Miami Accident Lawyer Blog

Typically, when a person is injured in a car accident, the insurance company of the at-fault party will step in and attempt to settle the dispute on behalf of its insured. Sometimes, however, the insurance company is unable or unwilling to settle the claim, forcing the injured party to sue. The injured party may later receive a judgment against the insured party that exceeds the amount of the insured’s coverage, leaving him or her on the hook to the injured person for the full amount of the award less what was covered by under the insurance policy.

Under Florida law, bad faith claims allow the insured to sue his or her insurance company to recover the difference between the limit of coverage and the amount of the judgment if the insurance company acted in “bad faith” in attempting to settle the injured party’s claims. Last month, the United States District Court for the Middle District of Florida, issued an opinion in the case of Markel American Insurance Company v. Flugga discussing the elements of a bad faith claim and the elements necessary to establish such a cause of action.

In Flugga, Mark Flugga was found to be at fault for a 2010 motor vehicle accident in which he, his passenger, and two individuals in another vehicle were injured. Flugga’s insurance company, Markel American Insurance Company, was notified of the accident four days after it occurred.

Last month, the U.S. Supreme Court issued a landmark opinion in the case of Wos v. E.M.A. that protects the rights of those who receive settlements or judgements following an accident. Specifically, the ruling prevents states from taking unnecessary large portions of the award for Medicaid reimbursements.

In WOS a victim of medical malpractice and subsequent Medicaid recipient challenged a North Carolina statute requiring that up to one-third of any settlement recovered by a Medicaid beneficiary be paid to the State as reimbursement for payments made for medical treatment. The victim estimated her damages to exceed $42 million, but she eventually settled the claims for $2.8 million. The state court approved the settlement but put one-third of the recovery into escrow pending a determination as to the amount owed to North Carolina for Medicaid payments.

While the case was pending, the North Carolina Supreme Court issued an opinion holding that the irrebuttable statutory one-third presumption was a reasonable method for determining the amount due the State for medical expenses. The Federal District Court that originally heard WOS agreed with the North Carolina Supreme Court, but, on appeal, the Fourth Circuit Court of found otherwise. The U.S. Supreme Court granted certiorari to resolve the conflict between the Fourth Circuit and North Carolina Supreme Court.

In a previous case, the Supreme Court held that the federal Medicaid statute sets both a floor and a ceiling on a State’s potential share of a beneficiary’s tort recovery. The Court determined that federal law requires an assignment to the State of “the right to recover that portion of a settlement that represents payments for medical care,” but also “precludes attachment or encumbrance of the remainder of the settlement.”
Unfortunately, the earlier case did not establish how to determine what portion of a settlement constitutes payment for medical care, allowing North Carolina to adopt the statute presuming one-third a recipient’s the recovery represents compensation for medical expenses.
Writing for a 6-3 majority in WOS, Justice Kennedy stated that the statute’s arbitrary determination that one-third of every settlement was reimbursable to Medicaid constituted a violation of the Federal Medicaid anti-lien provision.

Continue reading