Volume 15

15 Fla. L. Weekly Supp. 900a

Insurance -- Uninsured motorist -- Other insurance -- Priority

15 Fla. L. Weekly Supp. 901b

Insurance -- Uninsured motorist -- County that was self-insured at time county bus collided with insured's vehicle is deemed statutorily uninsured, and insured was not required to seek compensation from county prior to seeking payment under UM coverage -- County is not indispensable party to insured's action against UM carrier

15 Fla. L. Weekly Supp. 1174a

Insurance -- Uninsured motorist -- Coverage -- Stacking -- Where policy had non-stacking UM option, insured is not covered for accident that occurred while insured was driving vehicle owned by named insured and not insured under policy

15 Fla. L. Weekly Supp. 1015b

Insurance -- Property -- Failure to pay or deny claim within 90 days -- Statute that requires property insurer to pay or deny claim within 90 days of receipt specifically forbids private cause of action based solely on failure to comply with requirement -- Complaint for breach of contract based on failure to comply is dismissed with prejudice

15 Fla. L. Weekly Supp. 744a

Insurance -- Personal injury protection -- Witnesses -- Expert -- Where expert witness who performed medical records review testified in deposition that he does not maintain record of other cases in which he has testified at trial or by deposition and would not be able to supply that information to medical provider, motion to strike witness is granted

15 Fla. L. Weekly Supp. 630c

Insurance -- Personal injury protection -- Provider/assignee's action against insurer -- Venue -- Forum non conveniens -- Motion to transfer venue from Broward County to Orange County -- Discussion of factors underlying court's ruling

15 Fla. L. Weekly Supp. 850a

Insurance -- Personal injury protection -- Venue -- Forum non conveniens -- Insurer's motion to transfer venue based on forum non conveniens is denied where insurer has failed to identify potential witnesses

15 Fla. L. Weekly Supp. 1208b

Insurance -- Personal injury protection -- Venue -- Forum non conveniens -- Where fact witnesses are located in county other than Sarasota County, and only connection to Sarasota County is chance that medical provider chose to locate corporate operations manager there, interests of justice are not achieved by litigating PIP case in Sarasota County -- Motion to transfer venue granted

15 Fla. L. Weekly Supp. 1207b

Insurance -- Personal injury protection -- Venue -- Motion to transfer venue granted

15 Fla. L. Weekly Supp. 935b Insurance -- Personal injury protection -- Tender -- Validity -- No merit to argument that tender of full amount of claim accompanied by letter…

15 Fla. L. Weekly Supp. 1201a

Insurance -- Personal injury protection -- Standing -- Assignment -- Reformation -- Where it is undisputed that assignment contains scrivener's error naming wrong assignee, and true intent of parties to assignment was to name medical provider personally, rather than medical center, as assignee, provider and insured are entitled to reformation of assignment -- Reformation relates back to date assignment was executed and renders insurer's defense of lack of standing moot -- Motion to dismiss reformation count for failure to name medical center as indispensable party is denied where it was unnecessary to add center as party because center is wholly owned by medical provider who was before court

15 Fla. L. Weekly Supp. 282b

Insurance -- Personal injury protection -- Fraud on court -- Sanctions -- Where insurer repeatedly and contumaciously violated court orders and falsely attested that medical bills at issue were applied to deductible and as to amount expert witness was paid for participation in another trial, insurer's pleadings are stricken and default is entered

15 Fla. L. Weekly Supp. 263a

Insurance -- Personal injury protection -- Reimbursement from owner or insurer of commercial vehicle -- Taxicab passenger -- Taxi company's commercial and general liability insurance carrier is required to reimburse injured passenger's PIP insurer -- Where evidence shows vehicle was primarily used for business, occupational, and professional purposes, sedan occupied by insured at time of accident is deemed commercial motor vehicle regardless of shape of vehicle -- Interpretation of statute to provide that sedan is never commercial vehicle would lead to unreasonable and impractical reading of statute -- Fact that commercial policy does not include no-fault coverage is irrelevant since policy is clearly intended to cover losses due to accident, and there is no dispute that current loss relates to accident

15 Fla. L. Weekly Supp. 913a

Insurance -- Personal injury protection -- Reimbursement by insurer of commercial vehicle -- Florida Highway Patrol sedan is commercial vehicle within meaning of statute providing for reimbursement of PIP carrier for benefits paid for injuries sustained by insured while occupant of commercial vehicle

15 Fla. L. Weekly Supp. 912a Insurance -- Personal injury protection -- Reimbursement by insurer of commercial vehicle -- Florida Highway Patrol sedan is not private passenger vehicle within meaning…

15 Fla. L. Weekly Supp. 375a

Insurance -- Personal injury protection -- Counties -- Sovereign immunity -- Action by PIP carrier against county/employer of insured for reimbursement of PIP benefits paid for injuries incurred while insured was occupant of county-owned vehicle is dismissed -- County cannot be sued for cause of action under PIP statute

15 Fla. L. Weekly Supp. 1219a

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form -- Statute does not require that licensed medical professional sign D&A form on date of initial treatment or service

15 Fla. L. Weekly Supp. 1233a

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form -- Failure to use state-mandated D&A form and use of alternate form instead does not preclude payment of PIP benefits

15 Fla. L. Weekly Supp. 180a

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form -- Necessity -- Where PIP policy was issued prior to effective date of statutory amendment imposing D&A form requirement, form is not required -- Signature of medical provider -- MRI -- Even if D&A form requirement were applicable, where MRI was begun by technician in face-to-face encounter with insured and completed outside insured's presence by radiologist interpreting test, signature by radiologist was not required -- When imaging center performs both components of test, signature by radiologist is only required when insured and radiologist have face-to-face contact

15 Fla. L. Weekly Supp. 638a

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form -- Where medical records and bills were submitted to insurer with standard D&A form, insurer was on notice of services and treatment rendered

15 Fla. L. Weekly Supp. 430a

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form -- Trial court erred in applying section 627.736(5)(e)(5) to incorporate section 627.736(4)(b) in toto and find D&A form deficient -- Reference to section 627.736(4)(b) only applies to manner of furnishing form, and D&A form furnished by U.S. mail in properly addressed, postpaid envelope was sufficient to meet threshold requirements of statute -- Error to fail to consider bills for subsequent treatment based on alleged deficiency in D&A form -- Requirement of D&A form applies only to initial date of treatment -- Final summary judgment reversed

15 Fla. L. Weekly Supp. 160a

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form -- Medical provider's affidavit stating that he would have attempted to cure defect had insurer cited failure to provide disclosure and acknowledgment form as reason for denial of claim in explanation of benefits is improper where affidavit was not signed in presence of notary -- Even if affidavit were proper, it is not legally sufficient to raise disputed issue of material fact as to whether insurer waived disclosure and acknowledgment defense because failure to provide required form failed to put insurer on notice of covered loss, and insurer is not required to list every reason for denial of claim in EOB

15 Fla. L. Weekly Supp. 738a

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form that does not list services rendered on form but to which medical records and bills were attached substantially complied with statute -- Defense of noncompliant D&A form was waived where insurer did not provide medical provider with response or explanation of benefits indicating form was noncompliant

15 Fla. L. Weekly Supp. 750b

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form -- Where medical provider failed to list services provided on D&A form, insurer did not have notice of covered loss -- Summary final judgment entered for insurer

15 Fla. L. Weekly Supp. 502a

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form -- Failure to detail services rendered on D&A form or write “see attached” on form does not render form deficient where there is no allegation of fraud and PIP patient log that contains insured's signature and attests that services were actually rendered and explained to insured, physician's notes and CMS 1500 billing statements were attached to D&A form

15 Fla. L. Weekly Supp. 1008a

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form that listed “medical treatment” on line where services rendered should have been specified was insufficient to put insurer on notice of covered loss -- Defense of defective D&A form can be raised at any time, even after payment of claim -- Defect in D&A form cannot be cured

15 Fla. L. Weekly Supp. 91b

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form -- Description of services rendered on D&A form as “Notas del Doctor” and “Therapy,” in combination with attached HCFA forms that D&A form referred to, substantially complied with requirements of section 627.736(5)(e) -- D&A form signed by medical provider and insured 50 days apart does not comply with statutory requirement that insured countersign form -- Waiver -- Where insurer's conduct of continuing to investigate claim, scheduling independent medical examinations and peer review and ultimately denying claim on ground other than defective D&A form evinces intent to accept notice of loss, insurer waived right to assert defective form as bar to payment

15 Fla. L. Weekly Supp. 1227a

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form that has not been properly authenticated, sworn to or certified is not admissible for purposes of summary judgment -- Insurer that did not send explanation of benefits explaining that it was denying claim due to incomplete/defective D&A form and denied payment of bill in full on other grounds is estopped from asserting defect -- D&A form requirement applies only to first date of service

15 Fla. L. Weekly Supp. 923b

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form -- Where medical provider failed to submit proper D&A form, summary judgment is granted in favor of insurer as to first date of service only -- Argument that insurer waived D&A form defense by failing to furnish proper explanation of benefits complaining of defect is inapplicable

15 Fla. L. Weekly Supp. 372a

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form -- Sufficiency -- D&A form that does not list services allegedly rendered failed to place insurer on notice of covered loss -- Deficient D&A form is fatal to provider's entire claim, not just claim for initial date of service, and deprives provider of standing to bring action for declaratory relief

15 Fla. L. Weekly Supp. 611a

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form -- Failure to submit -- Where medical provider failed to submit D&A form to insurer prior to insured filing suit, insurer was never placed on notice of covered loss, and claim was never overdue and is legal nullity -- No prejudice to insured because, where provider fails to comply with legal requirement to submit bill, neither insurer nor insured is responsible for payment -- No merit to argument that failure to provide D&A form impacts only initial date of service, not entire claim

15 Fla. L. Weekly Supp. 1007b

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form requirement applies to initial date of service only -- On insurer's motion for summary judgment, it is insurer's burden to present evidence that patient logs for subsequent dates of service were not maintained, not medical provider's burden to prove logs were maintained -- Where insurer sent generic explanation of benefits that did not indicate that D&A form is defective, insurer is estopped from asserting D&A form defense

15 Fla. L. Weekly Supp. 393a

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and Acknowledgment form -- Fact question as to whether insurer waived D&A form requirement by processing claim without raising objection or sending explanation of benefits concerning lack of form precludes summary judgment on D&A form issue as to initial date of service -- Summary judgment is denied as to subsequent dates of service because D&A form requirement applies only to initial date of service

15 Fla. L. Weekly Supp. 389a

Insurance -- Personal injury protection -- Notice of loss -- Disclosure and acknowledgment form -- D&A form that did not list services rendered and was not signed by medical provider was insufficient -- Insurer did not waive D&A form defense by failing to furnish explanation of benefits denying claim based on insufficient form where insurer asserted defense in all pleadings, and EOB did state that insurer might raise defense of failure to comply with section 627.736(5) -- Because D&A form requirement is applicable to first date of service only, failure to properly complete form is not fatal to entire claim

15 Fla. L. Weekly Supp. 922b

Insurance -- Personal injury protection -- Medical treatment -- Reasonable, related and necessary expenses -- Evidence -- Peer review -- Affidavit of peer review physician was sufficient to create question of fact as to reasonableness, relatedness and medical necessity of treatment although peer review was not conducted until after litigation had commenced

15 Fla. L. Weekly Supp. 279b

Insurance -- Personal injury protection -- Mediation -- Failure to appear -- Sanctions -- Default -- Where insurer willfully failed to comply with order to appear at mediation and pay mediation fee prior to mediation and failed to respond to order to show cause why default should not be entered, insurer's pleadings are stricken and default is entered as to liability

15 Fla. L. Weekly Supp. 84b

Insurance -- Personal injury protection -- Interest due on overdue claim is not subject to 10% statutory penalty

15 Fla. L. Weekly Supp. 950a

Insurance -- Personal injury protection -- Independent medical examination -- Location -- Where insurer did not have IME conducted in limited areas required by PIP statute, IME report was invalid, and suspension of benefits based solely on IME violated statute prohibiting withdrawal of payment without first obtaining valid report stating treatment was not reasonable, related or necessary -- Request by insured's mother that IME take place in certain area does not constitute valid waiver of statutory requirement regarding IME locations

15 Fla. L. Weekly Supp. 1115b

Insurance -- Personal injury protection -- Fraud -- Insurer's motion for summary judgment on claim that provider committed fraud by charging patient 20% of the amount actually collected from insurer is denied

15 Fla. L. Weekly Supp. 499c

Insurance -- Personal injury protection -- Filing fees -- Waiver -- County court has no discretion to waive case reopen fee

15 Fla. L. Weekly Supp. 1101b

Insurance -- Personal injury protection -- Explanation of benefits -- Insurer is not required to provide EOB to medical provider where insurer has not rejected or reduced claim, and provider has not made presuit request for EOB

15 Fla. L. Weekly Supp. 621b

Insurance -- Personal injury protection -- Explanation of benefits -- Sufficiency -- Statement on checklist that “Bills were not in compliance with Florida statute based on disclosure” is not sufficient EOB -- Medical provider's failure to provide disclosure and acknowledgment form does not excuse insurer's breach of contract for failure to provide EOB -- Fact that provider suffered only nominal damages from breach does not preclude entry of partial summary judgment

