Workers Compensation Lawyers Florida, West Palm Beach, Fort Lauderdale, Orlando, Workers Comp Lawyer http://workerscompfl.net Tue, 30 Jun 2020 15:22:17 +0000 en-US hourly 1 https://wordpress.org/?v=4.4.23 Material Misrepresentation wihout the Misrepresentation http://workerscompfl.net/material-misrepresentation-wihout-the-misrepresentation/ http://workerscompfl.net/material-misrepresentation-wihout-the-misrepresentation/#respond Mon, 01 Jun 2020 21:58:30 +0000 https://workerscompfl.net/?p=4612
A number of low-budget insurers target segments of South Florida’s population where English is a second language.  The scam by insurance companies works as follows:
First, the individual goes to an insurance agency to obtain PIP insurance for their automobile.  The insured pays their premium and believe they have automobile insurance to cover their medical expenses if and when they are injured in an automobile accident.
Upon getting in an automobile accident and seeking medical treatment, the insurance company sets up an Examination Under Oath (EUO), and asks the insured all sorts of questions.  The questions revolve around a number of issues ancillary to the insurer’s purpose for the questioning, such as the medical treatment and what happened to cause the accident.  The real purpose for the EUO is engage in post-loss underwriting.
Post-loss underwriting is a practice in which  the insurer investigates the application for insurance after an insurance claim.  The insurer asks questions about prior accidents and household members.  If they found out that something was not disclosed on the application for insurance, they claim there is a  “material misrepresentation” and rescind the insurance policy.  The insured’s medical bills are never paid for, and it is as if there was no insurance in the first place.

Post-loss underwriting is an illegal practice in many states.  However, this reprehensible practice is still legal in the state of Florida.  What this practice allows insurers to do is to collect premiums, and make money off those premiums.  The insurer, despite having many tools accessible to them, does not verify any of the information obtained by their agents unless and until there is a claim by the insured.  Once there is a claim, the insurer seeks to rescind the policy.
This practice seeks to guarantee that the insurer does not have any risk.  The insurer collects premiums on policies where there are no claims, and does not pay out on policies where there are claims.  This guarantees maximum profits for these predatory insurers.
The majority of the time, the target of these scams are some of the minority communities in South Florida.  These insurers have targeted our Haitian and Hispanic communities predominantly.
Our firm has discovered the prevalence of fraud by these insurers and their agents in procuring
pplications for insurance and in improperly rescinding insurance policies.  Many times, the insurer is lying about household members they “discover” live with the applicant for insurace.  Other times, none of the questions on the application have ever been asked of the insurance applicant.  Much of the time, the applicant for insurance does not even speak English.

If you have had any claims denied for material misrepresentation, please contact Attorney Lyle Masnikoff or Attorney Kevin Davies at

(877)817-4127, so that we can fight for your rights.
Lyle Masnikoff & Associates, P.A.
1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
877-817-4127
www.workerscompfl.net

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Social Security Disability Grid Rules http://workerscompfl.net/social-security-disability-grid-rules/ http://workerscompfl.net/social-security-disability-grid-rules/#respond Mon, 01 Jun 2020 21:36:03 +0000 https://workerscompfl.net/?p=4608 If a person has a severe impairment, does not meet or equal a disability listing, and is unable to return to any work they performed in the past 15 years, the Grid Rules come into play to determine if they are disabled.  The Grid Rules are basically a series of charts that are set up based on the exertional level of work that SSA believes a person is capable of functioning at, their highest level of education, their age and past work.   

The charts range from sedentary to very heavy work.  Using the Grid Rules a person with physical impairments who is at advanced age, 55 plus, has a much higher chance of being considered disabled then someone aged 18-49 who is considered a younger individual.  Anyone 49 and younger who can speak English is generally considered not disabled under the Grid Rules.  If a person has both  physical and mental impairments, SSA will first determine if they are considered disabled based on the physical conditions per the Grid Rules.

If there is a finding of not disabled based on the physical, exertional limitations, the mental non-exertional limitations are considered to determine how they would further affect your ability to perform work.  Non-exertional limitations include difficulty with concentration and memory and normally come from conditions such as Bipolar Disorder and Depression.  Exertional limitations include ability to walk, sit, bend and stoop and can be caused by back or joint problem.

