SELECTED CASE EXAMPLES     Updated 1 02 2007

MEDICAL DOCTORS SUE HMOs FOR PAYMENT OF MEDICAL BILLS

Case: Westside EKG vs. Foundation Health, Health Options, and Humana Medical Plan SC05-870, SC05-871, 4D03-4837, Florida Supreme Court

In Westside EKG vs. Foundation, a group of Broward County medical doctors brought a class action lawsuit against several HMOs to recover payment on medical bills. Under Florida Laws, HMOs like those named in this lawsuit are required to “promptly” pay medical claims. The HMOs in this case argued that no private right existed to sue in court for unpaid medical claims under Florida’s HMO Law and that at best, medical providers like Westside EKG can only seek recovery through a state administrative process rather than sue in court. Westside has argued that the HMOs insurance plan document itself requires it to follow the law and “promptly” pay medical claims. Westside EKG further argued that it is a third party beneficiary of the HMO plan since it rendered medical services to patients in the HMO Plan, therefore, it should be entitled to sue under common law theories. The Fourth District Court of Appeal ruled in favor of Westside EKG and reversed a judgment on the pleadings in favor of the HMOs. The Florida Supreme Court affirmed ruling in favor of Westside EKG. The Florida Supreme Court stated that a medical service provider can bring a lawsuit against an HMO for failure to promptly pay claims.

LAWSUIT FILED AGAINST THE NATION’s 5th LARGEST HOUSING PROVIDER FOR DISCRIMINATING AGAINST FAMILIES WITH MINOR CHILDREN
Milsap, Fair Housing Center of the Greater Palm Beaches (FHC), Housing Opportunities Project for Excellence, Inc. (HOPE), vs. Cornerstone Residential Management, Inc., et. al.,
Case: 05-60033-CIV, Judge Marra, United States District Court Southern District of Florida

Miami Resident, Terri Milsap and her two young boys, along with several other single moms, HOPE of Miami, and the Fair Housing Center of the Greater Palm Beaches have filed a class action lawsuit against Cornerstone Residential Management company for discriminating and refusing to rent apartment units to families with minor children at 52 different apartment complexes all over Florida. Cornerstone’s representatives discouraged families with minor children from renting and limited the number of children who may live in apartment buildings. Such discrimination violates the Federal Fair Housing Act of 1968. Cornerstone’s position is that such discrimination did not occur at all 52 complexes and that due to certain green space requirements, limited space and plumbing requirements, it could not enforce the minimum requirements of the law. Milsap, HOPE, and the FHC have discovered that Cornerstone received ½ billion dollars in federal government tax dollars (credits) to develop its residential rental properties and promised the federal government that it would in turn market its rental units to families with children and low-income families. Since the time the lawsuit was filed, Cornerstone has changed its occupancy policies in favor of families with minor children. The case is pending before Judge Marra.

FRANCES VICTIMS WIN PROPERTY INSURANCE CASE

KELSO v. UNIVERSAL PROPERTY & CASUALTY

Patrick and Carolyn Kelso’s modest Stuart home was destroyed by Hurricane Frances and Universal Property and Casualty Insurance did not want to pay the price. Last week, on Wednesday April 19th, they became one more example of ordinary people, victim’s of natural disasters in Florida, that have to fight to get what is their due. The good news? Following a three-day trial, a Martin County jury decided in less than an hour that Universal Property & Casualty must pay the Kelsos for damages to their home caused by Hurricane Frances. As you may recall, on September 4, 2004 this category two Hurricane pounded the Martin County area for nineteen hours. Hurricane Frances lifted the home off the foundation and dropped it back down several times, causing the whole foundation to be twisted and racked. Both the engineer and contractor declared it a total loss. Big Insurance disagreed”

The monster hurricane also ripped the aluminum siding off the home and revealed a 3 foot section of termite-damaged wood. Universal Property & Casualty alleged this three-foot area was “load bearing.” In other words, the carrier denied the Kelso’s claim for over two years, alleging that the foundation was damaged before Frances by the termites. Anexpert engineer, reporting in defense of the Kelso’s testified convincingly that the house was a total loss and the cause was, undoubtedly, Hurricane Frances. Benrubi, argued that the two termite damaged boards, which measured only several feet in length, were not structurally supporting the house and had no effect, direct or indirect, on the damage the house sustained following the hurricane.

