Volume 20

20 Fla. L. Weekly Supp. 936a

Online Reference: FLWSUPP 2009STRAInsurance -- Venue -- Motion to transfer venue that is not sworn and is not accompanied by supporting affidavit is denied without prejudice

20 Fla. L. Weekly Supp. 660a

Online Reference: FLWSUPP 2007GEICInsurance -- Uninsured motorist -- Wife is bound by husband's election of non-stacked UM coverage when he purchased insurance coverage where it was established wife authorized husband to procure insurance on her behalf

20 Fla. L. Weekly Supp. 1054b

Online Reference: FLWSUPP 2011MANLInsurance -- Property -- Standing -- Action by contractor assigned prospective insurance recovery of undetermined amount is dismissed

20 Fla. L. Weekly Supp. 499a

Online Reference: FLWSUPP 2005REEVInsurance -- Amendment of statement of claim -- Substitution of defendant -- On reconsideration, court concludes that it properly denied plaintiff's motion to amend statement of claim to substitute an entirely new party to the lawsuit in place of the defendant against whom the action had been pending -- Denial is without prejudice to plaintiff's filing an amended motion to amend statement of claim, if appropriate and not barred by the statute of limitations or other affirmative defense, seeking to add defendant as a party defendant pursuant to Rule 1.250(c)

20 Fla. L. Weekly Supp. 446c

Online Reference: FLWSUPP 2004KERSInsurance -- Proposal for settlement -- Extension of time within which to respond

20 Fla. L. Weekly Supp. 1000a

Online Reference: FLWSUPP 2010FERRInsurance -- Property -- Standing -- Assignment of claim for post-loss recovery is permitted under law

20 Fla. L. Weekly Supp. 429a

Online Reference: FLWSUPP 2004MONGInsurance -- Property -- Plaintiff-contractor which had an assignment of rights from insured for work performed by contractor was not acting as a public adjuster -- Insurer's emergency motion to abate action based on a consent order from state agency preventing plaintiffs from acting as a public adjuster is denied

20 Fla. L. Weekly Supp. 54a

Online Reference: FLWSUPP 2001HISCInsurance -- Professional indemnity -- Declaratory judgment -- Comity -- First-filed rule -- Insurers move to dismiss count of Florida action seeking declaration regarding coverage for punitive damages, brought by plaintiff that was awarded compensatory and punitive damages against an insured auditing firm in a Florida court, based on a prior summary judgment entered in the insurers' New York declaratory judgment action against the insured, which concluded that New York law governed pursuant to the parties' stipulation and that punitive damages were not covered by policies under New York law -- First-filed rule is not applicable where neither parties nor issues in actions are sufficiently similar to justify imposition of rule -- Parties are not sufficiently similar where plaintiff to whom damages were owed was not party to New York case, and insured acted against own interests to detriment of plaintiff's rights in that case by agreeing that New York law, which recognizes no exception to general rule that punitive damages, are not insurable would control -- Issues are not sufficiently similar where choice of law may be different in each action -- Further, due process concerns raised by parties' conduct in New York proceeding are special circumstances that warrant departure from first-filed rule -- Due process concerns also preclude giving res judicata effect to New York judgment

20 Fla. L. Weekly Supp. 730a

Online Reference: FLWSUPP 2007COLOInsurance -- Personal injury protection -- Exhaustion of benefits -- Affidavit filed by insurer in support of motion for summary judgment on affirmative defense of exhaustion of benefits was shown by clear and convincing evidence to be materially false -- Plaintiff's motion to strike defendant's pleadings for fraud on court is granted -- Final judgment to be entered in plaintiff's favor

20 Fla. L. Weekly Supp. 668a

Online Reference: FLWSUPP 2007STATInsurance -- Personal injury protection -- Reimbursement by insurer of commercial vehicle -- Sedan leased under commercial lease and used as commercial vehicle is commercial vehicle under PIP statute

