WeSuThem

  “On consideration of the above authority, we now hold that where, as here, a plaintiff recovers compensatory damages for a medical professional’s malpractice, a plaintiff may also recover punitive damages for that medical professional’s act of altering or destroying medical records in an effort to evade potential medical malpractice liability. Allowing an award of punitive damages for a medical professional’s act of altering or destroying medical records in an effort to evade potential medical malpractice liability will serve to deter medical professionals from engaging in such wrongful conduct, punish medical professionals who engage in such conduct, and express public condemnation of such conduct. Thus, the Supreme Court did not err in submitting the issue of punitive damages to the jury.” Good public policy.

  Something very interesting happened last week in the Sunshine State. A comprehensive bill i) Mandating BI coverage for the first time in state history; ii) Legislatively approving Florida’s crazy bad-faith case law; and iii) Eliminating PIP passed both houses. Where do I stand? I do both Plaintiff and Defense PIP in FLA, so I am saddened that my $3000 attorney fee and cost settlements may end. I also think the new bad faith statute will trip up insurance carriers more than the Harvey v. Geico standard. Also, eliminating threshold will lead to larger verdicts and more reversals where the jury find for Plaintiff on LOP medical bills but denies compensation for pain and suffering. The PIP system is quite broken here, only beat out by the roofing cases and the out of control litigation on those matters. Yet, the way people drive in Florida, PIP is a very helpful coverage. There was a compromise bill that I thought would pass – it would replace PIP with $5,000 in mandatory Medpay coverag

  Florida’s version of American Transit Ins. Co., United Auto Ins. Co, disclaimed benefits on the basis of a purported material misrepresentation that was made on the insurance application. United later realized there was no material misrepresentation and they were mistaken. Medical provider sends bills United Auto Ins. Co well after the 35-day period under FSA 627.736(5)(c) to submit the bills. United Auto denies on this ground. Provider brings a lawsuit stating that the insurance carrier is “equittably esopped” from disclaiming coverage based upon the prior disclaimer. Presuit demand was made; the carrier did not pay. A lawsuit was commenced in Miami-Dade County Court. The parties agreed that necessity, relatedness and reasonableness were not issues. The parties made dueling summary judgment motions. The County Court sustained the defense of equittable estoppel United appealed and the 3d DCA affirned in a written opinion. “Through no fault of his own, Akins was advised by United Auto

  In a case with major implications, the Appellate Term for the 9th and 10th Judicial Districts reached a key compromise behind the dicta found at the Appellate Term’s holding in Fair Price v. Travelers (a precluded defense based upon fraud and unjust enrichment may be recouped in a civil action) and one of the many holdings in Cornell Medical v. Mercury (counterclaims or civil actions for paid-out monies are not permitted when the defense to the paid-out monies has been precluded). Namely, a counterclaim or civil action is permitted where the payments to the alleged fraudulent claims are made within 30-days of receipt of the bills.  To quote the court: If an insurer is precluded from asserting a defense due to its failure to pay or deny a claim within the 30-day claim determination period, it may not later seek to recover amounts it paid on the claim based on a theory of unjust enrichment ( see e.g. Cornell Med., P.C. v Mercury Cas. Co. , 24 Misc 3d 58  [App Term, 2d, 11th & 13th

  I was asked again about the defamation that appears sporadically against me on the internet. I took down my last post because I thought by both OREN ZIV and his attorney being sued for defaming me, it would stop. Well, I was being rational and that was a mistake. I would note that I rid my condominium complex in New York of some bad actors and now I have the joy of having to eliminate the internet of defamation – mostly written in broken English – on a weekly basis. Whatever is written about me is untrue. Sadly, the internet gives anyone the ability to attack who they want anonymously. My next focus in life will be to deal with the protections 230 gives to website operators; I will put that on my 2022 bucket list. What you will note is that if you type my name on yahoo or google, you will see blog posts explaining what I have done and why I am being harassed. Those are written by people who have access to all the facts and are true. Some of them are written by me, but most are not as

  Lumbermens Mut. Cas. Co. v A B Med. Servs., PLLC , 2020 NY Slip Op 07280 (1st Dept. 2020) “As an initial issue, 11 NYCRR 65-3.11 (a) limits no-fault medical billing to employees of the provider that submits claims for no-fault benefits. It is submitted that Supreme Court properly granted judgment in favor of plaintiffs, because the treating providers were independent contractors, as opposed to employees. The record supports a finding that the “degree of control exercised by the purported employer” ( Bynog v Cipriani Group , 1 NY3d 193 , 198 [2003]), “not only over the results produced but also over the means used to produce the results” ( Matter of O’Brien v Spitzer , 7 NY3d 239 , 242 [2006]), was insufficient to give rise to an employer-employee relationship. “Factors relevant to assessing control include whether the worker (1) worked at his [or her] convenience, (2) was free to engage in other employment, (3) received fringe benefits, (4) was on the employer’s payroll and (5) was o

CEDA HEALTH OF HIALEAH, LLC, etc., vs STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY   , 3D21-11 Similar to the 2012 NY regulatory changes, the Florida law prohibits billings for services not rendered.  See  FSA 627.736(5)(b)1.c.. The statute, when triggered, applies to all billings. The NY regulation only seems to apply to services that were billed but not provided. Here are the facts: ” Dr. Canizares testified that he did not have personal knowledge of the treatments, but that based on his review of the records, it appeared that two units of Current Procedural Terminology (“CPT”) code 97110 were mistakenly billed at $90.00 each instead of one unit of CPT code 97110 at $90.00 and one unit of CPT code 97112 at $95.00. Dr. Canizares attested that two units of code 97110 were billed, although only one unit was performed on the date of treatment, and that there was no entry for code 97112 although one unit was performed on that date” The question is whether the provider’s using 97110 twic