Proposed ‘PIP’ jury instructions

first_imgThe Supreme Court Committee on Standard Jury Instructions in Civil Cases is proposing an instruction and verdict form for claims for personal injury protection (PIP) medical benefits, which are reproduced in full below as well as online at Interested persons may provide comments on the proposals by December 15, but are encouraged to submit them by November 1 for consideration at the committee’s meeting on November 3-4. All comments should be sent to the committee chair, Scott D. Makar, Office of General Counsel, 117 West Duval St., Suite 480, Jacksonville 32202-5721 or via e-mail at [email protected] MI 13 CLAIM FOR PERSONAL INJURY PROTECTION BENEFITS (PIP) (Medical Benefits Only) a. Issues: (Plaintiff) seeks personal injury benefits from (Defendant) for [a medical service] [medical services]. (Plaintiff) is entitled to recover benefits if the service[s] is [are] related to the accident, the service[s] is [are] medically necessary, and the charge[s] for the service[s] is [are] reasonable. [Give this preemptive instruction only where rulings or stipulations have altered the number of issues to be proven.] In this case, there is no dispute that (the service[s] is [are] related to the accident) [and] (that the service[s] is [are] medically necessary) [and] (that the charge[s] is [are] reasonable), but there is dispute over (whether the service[s] is [are] related to the accident) [and] (whether the service[s] is [are] medically necessary) [and] (whether the charge[s] for the service[s] is [are] reasonable). [To be given in all cases. Alter numbering where required due to rulings or stipulations.] Therefore, on this claim for personal injury benefits, you must decide the following: The first issue is whether the service is related to the automobile accident of (date). If you decide that a service is not related to the accident, you should not award damages for that service. If you decide that one or more services are related to the accident, you must then decide a second issue. The second issue is whether the service is medically necessary. If you decide that a service was not medically necessary, you should not award damages for that service. If you decide that one or more services are medically necessary, you must then decide a third issue. The third issue is whether the charge is reasonable. If you find the charge for a service or services reasonable, you should award that amount as damages. If you find the charge for a service is not reasonable, you should determine what is a reasonable amount and award that amount. In determining these issues, you should apply the following definitions: [Give applicable definitions below] a. Services: The term “services” includes, but is not limited to, treatment, diagnostic studies, and supplies provided by the medical provider to the insured. b. Medically Necessary: “Medically necessary” refers to a medical service or supply that a prudent physician would provide for the purpose of preventing, diagnosing, or treating an illness, injury, disease, or symptom in a manner that is: (a) In accordance with generally accepted standards of medical practice; (b) Clinically appropriate in terms of type, frequency, extent, site, and duration; and, (c) Not primarily for the convenience of the patient, physician, or other health care provider. c. Reasonable Charge: 1 In deciding whether the amount of a charge is reasonable, you may consider evidence of: · usual and customary amounts charged and payments accepted by the provider; · reimbursement levels in the community; · various federal and state medical fee schedules applicable to automobile coverages; and · any other evidence relevant to the reasonableness of the charges. You may not, however, award an amount that exceeds the amount the provider customarily charges for like services or supplies. [Burden – To be given in all cases.] If the greater weight of the evidence does not support the claim of (Plaintiff), then your verdict should be for (Defendant). However if the greater weight of the evidence does support the claim of (Plaintiff), then your verdict should be for (Plaintiff) and against (Defendant). [Give when defenses to the claim have been raised.] If, however, the greater weight of the evidence does support the claim of (Plaintiff), then you shall consider the defense[s] raised by (Defendant). [Give in all cases.] “Greater weight of the evidence” means the more persuasive and convincing force and effect of the entire evidence in the case. NOTES ON USE This instruction assumes that the jury will be asked to decide the total amount of medical charges. It is anticipated that the judge will adjust this award in entering judgment to account for any payments previously made by the insurer, as well as for the effect of the 80% limitation in section 627.736(1)(a) and any deductible. COMMENT 1. The definition of “medically necessary” is based on section 736.732(2), Florida Statutes (2003). The committee has added the option of a “prudent health care provider” to this definition in anticipation that the phrase, “prudent physician,” as described in the statute could sometimes be inadequate. This statutory definition is somewhat complex. It is possible that the parties could agree upon a plainer and simpler definition. 2. No definition of “related” is provided in this instruction. Causation can be a complex issue in a PIP case. Generally, to invoke this insurance coverage a bodily injury must “arise out of the ownership, maintenance, or use of a motor vehicle.” See § 768.736(1), Fla. Stat. (2003); Lumbermen’s Mutual Casualty Co. v. Castagna, 368 So. 2d 348 (Fla. 1979). The medical treatment covered by the insurance policy is the treatment that is related to the bodily injury arising out of the ownership, maintenance, or use of the motor vehicle. The committee has been advised that most practitioners prefer to use the term, “related,” as a simple method to explain causation to the jury. The committee does not intend for S.J.I. 5.1 to be given in a PIP case as an explanation of causation. (Footnotes) 1 T his statutory description of reasonable amount may require a supplemental instruction for fee capped diagnostic testing services as described in Section 627.736(5)(b), Florida Statutes (2003). IN THE COUNTY COURT IN AND FOR _________________COUNTY, FLORIDA Case No. Judge Plaintiff, v. Defendant. ________________________________/ VERDICT FORM MI 13 PIP – Medical Services 1. Are any of the services related to the accident of (date). ______ Yes ______ No If your answer is no, your verdict is for the Defendant and you should go no further but to sign and date the verdict form. If your answer is yes, you should answer question 2. 2. Are any of the services medically necessary? ______ Yes ______ No If your answer is no, your verdict is for the Defendant and you should go no further but to sign and date the verdict form. If your answer is yes, you should answer question 3. 3. Are [is] the charge[s] for the service[s] reasonable? If you find the charge or charges reasonable, you should proceed to number 4. However, if you find the charge or charges unreasonable, you must determine a reasonable amount for the charge or charges, then proceed to question 4. 4. What is the total amount do you find reasonable? $____________________ SO SAY WE ALL, this _____ day of ________________________, _______. ___________________________ FOREPERSON October 15, 2005 Regular News Proposed ‘PIP’ jury instructionscenter_img Proposed ‘PIP’ jury instructionslast_img read more