20 Fla. L. Weekly Supp. 524a

Online Reference: FLWSUPP 2005JACKInsurance -- Personal injury protection -- Reimbursement by insurer of commercial vehicle -- Van used primarily for business and commercial purposes is commercial motor vehicle under PIP statute

20 Fla. L. Weekly Supp. 268a

Online Reference: FLWSUPP 2003WANEInsurance -- Personal injury protection -- Counterclaims -- Insurer cannot file counterclaim against medical provider in individual capacity where provider brought original action solely as assignee of patient -- Because medical provider is not opposing party in individual capacity, and physician and other individuals named as counter-defendants are not parties to original action, entire counterclaim must be dismissed

20 Fla. L. Weekly Supp. 21a

Online Reference: FLWSUPP 2001GEDEInsurance -- Personal injury protection -- Expert witnesses -- Abuse of discretion to exclude expert witness not disclosed in accordance with pretrial order where medical provider cannot claim surprise because insurer provided provider with expert's peer review report and disclosed intent to rely on expert's opinion, and there is no evidence that insurer's failure to comply with pretrial order was willful or motivated by bad faith

20 Fla. L. Weekly Supp. 373a

Online Reference: FLWSUPP 2004GUTIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Examination under oath -- Trial court erred in entering summary judgment in favor of insurer on ground that failure of an insured to provide answers for certain questions asked during examination under oath conducted by the insurer was tantamount to a failure to submit to a contractually mandated EUO and constituted a failure to fulfill a condition precedent to lawsuit for PIP benefits -- Because insurer asserted in its affirmative defense that insured refused to answer “material” questions, insurer was obligated to establish materiality of unanswered questions -- Whether an insured's refusal to answer certain questions at an EUO amounts to a failure to cooperate is a question which requires an evaluation of the degree of cooperation and, accordingly, a question for factfinder rather than an issue for judicial determination on a motion for summary judgment -- Condition subsequent -- Under statute in effect at time policy was issued, submitting to EUO was condition subsequent, not a condition precedent to coverage

20 Fla. L. Weekly Supp. 732b

Online Reference: FLWSUPP 2007BURKInsurance -- Personal injury protection -- Evidence -- Judicial notice -- Policy endorsementSTAND-UP MRI & DIAGNOSTIC CENTER, P.A., as assignee of Lekisha Burke, Plaintiff, v. LIBERTY MUTUAL INSURANCE COMPANY, Defendant. County Court, 18th Judicial Circuit in and for Seminole County. Case No. 2012-SC-360. December 10, 2012. Jerri L. Collins, Judge. Counsel: David B. Alexander, Bradford Cederberg, Orlando, for Plaintiff. Maddge B. Penton, Orlando, for Defendant.

20 Fla. L. Weekly Supp. 1002b

Online Reference: FLWSUPP 2010BRUNInsurance -- Personal injury protection -- Discovery -- Reasons why individual bills were not paid at 80% or 100%, name and address of person employed by insurer who has most knowledge of why each individual bill was not paid at 80%or 100%, and name and address of each person who will testify at trial as to why each individual was not paid at 80% or 100% -- Range of charges submitted by all providers in particular zip for certain CPT codes -- Motion to compel better answers granted

20 Fla. L. Weekly Supp. 620a

Online Reference: FLWSUPP 2006XTREInsurance -- Personal injury protection -- Demand letter that contained itemized statement in form of billing ledger and stated amount claimed to be due satisfied statutory condition precedent to suit -- Statute does not require that demand letter state amount ultimately determined to be due or itemized statement of amount claimed by CPT code

20 Fla. L. Weekly Supp. 122a

Online Reference: FLWSUPP 2002NELSInsurance -- Personal injury protection -- Demand letter that did not state exact amount insurer could pay to avoid litigation was insufficient to satisfy condition precedent -- Order granting insured's motion for summary judgment is reversed

20 Fla. L. Weekly Supp. 123a

Online Reference: FLWSUPP 2002SEVIInsurance -- Personal injury protection -- Demand letter -- Demand letters which contained incorrect claim numbers and either failed to reference policy number or referenced incorrect policy number were legally insufficient -- Trial court did not err in granting summary judgment in favor of insurer due to insufficiency of demand letters