15 Fla. L. Weekly Supp. 745b

Insurance -- Personal injury protection -- Explanation of benefits -- Summary judgment is entered in favor of medical provider as to count alleging breach of contract for failure to provide EOB where insurer provided no EOB prior to suit and, in response to demand letter, provided letter stating reasons for denial that was neither itemized nor correct

15 Fla. L. Weekly Supp. 744c

Insurance -- Personal injury protection -- Explanation of benefits -- Summary judgment is entered in favor of medical provider as to count alleging breach of contract for failure to provide EOB

15 Fla. L. Weekly Supp. 624c

Insurance -- Personal injury protection -- Explanation of benefits -- Failure to provide -- Complaint does not specifically and sufficiently plead cause of action for breach of contract regarding failure to furnish EOB where there is no actual pleading of damages or demand for relief

15 Fla. L. Weekly Supp. 1205a

Insurance -- Personal injury protection -- Explanation of benefits -- Failure to provide -- Medical provider is entitled to award of nominal damages as result of insurer's failure to provide EOB -- Trial court also finds that provider suffered actual damages

15 Fla. L. Weekly Supp. 1211a

Insurance -- Personal injury protection -- Explanation of benefits -- Failure to provide -- Where no damages arose from insurer's failure to timely provide EOB, insured cannot prevail on breach of contract claim seeking damages for that inaction -- Where legislature has not provided remedy for failure to comply with statutory mandate to provide EOB, court is barred from implying one

15 Fla. L. Weekly Supp. 179a

Insurance -- Personal injury protection -- Explanation of benefits -- Failure to provide EOB may give rise to breach of contract claim -- Declaratory judgment -- Claim for declaratory relief for failure to provide EOB dismissed -- Insurer's obligation to provide policy, declarations page and/or PIP log on presuit request from assignee/medical provider -- Despite case law determining that claimant is not entitled to PIP log under section 627.736(6)(d), question of whether claimant is entitled to log under section 627.736(4)(b) remains open and is proper subject for declaratory relief -- Complaint states proper cause of action for breach of contract and declaratory relief for failure to provide declarations page and policy

15 Fla. L. Weekly Supp. 155e

Insurance -- Personal injury protection -- Explanation of benefits -- Failure to provide EOB within 30 days of receipt of medical bill breached contract

15 Fla. L. Weekly Supp. 91a

Insurance -- Personal injury protection -- Explanation of benefits -- Failure to provide -- Letter cutting off benefits after independent medical examination is not EOB where letter was not sent to medical provider, was not labeled as EOB, is not itemized as required for EOB and did not give reasons for nonpayment of pre-IME bills -- No merit to argument that letter substantially complied with EOB requirement

15 Fla. L. Weekly Supp. 269a

Insurance -- Personal injury protection -- Examination under oath -- Refusal to cooperate -- Final summary judgment is granted in favor of insurer where insured invoked Fifth Amendment right against self-incrimination when asked during EUO whether she was given money to go to medical provider's clinic -- Fact that insured assigned benefits to provider does not allow provider to use privilege as sword in PIP litigation -- Insured's unreasonable refusal to cooperate in EUO binds provider and relieves insurer of liability to pay benefits

15 Fla. L. Weekly Supp. 746a

Insurance -- Personal injury protection -- Examination under oath -- Failure to attend -- Where insurer did not inform insured or medical provider that it was asserting EUO no-show defense until four years after alleged no-show, insurer waived defense

15 Fla. L. Weekly Supp. 723a

Insurance -- Personal injury protection -- Examination under oath -- Failure to attend EUO was not unreasonable where it is undisputed that insurer did not provide copy of correct insurance policy and declarations page to insured or her counsel prior to or during suit, and insurer made no effort to provide correct policy and reschedule EUO, despite request by insured's counsel that EUO be reset for mutually convenient date upon receipt of policy -- Directed verdict granted in favor of medical provider

15 Fla. L. Weekly Supp. 483b

Insurance -- Personal injury protection -- Claimant's failure to appear at examination under oath -- Where the insured attempted to provide a reason for his failure to appear at his EUO, a genuine issue of material fact remains, precluding summary judgment on behalf of insurer

15 Fla. L. Weekly Supp. 1199a

Insurance -- Personal injury protection -- Examination under oath -- Failure to attend -- Claimant's failure to appear for EUO without cause or explanation warrants entry of summary judgment in favor of insurer -- Medical provider/assignee, who stands in shoes of claimant, is subject to denial of its claim for claimant's failure to attend EUO -- No merit to argument that claimant was not bound by terms of PIP contract to which she was not party where contract requires any person or claimant to submit to EUO as condition precedent to maintaining suit for breach of policy

15 Fla. L. Weekly Supp. 826b

Insurance -- Personal injury protection -- Independent medical examination -- Examination under oath -- Failure to attend -- Where insurer timely mailed notices of IME and EUO to address provided by insured, but from which insured had moved without notifying insurer of new address or leaving forwarding address, insured is presumed to have received notices -- Where insured offered no explanation for nonattendance at IME and EUO to insurer or trial court, insurer properly denied assignee/medical provider's claim for PIP benefits

15 Fla. L. Weekly Supp. 282a

Insurance -- Personal injury protection -- Examination under oath -- Failure to attend -- Omnibus insured was not required by policy to attend EUO, and failure to attend, even if without reasonable excuse, cannot rise to level of defense to nonpayment of benefits

15 Fla. L. Weekly Supp. 1116a

Insurance -- Personal injury protection -- Motion to dismiss -- Allegations that go to merits of action are improper for motion to dismiss

15 Fla. L. Weekly Supp. 392a

Insurance -- Personal injury protection -- Insurer's obligation under section 627.4137 to provide information and copy of policy upon request from medical provider was not eliminated by defect in claim

15 Fla. L. Weekly Supp. 639b

Insurance -- Personal injury protection -- Discovery -- Depositions -- Where attorney for medical provider improperly asserted work-product privilege and instructed insured who was deposed as non-party witness not to answer questions regarding pre-deposition coaching, attorney is personally sanctioned

15 Fla. L. Weekly Supp. 373a

Insurance -- Personal injury protection -- Discovery -- Insurer is required to produce all amounts paid for CPT code at issue within county during six-month period, records reflecting how it determined benefits owed to medical provider, and documents justifying reduced charge

15 Fla. L. Weekly Supp. 1188a

Insurance -- Personal injury protection -- Demand letter -- Medical provider that continued to provide treatment to insured after insurer withdrew benefits was not required to furnish written plan for additional treatment to insurer as condition precedent to serving demand letter and filing suit -- Medical provider had option to simply continue treatment with risk of nonpayment or attempt to gain insurer's concession to continued coverage through treatment plan

15 Fla. L. Weekly Supp. 1206a

Insurance -- Personal injury protection -- Demand letter -- Three demand letters for three periods of service comply with section 627.736(11), despite fact that ledger attached to each demand letter lists all dates of service, where each letter on its face specifies dates of service and charges claimed by that letter and amount claimed can be easily verified by reference to ledger

15 Fla. L. Weekly Supp. 99a

Insurance -- Personal injury protection -- Demand letter that includes sums already paid by insurer is not legally sufficient

15 Fla. L. Weekly Supp. 390b

Insurance -- Personal injury protection -- Demand letter -- Sufficiency -- Demand letter was not deficient for demanding payment for dates of service already paid in full by insurer and claiming inaccurate amount due

15 Fla. L. Weekly Supp. 1209a

Insurance -- Personal injury protection -- Demand letter -- Demand letter to which insured attached patient ledger and therapy notes, but which did not otherwise state exact amount claimed to be due, fails to satisfy statutory requirements -- Further, demand letter was not sent to person specified by insurer for purposes of receiving such notices

15 Fla. L. Weekly Supp. 156b

Insurance -- Personal injury protection -- Demand letter -- Sufficiency -- Presuit demand letter with attached ledger identifying all charges and not acknowledging payments made by insurer did not comply with statute -- Summary judgment entered in favor of insurer

15 Fla. L. Weekly Supp. 823a

Insurance -- Personal injury protection -- Demand letter -- Sufficiency -- Demand letter that included copy of previously submitted claim form for single MRI service billed by medical provider complied with statute -- Fact that claim form states amount in excess of MRI fee schedule does not render demand letter defective -- Further, any defect in failing to state exact amount of claim was waived by insurer's failure to raise defect in response to demand letter -- No merit to argument that demand letter must account for deductible or calculate percentage payable

15 Fla. L. Weekly Supp. 1029a

Insurance -- Personal injury protection -- Demand letter -- Sufficiency -- Demand letter that did not provide amount of postage medical provider now claims in complaint and requested amount not due at time letter was served failed to satisfy condition precedent to PIP action -- Insurer's motion for final summary judgment is granted

15 Fla. L. Weekly Supp. 1189a

Insurance -- Personal injury protection -- Demand letter that did not state exact amount claimed, but instead attached billing ledgers for three medical providers and claimed entire amount billed without deduction of any amounts insurer had paid, did not satisfy condition precedent of filing demand letter -- Standing -- Assignment -- Insured who had not obtained revocation of assignments given to two providers did not have right to serve demand letter for those providers' bills

15 Fla. L. Weekly Supp. 1203a

Insurance -- Personal injury protection -- Demand letter sent less than 30 days after insurer's receipt of bills was premature, and prematurity cannot be cured by passage of time -- Further, complaint filed before all bills were overdue and before 15-day window created by demand letter had passed was prematurely filed -- Insurer has not waived right to assert premature demand letter as defense -- Insurer is not required to pay for treatment rendered and is entitled to judgment as matter of law

15 Fla. L. Weekly Supp. 831a

Insurance -- Personal injury protection -- Demand letter -- Where medical provider failed to serve demand letter prior to filing suit, but corrected noncompliance by serving demand letter after suit commenced and amending complaint with leave of court when insurer ignored demand, motion for summary judgment is denied -- Even if provider had not moved for leave to amend, insurer would only be entitled to order granting summary judgment with leave to amend because statute of limitations has not run

15 Fla. L. Weekly Supp. 624d

Insurance -- Personal injury protection -- Explanation of benefits -- Insurer breached policy by failing to provide EOB and failing to provide copy of policy and endorsements requested in demand letter

15 Fla. L. Weekly Supp. 1150a

Insurance -- Personal injury protection -- Demand letter -- Statute requiring presuit demand letter applies to insured who received treatment prior to effective date of statute -- Substantially compliant demand letter was sent to insurer, and it had implied actual notice of insured's suit from statement in letter that it was presuit demand letter pursuant to section 627.736(11) -- Because first presuit demand letter was substantially compliant, amended complaint filed on same day as amended presuit demand letter was proper, and refiling of entire action was not required

15 Fla. L. Weekly Supp. 1153a

Insurance -- Personal injury protection -- Standing -- Failure to comply with condition precedent -- Demand letter -- Final summary judgment in favor of insurer finding insured lacked standing in action for bills incurred with two medical providers because demand letters were filed by providers after they had revoked assignments of benefits -- Trial court erred in entering summary judgment concerning one provider's bills where insured properly filed demand letter in own name for those bills before submitting second amended complaint -- Further, where insured served demand letter for second provider's bills at same time as second amended complaint, complaint should have been dismissed relative to those bills with leave to amend

15 Fla. L. Weekly Supp. 336c

Insurance -- Personal injury protection -- Default -- Vacation -- Abuse of discretion to deny motion to vacate default -- Mishandling that resulted in late filing of insurer's responsive pleading constituted excusable neglect, and insurer's answer and affirmative defenses established meritorious defense

15 Fla. L. Weekly Supp. 106b

Insurance -- Personal injury protection -- Default entered against insurer

15 Fla. L. Weekly Supp. 563b

Insurance -- Personal injury protection -- Independent medical examination -- Failure to attend -- Error to find that insurer's act of automatically rescheduling missed IME waived its right to rely on first scheduled IME date as date of suspension of PIP benefits where insured did not notify insurer of inability to attend first IME, IME was not rescheduled to correct statutory deficiency, and insured did not attend rescheduled IME

15 Fla. L. Weekly Supp. 373c

Insurance -- Personal injury protection -- Coverage -- Claimant who resided with his brother-in-law at time of accident was not entitled to PIP coverage under policy of insurance issued to brother-in-law where uncontroverted evidence established that brother-in-law did not obtain his driver's license until at least three months after the accident at issue and was not eligible to purchase automobile insurance prior to obtaining his driver's license

15 Fla. L. Weekly Supp. 1004b

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Bill in excess of customary charges -- Where medical provider charged PIP insurer amount for x-ray interpretative services in excess of what it charges other entities with which it has agreements to provide same services, provider violated statutory requirement that charges to PIP insurer not exceed amount provider customarily charges for like services -- Provider is not entitled to recover disputed balance of reduced bill

15 Fla. L. Weekly Supp. 958a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Customary charges -- Error to enter summary judgment in favor of insurer based on finding that provider charged insurer an amount in excess of what provider “customarily” charged others -- Although there did not appear to be factual dispute that plaintiff reduced charges for other medical providers or for direct-billed patients, whether plaintiff violated his own customer billing practices is issue to be resolved by trier of fact

