Case Law Update September 2019
This Update contains summaries of all relevant Appellate decisions usually for the preceding week, with comments on how a particular decision affects you. In addition, we review daily the Merit Orders posted on the DOAH website. This Update contains summaries and links to relevant JCC decisions for the past week or so. Please feel free to contact Rogers Turner (rturner@hrmcw.com) with questions or comments on any of the listed cases.
DCA Cases
Coto v. Univision/Sentry Casualty, ___ So.3d _____ (Fla. 1st DCA 9/25/2019) Claimant’s payment of prevailing party costs.
The JCC awarded the E/C prevailing party costs, of $1,074.34 which the DCA affirmed per curiam. Judge Makar, however wrote a special concurring opinion. He acknowledged that prior DCA cases (Frederick v. Monroe County School Board) state the award of such costs is mandatory. He then recited the facts of this case, where the claimant had a compensable ankle fracture, filed a PFB for plasma rich injections, or in the alternative surgery, received the injections and immediately withdrew the PFB for surgery. He concluded “imposition of costs makes little sense and operates as a deterrent to those seeking benefits in good faith in situations such as those confronting Coto and Frederick. For this reason, it bears reiterating the recommendation of the panel in Frederick “that the Legislature consider whether an employee who files a petition for benefits in good faith should be subject to the imposition of costs.”
Liberty Mutual Ins./UPS v. Miller, ___ So.3d ___ (Fla. 1st DCA 9/20/2019) Motions to Enforce/Non-appealable Interlocutory Orders
The DCA dismissed the E/C’s attempt to appeal the JCC’s denial of a Motion to Enforce Settlement Agreement. They rejected the E/C’s argument that a “modified finality standard” should apply to WC orders. The Florida Appellate Rules allow review of only non-final orders that adjudicate jurisdiction, venue and compensability (subject to specific findings in the Order). Orders finding a settlement agreement not enforceable are not within that list. The E/C attempted to argue that although prior case law (Naghtin v. Jones et. al) already held such orders were non-final, the “serial nature” of WC and the term “Final Order” should have a “modified meaning” under the rule. The DCA noted that Orders granting Enforcement of a Settlement or Dismissal are appealable because they constitute an end to judicial labor and nothing further remains to be done in the case. An Order Denying Enforcement or a Motion to Dismiss does the opposite, resulting in additional judicial labor. The DCA found it was without jurisdiction to review the non-final, non-appealable Order.
Gray v. Agency for Healthcare Administration ___ So.3d ___ (Fla. 1st DCA 9/3/2019) Medicaid Liens
Gray suffered a severe spinal cord injury in an auto accident. Although he obtained a 2.8 million dollar jury verdict, the only amount he collected was $10,000.00 in insurance proceeds. AHCA subsequently sought to collect upon their lien for the $65,615.00 it had paid on behalf of Gray. Pursuant to F.S. s. 409.910(1) (the Medicaid Lien Law) AHCA asserted a lien of $3,750.00 on the $10,000.00 recovery, as the law allows for recovery of half the amount recovered less attorney fees and costs. The Florida Supreme Court’s 2018 Giraldo decision limits this recovery to amounts already paid. However, the amounts allocated to past and future medical payments must derive from either judicial decree, jury verdict or settlement. If the parties cannot agree, an ALJ determines the amount. Here the ALJ found the lien amount to be $3,750.00, rejecting Gray’s arguments that (1) the lien determination included future medical, (2) that the ALJ should not have required Gray to prove the determination was incorrect by clear and convincing evidence and (3) that the lien should have been determined on a pro rata basis (i.e. since he only received .349% of the $2.8 million dollar verdict, the lien amount should have been $229.49). The DCA noted as to the first argument that Gray had no evidence of any allocation of future medical in the settlement. As to the second argument, although the Federal Northern District of Florida has recently questioned a Medicaid recipient’s burden of proof in Gallardo v. Dudek, that decision is not binding on the DCA, and AHCA has appealed that to the 11th Circuit. Finally, there is no authority to allow a prorated allocation under the Medicaid lien law. A concurring opinion noted the legislature may wish to consider adjusting the statutory formula to reduce its regressive effect on severely injured persons, who receive uncollectible judgments and are then required to forego half of the unallocated proceeds of small value insurance policies in these unfortunate situations.
Eady v. State of FL/AHCA, ___ So.3d ___ (Fla. 1st DCA 9/12/2019) Medicaid Liens/Evidence of a Settlement’s Allocation of Medical Expense
Eady was rendered an incomplete quadriplegic in an auto accident. Medicaid paid $177,747.91 for his care, and asserted a lien on the confidential $1 million dollar settlement the claimant obtained from several parties. At a hearing to determine the amount of the AHCA lien (the parties stipulated the claimant would have the preponderance vs. clear and convincing burden), Eady offered the testimony of two long time plaintiff personal injury attorneys, who testified claimant’s damages would be at least $15,000,000, and that the $1,000,000 recovery represented approximately 6.6% of the total damages. Applying this percentage to the lien amount, Eady argued the lien should be $11,838. The opinion describes AHCA’s cross examination of these experts as “timid” and “half-hearted,” noting AHCA put on no conflicting evidence. The ALJ found Eady did not sustain his burden to show a lesser amount should be allocated for past medical, noted the confidential settlement agreements shielded information from her, and awarded the full amount of the lien. The DCA conducted a lengthy examination of the Medicaid lien law, including last week’s Gray decision, and found Eady presented competent, substantial, and uncontradicted evidence establishing $11,838.01 as the settlement portion properly allocated to past medical expenses. The case was remanded for the ALJ to reduce the lien by that amount.
Please note that the DCA Opinions and Merit Orders contained in this newsletter are non-final until 30 days after their rendition. Until that time, they are subject to amendment, vacation, or other action which may remove or alter some or all of the decision. Please contact any HRMCW attorney if you have a question as to the finality and applicability of an Opinion or Order. We endeavor to include any amendments or alterations to Opinions or Orders that may occur at a later date