‘Do justice’: House panel advances tweaks to health insurance lawsuit rules

St. Vincent’s Medical Center requested arbitration.

Legislation to improve two-year-old guardrails for health insurance lawsuits cleared its first House hurdle this week with uniform support on the dais, but mixed reviews from stakeholders.

Members of the House Civil Justice and Claims Subcommittee voted 15-0 for HB 947, which targets a law passed in 2023 to tamp down on lawsuit abuses in Florida.

Supporters say the new, three-page proposal fixes confusion over the 2023 law, through small but vital tweaks, swapping the word “may” for “shall” to afford plaintiffs, defendants and courts the flexibility to include all information pertinent to a case.

Opponents argue it will remove beneficial guidance that outlined mandatory information cases must include while disincentivizing unreasonable claims.

Miami Republican Rep. Omar Blanco, the bill’s sponsor, said HB 947 “promotes consistency, clarity and trust in Florida’s legal system.”

“I’m on no side of anybody but the people who are suffering and to do justice for what has transpired,” he said. “A couple years ago, this took a turn for the worse, and now we’re looking to right that and take a path to a better solution for everybody.”

HB 947, which would go into effect July 1, would allow any court-approved evidence demonstrating the actual value of medical treatments or services, rather than predefined criteria — 120% and 170% reimbursement rates for Medicare and Medicaid, respectively — that is currently allowed.

It would permit evidence in cases about the amount of health care coverage insurers are obligated to pay, reasonable and customary rates, or the amount paid under a letter of protection (LOP) for past unpaid charges. Similar evidence types for future medical treatments or services would also be admissible.

That’s important, said Davie Democratic Rep. Mike Gottlieb, a lawyer, because Medicare and Medicaid rates are “generally significantly lower than what is reasonable and customary” and are not ideal benchmarks.

“Anybody on the defense can bring in the Medicaid or Medicare if they believe that’s reasonable or customary, and a jury can see and hear that evidence,” he said. “This is a better bill. I think we got it wrong in 2023. I think we’re fixing it now.”

Punta Gorda Republican Rep. Vanessa Oliver, a lawyer-turned-ambulance company CEO, agreed “health care rates are all over the place” and that the “government-imposed rate is the floor,” in terms of cost.

“Juries need to see every single (data point and cost) and hear all the relevant testimony so they can make a good, informed decision,” she said.

Public arguments on both sides of the issue were ample at the Thursday committee meeting. Organizations and companies opposing HB 947 included the Florida Insurance Council, The Doctors Company, U.S. Chamber of Commerce, State Farm, Publix, American Property Casualty Insurance Association, Uber, Personal Insurance Federation of Florida and Associated Industries of Florida.

Laurette Balinsky of the Florida Justice Reform Institute said the bill would “undo all the good progress (Florida) made on transparency and damages since 2023,” before which charges on bills were “not grounded in reality.”

Balinsky said health care costs have fallen since Gov. Ron DeSantis signed the 2023 bill (HB 837), a priority for then-Senate President Kathleen Passidomo and House Speaker Paul Renner. She said swapping “may” for “shall” will eliminate uniformity in what evidence must be presented to jurors, replacing it with a discretionary, inconsistent standard.

Ellin Kunz, a certified medical auditor working for Associated Industries of Florida with more than three decades of experience in health care work, said courts before 2023 had a “complete lack of guidance as to what constitutes reasonable value of health care,” but that’s no longer the case.

“We now have guidelines in place to provide objective benchmarks,” she said. “By removing these benchmarks, we will once again not have anything objective.”

But that’s not what HB 947 would do, according to Waylon Thomson of the Florida Justice Association. He noted that when HB 837 passed two years ago, its sponsor, former Sarasota Republican Rep. Tommy Gregory, said its goal was to enable juries to hear all the evidence plaintiffs and defendants bring.

“That’s a fair system,” he said. “Unfortunately, it did not bring balance in application. … Now, the plaintiff is required to not only produce the evidence of the value of the reasonable medical expenses that were incurred, but they also have to bring forth evidence that supports the defendant’s ability to then say the treatment was not proper (and) the expense was not reasonable.”

Thompson cited what he said are conflicting parts of the relevant statute (768.0427). In one section, (b)1, it says the plaintiff “shall” — must — introduce evidence of what health insurance will pay. He said if the plaintiff does not do this, they don’t get any compensation for medical expenses.

And the problem, he said, is that section runs contrary to another subsection, (e), which states, “Individual contracts between providers and authorized commercial insurers or authorized health maintenance organizations are not subject to discovery or disclosure and are not admissible into evidence.”

Thompson pointed out that other bills advancing this Session are also “cleaning up” language in Florida Statutes by replacing “shall” with “may.”

“That’s what needs to be done, and that’s what the bill is doing here,” he said. “It’s saying evidence may include from either the plaintiff or the defendant all the evidence regarding the medical care and (the) cost of it.”

The Florida Medical Association, Florida Chiropractic Association and Anthony Albert, an orthopedic surgeon from St. Petersburg, also appeared at the meeting to support HB 947.

Shortly after the measure advanced Thursday, Florida Chamber of Commerce Mark Wilson issued a statement expressing disappointment.

The bill, he said, undoes the progress made to rebalance Florida’s civil justice system by reinstituting an abusive legal practice that artificially drives up medical damages and allows a handful of unscrupulous doctors and billboard trial lawyers to literally inflate verdicts and exploit the system at the expense of Florida families and local businesses.”

HB 947 will next go to the House Judiciary Committee, its last stop before the House floor. Its upper-chamber companion (SB 1520) by Fort Pierce Republican Sen. Erin Grall awaits a hearing before the first of three committees to which it was referred this month.