Keep in mind, the Grid Rules is only one way to qualify for benefits, but age plays a huge role in the results when applying the grid rules to determine disability.
If you have questions about the Grid Rules and any other Social Security Disability topic, please do not hesitate to contact Attorney Lyle Masnikoff at (877)817-4127.

 

Lyle Masnikoff & Associates, P.A.
1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
877-817-4127
www.workerscompfl.net

 

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State Farm’s 9810A Policy Before Supreme Court of Florida http://workerscompfl.net/state-farms-9810a-policy-before-supreme-court-of-florida/ http://workerscompfl.net/state-farms-9810a-policy-before-supreme-court-of-florida/#respond Fri, 27 Mar 2020 14:05:23 +0000 https://workerscompfl.net/?p=4592 Currently before the Supreme Court of Florida is the case of MRI Associates of Tampa, Inc., Etc. vs. State Farm Mutual Automobile Insurance Company.  At issue is whether the 9810A policy unambiguously elected to reimburse at 80 percent of the schedule of maximum charges.
The case is an appeal from the 2nd DCA’s decision in which the appellate court ruled in favor of State Farm.  The 2nd DCA found that State Farm’s policy was properly written to properly elect to pay at fee schedule.  While the 2nd DCA is the only district court of appeal decision on the matter, lower courts have been split on the issue.  The 2nd DCA certified the question to the Florida Supreme Court  as one of great public importance.

If the Florida Supreme Court rules in favor of medical providers, we can expect medical providers who billed at above medicare fee schedule to receive additional payments for their underpaid services.

Oral arguments before the Florida Supreme Court are scheduled for May 6, 2020.   We will update you once the Supreme Court rules on the matter.  If you have questions about this case or any other PIP issues, please do not hesitate to call Attorney Lyle Masnikoff or Attorney Kevin Davies at (877)817-4127.

 

Lyle Masnikoff & Associates, P.A.
1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
877-817-4127
www.workerscompfl.net

 

© Copyright 2020. All Rights Reserved.

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Effects of Coronavirus (COVID-19) on Social Security Disability Cases http://workerscompfl.net/effects-of-coronavirus-covid-19-on-social-security-disability-cases/ http://workerscompfl.net/effects-of-coronavirus-covid-19-on-social-security-disability-cases/#respond Thu, 26 Mar 2020 15:42:45 +0000 https://workerscompfl.net/?p=4588 As we are facing a healthcare pandemic, many people are wondering what will happen with their Social Security Disability case and/or benefits.  The good news is your benefits will not be stopped or suspended nor will upcoming hearings. 

As of March 17, 2020, all Social Security Offices are closed to the public but if you have an upcoming hearing, you will be contacted by the hearings office to offer you a hearing via telephone. 

Telephonic hearings are being offered so that your case is not delayed but if you prefer your hearing to be heard in person, they will rescheduled your hearing for a later time so that you can see the Administrative Law Judge live.  If you elect a telephonic hearing, you will be called on the date and time of your hearing in a conference call with your representative and the Judges office.

Social Security can still be contacted by telephone and they are also being very lenient with time deadlines for submitting documentation and appeals with their good cause policy.  Many documents can be mailed or faxed into their offices or deadlines will be waived until the office re-opens to the public.

Social Security will also be suspending any current continuing medical disability reviews, where possible collections of over payments, any third party requests for information except for Appointed Representatives and Representative Payees, and Freedom of Information Act requests.

Our office remains open.  We are continuing to help our clients get accepted as Disabled by the Social Security Administration.  If you have any questions or need help getting SSDI, please do not hesitate to call Attorney Lyle Masnikoff. We practice throughout Florida and you can reach any one of our offices at (877)817-4127.  Stay safe, and we will go get through this!

 

Lyle Masnikoff & Associates, P.A.
1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
877-817-4127
www.workerscompfl.net

 

© Copyright 2020. All Rights Reserved.

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“Coronavirus and Workers’ Compensation” http://workerscompfl.net/coronavirus-and-workers-compensation/ http://workerscompfl.net/coronavirus-and-workers-compensation/#respond Tue, 24 Mar 2020 14:34:29 +0000 https://workerscompfl.net/?p=4585

 As more and more businesses are shuttering their doors due to the Coronavirus pandemic, employees and employers are left with many unanswered questions regarding what is going to happen in terms of  what benefits the employees and employers may be entitled to in an effort to stave off the negative financial impact that this will have on everyone’s lives.