15 Fla. L. Weekly Supp. 1196a

Insurance -- Personal injury protection -- Demand letter is not deficient for failing to state 80% of exact amount due where letter demands payment of sum that is 80% of total amount billed -- Failure to include deductible in calculation of amount demanded does not render letter insufficient -- Demand letter that fails to state correct date of accident, claim or policy number substantially complied with statute where copies of bills listing correct claim number were attached to letter -- Insurer that ignored demand letter and belatedly raised issue of technical errors in letter after suit was commenced waived right to challenge sufficiency of letter -- Because timeliness of submission of medical bills to insurer is determined by date of mailing rather than date of receipt, litigation adjuster's affidavit stating that bills were not received does not rebut postmark and certified mail receipt showing bills were timely mailed -- Medical provider's motion for summary judgment on affirmative defenses of insufficient demand letter and late billing is granted

15 Fla. L. Weekly Supp. 435a

Insurance -- Personal injury protection -- Coverage -- Medical bills -- Timeliness -- Waiver -- Because section 627.736(5)(c)(1), which permits payment of medical bills submitted to insurer no more than 75 days after initial date of service pursuant to notice of initiation of treatment, is not statute of repose, but operates as statute of limitations or condition precedent, fact that initial set of bills sent to insurer were untimely does not bar action for later timely bills -- Where insurer never advised medical provider that bills would not be paid due to late billing, explanation of benefits cited other reasons for denying claims, and insurer sent some late bills to peer review doctor for evaluation and indicated in PIP log that some of those bills would be paid, insurer waived right to assert untimeliness of bills as affirmative defense -- No abuse of discretion in granting summary judgment in favor of provider

15 Fla. L. Weekly Supp. 779b

Insurance -- Personal injury protection -- Summary judgment -- Opposing affidavit -- Notarization -- Trial court was correct in finding that initial affidavit filed by doctor who performed independent medical examination was legally insufficient for failing to indicate whether doctor was personally known or had produced identification to notary -- Trial court erred by not permitting insurer to cure this technical defect -- Trial court should have considered corrected affidavit attached to timely motion for rehearing

15 Fla. L. Weekly Supp. 569a

Insurance -- Personal injury protection -- Summary judgment -- Opposing affidavit -- Sufficiency -- Error to strike affidavit of physician who conducted physical medical examination of insured and peer review where affidavit complied with requirements of rule 1.510(e) -- Although medical records referenced in affidavit were not attached thereto, records were already filed with clerk of courts and references to records in affidavit were so explicit that there was no question as to documents identified -- Error to grant motion for summary judgment where affidavits of parties' experts create genuine issue of material fact as to whether treatment was reasonable, related and necessary

15 Fla. L. Weekly Supp. 1119a

Insurance -- Personal injury protection -- Motion to set aside order denying medical provider's motion for summary judgment, alleging ex parte communication between judge entering order and insurer's counsel, is denied where judge adopted insurer's arguments and requested through judicial assistant that insurer draft order

15 Fla. L. Weekly Supp. 234a

Insurance -- Personal injury protection -- Summary judgment -- Error to enter summary judgment in favor of medical provider based on determination that provider submitted medical records to insurer before filing suit where trial court relied on affidavit and deposition of provider's billing clerk although documents were not timely filed and served, court rejected evidence that there was genuine issue of material fact on timely delivery of records, and court applied “more likely than not” standard rather than “undisputed facts and legal entitlement” standard

15 Fla. L. Weekly Supp. 85a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Insurer's explanation that it calculates allowable charge for CPT code based on 200% of amount allowed for code under Medicare Part B is not sufficient to raise disputed issue of material fact that fees charged by medical provider are reasonable in non-Medicare context

15 Fla. L. Weekly Supp. 84c

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Insurer's explanation that it calculates allowable charge for CPT code based on 200% of amount allowed for code under Medicare Part B is not sufficient to raise disputed issue of material fact that fees charged by medical provider are reasonable in non-Medicare context

15 Fla. L. Weekly Supp. 713a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable charges -- Where medical provider does not accept Medicare patients and is not certified provider for workers' compensation patients, Medicare and workers' compensation fee schedules are irrelevant to issue of reasonableness of charges for treatment that does not include nerve conduction testing, MRI or other procedures listed in section 627.736(5)(a)(2) -- Motion to take judicial notice of fee schedules denied

15 Fla. L. Weekly Supp. 1051a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable charges -- Error to enter summary judgment in favor of medical provider on sole issue of reasonableness of charges based solely on affidavit of billing manager where billing manager's attestation that charges were reasonable was based solely on manager's knowledge and experience with the insurer and other insurers regarding reimbursements for the same procedures -- Knowledge and experience with insurer are not addressed in statute as factors for consideration in determining reasonableness of medical charge

15 Fla. L. Weekly Supp. 581a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Withdrawal -- Valid physician's report -- Where insurer had physician's report finding that further treatment would not be reasonable, related or necessary when it issued letter withdrawing treatment and refused payment for MRI that was performed in interim between report and issuance of cutoff letter, trial court erred in refusing to consider physician's affidavit and report in ruling on motion for summary judgment

15 Fla. L. Weekly Supp. 618a

Insurance -- Personal injury protection -- Medical provider's motion for partial summary judgment on issue of whether treatment was reasonable, related and medically necessary is denied where insurer has filed at least one opposing affidavit that raises issue of material fact

15 Fla. L. Weekly Supp. 628b

Insurance -- Personal injury protection -- Summary judgment -- Opposing affidavit -- Insurer's affidavit opposing medical provider's motion for partial summary judgment on reasonable, related and necessary issue was untimely where affidavit was hand-delivered less than two business days prior to hearing -- Attachments to affidavit that are not sworn or certified cannot be considered by court -- Where affidavit of litigation adjuster is not based on personal knowledge but on review of file, and affiant failed to attach extrinsic evidence relied upon regarding usual and customary charges, affidavit cannot be considered by court -- Litigation adjuster cannot address whether treatment is reasonable, related to accident or medically necessary -- In light of technical admissions and insurer's failure to present countervailing evidence from licensed physician or to impeach provider's medical expert, provider's motion for partial summary judgment is granted

15 Fla. L. Weekly Supp. 563a

Insurance -- Personal injury protection -- Summary judgment -- Factual issues -- Where summary judgment motion and supporting affidavits failed to address insurer's affirmative defenses, trial court had discretion to enter partial summary judgment as to whether medical bills were reasonable, related and necessary but not to enter summary judgment as to affirmative defenses

15 Fla. L. Weekly Supp. 433b

Insurance -- Personal injury protection -- Summary judgment -- Opposing affidavits -- In ruling on motion for summary judgment, trial court erred in rejecting peer review obtained more than 30 days after notice of loss as time barred

15 Fla. L. Weekly Supp. 432a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable, related and necessary expenses -- Evidence -- Peer review -- Error to refuse to consider peer review because it was obtained more than thirty days after medical bills became due

15 Fla. L. Weekly Supp. 123a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Failure to obtain reasonable proof within 30 days -- Clarification -- Appellate court clarifies that in reversing summary judgment predicated on peer review having been obtained after benefits were denied and due and remanding case, question of legal and factual sufficiency of peer review affidavit remains, and trial court must determine validity

15 Fla. L. Weekly Supp. 567a

Insurance -- Personal injury protection -- Summary judgment -- Opposing affidavit -- Sufficiency -- Error to strike affidavit of physician who conducted physical medical examination of insured and peer review where affidavit complied with requirements of rule 1.510(e) -- Although medical records referenced in affidavit were not attached thereto, records were already filed with clerk of courts and references to records in affidavit were so explicit that there was no question as to documents identified -- Requirement that insurer obtain valid medical report before withdrawing, reducing or denying payment of further benefits does not extend to instance in which insurer refuses payment of benefits -- Error to grant motion for summary judgment where there exists genuine issue of material fact as to whether treatment was reasonable, related and necessary

15 Fla. L. Weekly Supp. 1193a

Insurance -- Personal injury protection -- Declaratory judgment -- Physician's report that is based solely on review of insured's treatment records and is not supported by physical examination conducted by another physician at request of insurer is not valid report under section 627.736(7)(a) -- Objection to admissibility of peer review report is sustained, and summary judgment is entered in favor of medical provider -- Question certified

15 Fla. L. Weekly Supp. 924a

Insurance -- Personal injury protection -- Withdrawal of benefits -- Reasonable proof -- Peer review report is valid despite fact that peer review doctor did not personally examine insured where report is factually supported by treatment records and independent medical examination conducted by another doctor -- However, where insurer did not obtain report before withdrawing treatment authorization and benefits, report is inadmissible to support claim that treatment was not medically necessary or related -- Insurer did not forfeit right to assert lack of necessity or relatedness as defense and may rely on other reasonable proof to support defense -- Requirement to obtain reasonable proof prior to action applies regardless of whether refusal to pay is labeled as “withdrawal” or “denial”

15 Fla. L. Weekly Supp. 322a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable, related and necessary expenses -- Evidence -- Peer review -- Error to strike peer review report and testimony of reviewer on grounds that review was not prepared within 30 days from date of notice of loss and was not based on physical examination -- Directed verdict in favor of medical provider is reversed and case is remanded for factual determination of whether medical bills were reasonable, related and necessary

15 Fla. L. Weekly Supp. 320a

NOT FINAL VERSION OF OPINION
Subsequent Changes at FLWSUPP 165AMADO

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable, related and necessary expenses -- Evidence -- Peer review -- Error to refuse to consider peer review because it was obtained more than 30 days after medical bills became due -- Remand for determination of legal and factual validity of peer review affidavit -- Disclosure and acknowledgment form -- Statute requiring D&A form is applicable to all services rendered after effective date of statute, regardless of fact that policy predates statute -- Insurer is estopped from asserting defense of defective D&A form where insurer acknowledges that it received medical records and HCFA form as attachments to D&A form that left blank lines provided for setting forth services rendered; after receiving form, insurer dealt with insured as if there were no problems with form and required her to submit to examination under oath and independent medical examination; and insurer did not send explanation of benefits denying claim based on insufficient form

15 Fla. L. Weekly Supp. 317a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable, related and necessary expenses -- Evidence -- Peer review -- Error to find that peer review could not establish reasonable proof to contest medical bills as unreasonable, unrelated or unnecessary because review was not completed within 30 days of receipt of medical bills and was not performed by physician who examined insured -- As peer review presented clear genuine issue of material fact as to whether treatment was reasonable, related and necessary, summary judgment in favor of medical provider is reversed and case is remanded for factual determination of issue

15 Fla. L. Weekly Supp. 1154b

Insurance -- Personal injury protection -- Trial -- Continuance -- Abuse of discretion to deny one-day continuance to present testimony of peer review physician who was unavailable on day of trial due to patient emergencies -- No merit to argument that physician should not be allowed to testify because peer review was conducted more than 30 days after treatment was rendered

15 Fla. L. Weekly Supp. 908b

Insurance -- Personal injury protection -- Summary judgment is granted in favor of medical provider where affidavit of physician is sufficient to establish that fees charged were reasonable and necessary -- No merit to argument that summary judgment cannot be granted due to insufficient discovery where insurer failed to request continuance or file and schedule a motion to compel discovery, and insurer did not raise argument until amended motion for summary judgment was filed

15 Fla. L. Weekly Supp. 319a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable, related and necessary expenses -- Evidence -- Peer review conducted more than 30 days after receipt of claim -- Where insurer did not withdraw payment but denied claim from outset, insurer did not forfeit ability to contest payment by failure to obtain reasonable proof within 30 days of receipt of claim, and trial court erred in refusing to consider peer review report not prepared within 30-day period -- Affidavit -- Sufficiency -- Where peer review report attached to affidavit detailed the medical records reviewed, and the medical records were filed in court record, affidavit was not insufficient for failure to attach referenced records -- No merit to claim that affidavit was unsworn -- Although peer review states that it is based on best of doctor's knowledge, attached affidavit indicated that information in peer review was based on doctor's personal knowledge, and this rebutted claim that peer review was not based on personal knowledge -- No merit to argument that peer review is invalid because it was not based on physical examination of insured by peer review doctor -- Statute authorizes report based on review of examination and treatment records and does not require separate physical exam -- Summary judgment in favor of medical provider reversed and remanded

15 Fla. L. Weekly Supp. 776b

Insurance -- Personal injury protection -- Withdrawal of benefits -- Reasonable proof -- Physician's peer review report opining that treatment is not reasonable, related or necessary can constitute reasonable proof that insurer is not responsible for payment of claim even though report was prepared more than 30 days after receipt of claim -- Peer review report constitutes valid report supporting withdrawal of benefits even though it is not based on physical examination by physician who prepared report

15 Fla. L. Weekly Supp. 429a

Insurance -- Personal injury protection -- Summary judgment -- Opposing affidavit -- Where affidavit of doctor who performed peer review but did not personally examine insured is not made on personal knowledge, peer review report adopted by affidavit makes reference to medical records not attached thereto, and insurer gave no notice that affidavit and report were filed to oppose summary judgment, trial court did not abuse discretion in refusing to consider affidavit and report -- No merit to argument that statutory requirement to obtain report by physician who has examined insured prior to withdrawal of treatment authorization is not applicable to insurer that never paid any benefits to medical provider

15 Fla. L. Weekly Supp. 312a

Insurance -- Personal injury protection -- Peer review report and affidavit by physician who never examined insured is inadmissible hearsay that should not have been considered by court ruling on motion for summary judgment -- No merit to argument that physical examination requirement of PIP statute does not apply where benefits are denied, rather than commenced then withdrawn -- No abuse of discretion in granting motion for summary judgment