20 Fla. L. Weekly Supp. 694c

Online Reference: FLWSUPP 2007SOLOInsurance -- Personal injury protection -- Demand letter -- Where billing ledger attached to demand letter contained incorrect double charge for one date of service, demand letter was defective and failed to satisfy condition precedent to suit -- Final summary judgment is entered for insurer

20 Fla. L. Weekly Supp. 185b

Online Reference: FLWSUPP 2002RODRInsurance -- Personal injury protection -- Demand letter addressed to correct authorized representative at incorrect post office box which was actually received by insurer substantially complied with section 627.736(10) -- Proper standard when reviewing compliance of a PDL is “substantial compliance” and not “strict compliance”

20 Fla. L. Weekly Supp. 389a

Online Reference: FLWSUPP 2004NBURInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible -- Claims need not be applied to deductible within 30 days so long as there is a “reasonable basis” for denying the claim -- Where insurer initially denied claims based on a coverage investigation regarding alleged material misrepresentations made by insured in her insurance application, and trial court determined that these defenses were not meritorious, insurer thereafter properly applied the bills and determined that the costs were within the deductible -- Trial court erred in awarding payment to provider

20 Fla. L. Weekly Supp. 77a

Online Reference: FLWSUPP 2001MCCLInsurance -- Personal injury protection -- Deductible -- PIP statute and policy require that deductible be subtracted from total billing amount before statutory or contractual reductions are applied

20 Fla. L. Weekly Supp. 322a

Online Reference: FLWSUPP 2004JALVInsurance -- Personal injury protection -- Trial court erred in entering final summary judgment in favor of provider who sought payment for treatment provided to insured's mother for injuries sustained when she was a passenger in insured's vehicle where at time of accident mother was registrant of operable leased vehicle -- Trial court erred in finding that, because mother signed lease papers for her daughter because of her daughter's bad credit, the daughter was the beneficial owner of the leased vehicle -- Subjective intent of mother to gift leased vehicle to her daughter was not sufficient to contradict mother's legal interest in the vehicle

20 Fla. L. Weekly Supp. 887a

Online Reference: FLWSUPP 2009SURDInsurance -- Personal injury protection -- No abuse of discretion in granting summary judgment for medical provider despite pendency of petition for rule to show cause why proposed deponents should not be held in contempt for failing to appear at depositions where insurer failed to act diligently in seeking discovery and did not request continuance of summary judgment hearing to complete discovery

20 Fla. L. Weekly Supp. 676a

Online Reference: FLWSUPP 2007MATIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Policy language providing that insurer will pay 80% of reasonable expenses but also referencing “applicable fee schedules” does not provide clear and unambiguous notice of intent to limit reimbursement pursuant to Medicare Part B fee schedule of section 627.736(5)(a)2.f.

20 Fla. L. Weekly Supp. 673a

Online Reference: FLWSUPP 2007SCHWInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Policy language providing that insurer will pay 80% of reasonable expenses but also referencing “all fee schedules” does not provide clear and unambiguous notice of intent to limit reimbursement pursuant to Medicare Part B fee schedule of section 627.736(5)(a)2.f.

20 Fla. L. Weekly Supp. 824a

Online Reference: FLWSUPP 2008COTTInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where policy provides that insurer will pay 80% of reasonable expenses, insurer cannot sytematically reimburse medical expenses at 200% of Medicare Part B fee schedule without any consideration of reasonableness of amounts charged

20 Fla. L. Weekly Supp. 683a

Online Reference: FLWSUPP 2007TMORInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where policy provides that insurer will pay 80% of reasonable expenses, insurer cannot reimburse medical expenses at 200% of Medicare Part B fee schedule without any analysis of reasonableness of amounts charged

20 Fla. L. Weekly Supp. 598a

Online Reference: FLWSUPP 2006JEANInsurance -- Personal injury protection -- Coverage -- Insurer cannot rely on statutory permissive Medicare Part B fee schedule where insurer did not mention that payment methodology in its policy, and clear language in policy provides that insurer will pay 80% of reasonable expenses

