasco County, Florida. Defendant,
James Ferro, had been the driver of a vehicle that failed to stop, colliding with the rear of
Plaintiff’s vehicle.

Plaintiff alleged she sustained injury to her lumbar spine and underwent radio frequency ablation
with medical expenses totalling over $50,000. Plaintiff sought damages for future medical
expenses as well as past and future pain and suffering in excess of $1,000,000.

Experts testifying for Plaintiff included: Lee Ann Brown, DO, Jay Parekh, DO

Plaintiff denied pre-existing condition.

Experts testifying for Defendant included: Michael Foley, MD, Ananda Som, MD, Peter
Candelora, MD

Defendant argued that Plaintiff presented with pre-existing conditions.

The jury returned a verdict limited to the Emergency Department medical bill in the amount of
$7,442.46, finding no permanent injury had been sustained.

After collateral source offsets, net verdict was zero.

Last modified: April 4, 2019

Mason v. Whiting 11-1-18

November 1, 2018 CATASTROPHIC INJURY, VEGETATIVE STATE

Style: Earl B. Mason Sr. as Plenary Guardian of the ward, Earl B. Mason Jr. v. Robert Hines as Personal Representative of the Estate of Nyla Whiting

Venue: Circuit Court , Hillsborough County , Florida

Defendant Nyla Whiting, age 70, had been the driver of a 2002 Toyota Corolla traveling southbound on 78th St., Tampa, Florida. Plaintiff Earl B Mason Jr. had been a pedestrian who walked into the path of traffic as he attempted to cross 78th St eastbound, approximately 70 ft. from an available pedestrian crosswalk.

Ms. Whiting was unable to avoid striking Mr. Mason making impact between 18 and 22 mph.

Mr. Mason suffered catastrophic injuries and institutionalized in a vegetative state since the accident.

Past medical expenses was $546,742.

Plaintiff sought future medical expense and cost of life care in the amount of $5,514,679 in addition to unspecified amount for pain and suffering.

Experts on behalf of Plaintiff: Robert Martinez MD, Gerri Pennachio, vocational rehab, Brenda Mulder MBA, Steven Koontz PE

Experts on behalf of Defendant: Steven Bifulco MD, Cynthia Stephens Ph D, Charles O Funk Ph D, PE

The matter proceeded to arbitration October 29 2018 with arbitration award entered November 1 2018 in favor of Defendant.

No damages were awarded.

 

Through the Eyes of the Jury

Throughout law school and during my first few years of practice as a trial attorney, I have been told by professors, mentors, and peers alike what should and should not be worn in a courtroom. The goal was to not offend anyone on the jury. This theory seemed simple and easy to follow.

The recommendations I received included such thing as: do not wear bright nail polish, do not wear heels which are too tall or open-toed, ensure your suit and shirt are freshly pressed, etc. I followed these tips to the letter during each and every trial attended. After the first few trials, and feeling the eyes of a jury panel scrutinizing my every move, I wondered what else jurors noticed about attorneys during trial.

A few months ago, I had the opportunity to see trial attorneys through the eyes of the jury when I was called for jury duty. As I entered the courtroom, I focused my attention on the attorneys. I immediately noticed their appearance and went over all the check-boxes in my mind to determine who had followed the unwritten rules that were ingrained into my conscious and subconscious. As the attorneys began voir dire, I realized that, as a juror, I noticed much more than the appearance of the attorneys. The conduct of the attorneys is also under strict scrutiny. Did the attorney try to make a connection with the jurors? Was their presentation concise? Did they seem prepared?

As these thoughts raced through my mind, I wondered what other jurors were thinking. Maybe I was being too harsh on these attorneys because I was one myself. After I was dismissed from jury duty, I conducted a little research into what juries actually think. This lead me to a recently published report by the Cornell University Law School Law Review titled “What Juries Really Think: Practical Guidance for Trial Lawyers.”

Surprisingly, a very small percentage (only 4%) of the jurors surveyed commented about attorney appearance. These jurors reported that the attorneys had holes in their jackets, wore wrinkled clothing, and looked sloppy. Such comments were consistent with what I heard from professors, mentors, and peers.

However, there were other factors that the jurors found more important than attorney appearance. Those factors included:

  • Organization/Preparation/ Efficiency: 44.7% of jurors expect attorneys to do more than simply “wing it.” Jurors expect attorneys to be organized and present their case efficiently.
  • Delivery or Style of Presentation: 36.1% of jurors expect attorneys to speak clearly, appear personable, and to refrain from dramatic presentations.
  • Repetition: 33.7% of jurors are insulted when attorneys repeat questions. Jurors expect attorneys to utilize technology and timelines during the presentation of evidence.
  • Good Behavior toward Opposing Counsel, Witnesses, and Jury: 31.3% of jurors expect attorneys to be respectful to other persons in the courtroom.
  • Other Professionalism Indicators: 29.3%.

