Citations
- 50 Fla. Supp. 2d 96
Full opinion text
OPINION OF THE COURT
WALLACE M. JOPLING, Circuit Judge.
THIS CAUSE having come to be heard and after hearing argument and reviewing memoranda filed by counsel the court finds as follows:
1. The Plaintiffs and Intervenor Department of Health and Rehabilitative Services (the “Department”) stipulated as to the significant facts of the case, which are as stipulated in the Joint Stipulation dated February 13, 1990. Editor’s Note: Joint Stipulation attached hereto.
2. Plaintiffs stipulated as to the intervention of the Department in this case.
3. Pursuant to §409.266(4), Fla. Stat. (1989), the Department is entitled to recovery in full of all amounts of medical expenses provided by the Florida Medicaid Program on behalf of Charles E. Conners, Plaintiff (“Conners”), in the amount of $14,383.06.
(a) The Department has an assignment of Conners’ right to any payments for medical care from a third party, in the amount of $14,383.06, the amount of medical assistance paid by the Department. § 409.266(4)(c), Fla. Stat. (1989); 42 CFR § 433.145 — § 433.146.
(b) Since the Department has paid for medical care pursuant to the Florida Medicaid program, the Department has a lien, for the amount of $14,383.06, the amount of medical assistance paid, upon collateral consisting of the present cause of action at issue in this case, which accrued to Plaintiff Conners as a result of sickness, injury, disease or disability due to the liability of a third party which necessitated the medical care. § 409.266(4)(f), Fla. Stat. (1989).
(c) The Department is automatically subrogated to any rights Plaintiff Conners has to third party payments, and is to recover to the fullest extent possible the amount of medical assistance payments made on Conners’ behalf by Medicaid. § 409.266(4)(b), Fla. Stat. (1989). The Department, as a subrogee which has paid medical expenses, is not limited to a portion of its outlay on the basis of equitable distribution or equitable adjustment. Travelers Ins. Co. v Rodriquez, 387 So.2d 341, 343 (Fla. 1980).
(d) The Department’s rights are not diminished or affected as a result of the recipient’s settlement agreement or agreement to pay contingency fees. § 409.266(4)(e), Fla. Stat. (1989).
(e) Plaintiff Conners relies upon the case of Underwood v Department of Health and Rehabilitative Services, 551 So.2d 522 (Fla. 2d DCA, September 15, 1989) (reh. den. November 8, 1989, mandate issued November 28, 1989, Notice to Invoke Discretionary Jurisdiction of the Supreme Court filed December 8, 1989).
Without deciding as to whether Underwood is binding upon this court, under Stanfil v State 384 So.2d 141 (Fla. 1980), this court finds that the facts in the present case are distinguishable from those in Underwood.
Appellant Underwood had grievous injuries claimed to be worth $3 million for which only $105,000 in insurance was available, $100,000 liability coverage and $5,000 medical pay coverage. In the present case, although a verdict showed Plaintiff Conners’ damages to be $800,000, Conners’ damages agreed upon by Conners and Defendant were $400,000. The reduction of the amount of damages was the result of Conners’ actions, both his own comparative negligence and his settlement agreement. The Department took no part in either. Unlike the situation in Underwood, apparently there were sufficient resources in this case to pay both the claim of Conners and that of his wife.
The 50% reduction in damages was solely due to the actions of Conners, through his negligence and agreement with defendant, after an evaluation of the value of his case. Since no action of a Medicaid recipient can prejudice the subrogation rights of the Department (§ 409.266(4)(e), Fla. Stat.), the 50% reduction agreed to by Conners cannot have the effect of reducing or prorating recovery by the Department. In Underwood, the prorating was not due to the action of the recipient, but due to lack of sufficient third party resources to cover Appellant Underwood’s damages. Accordingly, the equitable prorating established in Underwood should not be applicable in this case.
The Plaintiff Charles Conners’ claim having been settled for an amount far in excess of the medical assistance paid by Medicaid, it is
ORDERED AND ADJUDGED that the Department of Health and Rehabilitative Services be, and the same is, hereby entitled to recover from the proceeds of the settlement in this case, the full amount of medical assistance paid on behalf of Plaintiff Charles E. Conners in the amount of Fourteen Thousand Three Hundred Eighty Three Dollars and Six Cents ($14,383.06) from Plaintiffs or any person holding the proceeds of settlement on Plaintiffs behalf.
DONE AND ORDERED this 13th day of March, 1990, in Chambers at Lake City, Florida.
IN THE CIRCUIT COURT OF THE THIRD JUDICIAL CIRCUIT IN AND FOR MADISON COUNTY, FLORIDA
CHARLES E. CONNERS and SYLVIA M. CONNERS, his wife
JOINT STIPULATION
Plaintiffs Charles E. Conners ("Recipient") and Sylvia M. Conners, his wife, and Intervenor, Department of Health and Rehabilitative Services (the "Department") by and through their undersigned Counsel, jointly stipulate to the following matters:
1. On or about February 19, 1987, Recipient received injuries which are the basis of the current litigation and for which Recipient received medical assistance under the Florida Medicaid Program.