TRAVELERS INDEMNITY CO. OF ILLINOIS v. MEADOWS MRI, INC.

The firm represented MEADOWS MRI, LLP, MEADOWS, Inc. center of Boca Raton whose only scanner was destroyed when an explosion within the magnet caused a loss of the magnetic field. Meadows property insurer, Travelers Indemnity, initially denied coverage for the claim and subsequently demanded appraisal to determine the disputed amount of the loss. The trial court awarded Meadows its attorneys’ fees after the firm obtained a significant appraisal award in Meadows favor. Travelers appealed the attorneys’ fee award. The Fourth District Court of Appeal affirmed the fee award, while again recognizing an insured’s right to an attorneys’ fee award upon prevailing in appraisal.

MATHEWS v. AUTO-OWNERS

The firm represented the Mathews who were subject to a $13.8 million dollar judgment resulting from a tragic car accident that left the injured victim a paraplegic. Kelly Matthews and the injured victim were close friends and college roommates at the time of the accident some eight years earlier, but had not spoken since. The firm, brought a bad faith action against Mathews’ automobile insurer, Auto-Owners, alleging their bad faith claims handling caused them to be exposed to the multi-million dollar judgment. The firm successfully negotiated a confidential settlement with Auto-Owners, the result of which generated funding for the lifetime of medical care required by the injured victim and also satisfied the judgment against our clients. This settlement also served as the basis for satisfying a several hundred thousand dollar restitution order entered against Kelly Mathews, now clearing the way for Kelly to obtain her nursing license, and reestablished a severed relationship for old friends.

LAWSUIT FILED AGAINST DELRAY BEACH CONDO ASSOCIATION FOR RACIAL DISCRIMINATION AGAINST WIDOWED BLACK FEMALE

Case: Thomas and Fair Housing Center of the Greater Palm Beaches, Inc., vs. High Point of Delray, Section 1, 05-81040-CIV, Judge Hurley, United States District Court Southern District of Florida

Sometime in July 2006, West Palm Beach Resident Elois Thomas was selling her marital home as her husband passed on, and was seeking to buy a condo in Delray Beach close to her family to live out her retirement days. Mrs. Thomas signed a real estate contract to buy a condo unit in High Point of Delray, Section One for $127,000 cash. Mrs. Thomas submitted her residency application to the Condo Association and awaited her interview. However, the President of the Association, Charles Jordan, rejected her application and returned it to the seller’s realtor stating “she’s black, and blacks are not accepted here” and that he would “stall the application process so that she would be discouraged enough to move on.”The seller’s realtor reported Mr. Jordan and the Association to the Fair Housing Center of the Greater Palm Beaches, who in turn, brought a lawsuit for racial discrimination under the Federal Fair Housing Act of 1968. On the eve of trial, the Association agreed to a settlement of $150,000. Since the time of the discrimination, Mrs. Thomas was able to secure another condo unit in Section Six, High Point of Delray, free of discrimination.

DENTIST/PATIENT SUES HEALTH INSURANCE COMPANY TO FORCE PAYMENT OF MEDICAL BILLS

Case: Chace v. Medical Savings Insurance Company, 03-258, Judge Makemson, Martin County, Florida

The Chaces, both dentists themselves, were insured for health insurance with Medical Savings Insurance Company. After being admitted in the hospital to remove benign tumors, Jennifer Chace’s insurance company failed to fully pay her hospital bills. As a result, the Chaces’ were sued by their hospital for the unpaid bills. Medical Savings paid only a portion of the Chaces’ hospital bills and reduced the payments based on an undisclosed formula not contained in the insurance policy. The Chases’ filed a class action lawsuit against Medical Savings to require it to pay the hospital’s usual and customary charges. The Chases’ also sued claiming that the insurance policy failed to meet the requirements of Florida’s Out of State Group Insurance Laws and the payment formula used by Medical Savings was not disclosed in the insurance policy. The Chaces’ lawsuit is brought on behalf of all insureds in Florida who treated in Florida hospitals and whose bills were not paid or partially paid under the insurance contract. This class action lawsuit was certified and the Fourth District Court of Appeal affirmed the trial court’s certification order.