20 Fla. L. Weekly Supp. 596b

Online Reference: FLWSUPP 2006VISCInsurance -- Personal injury protection -- Coverage -- Insurer cannot rely on statutory permissive Medicare Part B fee schedule where insurer did not clearly and unambiguously adopt that payment methodology in its policy, and clear language in policy provides that insurer will pay 80% of reasonable expenses

20 Fla. L. Weekly Supp. 451b

Online Reference: FLWSUPP 2004RINCInsurance -- Personal injury protection -- Coverage -- Insurer cannot rely on permissive Medicare Part B fee schedule of section 627.736(5)(a)2.f. where insurer did not clearly and unambiguously adopt that payment methodology in its policy, and clear language in policy provides that insurer will pay 80% of reasonable expenses

20 Fla. L. Weekly Supp. 930a

Online Reference: FLWSUPP 2009RODRInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Insurer may not limit coverage in accordance with permissive statutory fee schedule where policy provides that insurer will reimburse 80% of medically necessary expenses and does not mention Medicare Part B fee schedule

20 Fla. L. Weekly Supp. 509a

Online Reference: FLWSUPP 2005BARKInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Policy language providing that insurer will pay 80% of reasonable medical expenses controls over permissive statutory fee schedule where policy makes no reference to statutory fee schedule

20 Fla. L. Weekly Supp. 150a

Online Reference: FLWSUPP 2002HACKInsurance -- Personal injury protection -- Coverage -- Where policy does not reference permissive fee schedule of section 627.736(5)(a)2, PIP insurer is required to reimburse 80% of reasonable medical expenses pursuant to mandatory language of PIP statute

20 Fla. L. Weekly Supp. 149c

Online Reference: FLWSUPP 2002JONEInsurance -- Personal injury protection -- Coverage -- Where policy does not reference permissive fee schedule of section 627.736(5)(a)2, PIP insurer is required to reimburse 80% of reasonable medical expenses pursuant to mandatory language of PIP statute

20 Fla. L. Weekly Supp. 1073b

Online Reference: FLWSUPP 2011BURNInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where PIP policy provides that insurer may limit reimbursement to 80% of reasonable expenses allowed by No-Fault Law subject to applicable fee schedule and payment limitations, insurer is allowed to limit payment using statutory fee schedules -- Fact that policy also states that insurer will pay 80% of all reasonable expenses allowed by No-Fault Law is not inconsistent with application of fee schedules

20 Fla. L. Weekly Supp. 289a

Online Reference: FLWSUPP 2003VEGAInsurance -- Personal injury protection -- Coverage -- Permissive fee schedule of section 627.736(5)(a)2 can be applied where policy language specifically and unambiguously advises that insurer will pay 80% of reasonable expenses, subject to applicable fee schedules and payment limitations

20 Fla. L. Weekly Supp. 161a

Online Reference: FLWSUPP 2002GOLDInsurance -- Personal injury protection -- Coverage -- Where PIP policy provides that insurer will pay 80% of reasonable expenses and on separate page provides that any amounts payable will be “subject to” limitations in PIP statute, insurer has not incorporated optional provisions of Medicare fee schedule into policy -- Even if “subject to” language could be interpreted as incorporating Medicare fee schedule, by using confusing language on separate page of policy from provision requiring payment of 80% of reasonable expenses, insurer failed to satisfy requirement of Kingsway that election to use permissive statutory fee schedule be made in manner so that insured and medical providers would be aware of it

20 Fla. L. Weekly Supp. 1000c

Online Reference: FLWSUPP 2010QUINInsurance -- Personal injury protection -- Coverage -- Medical expenses -- By using confusing language providing for payment of 80% of reasonable expenses while also referencing “other payment guidelines in No Fault Law,” “any schedule and limitations under federal or state law for medical expenses,” and “various sources of information” to determine if medical expense is “reasonable,” insurer failed to satisfy requirement that election to use permissive statutory fee schedule be made in manner so that insured and medical providers would be aware of it

