Appellate Case Law Update – Necessity of Objection to Boarding Full Medicals Where Medicare Paid

June 12, 2020 by on News

The Fourth District Court of Appeal in Matrisciani v. Garrison Property and Casualty Insurance Co., 4D19-406 (Fla. 4th DCA June 10, 2020), addressed multiple issues frequently argued in personal injury suits.

First, the court concluded a trial court was within its discretion in granting remittitur of an amount of past medical expenses where the amount awarded was more than the expenses submitted to the jury.

In relation to setoffs, the court held that PIP benefits may be setoff from an award after verdict, but the plaintiff is entitled to credit for the premiums that were paid for the PIP coverage.

The court addressed the treatment of Medicare benefits post-trial. It held that Medicare benefits may not be set-off from verdict nor are they properly reduced based on remittitur. Instead, to prevent the Medicare reductions from being included in a verdict calculation, an objection must be raised during trial. Garrison argued the Medicare reduction was required because the plaintiff was a Medicare recipient and Medicare had paid for most of her medical bills. Thus, Garrison argued, the jury verdict should be reduced to reflect the amount the plaintiff had actually paid or was responsible for paying rather than the total amount of Medicare payments. The court noted that in Thyssenkrupp Elevator Corp. v. Lasky, 868 So. 2d 547 (Fla. 4th DCA 2003), it had explained that the reduction of Medicare benefits is solely an evidentiary issue for trial and Medicare payments should not be set-off post-trial. The court reasoned, “If Medicare payments should not be reduced post-trial by way of setoff, reducing them from the verdict pursuant to a remittitur would subvert the purpose of the setoff restriction.” The court concluded Garrison should have raised an objection to evidence during trial if it did not want the Medicare reductions to be included in the calculation of the verdict.

The court explained how trial courts should determine whether a proposal for settlement served by an underinsured motorist (UIM) coverage carrier meets the threshold for entitlement to attorney’s fees based on section 768.79, Florida Statutes. The plaintiff was a front-seat passenger in a vehicle involved in an accident. The plaintiff sued the both the driver and her own insurer, Garrison, because she was concerned that the other driver’s insurance would be insufficient to pay for her medical expenses. Garrison served the plaintiff a $1,000, proposal for settlement. The other driver’s policy limit was $100,000. After a $92,000 verdict was returned, the plaintiff settled with the other driver and based on that settlement, the trial court issued a $111,461.31 judgment. After post-trial reductions, the trial court adjusted the total award to $62,147.73. A judgment against Garrison for $0 was entered because the total award was less than the other driver’s $100,000 policy limit. Based on the $0 judgment and the proposal for settlement, the trial court concluded Garrison was entitled to attorney’s fees.

On appeal, the plaintiff challenged the proposal for settlement arguing, among other things, that the trial court erred in concluding that Garrison had met the threshold amount for an award of fees. The Fourth District disagreed. First, the court explained that the judgment obtained against Garrison, as opposed to the judgment based on the settlement with the other driver, was the proper judgment to be considered. Next, the court explained a UIM carrier’s proposal for settlement “should be viewed in relation to the plaintiff’s potential recovery over the tortfeasor’s insurance limits.” Where a judgement recovered against the tortfeasor is within the tortfeasor’s limits, the UIM carrier is without liability and a $0 judgment is properly awarded. “Thus, any settlement offer made by a UIM carrier in such a case will be greater than the plaintiff’s recovery.”

The court held that the $1,000 proposal was made in good faith and was reasonably related to the amount of damages and was a “realistic assessment” of liability. The court noted that Garrison made the proposal after about two years of litigation and discovery, knew the amount of past medical bills, and the extent of the plaintiff’s injuries. Thus, Garrison could assess the pain and suffering and possible future medical needs in relation to the limit of the tortfeasor’s liability coverage. The $1,000, nominal offer was made in good faith as Garrison “had a reasonable basis at the time of the offer to conclude that [its] exposure [as to its [UIM coverage] was nominal.” (alterations in original).

A key takeaway from this case is that where Medicare benefits have been paid, a party must object during trial to evidence of the full amount of medical bills. Medicare benefits cannot be reduced from an award based on a post-trial motion for remittitur or based on a post-trial motion for setoffs.

If you have any questions about this case or would like to refer an appellate matter, please contact our appellate attorneys.

Geneva R. Fountain
Senior Associate
Direct: 904.493.3769

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