15 Fla. L. Weekly Supp. 136a

NOT FINAL VERSION OF OPINION
Subsequent Changes at 15 Fla. L. Weekly Supp. 333c

Insurance -- Personal injury protection -- Summary judgment -- Error to fail to consider independent medical examination report which created genuine issue of material fact regarding necessity of treatment -- Insurer did not waive right to assert that treatment is not reasonable, related or necessary or that charge was excessive by failing to notify medical provider of intent to dispute claim on that basis -- Defects in IME report and affidavit are not sufficient to exclude evidence; insurer should have been given opportunity to correct defects

15 Fla. L. Weekly Supp. 375b

Insurance -- Personal injury protection -- Demand letter -- Sufficiency -- Demand letter was not deficient for failing to calculate exact amount to be paid after application of deductible and co-payment -- Coverage -- Medical expenses -- Reasonable, related and necessary expenses -- Affidavit of claims adjuster creates genuine issue of material fact as to reasonableness of those charges to which adjuster testified -- Jury will decide reasonable charge between amount testified to by adjuster and amount billed -- Insurer is estopped from denying benefits for dates prior to date IME cutoff letter was sent where insurer failed to timely furnish notice of result of independent medical examination opining that further treatment would not be reasonable

15 Fla. L. Weekly Supp. 190a

Insurance -- Personal injury protection -- Summary judgment -- Affidavits -- Notarization -- Affidavits not signed in presence of notary are stricken -- Failure to maintain patient logs and sign-in sheets is not fatal to medical provider's claim where, although PIP statute requires that records be maintained, it does not make records part of claims process by requiring that provider submit records to insurer

15 Fla. L. Weekly Supp. 28b

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Needle electromyography -- Section 627.736 does not cap fees for needle EMG procedures -- Error to enter summary judgment in favor of medical provider where insurer was not confined to explanation of benefits which erroneously cited statutory fee cap in refuting provider's claim that charge for needle EMG was reasonable, and affidavit of peer review doctor was sufficient to raise disputed issue of material fact as to reasonableness of charge -- Error to find affidavit conclusory, irrelevant under section 627.736(7)(a), which does not apply to reduction of benefits at issue, and invalid due to failure to attach referenced peer review report

15 Fla. L. Weekly Supp. 1223a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- MRI -- Allowable amount -- Adjustment to Consumer Price Index -- Insurer failed to apply cumulative and compounding inflation adjustments for 2001, 2002 and succeeding years such that fee schedule amount will reflect prior years' increases through August 1 of year MRI scan was performed -- Demand letter with HCFA form attached was fully compliant with statute, irrespective of fact that amount demanded for MRI exceeded amount allowed under preset fee schedule

15 Fla. L. Weekly Supp. 271a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- MRI -- Allowable amount -- Adjustment to Consumer Price Index for All Urban Consumers in South Region -- Calculation -- CPI adjustment must be made on August 1, 2001, and adjusted annually on August 1 of each subsequent year through date of treatment -- No merit to argument that first CPI adjustment should be applied as of November 1, 2002 -- Applicable CPI adjustment factor is number published for 12-month period ending June 30 of each year since 2001 -- Where correct CPI adjustment calculation reveals insurer did not pay medical provider appropriate amount for MRI, provider is entitled to difference plus prejudgment interest

15 Fla. L. Weekly Supp. 265c

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- MRI -- Allowable amount -- Adjustment to Consumer Price Index for All Urban Consumers in South Region -- Calculation -- CPI calculation must be made annually and cumulatively, reflecting combined prior years' increases from 2001 through August 1 of year MRI was performed -- Where correct CPI adjustment calculation reveals insurer did not pay medical provider appropriate amount for MRI within 30 days, provider is entitled to statutory interest and attorney's fees

15 Fla. L. Weekly Supp. 182a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- MRI -- Allowable amount -- Adjustment to Consumer Price Index for All Urban Consumers in South Region -- Calculation -- CPI calculation must be made annually and cumulatively, reflecting combined prior years' increases from 2001 through August 1 of year MRI was performed -- Correct CPI adjustment calculation reveals insurer paid medical provider less than allowable amount for MRIs

15 Fla. L. Weekly Supp. 93a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Lawfully rendered treatment -- Medical provider's failure to maintain massage establishment license at time massage treatments were performed renders treatments unlawful and noncompensable -- Where provider was never certified to supervise certified chiropractic physician's assistants who examined insured and made recommendations for his treatment, and CCPAs were never authorized to work under supervision of provider, treatments were unlawful and noncompensable -- Treatments were not rendered unlawful by failure to obtain county occupational license

15 Fla. L. Weekly Supp. 88a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Lawfully rendered treatment -- Medical provider's failure to maintain massage establishment license at time massage treatments were performed renders treatments unlawful and noncompensable -- Where provider was never certified to supervise certified chiropractic physician's assistants who examined insured and made recommendations for her treatment, and CCPAs were never authorized to work under supervision of provider, treatments were unlawful and noncompensable -- Treatments were not rendered unlawful by failure to obtain county occupational license

15 Fla. L. Weekly Supp. 1094a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Lawfully rendered services -- Nonperformance of medical director -- Where medical provider appointed doctor to be medical director as required by clinic registration/licensing statutes, but doctor failed to perform duties of medical director, provider's services were not lawfully rendered, and bills are noncompensable and unenforceable

15 Fla. L. Weekly Supp. 964a

Insurance -- Personal injury protection -- Judgment on pleadings -- Trial court erred in considering matters outside pleadings when granting judgment on pleadings in favor of insurer -- Tipsy coachman doctrine cannot be applied to affirm decision as summary judgment where medical provider was not given notice that summary judgment would be considered or opportunity to present evidence establishing existence of genuine issue of material fact

15 Fla. L. Weekly Supp. 1016a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Where insurer failed to request additional documentation within 30 days of receipt of bill for functional capacity test and supplies, request was untimely -- Partial summary judgment is entered in favor of medical provider as to test and supplies

15 Fla. L. Weekly Supp. 1213b

Insurance -- Personal injury protection -- Insurer cannot use its investigative rights to extend 30-day period without reasonable proof that it is not responsible for claim -- Insurer owes statutory interest and penalty on bills which were paid late

15 Fla. L. Weekly Supp. 821a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Motion for summary judgment is granted where benefits were exhausted before suit was filed -- Motion to amend complaint is denied

15 Fla. L. Weekly Supp. 907b

NOT FINAL VERSION OF OPINION
Subsequent changes at 16 Fla. L. Weekly Supp. 92a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- If amount of benefits claimed by medical provider/assignee was available at time of claim, provider is allowed to challenge reasonableness of reduction in payment regardless of whether benefits were subsequently exhausted and is entitled to damages if insurer did not pay claim in manner prescribed by statute -- Insurer's motion for summary judgment is denied

15 Fla. L. Weekly Supp. 1005a

Insurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- In absence of bad faith, medical provider cannot maintain cause of action for unpaid portion of reduced medical bills where policy limits have been exhausted, even where exhaustion occurred after suit was filed -- Insurer is not required to reserve funds for disputed claims

15 Fla. L. Weekly Supp. 682b

Insurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- Priority of payments -- Hospital lien -- Trial court did not err in finding that insurer improperly exhausted benefits in favor of hospital where provider's bill was received by insurer long before hospital lien was properly recorded and became entitled to priority -- Demand letter -- Sufficiency -- Where demand letter erroneously requested reimbursement of full amount of single medical bill that has been partially paid by Medicare, but insurer was able to easily verify partial payment from attached patient account information sheet and note balance due, insurer should not be permitted to escape liability due to form of demand letter

15 Fla. L. Weekly Supp. 936b

Insurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- In absence of bad faith, manipulation, or other improper conduct, medical provider cannot sustain action for PIP benefits once benefits have been exhausted in payment of other claims while coverage investigation regarding provider's claim was pending -- Prior order denying motion to amend complaint is withdrawn as to amendment to allege bad faith and improper conduct, but reaffirmed as to requested substantive amendment by interlineation and untimely request to amend complaint to allege that insurer has adopted improper reimbursement method -- If exhaustion of benefits eliminates recovery of PIP benefits, it also eliminates recovery of interest, penalties, and attorney's fees to which provider would otherwise be entitled due to wrongful denial of claim

15 Fla. L. Weekly Supp. 615a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Nerve conduction velocity test and electromyography procedure -- Denial of motion for reconsideration of order holding that, where statute allows charges for NCV testing done in conjunction with EMG procedure to be billed at rate not exceeding 200% of fee schedule of Medicare Part B when both procedures are performed and billed solely by appropriately licensed physician and for payment under lower workers' compensation rates when NCV does not meet those requirements, medical provider's use of medical and physician assistants to perform physical portions of NCV and EMG did not require that provider be paid only under lower rates -- Insurer that did not pay consumer price adjustment for year 2002 for either MRI or EMG/NCV charges did not pay amount due

15 Fla. L. Weekly Supp. 671a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Withdrawal of benefits -- Insurer who denied payment of benefits altogether, rather than starting and then withdrawing payment, was not required to obtain medical report prior to denial of benefits -- Error to enter summary judgment in favor of medical provider based on finding that insurer was barred from raising defense that treatment was not reasonable, related or necessary by failure to obtain report prior to withdrawing benefits

15 Fla. L. Weekly Supp. 749a

Insurance -- Personal injury protection -- Coverage -- Denial -- Failure to maintain patient logs does not permit insurer to deny responsibility to pay claims for lawfully rendered treatment

15 Fla. L. Weekly Supp. 1013a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Failure to pay or obtain reasonable proof within 30 days -- Insurer is liable for statutory interest on late-paid bill where insurer failed to pay claim or obtain reasonable proof that it was not responsible for claim within 30-day period allocated for authentication, and thereafter paid claim

15 Fla. L. Weekly Supp. 330b

Insurance -- Personal injury protection -- Summary judgment -- Factual issues -- Error to strike opposing affidavit for failure to attach referenced documents and on grounds that it was irrelevant, conclusory and contained hearsay -- Medical provider's affidavit in support of summary judgment, stating that charged amount was reasonable charge for doctor within county, was not sufficient to support summary judgment on issue -- Summary judgment on issue of proper coding was not appropriate where opposing affidavits presented contrary evidence -- Error to enter summary judgment in favor of provider on issue of claim for lumbar support based on determination that provider had satisfied “mailbox rule” presumption that requested invoice was mailed to insurer -- Claims adjuster's testimony that invoice was never received raises disputed issue of fact requiring evidentiary hearing

15 Fla. L. Weekly Supp. 1207c

Insurance -- Personal injury protection -- Coverage -- Version of PIP statute in effect at time PIP policy was executed, which provided for payment of 80% of reasonable charges, rather than version of statute in effect at time of treatment after expiration of policy, which provides for payment of 80% of Medicare fee schedule, is applicable -- Provision in policy stating that it is controlled by PIP statute “as amended” cannot reasonably be construed to refer to amendments occurring after policy's expiration -- At best, “as amended” language is ambiguous and construed against drafter -- Amendment at issue is not remedial amendment but substantive amendment that should not be applied retroactively -- No merit to argument that version of statute at time claim was actually reduced controls

15 Fla. L. Weekly Supp. 1132c

Insurance -- Personal injury protection -- Affirmative defenses -- Amendment -- Denial -- Insurer does not have standing to assert plaintiff's violations of certain statutes as basis for non-payment of PIP benefits

15 Fla. L. Weekly Supp. 1132b

Insurance -- Personal injury protection -- Affirmative defenses -- Amendment -- Denial -- Insurer does not have standing to assert plaintiff's violations of certain statutes as basis for non-payment of PIP benefits

15 Fla. L. Weekly Supp. 1132a

Insurance -- Personal injury protection -- Affirmative defenses -- Amendment -- Denial

15 Fla. L. Weekly Supp. 265b

Insurance -- Personal injury protection -- Coverage is extended to toddler's head injury incurred in fall on seat belt bolt in vehicle floor while playing in parked vehicle because injury resulted from ownership and use of vehicle

15 Fla. L. Weekly Supp. 159a

Insurance -- Personal injury protection -- Priority of payments -- Exhaustion of policy limits -- Where lost wage claim was made before insured gave assignment to medical provider, and assignment only assigned benefits for treatment, not for any lost wages, insurer was correct in paying lost wage claim that exhausted policy limits even after receipt of provider's demand letter disputing reduced medical bills and notice of assignment

15 Fla. L. Weekly Supp. 394b

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Insurer is not required to escrow or reserve PIP benefits for claims that are reduced or denied -- Right to contest PIP claim, including claims for past due interest and attorney's fees, can be extinguished through exhaustion of benefits after demand letter has been submitted and before suit is filed absent showing of bad faith -- Summary judgment granted

15 Fla. L. Weekly Supp. 383b

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Insurer has no duty to escrow funds pending resolution of contested claim -- Insured cannot maintain action to recover PIP benefits when insured's benefits have been exhausted after medical provider filed suit against insurer and there is no evidence that insurer acted in bad faith in exhausting benefits

15 Fla. L. Weekly Supp. 334a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Insurer was not required to set aside reserve fund for monies in dispute with medical provider

15 Fla. L. Weekly Supp. 1115a

Insurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- Insurer is not liable to pay PIP benefits once benefits are exhausted, absent showing that benefits were exhausted in bad faith, and is not required to set aside reserve for disputed claims

15 Fla. L. Weekly Supp. 1122b

Insurance -- Personal injury protection -- Motion to continue trial and strike from trial docket, on ground that discovery was incomplete when insurer noticed case for trial, is denied where pleadings are complete and, as matter of law, action is at issue and ready for trial