Luckily, the Government is working very hard to try to devise and implement stimulus packages that will  help alleviate the burden on business owners, as well as on employees who are out of work due to their job being forced to close or work within very restrictive, buy important, parameters.

The industry that comes to mind is restaurants.  In Florida, restaurants can still stay open but only for take out purposes.  This means that many servers and bar tenders will not be needed, leaving many Floridians out of a job.  On the other hand, some industries seem to be thriving and even hiring temporary employees.  Company’s such as Publix, Walmart, Domino’s, Amazon, etc… have all stated that they are hiring thousands of workers to keep up with the demand.  This could be a huge blessing to those workers who are displaced due to the Coronavirus, as they now have an opportunity for employment, even if temporary, until this pandemic passes.  Which it will.

A lot of workers, and employers, have questions regarding what to do if you come into contact with someone in the workplace and end up testing positive for Coronavirus.  Does workers’ compensation kick in?  The short answer is that it depends.  It depends on what industry you are working in.   If the employee contracts the virus in the course and scope of their employment because their job requires them to be exposed to persons who are infected, then there could be a potential workers compensation claim where the employee is entitled to benefits, such as medical treatment and indemnity, or missed wages.

The most common industry where one would see this are health care workers who, as part of their duties, have no choice but to be exposed to patients who may have Coronavirus.  On the other hand, if you contract the disease from a co-worker, customer, or someone else who just happens to be at your jobsite or place of business, workers’ compensation benefits would most likely not apply.   If you fall into the ladder and contract the disease, we implore you to use your paid time off as well as the Family Medical Leave Act.  With the stimulus that passed last week, you may be entitled to paid sick leave for up to two weeks as well as some economic benefit while on FMLA, which typically is unpaid.

Throughout Mr. Masnikoff’s twenty-year career he has worked tirelessly to ensure that Floridians are provided quick and efficient medical and missed wage benefits under the law so that they are able to return to gainful employment.   If you or a loved one are in the medical industry and have questions regarding what to do if you have contracted Coronavirus through contact with a patient or have temporarily lost your job due to the pandemic, please contact us as we are here to answer any question.  The consultation is always free.  We practice throughout Florida and you can reach any one of our offices at (877)817-4127.  Stay safe, and we will go get through this!

 

Lyle Masnikoff & Associates, P.A.
1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
877-817-4127
www.workerscompfl.net

 

© Copyright 2020. All Rights Reserved.

 

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“Chronic Traumatic Encephalopathy or CTE and Workers Compensation” http://workerscompfl.net/chronic-traumatic-encephalopathy-or-cte-and-workers-compensation/ http://workerscompfl.net/chronic-traumatic-encephalopathy-or-cte-and-workers-compensation/#respond Tue, 10 Mar 2020 13:06:32 +0000 https://workerscompfl.net/?p=4582 As the Big Game has come and went and another football season behind us, most of us outside of Kansas City are left to wonder what changes our team could have made to have been in the hunt and come away with that trophy.  In recent years however, there has been another story permeating away from the lights and glamor and super bowl wins.  A phrase that is unfortunately becoming somewhat of common place.  “CTE” or Chronic Traumatic Encephalopathy has been making head lines in recent years mainly due to ex-football players being diagnosed with same.

According to the Concussion Foundation, CTE is a degenerative brain disease mainly found in athletes, military veterans and others with a history of repetitive brain trauma.   One major issue in the diagnosis is that symptoms do not generally begin until years after the impacts.  The Concussion Foundation states that CTE can currently only be diagnosed after death through brain tissue analysis.  A recent case out of California found Pro Football Hall of Famer Kellen Winslow Sr. filing a workers’ compensation claim for brain and nervous system injures due to repetitive trauma to his head during his football career.  In the workers’ compensation case Winslow Sr. claims that his years of playing football resulted in “cognitive and behavioral disorders.”  According to the Concussion Foundation early symptoms of CTE usually manifest in a patient’s altered mood and behavior and case impulse control problems, aggression, depression, and paranoia.  Mr. Winslow Sr. could be experiencing the onset of CTE.   The claim was denied on the defense that the Statute of Limitations had expired.