20 Fla. L. Weekly Supp. 586a

Online Reference: FLWSUPP 2006TERPInsurance -- Personal injury protection -- Coverage -- Medical expenses -- By using confusing language providing for payment of 80% of reasonable expenses while also referencing “other payment guidelines in No Fault Law,” “any schedule and limitations under federal or state law for medical expenses,” and “various sources of information” to determine if medical expense is “reasonable,” insurer failed to satisfy requirement that election to use permissive statutory fee schedule be made in manner so that insured and medical providers would be aware of it

20 Fla. L. Weekly Supp. 711a

Online Reference: FLWSUPP 2007BRADInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible -- Where PIP policy specifically refers to fee schedule limitations of section 627.736(5)(a)2.f., insurer properly applied deductible to 200% of Medicare Part B or workers compensation fee schedule

20 Fla. L. Weekly Supp. 932a

Online Reference: FLWSUPP 2009DOMIInsurance -- Personal injury protection -- Coverage -- Plaintiff's motion for summary disposition on issue of insurer's application of permissive statutory fee schedule is denied where amendment to PIP policy clearly and unambiguously advises that insurer will pay 80% of expenses at 200% of Medicare Part B fee schedule

20 Fla. L. Weekly Supp. 1096c

Online Reference: FLWSUPP 2011GOMEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP insurer was not entitled to limit reimbursement pursuant to Medicare Part B fee schedule where permissive statutory fee schedule is not properly incorporated into policy

20 Fla. L. Weekly Supp. 1096b

Online Reference: FLWSUPP 2011FRAGInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP insurer was not entitled to limit reimbursement pursuant to Medicare Part B fee schedule where permissive statutory fee schedule is not properly incorporated into policy

20 Fla. L. Weekly Supp. 1096a

Online Reference: FLWSUPP 2011DIAZInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP insurer was not entitled to limit reimbursement pursuant to Medicare Part B fee schedule where permissive statutory fees schedule is not properly incorporated into policy

20 Fla. L. Weekly Supp. 1088b

Online Reference: FLWSUPP 2011SALIInsurance -- Personal injury protection -- Doctrine of de minimis non curat lex does not preclude action seeking $36 in unpaid PIP benefits

20 Fla. L. Weekly Supp. 920a

Online Reference: FLWSUPP 2009CACCInsurance -- Personal injury protection -- Doctrine of de minimis non curat lex does not preclude action seeking $65 in unpaid PIP benefits

20 Fla. L. Weekly Supp. 518a

Online Reference: FLWSUPP 2005ALGUInsurance -- Personal injury protection -- Small claims -- Doctrine of de minimis non curat lex does not preclude small claims action seeking less than $100 for breach of contract and unpaid PIP benefits

20 Fla. L. Weekly Supp. 829a

Online Reference: FLWSUPP 2008IRVIInsurance -- Personal injury protection -- Coverage -- Medical benefits -- Second opinion sought after insurer terminated benefits following independent medical examination -- Bill submitted under CPT Code for outpatient visit for the evaluation and management of a new patient was compensable under policy and Florida No-Fault Law notwithstanding insurer's classification of claim as one for “second opinion independent Medical Examination” -- Whether services were medically necessary and related to accident at issue and whether amount billed was reasonable are issues for jury to determine

20 Fla. L. Weekly Supp. 375a

Online Reference: FLWSUPP 2004UNITInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Res judicata -- Final judgment in provider's first case against insurer foreclosed provider's later suit based on invoices resulting from treatment of same patient for same injuries resulting from same accident -- Each of insurer's successive breaches was related in time, origin, and motivation, they collectively formed a convenient trial unit, and provider had ample procedural means for fully developing entire transaction in one action going to the merits