Although the jurors surveyed were only asked to relay their thoughts about attorneys, it stands to reason that some of these concepts apply to corporate representatives, clients, and witnesses, who are also present during a trial. Since jurors are watching everything, it is reasonable to believe that the actions, appearance, and conduct of everyone in the courtroom must also be under the jury’s scrutiny.

While these concepts may seem simple and self-evident, we’ve all witnessed trial counsel who has failed to abide by these unwritten rules. Understanding a juror’s perspective can help trial attorneys meet expectations and earn the jury panel’s respect. Although the right conduct will not guarantee you will win, it certainly cannot hurt.

 

 

Healthcare fraud action highlights ongoing problem

The sweep of healthcare fraud cases announced by the Justice Department is sweeping and vast. Over $2 billion in fraud was identified by 600 defendants charged across the nation, defrauding health insurance for opiods that were re-sold as well as general services.

A stunning $350 million of that fraud comes from South Florida alone. Those charged come from all over the state, too. Prosecutors make it clear that this is only the tip of the iceberg, however, and there is much more that they have not yet uncovered.

The enforcement operation

It appears to be the largest operation ever undertaken against healthcare fraud. The press often highlights the abuse of Medicaid reimbursements, but private insurance companies were caught up in it as well.

Like much of the fraud today, it involved a vast network of doctors, clinics, patients, and services all working together. It even connected the opiods obtained with false prescriptions to a drug cartel that is traffic in them.

Much is South Florida based

Fully 20% of the defendants ensnared are from South Florida. In the Tampa area alone, 13 defendants including four doctors have been charged. The network of fraud reached out all across the nation but was clearly centered here.

The $350 million in fraud in South Florida came from nearly every aspect of the healthcare industry, too. All insurers in the state have probably been defrauded, at least in part, by this operation. And officials are stressing that this is only what is known at this time, there is likely to be more.

What can be done?

Fraud that is identified by the Justice Department can be recovered. It takes experience in insurance fraud to navigate a case like this, especially when the operation is so vast and criminal charges are involved. More importantly, there may be evidence in the criminal trial which highlights other fraud not currently charged.

Insurance fraud is so common in South Florida that vigorously pursuing it is critical for any insurer. A legal team with a proven track record pursuing every case to full recovery can make a large difference in the bottom line for any insurer operating in Florida.

Over-payments: getting the advantage for the insurer

Overpayments to providers by insurers happen all the time. It’s not a matter of fraud but the complexities of the system. Medical providers rarely have fixed tables of cost for any given services and the actual price for any given treatment is often negotiable.

Insurers have a disadvantage in this system. The position is made even weaker by Florida law. The only way to regain the advantage, when necessary, is to be prepared for civil litigation.

The law in Florida

Insurance payments to providers are covered in Florida statute 627.6131, Payment of claims. The exact dates and methods for all claims are spelled out in great detail. Section (6)(a) covers overpayments discovered as part of a review or audit and not related to fraud.

1. All claims for overpayment must be submitted to a provider within 30 months after the health insurer’s payment of the claim. A provider must pay, deny, or contest the health insurer’s claim for overpayment within 40 days after the receipt of the claim. All contested claims for overpayment must be paid or denied within 120 days after receipt of the claim. Failure to pay or deny overpayment and claim within 140 days after receipt creates an uncontestable obligation to pay the claim.

This establishes the procedures and the clock for payments. Further, in section 3 it is made clear that insurers cannot take any action on their own including reducing payment for other services as part of an overpayment claim.

What this means

If a provider simply ignores the overpayment request, it can be enforced after 140 days. But it often takes the threat of civil action in order to have that reimbursement occur.

It is often in the best interests of any provider to simply deny the overpayment as a matter of course. This leaves them in the even stronger position, given that it is not legal to reduce any payments to the provider. There is no recourse for hte insurer other than to threaten to sue.

How to proceed

For this reason, all situations involving overpayment have to be considered on the basis of how the information will be presented at trial. The providers must believe that the overpayment is going to proceed to trial before they will take it seriously, based on their strong position under the law.

That is why any collection action against a provider must be undertaken with a law firm experienced in handling collection and refunds from providers. There is simply no alternative, given the position insurers are in under Florida law.