The Nation Law Firm Files Class Action Suit Against Florida Insurer

Posted on August 26, 2008 by Mark Nation
The Nation Law Firm has recently filed a class action lawsuit against Blue Cross Blue Shield of Florida, Inc.  

Initially, the Nation Law Firm had sued the Florida Insurance Company for failing to reimburse our client for medical expenses she incurred from two separate back surgeries.  The client sought highly specialized, minimally invasive laser disc ablation as opposed to traditional, open back surgery (discectomy).  Since none of the providers on the Florida insurance company's PPO (Preferred Provider Organization) Plan performed such highly specialized surgery, the insured client was required to go out of the PPO network. 

Our client paid for the two surgeries out-of-pocket, then turned to Blue Cross Blue Shield of Florida for reimbursement.  The Florida insurance company: partially reimbursed her for some of the medical procedures, services, and supplies; approved but did not reimburse her for others; and neither approved nor reimbursed for others.  Incredibly, while the insurer approved and partially reimbursed her for laser surgery at one level of her spine, it refused payment for the identical surgery at a different level of her spine (two months later).  The reason given for the refusal was "this procedure was submitted with a similar procedure and is not payable on the same service date." 

After filing suit against the Florida insurance company, the Nation Law Firm was contacted by another Blue Cross Blue Shield of Florida PPO policyholder with the identical complaint and identical problems with reimbursement.

Research into the Blue Cross Blue Shield of Florida PPO policy and claims payments by the insurer revealed the Nation Law Firm's belief that the Florida insurance company's PPO policy violated Section 627.6044, Florida Statutes, by failing to disclosed actual the specific methodology it used to pay claims.  The Nation Law Firm also believes: the PPO insurance policy violates section  627.6471, Fla. Stat., by reimbursing non-PPO providers at a rate lower that allowed by law and also by requiring the insureds to pay coinsurance in excess of the statutory maximum; the PPO Policy states Blue Cross Blue Shield will base reimbursement of non-PPO physicians on "many factors" when in actuality the insurance company bases its reimbursement on a single factor; and the Florida insurance company simply failed to pay the amounts it was obligated to pay (and even approved for payment).

If the class gets certified, the Nation Law firm will represent Blue Cross Blue Shield of Florida PPO policy holders statewide who have obtained services from non-PPO providers.  
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Court Says No Need to File Timesheets with Fee Motion

Posted on August 13, 2008 by Mark Nation
 In the recent case of McDaniel v. Edmonds, 2008 WL 285272 (Fla. 2nd DCA July 25, 2008), the court held that the Florida Rules of Civil Procedure do not require a party to file timesheets, affidavits, or other evidence along with a timely motion for attorney's fees.

In McDaniel, the previaling parties sought to recover attorney's fees and costs after successfully prosecuting their action. Significantly, the trial court made a determination the prevailing parties were actually entitled to fees and costs. However, the trial court denied the parties' motion for fees and costs.

The prevaling party's motion for attorney's fees and costs was simple and straightforward, referencing the court's prior ruling on entitlement to fees, and asked the court to proceed to set the amount of fees and costs "to comply with the time limitations imposed by the Florida Rules of Civil Procedure."

The trial court denied the motion as facially insufficient because it did not specifically allege a legal basis for attorney's fees and costs.

Florida Rule of Civil Procedure 1.100(b) requires that a motion "shall state with particularity the grounds therefor, and shall set forth the relief or order sought."

The prevailing parties appealed the trial court's denial of their motion. The appellate court held that the prevailing parties' motion sought attorney's fees and costs that the trial court had already determined they were entitled to recover. The appellate court determined that the specific legal basis for the fee award was not at issue in the motion; that at the time the prevailing parties filed their motion, the only remaining issue was the amount of fees and costs.

On appeal, the defendant alternatively argued that the trial court's denial should be upheld because the prevailing parties failed to request a particular amount of fees or costs, and failed to identify the specific costs sought and legal services performed.

The appellate court also dismissed this argument, holding that Fla. R. Civ. P. 1.100(b) does not impose a requirement that motions for attorney's fees and costs be accompanied by affidavits setting forth the amount of fees and costs claimed. This is similar to the federal rule. The advisory committee notes to Fed. R. Civ. P. 54 state, in pertinent part:

"The rule does not require that the motion be supported at the time of filing with the evidentiary material bearing on the fees. This material must of course be submitted in due course, according to such schedule as the court may direct in light of the circumstances of the case. What is required is the filing of a motion sufficient to alert the adversary and the court that there is a claim for fees, and the amount of such fees (or a fair estimate)."

Therefore, while it is important to ensure that post trial motions for attorney's fees and costs are sufficiently detailed and state "with particularity" the grounds and relief sought, nothing in the Rules of Civil Procedure requires that attorney time sheets, affidavits, or other supporting information must be filed with the fee motion.
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