20 Fla. L. Weekly Supp. 292b

Online Reference: FLWSUPP 2003WINNInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Opposing affidavit stating that insurer “considers 80% of 200% of the 2008 Medicare Part B Fee Schedule to be the maximum reasonable charge for the service/treatment billed by the Plaintiff” was insufficient to demonstrate existence of genuine issue of material fact in the face of sworn affidavit submitted by plaintiff in which affiant testified that she was familiar with usual and customary charges in the community because she had reviewed thousands of explanations of benefits indicating reimbursable amounts for the CPT codes at issue in instant case and that the amounts charged in this case were reasonable and customary in the community

20 Fla. L. Weekly Supp. 623b

Online Reference: FLWSUPP 2006LARAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges

20 Fla. L. Weekly Supp. 937a

Online Reference: FLWSUPP 2009SEARInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Insurer failed to create genuine issue of material fact regarding reasonableness of provider's charges where insurer's expert, who opined that charges were unreasonable and that an amount equal to 200% of Medicare Part B fee schedule was the only “reasonable” amount, relied exclusively on undisclosed “underlying data” which insurer failed to produce or make available for inspection

20 Fla. L. Weekly Supp. 80a

Online Reference: FLWSUPP 2001GUERInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Demand letter -- Insurer waived defense that presuit demand letter did not comply with requirements of statute by failing to raise issue in its response to demand -- Demand letter not defective for failing to attach copy of insurer's notice withdrawing payment for further treatment where demand letter was not seeking payment for future treatment, but for services already rendered -- Reasonableness of treatment -- Conclusory and self-serving affidavit filed by insurer in response to provider's affidavit was insufficient to create genuine issue of material fact regarding reasonableness of charges

20 Fla. L. Weekly Supp. 894a

Online Reference: FLWSUPP 2009RIVEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Error to enter summary judgment regarding relatedness and medical necessity of treatment where genuine issues of material fact exist

20 Fla. L. Weekly Supp. 155a

Online Reference: FLWSUPP 2002OLIVInsurance -- Personal injury protection -- Venue -- Insurer, which through offices of its independent brokers, regularly transacts substantial part of its usual and customary business from office within Broward County, cannot shield itself from being sued in that county -- Motion to transfer venue is denied

20 Fla. L. Weekly Supp. 154a

Online Reference: FLWSUPP 2002FJIMInsurance -- Personal injury protection -- Venue -- Insurer, which through offices of its independent brokers, regularly transacts substantial part of its usual and customary business from office within Broward County, cannot shield itself from being sued in that county -- Motion to transfer venue is denied

20 Fla. L. Weekly Supp. 153a

Online Reference: FLWSUPP 2002FARIInsurance -- Personal injury protection -- Venue -- Insurer, which through offices of its independent brokers, regularly transacts substantial part of its usual and customary business from office within Broward County, cannot shield itself from being sued in that county -- Motion to transfer venue is denied

20 Fla. L. Weekly Supp. 152b

Online Reference: FLWSUPP 2002VGONInsurance -- Personal injury protection -- Venue -- Insurer, which through offices of its independent brokers, regularly transacts substantial part of its usual and customary business from office within Broward County, cannot shield itself from being sued in that county -- Motion to transfer venue is denied

20 Fla. L. Weekly Supp. 151a

Online Reference: FLWSUPP 2002GRINInsurance -- Personal injury protection -- Plaintiff's motion to amend complaint to correct name of defendant insurer is granted -- Operative issues in this case show that the defendant named in the original complaint and defendant named in amended complaint are “sufficiently related”; that defendant knew plaintiff was making claim for unpaid PIP benefits prior to filing suit with the receipt of the pre-suit demand letter; and that plaintiff moved to amend in a timely manner and caused no prejudice to defendant

20 Fla. L. Weekly Supp. 482a

Online Reference: FLWSUPP 2005CAFIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- National Correct Coding Initiative -- Trial court did not err in finding that PIP insurer could not apply NCCI edits to deny payment for two different treatments by medical provider on same patient on same day -- No error in failing to consider affidavit of insurer's expert filed in support of motion for summary judgment where expert was stricken as expert witness and, therefore, was precluded from testifying at trial