15 Fla. L. Weekly Supp. 932b

Insurance -- Personal injury protection -- Consolidation of cases -- Motion to consolidate two PIP cases involving same medical provider, same insurer, and insureds who were injured in same accident is denied where cases involve separate policies, separate injuries and separate potential affirmative defenses

15 Fla. L. Weekly Supp. 743b

Insurance -- Personal injury protection -- Confession of judgment -- Post-suit partial payment of PIP benefits constitutes confession of judgment

15 Fla. L. Weekly Supp. 829c

Insurance -- Personal injury protection -- Complaint -- Premature -- Demand for mediation -- Statute which provides that filing demand for mediation tolls requirements for filing suit for 60 days does not apply to first-party PIP claims

15 Fla. L. Weekly Supp. 826a

Insurance -- Personal injury protection -- Complaint -- Premature -- Demand for mediation -- Statute which provides that filing demand for mediation tolls requirements for filing suit for 60 days does not apply to first-party PIP claims

15 Fla. L. Weekly Supp. 1101c

Insurance -- Personal injury protection -- Complaint -- Amendment -- Motion to amend complaint to delete “Inc.” from provider's name is granted -- Insurer was not confused or misled regarding identity of medical provider by addition or omission of “Inc.” to provider's name, and any defect in name was waived by insurer's failure to object to defect until five years after suit was filed

15 Fla. L. Weekly Supp. 472a

Insurance -- Personal injury protection -- Claims -- Timeliness -- Medical provider that submitted bills to insurer more than 35 days after dates of service forfeited any claim for payment from PIP carrier or insured -- Even if bills had been timely submitted, insurer properly applied bills to deductible

15 Fla. L. Weekly Supp. 385a

Insurance -- Personal injury protection -- Notice of loss -- HCFA form -- Failure to provide physician credentials on HCFA forms -- Partial summary judgment granted in favor of insurer

15 Fla. L. Weekly Supp. 618b

Insurance -- Personal injury protection -- Notice of loss -- HCFA claim form -- Waiver -- Insurer's issuance of partial payment and denial of balance of claim on grounds other than omission of professional license number from HCFA claim form showed intent to accept HCFA form as sufficient notice of covered loss -- Insurer waived right to raise defective HCFA form as statutory bar to payment

15 Fla. L. Weekly Supp. 940b

Insurance -- Personal injury protection -- Notice of loss -- HCFA form -- Professional license number -- Insurer has not been placed on notice of covered loss where HCFA forms submitted did not include professional license number of medical provider/diagnostic testing facility, notwithstanding argument that diagnostic testing facilities are not required to hold license

15 Fla. L. Weekly Supp. 735a

Insurance -- Personal injury protection -- Notice of loss -- HCFA form -- Professional license number -- Failure to include professional license number in box 31 of HCFA forms fails to put insurer on notice of covered loss and bars suit

15 Fla. L. Weekly Supp. 1229a

Insurance -- Personal injury protection -- Notice of loss -- Claim form -- Professional license number -- Insurer's action of failing to provide explanation of benefits alerting medical provider to lack of professional license number in box 31 of HCFA form and proceeding with independent medical examination as if no defect in claim existed waived right to assert defense of defective HCFA form

15 Fla. L. Weekly Supp. 119a

Insurance -- Personal injury protection -- Notice of loss -- HCFA form -- Statutory amendment creating obligation to include medical provider's professional license number on HCFA form is substantive change that does not apply retroactively to PIP policy entered into prior to effective date of amendment

15 Fla. L. Weekly Supp. 1225a

Insurance -- Personal injury protection -- Notice of loss -- Claim form -- Professional license number -- Where there is no professional license required for MRI facility to perform or bill for MRI, insurer cannot refuse to pay timely presented claim for medically necessary MRI on ground that provider failed to list professional license number in box 31 of CMS-1500 claim form

15 Fla. L. Weekly Supp. 1204a

Insurance -- Personal injury protection -- Notice of loss -- Claim form -- Professional license number -- Where there is no professional license required for MRI facility to perform or bill for MRI, insurer cannot refuse to pay timely presented claim for medically necessary MRI on ground that provider failed to list professional license number in box 31 of CMS-1500 claim form

15 Fla. L. Weekly Supp. 949b

Insurance -- Personal injury protection -- Notice of loss -- Claim form -- Professional license number -- Where there is no professional license required for MRI facility to perform or bill for MRI, insurer cannot refuse to pay timely presented claim for medically necessary MRI on ground that provider failed to list professional license number in box 31 of CMS-1500 claim form

15 Fla. L. Weekly Supp. 495a

Insurance -- Personal injury protection -- Notice of loss -- Claim form -- License number -- Medical provider billing globally for professional and technical component of MRI was required to disclose professional license number of person performing service in box 31 of CMS 1500 form, not merely healthcare facility license number -- Summary judgment entered in favor of insurer

15 Fla. L. Weekly Supp. 847a

Insurance -- Personal injury protection -- Notice of loss -- Claim form -- License number -- Where independent corporate diagnostic testing company that is entitled to submit claim for both professional and technical components of MRI has no professional license and is not required to be professionally licensed, company cannot lawfully comply with statutory provision requiring it to place professional license number on claim form, and form submitted without license number was properly completed -- No merit to argument that company should use professional license number of referring physician, interpreting radiologist, or company's medical director, who did not conduct test -- Such use would violate notices on claim form and subject company and physicians to claims of insurance fraud -- No merit to argument that failure to place facility license number on claim form precludes notice of loss where explanation of benefits did not address facility license number, and number is not required on form

15 Fla. L. Weekly Supp. 1210a

Insurance -- Personal injury protection -- Claim form -- Professional license number -- Where box 31 of CMS-1500 claim form lacks professional license number of medical provider, form does not place insurer on notice of covered loss

15 Fla. L. Weekly Supp. 626aNOT FINAL VERSION OF OPINION
Subsequent Changes at 15 Fla. L. Weekly Supp. 735a

Insurance -- Personal injury protection -- Notice of loss -- Medical bills -- Where medical provider's professional license number was not on medical bills, insurer was not on notice of covered loss -- Failure to raise physician license number deficiency prior to litigation did not waive right to assert that charge was in violation of section 627.736(5)(d)

15 Fla. L. Weekly Supp. 374b

Insurance -- Personal injury protection -- Notice of loss -- HCFA claim form -- Failure to provide a professional license number in Box 31 of HCFA form does not bar a claim for PIP benefits when provider submitted copies of all professional licenses in its possession along with the bills to the insurer

15 Fla. L. Weekly Supp. 893b

NOT FINAL VERSION OF OPINION
Subsequent Changes at 16 Fla. L. Weekly Supp. 33b

Insurance -- Personal injury protection -- Notice of loss -- Claim form -- Professional license number -- Error to find that insured substantially complied with notice requirement despite failure to provide doctor's professional license number on claim form -- Waiver -- Where, after receiving defective notice, insurer required insured to submit to examination under oath and independent medical examination and failed to alert insured to deficiency, trial court did not err in concluding that insurer waived right to dispute claim based on deficiency

15 Fla. L. Weekly Supp. 726a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- CPT coding -- Authoritative treatises designated by administrative rule prohibit billing range of motion and muscle tests separately from chiropractic manipulation treatment where no coding modifiers are used -- No merit to argument that PIP statute allows trial court to consider authoritative treatises designated by rule only if CPT book and items it references are ambiguous -- Insurer is not required to pay unbundled charges

15 Fla. L. Weekly Supp. 1114a

Insurance -- Personal injury protection -- Declaratory judgment -- Recoding CPT codes -- Where insurer did not make determination that CPT code for unattended electrical stimulation was improperly or incorrectly upcoded or unbundled but, rather, recoded CPT code that Medicare Part B fee schedule does not recognize to synonymous HCPCS system recognized by Medicare Part B fee schedule and explained action in explanation of benefits, insurer was not required to contact medical provider before changing code

15 Fla. L. Weekly Supp. 495b

Insurance -- Personal injury protection -- Declaratory judgment -- Recoding of CPT codes -- Where insurer did not make determination that CPT code for unattended electrical stimulation was improperly or incorrectly upcoded or unbundled but, rather, recoded CPT code that Medicare Part B fee schedule does not recognize to synonymous code in HCPCS system recognized by Medicare Part B fee schedule and explained action in explanation of benefits, insurer was not required to contact medical provider before changing code

15 Fla. L. Weekly Supp. 829b

Insurance -- Personal injury protection -- Recoding CPT codes -- No improper recoding occurred where code under which insurer paid bill was synonymous with CPT code referenced in bill for electrical stimulation

15 Fla. L. Weekly Supp. 939b

Insurance -- Personal injury protection -- Explanation of benefits -- Insurer breached contract by failing to provide EOB to medical provider

15 Fla. L. Weekly Supp. 188a

Insurance -- Personal injury protection

15 Fla. L. Weekly Supp. 482a

Insurance -- Personal injury protection -- Answer -- Amendment -- Motion to amend answer to assert defense of failure to attend examination under oath is denied as untimely where insurer did not list failure to attend EUO as basis for denial of claim in explanation of benefits or response to demand letter and did not move to amend until notice of trial was served, and medical provider would be prejudiced by amendment

15 Fla. L. Weekly Supp. 736a

Insurance -- Personal injury protection -- Mediation -- Statute providing for mediation of personal injury claims arising from ownership or negligent use of motor vehicles does not apply to first-party claims for PIP benefits -- Affirmative defense alleging that medical provider filed PIP suit prematurely before participating in mediation is stricken

15 Fla. L. Weekly Supp. 388a

Insurance -- Personal injury protection -- Coverage -- Affirmative defenses -- Accord and satisfaction -- Insurer cannot assert accord and satisfaction based on medical provider's acceptance of check for reduced amount for MRI where insurer failed to pay statutorily mandated schedule for MRI, provider did not agree to accept lesser amount tendered as payment in full, and there was no correspondence attached to check tendered

15 Fla. L. Weekly Supp. 996a

NOT FINAL VERSION OF OPINION
Subsequent Changes at 16 Fla. L. Weekly Supp. 92b

Insurance -- Personal injury protection -- Med Pay -- Notice of loss -- Disclosure and acknowledgment form -- Submission of D&A form is not prerequisite to payment of PIP benefits -- Accordingly, submission of D&A form is not billing requirement under Med Pay policy which provides that bills and statements for Med Pay coverage must be submitted in accordance with billing requirements applicable under PIP coverage

15 Fla. L. Weekly Supp. 1102a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Overdue bills -- Request for documentation/information -- Tolling of period to pay or reject claim -- Where insurer made timely request for additional documentation and information regarding claim, and provider failed to provide all documents and information requested until after suit was filed, time for payment of claim was tolled, and claim was not overdue and collectible at time of filing suit -- No merit to argument that substantial compliance with request for documentation and information is sufficient -- Med Pay -- Since PIP coverage is primary under terms of policy and PIP statutes, provider is not entitled to recover under Med Pay coverage for claims not payable under PIP coverage

15 Fla. L. Weekly Supp. 1107b

Insurance -- Personal injury protection -- Complaint -- Premature -- Demand for mediation -- Statute which provides that filing demand for mediation tolls requirements for filing suit for 60 days does not apply to PIP cases

15 Fla. L. Weekly Supp. 946a

Insurance -- Personal injury protection -- Complaint -- Premature -- Request for mediation -- Statute which provides that filing demand for mediation tolls requirements for filing suit for 60 days does not apply to action for PIP benefits

15 Fla. L. Weekly Supp. 920b

Insurance -- Personal injury protection -- Complaint -- Premature -- Demand for mediation -- Statute which provides that filing of demand for mediation tolls requirements for filing suit for 60 days does not apply to PIP cases

15 Fla. L. Weekly Supp. 920a

Insurance -- Personal injury protection -- Complaint -- Premature -- Demand for mediation -- Statute which provides that filing demand for mediation tolls requirement for filing suit for 60 days does not apply to PIP claims

15 Fla. L. Weekly Supp. 620a

NOT FINAL VERSION OF OPINION
Subsequent Changes at 15 Fla. L. Weekly Supp. 920b

Insurance -- Personal injury protection -- Complaint -- Premature -- Demand for mediation -- Statute which provides that filing of demand for mediation tolls requirements for filing suit for 60 days applies to first-party PIP claims

15 Fla. L. Weekly Supp. 1125b

Insurance -- Personal injury protection -- Complaint -- Conditions precedent -- Demand for mediation -- Mediation is not mandatory condition precedent to filing PIP suit -- Statute which provides that filing demand for mediation tolls requirements for filing personal injury suit for 60 days does not apply to PIP claims

15 Fla. L. Weekly Supp. 55a

Insurance -- Homeowners -- Coverage -- Where terms “resident” and “in care of” are ambiguous in homeowners policy that defines “insured” to include named insured, residents of household, relatives and persons under 21 in care of those persons, contract is interpreted in favor of coverage of two-year-old child temporarily staying in home while mother looks for apartment

15 Fla. L. Weekly Supp. 805a

Health maintenance organizations -- Declaratory judgment -- Balance billing -- Where sole provider of anesthesia at hospital under contract with HMO received authorization to deliver anesthesia services to HMO subscribers as part of hospital's authorization for surgeries and to bill subscribers for those services, HMO is liable for services rendered by anesthesia provider -- Where HMO accepted liability for payments to anesthesia provider, and provider was informed that HMO accepted liability and knew or should have known that HMO was liable, provider was prohibited by section 641.3154 from balance-billing subscribers -- No merit to argument that HMO could not accept liability if it did not make full payment for services rendered -- No merit to argument that provider is authorized to balance-bill by hospital's consent to treatment form