2. The Florida Medicaid Program is a joint program between state and federal governments pursuant to Section 409.266, Fla. Stat. (Supp. 1988) and Title XIX of the Social Security Act, 42 USC 1396, et seg. The Florida Medicaid Program is administered in Florida by the Department under said statutes and state and federal rules' and regulations promulgated under such statutes.
3. Medicaid provided medical assistance in the amount of $14,383.06 on behalf of the Recipient related to his injuries stated in paragraph 1, for medical care provided between February 19, 1987 and April 30, 1987.
4. The $14,383.06 paid by Medicaid covered medical charges of $43,145.06, as provided on Exhibit "A" hereto.
5. Pursuant to section 409.266(4)(f), Fla. Stat., a verified Statement of Lien was, filed on October 6, 1989 in the Official Records of Madison County, Florida in Book 205, pages 259 through 262. The copy of said Statement of Lien attached hereto as Exhibit "B" is a true and correct copy. There is no dispute as to the amount of the lien.
6. Plaintiffs do not dispute the existence of a Department of Health and Rehabilitative Services interest pursuant to Section 409.266(4), Fla. Stat.
7. A verdict was rendered in the present case on October 11, 1989, a copy of which is attached as Exhibit "C". Pursuant to the verdict:
(a) The amount of damages sustained by Recipient Charles Conners was determined to be $800,000, and by Sylvia Conners to be $200,000.
(b) Charles Conners was determined to be 30% negligent.
8. A thirty percent (30%) reduction was made in recovery by Plaintiffs because of the comparative negligence of Mr. Conner.
9. Upon further evaluation of the case", Plaintiff's agreed with Defendant to compromise their claims an additional twenty percent (20%).
10. Plaintiffs received a net settlement of $500,000, present value of agreed damages, $400,000 of which is attributable to Recipient Charles Conners of $100,000 of which is attributable to his wife, Sylvia Conners.
11. On or about November 21, 1989, Plaintiff's and their attorney ("Releasing Parties"), and Federated Mutual Insurance Company and its insured, the Defendant, J.T. Hinton Oil Company ("Released Parties"), entered into a Settlement Agreement and Release of All Claims, pursuant to which the Releasing Parties, inter alia, purport to release the Released Parties, and the Released Parties, inter alia, agreed to make immediate cash payments to the Releasing Parties of $317,849 and certain additional future periodic payments.
12. At no time was the Intervenor Department made a party to, nor did it participate in, settlement discussions or the settlement between the Plaintiffs, Defendant and Federated Mutual Insurance Company.
13. Plaintiffs have entered a contingency fee arrangement with their attorney pursuant to which they are obligated to pay a 40 percent attorney's fee. Their attorney incurred $13,596.63 in costs in pursuing the case against Defendant.
14. Both parties to this Joint Stipulation have read the foregoing and stipulate to said matters. -
IN WITNESS WHEREOF, Plaintiffs and Intervenor, by and through their undersigned counsel, have executed this Joint Stipulation this day of February, 1990.
PLAINTIFFS INTERVENOR
CHARLES E. CONNERS DEPARTMENT OF HEALTH AND
SYLVIA M. CONNERS REHABILITATIVE SERVICES
individually and as
husband and wife
CERTIFICATE. OF SERVICE
I HEREBY CERTIFY that a true copy of the foregoing Joint Stipulation has been sent. by U.S. Mail this /I? day of February 1990, to Stephen Mitchell, Post Office Box 14129, Tallahassee, Florida 32317.
Recipient: Medicaid Humber: TPL File Number: Date Prepared: Charles Conner 2063899011 88-64 December 14, 1988
VENDOR NAME AND ADDRESS VENDOR DATE OF NUMBER SERVICE CHARGES MEDICAID AMOUNT CLAIMED DUE
Tallahassee Memorial Hospital Magnolia t Miccouskee Roads Tallahassee, FL 32303 0101133 02-19-87 $40,905.30 $12,497.80
Tallahassee Regional Medical Center Business Office 1300 Mibcosukee Road Tallahassee, PL 32301 0839175 02-19-87 $557.00 $227.50
Tallahassee Memorial Hospital DP Extended Care 0204447 03-31-87 04-30-87 $720.72 887.04 $720.72 887.04
2nd Floor 1609 Medical Drive Tallahassee, FL 32308 VENDOR TOTAL $1607.76 $1607.76
Tallahassee Memorial er Physicians 1300 Miccosukee Road Tallahassee, FL 32303 0378895 02-19-87 $75.00 $50.00
GRAND TOTAL $43,145.06 $14/383,06
EXHIBIT "A"
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
Client Number: 2063899011
File Number: 88-64
VERIFIED STATEMENT OF LIEN
Pursuant to the provisions of Section 409.266(4)(f), Florida Statutes, notice is hereby given that the Department of Health and Rehabilitative Services has a lien for the amount of medical assistance, as set forth in items 8(f) and