In Florida, you have two years to bring your claim.  There are certain exceptions to this two-year Statute of Limitations, one of which you see in repetitive type claims.  Repetitive claims are difficult because essentially every impact or “hit” is arguably either a new injury or a continuation of an injury sustained in an earlier impact.

The major issue with these types of injuries is that you may not begin to feel the effect or even know that you were injured until years later, at a point where you may not even be in the same profession, just as with Mr. Winslow Sr.

Throughout Mr. Masnikoff’s twenty-year career he has worked tirelessly to ensure that Floridians who suffer repetitive injuries on the job receive the proper benefits and receive them timely.  If you or a loved one suffered repetitive trauma to your head, or any injury sustained due to some repetitive impact or action while working, and have concerns and or questions regarding what rights you are entitled to under Florida’s workers compensation law, please contact us as we are here to answer any question.  The consultation is free.  We practice throughout Florida and you can reach any one of our offices at (877)817-4127.

 

Lyle Masnikoff & Associates, P.A.
1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
877-817-4127
www.workerscompfl.net

 

© Copyright 2020. All Rights Reserved.

 

 

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Overpayments   http://workerscompfl.net/overpayments/ http://workerscompfl.net/overpayments/#respond Sat, 01 Feb 2020 16:03:12 +0000 https://workerscompfl.net/?p=4577  

Unfortunately overpayments are a pretty common occurrence that may or may not be at any fault of your own.  An overpayment occurs when Social Security pays you more then they should have paid.  This can happen due to changes in your living arrangements, no longer being disabled, beginning to work, receiving a settlement in a lawsuit, providing Social Security with insufficient information or changes in your marital status.

Once Social Security notices the error, they will send you a notice explaining why you have been overpaid, your repayment options, and your appeal and waiver rights.  If you do not believe you have been overpaid or you disagree with the amount of your overpayment, you can file an appeal.  If the overpayment was accurate but you feel you should not have to re-pay the money then you can file a waiver. The waiver must prove that the overpayment was not your fault and that paying back the overpayment would cause financial hardship or be unfair to you. If you file an appeal or waiver, Social Security will not withhold money until they decide if the appeal or waiver will be granted.

Failure to re pay overpayments to Social Security can result in them taking the money from your tax returns, your monthly pay checks, future benefits and even reporting you to the credit agencies.

If you have any questions about Social Security Disability Benefits or Overpayments, please do not hesitate to contact Attorney Lyle B. Masnikoff at 877-817-4127.

 

Lyle Masnikoff & Associates, P.A.
1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
877-817-4127
www.workerscompfl.net

 

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“Windhaven Bankruptcy and What it Means for Medical Providers” http://workerscompfl.net/windhaven-bankruptcy-and-what-it-means-for-medical-providers/ http://workerscompfl.net/windhaven-bankruptcy-and-what-it-means-for-medical-providers/#respond Wed, 01 Jan 2020 15:44:29 +0000 https://workerscompfl.net/?p=4572 It was recently announced that Windhaven Insurance Company went bankrupt and is in receivorship.  As many medical providers and insureds are aware, they were an insurance company that looked for any reason they could to avoid the payment of insurance claims.  As a result, many medical providers have significant amounts of unpaid medical bills.  The question on the minds of many of these medical providers is whether they will get paid or not.

For cases we have that are in litigation, the cases will be taken over by Florida Insurance Guaranty Association (FIGA).  While we were successful in resolving many Windhaven lawsuits prior to their liquidation, we still have dozens of lawsuits with Windhaven.  We have received correspondence from FIGA attorneys.  The attorneys have requested copies of itemized statements/billing ledgers.  In addition, they have requested copies of medical bills/therapy notes.

The reasons for the requests of these documents is so that FIGA can process these claims.  It is unsure at this point how that will be done, how long it will take, and how much money you will get.  Per statute, the medical provider will not be entitled to interest.

As always, we will continue to keep our clients updated on these matters.  We are available to answer any questions regarding this or any other issue.  If you have any questions, please feel free to call Attorney Lyle Masnikoff or Attorney Kevin Davies at 877-817-4127.