15 Fla. L. Weekly Supp. 249a

Insurance -- Personal injury protection -- Claims -- Timeliness -- Requirement that medical bills be submitted to insurer within 35 days of treatment applies to medical providers but not insureds -- Insurer's claim that amendatory endorsement of policy excluding coverage for medical expenses not payable under No-Fault Act bars insured's recovery is not dispositive where endorsement includes exceptions to exclusion in which coverage may be provided even though medical expenses are not payable under Act

15 Fla. L. Weekly Supp. 275b

Insurance -- Personal injury protection -- Coverage -- Insured occupying vehicle not covered under policy -- Where at time of accident insured was occupying vehicle owned solely by insured's resident wife who is named insured under policy, and policy excludes coverage for named insured while occupying vehicle owned by named insured and not covered under policy, insurer does not owe PIP benefits to insured, wife or medical provider/assignee

15 Fla. L. Weekly Supp. 621a

Insurance -- Personal injury protection -- Coverage -- Uninsured vehicle -- Where insured was driving vehicle that was not insured under policy and of which he was owner, insured was not entitled to seek PIP benefits under policy -- Summary judgment granted in favor of insurer

15 Fla. L. Weekly Supp. 98a

Insurance -- Personal injury protection -- Coverage -- Injury while occupying vehicle owned by named insured but not insured under policy -- Where plaintiff/named insured was injured while driving vehicle owned by his wife who is also named insured, vehicle was not insured under PIP policy, and exclusion of policy specifically provides for no coverage for injury sustained by named insured while occupying another vehicle owned by named insured and not insured under policy, plaintiff is precluded from coverage

15 Fla. L. Weekly Supp. 362a

Insurance -- Homeowners -- Exclusions -- Policy excluded liability for all claims arising from death of minor passenger in go-cart owned, possessed and controlled by homeowner that collided with car while off of insured property

15 Fla. L. Weekly Supp. 171b

Insurance -- Personal injury protection -- Evidence -- Judicial notice -- Medicare Part B fee schedule

15 Fla. L. Weekly Supp. 911a

Insurance -- Personal injury protection -- Evidence -- Court takes judicial notice of Medicare Part B fee schedule, but reserves ruling on relevancy and admissibility

15 Fla. L. Weekly Supp. 999c

Insurance -- Personal injury protection -- Evidence -- Fee schedules -- Motion to take judicial notice of Medicare Part B fee schedule and workers' compensation fee schedule is granted

15 Fla. L. Weekly Supp. 949c

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable charges -- Evidence -- Medical fee schedules -- Court takes judicial notice of Medicare Part B and workers' compensation fee schedules -- Fee schedules are self-authenticating, relevant and admissible

15 Fla. L. Weekly Supp. 1055a

Insurance -- Personal injury protection -- Discovery -- Privilege -- Work product -- Trial court departed from essential requirements of law, resulting in irreparable harm to provider, when it concluded that insurer was not required to produce adjuster's AS400 computerized notes generated before insurer received provider's presuit demand letter because provider did not establish a valid need for the notes to establish that treatment of insured was reasonable, related, and necessary -- Trial court applied wrong evidentiary burden when analyzing insurer's invocation of work-product privilege -- Had insurer stated that it prepared AS400 notes in anticipation of litigation, burden would have shifted to provider to demonstrate that i]t had need of the materials in preparation of case and was unable without undue hardship to obtain substantial equivalent by other means -- Discussion of procedural requirements and evidentiary burdens when one party invokes work-product privilege, including fact that Florida requires privilege logs when litigant claims work-product privilege and that failure to comply with this requirement results in waiver of privilege -- Remand for evidentiary hearing consistent with requirements of rule 1.280(b)(3)

15 Fla. L. Weekly Supp. 1057a

Insurance -- Personal injury protection -- Discovery -- Appeals -- No merit to claim that petition for writ of certiorari seeking review of order denying motion to strike certain discovery documents is untimely because order challenged is tantamount to rehearing of an earlier non-final order -- However, petitioner/insurer has not demonstrated that it will be irreparably harmed by disclosure of information, particularly since insurer admits that information would be discoverable in a deposition -- Certiorari denied

15 Fla. L. Weekly Supp. 218a

Insurance -- Personal injury protection -- Discovery -- Procedure reports -- Order compelling production of information regarding charges for certain CPT codes received by insurer during specified dates of service from medical providers in certain zip codes or, in the alternative, “procedure reports” reflecting this information was not departure from essential requirements of law resulting in material injury for which there was no adequate remedy on appeal

15 Fla. L. Weekly Supp. 742a

Insurance -- Personal injury protection -- Discovery -- Insurer's objections to interrogatories asking whether insurer contends that insured submitted medical bills that are unreasonable or unnecessary, for descriptions of documentary evidence supporting any such contentions, for names and addresses of medical practitioners that reviewed bills and persons with knowledge of issues raised in pleadings, for statement of method used to calculate partial payments, and for facts supporting answers of “denied” and “insufficient knowledge” in response to request for admissions on ground that interrogatories are overbroad, harassing and irrelevant are denied -- Motion to compel better responses granted and sanctions imposed

15 Fla. L. Weekly Supp. 176a

Insurance -- Personal injury protection -- Declaratory judgment -- Despite case resolving medical provider's entitlement to PIP log under different provision of PIP statute, question of whether provider is entitled to log under section 627.736(4)(b) remains open and is proper subject for declaratory relief -- Provider may maintain declaratory action for copy of policy and declarations page -- Provider is not required to plead damages as element of declaratory relief

15 Fla. L. Weekly Supp. 164b Insurance -- Personal injury protection -- Declaratory judgment -- Complaint alleging claim for failure to provide PIP log to medical provider states viable cause…

15 Fla. L. Weekly Supp. 164a

Insurance -- Personal injury protection -- Declaratory judgment -- Complaint alleging claims for failure to provide explanation of benefits, policy, declarations page and PIP log to medical provider states viable cause of action for declaratory relief -- Motion to dismiss denied

15 Fla. L. Weekly Supp. 1127b

Insurance -- Personal injury protection -- Discovery -- Physician who conducted independent medical examination is required to produce copies of reports for all IMEs and peer reviews performed in past three years -- In deference to concern for patients' privacy, court limits disclosure to portion of each report reflecting date of examination and physician's impressions or conclusions and establishes other safeguards

15 Fla. L. Weekly Supp. 946b

Insurance -- Personal injury protection -- Discovery -- Physician who conducted independent medical examination is required to comply with subpoena seeking copies of all IME and peer reviews performed during three-year period before date of last report prepared in case

15 Fla. L. Weekly Supp. 888a

Insurance -- Personal injury protection -- Discovery -- Physician who conducted independent medical examination is required to produce copies of reports for all IMEs and peer reviews performed in past three years

15 Fla. L. Weekly Supp. 494b

Insurance -- Personal injury protection -- Discovery -- Doctor selected to perform independent medical examination is ordered to produce copies of reports of all IMEs and peer reviews performed during three-year period before date of last report prepared in case -- Where records sought are reports IME doctor is required by PIP law to retain, request meets rule 1.280(b)(4) requirement of “unusual and compelling circumstances” for requiring expert to produce business records

15 Fla. L. Weekly Supp. 291a

Insurance -- Personal injury protection -- Discovery -- Documents -- Where PIP statute requires physician preparing report for insurer to maintain copies of all examination reports for 3 years, physician who conducted independent medical examination of insured is required to produce subpoenaed copies of peer review and IME reports -- Physician is entitled to reasonable copy charges, but provider may elect to use own copy service

15 Fla. L. Weekly Supp. 265a

Insurance -- Personal injury protection -- Discovery -- Request to produce any explanation of benefits indicating allowed amount greater than 200% of Medicare Part B Fee Schedule within 90 days of date of service at issue is overbroad

15 Fla. L. Weekly Supp. 116a

Insurance -- Personal injury protection -- Discovery -- Although medical provider may be entitled to information that would be contained in requested sliver and procedure reports, where reports do not exist and are not in possession, custody or control of insurer, trial court erred in ordering production of reports -- Court also erred in ordering insurer to produce all underlying data and documents used to compile production report in lieu of creating and producing report where provider did not request those documents and data and, therefore, insurer was not afforded notice and opportunity to object -- Petition for writ of certiorari granted

15 Fla. L. Weekly Supp. 286a

Insurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Insurer's failure to comply with discovery and with court orders relating to payment of monetary sanctions and to attendance at mediation and hearing on motion for sanctions warrants striking of pleadings and entry of default where misconduct is not fully result of neglect or inexperience of counsel who claims blame for misconduct, but is attributable to willful, deliberate and contumacious conduct on part of insurer

15 Fla. L. Weekly Supp. 981b

Insurance -- Personal injury protection -- Discovery violation -- Failure to pay sanction -- Abuse of discretion to impose additional sanction on insurer's attorney for insurer's failure to pay sanction for discovery violation without affording attorney notice -- Although personal imposition of sanctions on non-party attorneys is not provided for in rule 1.380, courts have inherent authority to impose attorney's fees against attorneys but should do so only sparingly, cautiously, and upon finding of egregious conduct or action in bad faith -- Abuse of discretion to impose sanctions on insurer's attorney without express finding of bad faith conduct that resulted in unnecessary incurrence of attorney's fees

15 Fla. L. Weekly Supp. 171c

Insurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Attorney's fees and costs assessed as sanction for willful violation of discovery order

15 Fla. L. Weekly Supp. 580b

Insurance -- Personal injury protection -- Dismissal -- Fraud on court -- No abuse of discretion in dismissing PIP case for fraud on court where trial court found that medical provider intended to conceal provider's lien and deceive insurer and court into believing that insured had executed assignment -- Discovery -- Failure to comply -- Sanctions -- No error in denying provider's motion to strike insurer's pleadings as sanction for discovery violation and imposing sanction of $500 instead

15 Fla. L. Weekly Supp. 797c

Insurance -- Personal injury protection -- Discovery -- Expert witnesses -- Order requiring insurer to provide information about non-party's use of expert physician is quashed

15 Fla. L. Weekly Supp. 1031b

Insurance -- Personal injury protection -- Discovery -- Depositions -- Failure to comply -- Sanctions -- Where counsel for medical provider violated multiple court orders by obstructing two attempted depositions of corporate representative, insurer is awarded attorney's fees and costs of depositions -- If counsel for provider fails again to comply with court orders at deposition of representative, court will entertain more severe sanctions, including striking of pleadings and dismissal

15 Fla. L. Weekly Supp. 1011a

Insurance -- Personal injury protection -- Discovery -- Depositions -- Failure to attend -- Sanctions -- Insurer that failed to attend deposition is ordered to pay sanctions to counsel for medical provider

15 Fla. L. Weekly Supp. 916b

Insurance -- Personal injury protection -- Discovery -- Depositions -- Failure to attend -- Sanctions -- Attorney's fees and court reporter fee

15 Fla. L. Weekly Supp. 787a

Insurance -- Personal injury protection -- Discovery -- Computer database used to reduce bills -- Trade secrets -- Where insurer resisted discovery of database used to reduce bills based on claim of trade secrets, trial court erred in ordering disclosure without conducting in camera inspection or hearing to evaluate material -- Waiver -- No merit to argument that insurer waived in camera inspection by failing to request it where trial court deprived insurer of opportunity for inspection by mistakenly holding that earlier order compelling disclosure was law of the case

15 Fla. L. Weekly Supp. 917a

Insurance -- Personal injury protection -- Discovery -- Interrogatories -- Objections to interrogatories seeking information regarding amount paid to non-party physician who performed orthopedic consult; whether consulting physician was paid by hour, by number of consults per day or by day; amount consulting physician is paid by medical provider for one day of work; whether cost of doing business was factor in determining consult charge; and factors, documents and sources consulted by provider in determining consult charge are overruled -- Admissions -- Provider is ordered to respond to request for admission regarding amount charged by different-named entity in year prior to registration of provider's current fictitious name where different-named entity was same corporation with same tax ID number as provider -- Documents -- Objections to requests to produce tax forms, pay stubs or other documents showing amounts paid to consulting physician are overruled

15 Fla. L. Weekly Supp. 1122c

Insurance -- Personal injury protection -- Discovery -- Depositions -- Expert witness fee -- Treating physician is entitled to expert witness fee if he testifies about treatment of insured, but not if he testifies about management and operation of medical provider

15 Fla. L. Weekly Supp. 929a

Insurance -- Personal injury protection -- Discovery -- Depositions -- Insurer shall pay expert witness fee for depositions of treating physicians

15 Fla. L. Weekly Supp. 841a

Insurance -- Personal injury protection -- Discovery -- Depositions -- Expert witness fee -- Treating physician is not entitled to expert witness fee for appearance at deposition

15 Fla. L. Weekly Supp. 1048a

Insurance -- Personal injury protection -- Discovery -- Depositions -- Expert witness fee -- Treating physician -- Where insurer sought to depose treating physician regarding professional services rendered and whether treatment was medically necessary and related to accident, trial court correctly determined that physician was entitled to expert witness fee under rule 1.390

