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Burden of Proof for Temporary Partial Disability Benefits

Posted in Legal Alerts on May 10, 2021

Where a claimant has work restrictions and no earnings, she only needs to prove a causal connection between the injury and the loss of income.  Specifically, a claimant can meet her prima facie entitlement to TPD benefits by demonstrating that she is unable to successfully perform the tasks of her pre-injury job which directly resulted in a cessation of the performance of that employment and a reduction of her income below 80% of her AWW.  See Wyeth/Phama Field Sales v. Toscano, 40 So.3d 795 (Fla. 1st DCA 2010).  The court has laid out a three part test; the claimant needs only to show (1) that she is not a maximum medical improvement, (2) that she has restrictions which prohibit her pre-injury employment and (3) that she has a reduction of income below 80% of her AWW.

 

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Filing for Workers’ Compensation Exemption in Florida

Posted in Legal Alerts, Newsletters - 2021 on May 6, 2021

Workers’ compensation is a type of insurance that protects employees if they are injured on the job and limits the liability exposure of the businesses that employ them. The insurance provides medical benefits and wage replacement for the employee depending on the nature of their injuries while also protecting the employer from lawsuits related to the incident that caused the injury at work. While workers’ compensation can be considered an essential benefit for employees, many business officers find they do not require the same protection.  Those who work in administrative and/or management roles may have a significantly lower risk of sustaining a work-related injury, making workers’ compensation coverage unnecessary. Because insurance providers use a business’ total payroll to calculate insurance premiums, removing an officer’s salary can reduce insurance expenses. To do this, the officer needs to file for a workers’ compensation exemption. Exemptions can make it easier for a business to meet Florida’s workers’ compensation requirements while maintaining a reasonable profit margin.

  

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The New Summary Judgment Rule

Posted in Legal Alerts, Newsletters - 2021 on April 29, 2021

On April 29, 2021, The Florida Supreme Court issued its long-awaited opinion on how the new summary judgment standard it promulgated on December 31, 2020 will be applied after its effective date of May 1, 2021. This standard is not “new” but rather it is patterned after the federal summary judgment standard. The Supreme Court has made it clear that, as a result, federal case law interpreting Federal Rule 56 will be persuasive in state courts. 

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Third District Court of Appeal Issues Important Ruling on Determining the Proper Medicare Fee Schedule for Purpose of PIP Reimbursement

Posted in Legal Alerts, Newsletters - 2021 on April 28, 2021

On April 28, 2021, Florida’s Third District Court of Appeal issued its opinion in Priority Medical Center, LLC. a/a/o Susan Boggiardino v. Allstate No. 3D20-291. In Priority, the Court addressed whether the non-facility participating price or the non-facility limiting charge was the applicable fee schedule for Medicare Part B for 2007, for purposes for PIP reimbursement under the Schedule of Maximum Charges. The Court held the higher 2007 non-facility limiting charge was the proper reimbursement rate, affirming the lower court’s decision.

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Trends in COVID-19 Florida Insurance Coverage Litigation

Posted in COVID-19, Legal Alerts on April 22, 2021

Historically, nationwide insurance coverage issues that significantly affect the economy do not get resolved quickly. For those who lived through the long-term and complex insurance coverage issues surrounding asbestos liability and environmental liability, it comes as no surprise that COVID-19 insurance coverage litigation is far from being over.

 

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