Multi-asset funds face challenge to win back investors

first_imgThe ethos of DGFs is to offer a wide range of assets that all react differently to market movements. Some will move up while others move down, theoretically offsetting losses.However, with equity markets being artificially supported by quantitative easing and bond markets finding favour with yield-hungry investors, the fundamental DGF process has often failed in the past 10 years, as loss-offsetting has not been needed.Yet, despite poor performances, Arthur said he valued the diversification these funds brought to institutional portfolios: “In many UK pension funds, a DGF is the only bit of the investment that can be used to express asset allocation decisions in a timely fashion.”However, some managers’ reliance on diversification – and a failure to use this opportunity to make dynamic investment decisions – was cited as one of the reasons for some investors’ disenchantment with the strategy.Steven Crane, a trustee for a small, open defined benefit scheme that has switched several of its managers in the past seven years, said some of its DGFs focused too much on diversification instead of tracking the equity market when it made sense, for example.Crane’s scheme was “wary of pulling the trigger now” and moving back into DGFs, he said, with the sponsor’s priority being low-volatility, low-risk return streams.The panel agreed that DGFs could help deliver lower volatility to an investment portfolio as a whole.Overall, the participants said the current mood could take another five years to change, with the onus falling on consultants to help clients decide which type of DGF might help them in the future.However, this has become a complex task, as the universe now contains more than 100 DGFs, up from 20 a decade ago, according to Arthur.The white paper is available to download here. Multi-asset funds face years of trying to win back institutional investment clients after a decade of wrong turns, according to a panel of trustees, fund managers and consultants.In a discussion, hosted by data provider Camradata, institutional investors pointed to where the funds had failed them since the financial crisis – and what their managers would have to do to win back confidence.John Arthur, senior consultant at MJ Hudson Allenbridge, said it had been a “tough few years” for diversified growth funds (DGFs), another term for multi-asset strategies.“A long bull market in equities since the global financial crisis has made clients wonder whether to keep faith with DGFs,” said Arthur. “A basic equity/bond allocation would have done a better job than most.”last_img read more

O’Neill: We were pathetic

first_img O’Neill has been buoyed by strong showings against the likes of Russia and Portugal in Group F but this was a nadir and he did not pull any punches in his assessment. “It was a really poor performance – we lacked energy, intensity, intelligence. The management of the game from start to finish was pathetic,” he said. “We got what we deserved. We didn’t deserve anything…Luxembourg were the better side. It was a really, really poor performance. “There was not a single positive out of that game.” Asked to put his finger on a precise reason for the way his side were outplayed by a side languishing 140th in the FIFA rankings, O’Neill had plenty. “Lack of energy, lack of desire to play, lack of intensity, lack of leadership. Take your pick,” he said. Northern Ireland were cheered on by an impressive away contingent of 1,200 – a group who did not turn on the side even as the game slipped from their grasp in the second half – and O’Neill offered a frank apology to them. “I feel for the people who have travelled to watch that,” he said. “It’s not acceptable and not the level of performance I would expect from my team. Luxembourg came into the match with more Eurovision Song Contest victories than World Cup qualifying wins, with five of the former and just three of the latter, but they narrowed the gap when Mathias Janisch stabbed home in the 87th minute to record a well-earned win. Northern Ireland had taken the lead through Martin Paterson and then levelled at 2-2 thanks to Gareth McAuley’s header but were comfortably second best and would have been fortunate to leave with a point. Press Association Northern Ireland manager Michael O’Neill branded his side’s performance against Luxembourg “pathetic” after they were turned over 3-2 at the Stade Josy Barthel. “The players are pretty clear on my feelings. As a manager and a group of players we owe the fans an apology.” O’Neill was controlled but simmering beneath the surface as he offered a scathing verdict on what he had seen and the positivity of last month’s morale-boosting 1-0 win over Russia seemed an age ago. “When we drew the home games against Luxembourg and Azerbaijan I had a certain level of sympathy because I felt on the night we did a lot of positive things, but this was as poor a performance as I’ve ever been associated with,” he said. “If we are at it all of the basic ingredients for playing football are there and we’ve shown what capable of. But if we’re not we have no right to think we’re better than Luxembourg or Azerbaijan or anyone out there. That has been proven.” Luxembourg boss Luc Holtz was effusive in his praise for the hosts, who last won a World Cup qualifier in 1972. “This was one of the best games our team has seen in a long time,” he said. “Northern Ireland’s first shot on goal went in, so we were unlucky, but in our eyes our team played much, much better. “It was a very good performance. The whole team was brilliant. “We like to play the attacking way and the players like to do this too. This is the way we will play in the future.” last_img read more