15 Fla. L. Weekly Supp. 372b

Insurance -- Personal injury protection -- Discovery -- Depositions -- Non-party deponent -- Insurer seeking order compelling discovery from non-party independent contractor who performed orthopedic consultation at issue must seek order from circuit court, not county court

15 Fla. L. Weekly Supp. 1106a

Insurance -- Personal injury protection -- Discovery -- Depositions -- Where insurer alleges affirmative defenses, medical provider may require corporate representative of insurer that maintains its place of business in Brevard County to travel to Miami-Dade County for deposition -- Request to stay case while insurer seeks certiorari review of order denying protective order is denied

15 Fla. L. Weekly Supp. 795a

Insurance -- Personal injury protection -- Discovery -- Depositions -- Location -- Certiorari challenge to order denying motion for protective order seeking to move location for deposition of insurer's litigation adjuster from Broward County to Brevard County or Addison, Texas -- Rule that defendant should not be required to travel great distance for discovery deposition is not applicable where insurer has asserted affirmative defense -- Standing -- Assignment -- Claim that insured who assigned benefits to medical provider lacks standing is not properly before appellate court where claim was never brought before trial court or raised as affirmative defense

15 Fla. L. Weekly Supp. 1056a

Insurance -- Personal injury protection -- Discovery -- Depositions -- County court did not depart from essential requirements of law by compelling defendant's claims adjuster, who resided in Hillsborough County, to attend deposition in Miami-Dade County -- Because insurer alleged in its answer affirmative defenses that medical services were not reasonable, related, or necessary and that insured made material misrepresentations on insurance application, plaintiff was permitted to depose adjuster in Miami-Dade County

15 Fla. L. Weekly Supp. 1198a

Insurance -- Personal injury protection -- Discovery -- Depositions -- Insurer that has designated litigation adjuster for deposition pursuant to rule 1.310(b)(6) is not required to produce presuit adjuster named in medical provider's notice of taking deposition

15 Fla. L. Weekly Supp. 1007a

Insurance -- Personal injury protection -- Discovery -- Depositions

15 Fla. L. Weekly Supp. 157b

Insurance -- Personal injury protection -- Discovery -- Deposition of insured limited in scope and duration

15 Fla. L. Weekly Supp. 680b

Insurance -- Personal injury protection -- Default -- Vacation -- Although insurer demonstrated due diligence in moving to set aside default and established excusable neglect through affidavit stating that untimely filing was due to courier's error, insurer failed to establish meritorious defense -- Denial of motion to vacate is affirmed

15 Fla. L. Weekly Supp. 1139a

Insurance -- Default -- Vacation -- Excusable neglect -- Abuse of discretion to deny motion to vacate default where affidavit of adjuster demonstrates that summons and complaint were mishandled internally by insurer and never forwarded to counsel

15 Fla. L. Weekly Supp. 843c

Insurance -- Personal injury protection -- Default -- Vacation -- Excusable neglect -- Claim that insurer's lawsuit manager failed to have matter assigned to attorney so that answer would be filed does not establish excusable neglect -- Insurer did not act with due diligence where motion to vacate was not filed until nearly a year after insurer knew or should have known of default

15 Fla. L. Weekly Supp. 123b

Insurance -- Personal injury protection -- Independent medical examination -- Necessity to plead as affirmative defense -- Error to prohibit testimony regarding IME based on insurer's failure to plead affirmative defense regarding IME where IME evidence would have been presented to refute medical provider's evidence regarding reasonableness, relatedness and necessity of treatment -- Expert witness -- Qualifications -- Expert's consideration of managed care fee schedules is not basis for finding expert unqualified to make determination of reasonableness of charges -- Deductible -- Application of deductible provision of policy need not be plead as affirmative defense -- If medical provider again obtains jury verdict on remand, trial court should reduce award by deductible set forth in policy -- Attorney's fees and cost award reversed based on reversal of judgment

15 Fla. L. Weekly Supp. 665b

Insurance -- Personal injury protection -- Demand letter -- Validity -- Demand letter that otherwise complies with statute but seeks specific amount for MRI in excess of statutory fee schedule is valid where insurer failed to send explanation of benefits in response to original claim -- No error in denying insurer's motion to amend answer and affirmative defenses to allege that demand letter was invalid where amendment would be futile -- Error to fail to address amendment alleging that policy deductible provision was applicable -- On remand trial court to determine applicability of deductible provision

15 Fla. L. Weekly Supp. 565a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Limitation to amount pled -- Where medical provider claimed PIP benefits not to exceed $1,500 in declaration, trial court erred in entering summary judgment in excess of amount pled -- Provider should have amended complaint to claim entire amount of bills and may do so on remand -- Affirmative defenses -- Application of deductible is not affirmative defense that must be raised and proved by insurer

15 Fla. L. Weekly Supp. 283a

Insurance -- Personal injury protection -- Explanation of benefits -- Medical provider may state cause of action for breach of contract and/or declaratory relief for failure to provide EOB -- Provider may also maintain action for copy of policy and declarations page

15 Fla. L. Weekly Supp. 280a

Insurance -- Personal injury protection -- Medical provider may state causes of action for breach of contract based on failure to provide explanation of benefits, declarations page and policy -- Declaratory judgment -- Claim for failure to provide PIP log pursuant to section 627.736(4)(b) states cause of action for declaratory relief

15 Fla. L. Weekly Supp. 682a

Insurance -- Personal injury protection -- Declaratory judgment -- PIP payout log -- Insurer was not required to provide PIP log to assignee/medical provider -- Trial court erred in entering summary judgment in favor of provider on claim for declaratory relief as to entitlement to PIP log

15 Fla. L. Weekly Supp. 944a

Insurance -- Personal injury protection -- Declaratory judgment -- Assignee/medical provider may maintain action to determine or enforce right to copy of insurance policy and declarations page under section 627.4137 -- No merit to argument that insurer satisfied obligation to furnish documents to provider by furnishing documents to insured

15 Fla. L. Weekly Supp. 943a

Insurance -- Personal injury protection -- Declaratory judgment -- Insurer breached PIP contract by failing to provide explanation of benefits to assignee/medical provider -- Provider may maintain action to determine or enforce right to copy of insurance policy and declarations page under section 627.4137 -- No merit to argument that insurer satisfied obligation to furnish documents to provider by furnishing documents to insured

15 Fla. L. Weekly Supp. 947a

Insurance -- Personal injury protection -- Explanation of benefits -- Insurer's letter to medical provider stating that bills were not compliant with section 627.736(5) does not refute charge that insurer failed to provide EOB where evidence was untimely filed, and letter is not legally sufficient itemized specification of unpaid charges -- Claim that insurer was not furnished with notice of covered loss because HCFA forms were not properly completed fails where evidence was untimely filed, and forms were properly completed -- Assignee/medical provider may maintain action to determine or enforce right to copy of insurance policy and declarations page under section 627.4137 -- No merit to argument that insurer was relieved of obligation to provide documents because request cited wrong statute -- Request for denial of motion for partial summary judgment or continuance due to outstanding discovery is denied where discovery at issue would not change pertinent facts

15 Fla. L. Weekly Supp. 1232a

Insurance -- Personal injury protection -- Declaratory judgment -- Insurer is required to provide copy of declarations page and policy to medical provider/assignee presuit

15 Fla. L. Weekly Supp. 1213a

Insurance -- Personal injury protection -- Declaratory judgment -- Medical provider/assignee is entitled to obtain copy of PIP policy and declarations page directly from insurer

15 Fla. L. Weekly Supp. 1011b

Insurance -- Personal injury protection -- Declaratory judgment -- Insurer is required to provide copy of declarations page and policy to medical provider/assignee -- No merit to argument that provision of documents to insured imputes knowledge of contents of documents to provider

15 Fla. L. Weekly Supp. 995b

Insurance -- Personal injury protection -- Declaratory judgment -- Motion to dismiss declaratory action concerning insurer's obligation to furnish policy, declarations page and/or PIP log on presuit request from assignee/medical provider is denied

15 Fla. L. Weekly Supp. 922c

Insurance -- Personal injury protection -- Assignee/medical provider may state causes of action for breach of contract for failure to provide explanation of benefits and for breach of contract and/or declaratory relief to determine and enforce right to copy of policy and declarations information

15 Fla. L. Weekly Supp. 850c

Insurance -- Personal injury protection -- Declaratory judgment -- Insurer is obligated presuit to provide copy of declaration page and policy to medical provider

15 Fla. L. Weekly Supp. 833a

Insurance -- Personal injury protection -- Declaratory judgment -- Assignee medical provider may maintain action to determine or enforce right to copy of policy and declarations page under section 627.4137 -- No merit to argument that insurer satisfied obligation by furnishing information to insured

15 Fla. L. Weekly Supp. 825b

Insurance -- Personal injury protection -- Explanation of benefits -- Assignee medical provider may state claim for breach of contract for failure to furnish EOB -- Declaratory judgment -- Assignee medical provider may maintain action for copy of policy and declarations page

15 Fla. L. Weekly Supp. 825a

Insurance -- Personal injury protection -- Declaratory judgment -- Assignee medical provider may maintain action for copy of policy and declarations page

15 Fla. L. Weekly Supp. 498a

Insurance -- Personal injury protection -- Declaratory judgment -- Insurer has obligation to provide policy and declarations page on presuit request from assignee/medical provider -- Obligation was not satisfied by furnishing documents to insured at inception of claim

15 Fla. L. Weekly Supp. 491b

Insurance -- Personal injury protection -- Declaratory judgment -- Assignee medical provider is entitled to maintain action to determine or enforce right to copy of policy and declarations page -- Insurer did not satisfy obligation to furnish documents to provider by furnishing information to insured

15 Fla. L. Weekly Supp. 374a

Insurance -- Personal injury protection -- Complaint states cause of action for breach of contract and declaratory relief for failure to provide policy and declarations page -- Motion to dismiss denied

15 Fla. L. Weekly Supp. 845b

Insurance -- Personal injury protection -- Declaratory judgment -- Assignee medical provider may maintain actions for declaratory relief and breach of contract to determine or enforce right to copy of PIP policy and declarations page under section 627.4137 -- No merit to arguments that insurer satisfied obligation by furnishing information to insured, that statute applies only to third-party claims, that assignment of benefits does not specifically assign right to policy and declarations page, or that provider failed to comply with preconditions of section 627.736

15 Fla. L. Weekly Supp. 1031a

Insurance -- Personal injury protection -- Declaratory judgment -- PIP log -- Where insurer was not required to provide PIP log to insured, insured never requested PIP log, insurer nonetheless provided log to insured presuit, and there is no present controversy regarding coverage or payment of medical bills, insurer is entitled to summary judgment in declaratory action for PIP log

15 Fla. L. Weekly Supp. 929b

Insurance -- Personal injury protection -- Declaratory judgment -- PIP insurer is not required to provide PIP log to assignee/medical provider upon pre-suit request -- There is no basis for provider's claim that insurer breached contract by failing to furnish requested policy information -- Knowledge of policy and declarations page previously furnished to assignor/insured is imputed to provider, and insurer indicated in response to demand letter that it had provided requested documents -- Explanation of benefits -- Insurer did not breach policy by failing to provide EOB where insurer did not deny or reduce any charges but paid charges until exhaustion of policy limits, at which time insurer provided EOB

15 Fla. L. Weekly Supp. 483a

Insurance -- Personal injury protection -- Declaratory judgment -- Motion to dismiss action seeking determination of whether insurer had right to unilaterally recode medical provider's charges is denied where determination will resolve actual dispute at issue in case -- Fact that provider can obtain complete relief in another pending civil action does not preclude declaratory judgment

15 Fla. L. Weekly Supp. 725a

Insurance -- Personal injury protection -- Explanation of benefits -- Failure to provide EOB is material breach of PIP contract -- Motion to dismiss counts claiming breach of contract and seeking declaratory relief regarding failure to provide EOB is denied -- Argument that medical provider failed to furnish disclosure and acknowledgment form not considered in ruling on motion to dismiss because argument is outside four corners of pleadings and relates to other dates of service

15 Fla. L. Weekly Supp. 481a

Insurance -- Personal injury protection -- Explanation of benefits -- Medical provider may state cause of action for breach of contract or declaratory relief for failure to provide EOB -- Assignee/medical provider may maintain action for copy of policy and declarations page

15 Fla. L. Weekly Supp. 624a

Insurance -- Personal injury protection -- Declaratory judgment -- Allegations seeking advisory opinion as to sufficiency of demand letter do not fall within bounds of what should be sought for declaratory relief

15 Fla. L. Weekly Supp. 1010a

Insurance -- Personal injury protection -- Declaratory judgment -- Coverage -- Where medical provider has failed to allege basis for doubt as to whether there is coverage, and insurer has raised no coverage defenses, summary judgment is entered in favor of insurer on claim for declaratory relief as to coverage -- Where insurer paid charges until exhaustion of policy limits, there has been no breach of policy -- Explanation of benefits -- Where insurer did not reduce, omit or decline any payments to provider, failure to provide EOB did not constitute breach of contract

15 Fla. L. Weekly Supp. 161b

Insurance -- Personal injury protection -- Declaratory judgment -- Claim regarding whether insurer may recode CPT codes states viable cause of action for declaratory relief