 

Lyle Masnikoff & Associates, P.A.
1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
877-817-4127
www.workerscompfl.net

 

© Copyright 2020. All Rights Reserved.

 

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Will RFC’s Really Help Me Get on Social Security Disability? http://workerscompfl.net/will-rfcs-really-help-me-get-on-social-security-disability/ http://workerscompfl.net/will-rfcs-really-help-me-get-on-social-security-disability/#respond Sun, 01 Dec 2019 12:51:30 +0000 https://workerscompfl.net/?p=4564 We provide RFC’s (residual functional capacity questionnaires) to our clients for them to take to their doctors to complete on our Client’s behalf.  Many of the clients ask the reasoning for these forms as we already have the client’s complete chart from the doctor’s office.

 The reasoning is that RFC’s both physical or mental are so important is that they ask of the doctor exactly what the Social Security Administration is looking for.   No matter how great your physician may be, their records may never provide Social Security with the information they will need to favorably approve a claim.

RFC’s help determine what a Claimant is capable of doing during a normal 8 hour workday due to your physical or mental conditions and also your impairments related symptoms such as pain, difficulty concentrating or fatigue.  RFC’s also determined if your medical conditions affect your ability to interact with others such as co-workers, supervisors and the general public.

At the hearing level the Administrative Law Judge will also take into high consideration the limitations placed on you by your treating physicians through the RFC.  The limitations placed may prevent you from returning to your past relevant work, and can also have the vocational expert state that there is not a job that you are capable of performing due to your limitations.

We highly recommend the use of RFC’s.  Many people who do not have an attorney, have no idea what an RFC is and how to use it.  If you have questions about RFC’s or anything else related to Social Security Disability benefits, please do not hesitate to contact us at (877)817-4127.  The consultation is free.

 

Lyle Masnikoff & Associates, P.A.
1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
877-817-4127
www.workerscompfl.net

 

© Copyright 2019. All Rights Reserved.

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Was Your Insurance Policy Rescinded? You May Still Have a Case http://workerscompfl.net/was-your-insurance-policy-rescinded-you-may-still-have-a-case/ http://workerscompfl.net/was-your-insurance-policy-rescinded-you-may-still-have-a-case/#respond Fri, 01 Nov 2019 12:01:19 +0000 https://workerscompfl.net/?p=4559 Policy Rescinded?
In, Jarvis McKiver v. Windhaven Insurance Company, 26 Fla. L. Weekly Supp. 320a (13th Judicial Circuit in and for Hillsborough County, June 7, 2018), in which the Court granted summary judgment in favor of the insured on the issue of material misrepresentation.

In finding for the insured, the Court held that the insurer’s opposing affidavit, on which the insurer relied as evidence that the premium rate would have changed if the insurer’s co-resident grandmother had been listed on the application for insurance, is inadmissible hearsay and not based on personal knowledge of the affiant.  As a result of the Court’s finding that the affidavit was based on inadmissible hearsay and not based upon the affiant’s personal knowledge, the Court struck the affidavit.

This case illustrates an important point.  Very often, medical providers will write-off PIP cases as being lost causes, particularly in situations such as material misrepresentation cases.  The medical provider gets notice from the insurer that the policy of insurance is rescinded due to material misrepresentation, and that there is no policy to provide coverage.

As with many other cases, the insurance company made a huge mistake in this material misrepresentation case: they did not have the proper evidence.  In many cases, the insurance company has incorrect information on which they base their rescission.  In other cases, the insurance company has an ambiguous policy and/or insurance application, which could be read any number of ways.  Still, in other cases, the correct information could have been relayed to the insurance agent, but the insurance agent put down incorrect information.

It is important for medical providers to send all PIP cases to a qualified PIP attorney.  While there is no guarantee of success in every case, a qualified PIP attorney will help a medical provider to maximize the recovery of PIP benefits.  If you have a question or need our help, please do not hesitate to contact Attorney Lyle Masnikoff or Kevin Davies at (877)817-4127.  The consultation is free.

 

Lyle Masnikoff & Associates, P.A.
1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401
877-817-4127
www.workerscompfl.net

 

© Copyright 2019. All Rights Reserved.

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