15 Fla. L. Weekly Supp. 633a

Insurance -- Personal injury protection -- Declaratory judgment -- Recoding CPT codes -- Complaint states cause of action for declaratory relief for improper recoding of charges -- Court ruling on motion to dismiss will not go outside four corners of complaint to consider explanation of benefits offered by insurer to show that it did not change CPT codes

15 Fla. L. Weekly Supp. 386b

Insurance -- Personal injury protection -- Declaratory judgment -- CPT coding -- Medical provider has stated viable cause of action for declaratory relief regarding recoding by insurer

15 Fla. L. Weekly Supp. 284a

Insurance -- Personal injury protection -- Declaratory judgment -- Recoding CPT codes -- Medical provider has stated viable cause of action for declaratory relief regarding whether insurer may recode CPT codes

15 Fla. L. Weekly Supp. 624b

Insurance -- Personal injury protection -- Declaratory judgment -- Motion to dismiss count of complaint seeking declaratory relief as to insurance information is granted where there is no need for declaration as to breach of contract regarding PIP benefits that is real issue in case

15 Fla. L. Weekly Supp. 630a

Insurance -- Personal injury protection -- Arbitration -- Count for declaratory relief

15 Fla. L. Weekly Supp. 722a

Insurance -- Personal injury protection -- Explanation of benefits -- Failure to provide EOB is material breach of PIP contract -- Motion to dismiss counts claiming breach of contract and seeking declaratory relief regarding failure to provide EOB, policy, and declarations page are denied -- Argument that medical provider failed to furnish disclosure and acknowledgment form, which is outside four corners of pleadings and relates to other dates of service, is not considered in ruling on motion to dismiss

15 Fla. L. Weekly Supp. 374d

Insurance -- Personal injury protection -- Explanation of benefits -- Motion to dismiss breach of contract claim for failure to provide EOB is denied -- Declaratory action regarding insurer's obligation to provide EOB is dismissed as unnecessary where statute is clear -- Insurer's obligation to provide copy of contract, declarations page, and/or PIP log upon presuit request from assignee/medical provider -- Section 627.736 does not require insurer to provide PIP log presuit -- Breach of contract claim and declaratory action for failure to provide declarations page and copy of policy are dismissed because insurer's failure to comply with duty to provide documents should not be pled as separate counts, but should fall under breach of PIP contract claim

15 Fla. L. Weekly Supp. 882a

Insurance -- Personal injury protection -- Declaratory judgment -- Dismissal -- Appeals -- Standard of review for dismissal of declaratory action based on failure to state cause of action is de novo -- Complaint for declaratory relief was correctly dismissed for failure to state cause of action where medical provider claims in complaint that it requires policy and PIP log to determine its status as claimant and but fails to specify right about which it is unsure

15 Fla. L. Weekly Supp. 177a

Insurance -- Personal injury protection -- Attorneys -- Disqualification -- Conflict of interest -- Prior representation -- Motion to disqualify medical provider's attorney due to prior employment with insurer is denied where cases in which attorney represented insurer were based on different factual circumstances than present case, attorney denies ever working on file for present case while employed by insurer, and attorney did not obtain confidential information related to insurer's defenses and strategies in present case

15 Fla. L. Weekly Supp. 386a

Insurance -- Personal injury protection -- Attorneys -- Disqualification

15 Fla. L. Weekly Supp. 810b

Insurance -- Commercial liability -- Coverage -- Exclusions -- Workers' compensation -- Where workers' compensation claim would have been employee's exclusive remedy for employer's alleged negligence, employer's failure to maintain statutorily mandated workers' compensation insurance precludes coverage under commercial liability policy that excludes any obligation of employer under workers' compensation and similar laws

15 Fla. L. Weekly Supp. 1054b

Insurance -- General liability -- Coverage -- Automobile accident on roadway in front of insured bank -- Error to interpret contractual promise to pay medical expenses for bodily injury caused by accident because of insured's operations as requiring that accident must occur at location where bank is actively engaged on behalf of its business -- Under plain meaning of contract, insurer is responsible for bodily injury caused by accident because of insured's operations so long as accident occurs in coverage territory -- Bodily injury caused by accident on “ways next to premises” includes injury occurring on public roadway adjacent to bank property -- Entry of summary judgment in favor of insurer was error where there remain disputed issues of material fact as to exactly where accident occurred and whether design and landscaping of bank caused claimant not to see vehicle she struck as it exited fast food restaurant next to bank

15 Fla. L. Weekly Supp. 1171a

Insurance -- Personal injury protection -- Cancellation for nonpayment of premium

15 Fla. L. Weekly Supp. 960b

Insurance -- Automobile -- Coverage -- Rental car used in business -- Where policy unambiguously excluded coverage of any vehicle rented and used in insured's employment or business, rental vehicle used by insured in his employment as salesperson was excluded -- Further, even if rental vehicle was covered as “non-owned” vehicle, there would still be no coverage where policy provided that insurance would not apply to claims arising from accidents occurring while insured vehicle was used in course of business unless policy was rated for business, and policy was not rated for business

15 Fla. L. Weekly Supp. 270c

Insurance -- Automobile -- Default -- Vacation -- Motion to vacate default judgment is denied where insurer strictly complied with constructive notice provisions and went beyond mere database search and cursory attempts to locate defendant by following investigative leads and going to possible addresses in attempts to serve process, and defendant would have been personally served had he complied with requirements to notify Department of Highway Safety and Motor Vehicles of changes of address

15 Fla. L. Weekly Supp. 270c

Insurance -- Automobile -- Default -- Vacation -- Motion to vacate default judgment is denied where insurer strictly complied with constructive notice provisions and went beyond mere database search and cursory attempts to locate defendant by following investigative leads and going to possible addresses in attempts to serve process, and defendant would have been personally served had he complied with requirements to notify Department of Highway Safety and Motor Vehicles of changes of address

15 Fla. L. Weekly Supp. 599a

Insurance -- Automobile -- Examination under oath -- Failure to attend -- Where insured failed to comply with three demands to submit to EUO regarding claim for insured vehicle that was stolen and burned while in his possession, insured willfully and materially breached policy, and coverage is precluded -- Neither submission of co-insured to EUO nor recorded statement given by insured satisfies requirement that insured submit to EUO -- Where co-insured filed suit before EUO condition of policy was satisfied by insured, neither law nor facts support application of innocent co-insured doctrine

15 Fla. L. Weekly Supp. 839a

Insurance -- Automobile -- Coverage -- Where insured took action to switch coverage from another insurer to defendant insurer, after date of accident defendant insurer submitted correspondence to agent requesting documentation regarding insured's prior coverage, agent failed to provide documentation, and defendant insurer subsequently issued insurance identification card retroactive to date prior to accident, insured is entitled to coverage for accident

15 Fla. L. Weekly Supp. 1214a

Insurance -- Automobile -- Comprehensive -- Limits of liability -- Windshield replacement -- Limits of liability provisions of insurance contract at issue clearly contemplates that a repair includes replacement of parts and equipment, such as windshields -- Accordingly, whether windshield replacement is termed repair or replacement, limits of liability provision applies to breach of contract claim brought by glass repair shop

15 Fla. L. Weekly Supp. 1071a

Insurance -- Commercial vehicle -- Coverage -- Insurer has no duty to defend or indemnify employer from claims brought by estate of employee who died as result of accident on employer's property where employee qualified as insured under commercial vehicle policy that excluded coverage for bodily injury to employer or insured

15 Fla. L. Weekly Supp. 1162b

Insurance -- Personal injury protection -- Attorney's fees -- No abuse of discretion in awarding attorney's fees and costs stipulated as reasonable by both parties' experts prior to hearing but claimed to be unreasonable by insurer because of inaccurate time-keeping by attorney

15 Fla. L. Weekly Supp. 181a

Attorney's fees -- Insurance -- Personal injury protection -- Dismissal -- Failure to prosecute -- Motion to dismiss claim for attorney's fees for failure to prosecute is granted -- Small claims rules do not require 30-day notice and grace period to afford opportunity to cure inaction prior to dismissal for failure to prosecute

15 Fla. L. Weekly Supp. 861b

Attorney's fees -- Insurance -- Personal injury protection -- Proposal for settlement -- Ambiguity -- Trial court erred in denying motion to tax attorney's fees and costs on ground that proposal for settlement was rendered ambiguous by phrase “but not limited to” in release where intent of release to encompass only claims that may be made in underlying litigation is clearly defined and unequivocal from reading of entire proposal

15 Fla. L. Weekly Supp. 170b

Attorney's fees -- Insurance -- Personal injury protection -- Proposal for settlement -- Timeliness -- Mere prematurity of proposal for settlement does not bar insurer from recovery of attorney's fees -- Proposal that does not require signing of release and requests only that matter be dismissed with prejudice is not ambiguous

15 Fla. L. Weekly Supp. 85b

Attorney's fees -- Insurance -- Personal injury protection -- Prevailing party -- Where insurer's third-party complaint against medical provider for common law indemnification, alleging assignment of benefits between insured and provider as special relationship required for indemnification, was dismissed, provider is entitled to award of attorney's fees and costs -- No merit to argument that provider is not entitled to fee award because assignment had been revoked by time complaint was filed where insurer filed complaint despite revocation and, if not for fact that provider accepted assignment, provider would not have been party to suit

15 Fla. L. Weekly Supp. 29a

Attorney's fees -- Insurance -- Personal injury protection -- Fee award is reversed where main judgment has been reversed

15 Fla. L. Weekly Supp. 582b

Attorney's fees -- Insurance -- Personal injury protection -- Offer of settlement -- Medical provider that accepted presuit settlement offer after suit was filed is not prevailing party entitled to attorney's fees and costs -- No merit to claim that provider is prevailing party because prior settlement offer was less than amount ultimately recovered by provider as settlement amount plus fees, costs and prejudgment interest where offer was made before suit was filed when there was no entitlement to fees, costs or interest

15 Fla. L. Weekly Supp. 129a

Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Where unrefuted evidence established that medical provider charged PIP insurer substantially more for like services than provider charges under cash discount plan, provider is not entitled to recover disputed balance of reduced claim -- Error to find that provider's intent to defraud is issue of fact precluding summary judgment; intent is not issue under statute precluding provider from charging PIP insurer more than customarily charged for like services not billed to PIP insurers -- Improper coding -- Upcoding is affirmative defense on which insurer had burden of persuasion -- Standing -- Because insurer waived standing defense by not raising it in answer, trial court erred in entering summary judgment in insurer's favor on issue -- However, trial court effectively corrected error by allowing provider to amend complaint to assert individual plaintiff to whom assignment was made rather than professional association -- Award of prevailing party attorney's fees in one case is set aside in view of reversal of judgment

15 Fla. L. Weekly Supp. 316a

Attorney's fees -- Insurance -- Personal injury protection -- Confession of judgment -- Error to find that insurer confessed judgment by paying claims for dates of service not included in demand letter or in complaint

15 Fla. L. Weekly Supp. 921a

Insurance -- Personal injury protection -- Attorney's fees -- Where insurer confessed judgment and thereby agreed that it had breached duty to provide explanation of benefits, medical provider is entitled to attorney's fees and costs despite failure to recover money or property

15 Fla. L. Weekly Supp. 939a

Insurance -- Personal injury protection -- Attorney's fees -- Attorney cannot recover attorney's fees for legal work performed while law license was suspended for failure to meet CLE requirements -- Attorney's subsequent reinstatement does not retroactively cure effect of suspension

15 Fla. L. Weekly Supp. 686b

Attorney's fees -- Insurance -- Personal injury protection -- Contingency risk multiplier -- Abuse of discretion to award 2.0 multiplier to medical provider where there was no compentent substantial evidence that provider had difficulty obtaining competent counsel, and there was testimony to the contrary

15 Fla. L. Weekly Supp. 893a

Attorney's fees -- Insurance -- Personal injury protection -- Amount -- No abuse of discretion in failing to reduce amount of attorney's fees based on testimony of insurer's expert where there is nothing to indicate ruling was arbitrary, fanciful or unreasonable

15 Fla. L. Weekly Supp. 1222a

Insurance -- Personal injury protection -- Attorney's fees -- Insurer's breach of obligation to provide explanation of benefits entitles medical provider to award of attorney's fees and costs irrespective of whether provider recovered on underlying claim for benefits -- Amount of fees calculated

15 Fla. L. Weekly Supp. 1190a

Insurance -- Personal injury protection -- Attorney's fees -- Amount

15 Fla. L. Weekly Supp. 1189b

Insurance -- Personal injury protection -- Attorney's fees -- Amount

15 Fla. L. Weekly Supp. 171a

Attorney's fees -- Insurance -- Personal injury protection -- Amount

15 Fla. L. Weekly Supp. 1046a

Insurance -- Personal injury protection -- Declaratory judgment -- Insurer is not obligated by section 627.736(6) to furnish PIP log to insured presuit -- Remand to consider whether insurer had contractual duty to furnish PIP log -- Attorney's fees -- Offer of judgment -- Where real issue in case was whether insurer was obligated to produce PIP log, case was not action for damages, and offer of judgment statute does not apply

15 Fla. L. Weekly Supp. 868a

Insurance -- Personal injury protection -- Declaratory judgment -- Conditions precedent -- Demand letter was not required where action sought declaration regarding existence of PIP coverage, not recovery of PIP benefits -- Error to dismiss action for failure to satisfy demand letter condition precedent -- Attorney's fees -- Appellate -- Entitlement to fees pursuant to section 627.428(1) when dispute with insurer results in declaratory judgment rather than monetary judgment