20 Fla. L. Weekly Supp. 671a

Online Reference: FLWSUPP 2007HORGInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where policy provides that insurer will pay 80% of reasonable expenses, insurer cannot systematically reimburse medical expenses at 200% of Medicare Part B fee schedule without any consideration of reasonableness of amounts charged

20 Fla. L. Weekly Supp. 883a

Online Reference: FLWSUPP 2009VSOLInsurance -- Personal injury protection -- Coverage -- Medical expenses -- MRI -- Accident occurring during statutory gap period -- County court erred in concluding that insurer correctly applied statute limiting amount MRI providers could charge to 200% of the allowable amount under Medicare Part B fee schedule where statute had been automatically repealed under “sunset” provisions at time of accident, policy provided for payment of 80% of reasonable and necessary medical expenses, and policy stated that in determining reasonableness, insurer would consider only the actual charge, the charge negotiated with a provider, or the charge determined by a statistically valid database -- Language indicating insurer would pay in accordance with No-Fault Law was not sufficient to place insured on notice that insurer intended to pay less than 80% of reasonable fee as determined by factors specified in policy -- Insurer had no vested right or legitimate expectation in continuing statutory fee limitations beyond repeal date stated in law's sunset provision

20 Fla. L. Weekly Supp. 1097a

Online Reference: FLWSUPP 2011GALDInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Insurer that did not incorporate permissive statutory fee schedule in PIP policy is not entitled to limit reimbursement for MRI to 200% of Medicare fee schedule where it has not demonstrated by some alternative means that 200% of Medicare fee schedule is maximum reasonable amount -- Where expert witness offered by insurer in opposition to summary judgment on issue of reasonableness of MRI charge relied upon undisclosed data to form opinion that amount equal to 200% of Medicare fee schedule is only reasonable charge for MRI, witness did not qualify as expert -- Offered as fact witness, witness's testimony is inadmissible lay opinion under guise of fact testimony -- Summary judgment granted in favor of medical provider

20 Fla. L. Weekly Supp. 587a

Online Reference: FLWSUPP 2006NASSInsurance -- Personal injury protection -- Coverage -- Medical expenses -- MRI -- Summary judgment is entered in favor of medical provider where affidavit submitted by provider establishes reasonableness of charge for MRI and opposing affidavit of insurer's adjuster containing conclusory statement that charge was not reasonable is contradicted by adjuster's admission at deposition that charge was within range of reasonable charges

20 Fla. L. Weekly Supp. 28a

Online Reference: FLWSUPP 2001DORInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Lawfully rendered services -- Patient Self Referral Act -- Order granting summary judgment determining that medical provider who referred insured to pain management clinic of which provider is sole shareholder violated Patient Self Referral Act -- Trial court erred in weighing conflicting evidence to conclude that cross-referral arrangement put in place by provider and clinic did not fall within any exclusions in Act and, therefore, disclosure did not cure violation

20 Fla. L. Weekly Supp. 1234a

Online Reference: FLWSUPP 2012IRODInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Lawfully rendered services -- Despite being issued clinic exemption by Agency for Health Care Administration, medical provider was not wholly owned by licensed physician where guilty plea agreement and factual proffer entered by true owners in criminal case demonstrate that owners who are not physicians handled all finances and clinic operations, including fraud scheme involving staged accidents, and retained bulk of proceeds -- Because provider's services were not lawfully rendered, they are not compensable under PIP statute

20 Fla. L. Weekly Supp. 1127b

Online Reference: FLWSUPP 2012FLOYInsurance -- Personal injury protection -- Affirmative defenses -- Failure of medical provider to comply with chiropractic record keeping requirements is valid ground to support affirmative defense that medical treatment was unlawfully rendered -- Summary judgment -- Error to enter summary judgment in favor of provider on issue of reasonableness, relatedness and necessity of treatment where supporting affidavits were legally deficient and deposition excerpts incorporated in motion for summary judgment did not conclusively show absence of genuine issue of material fact

20 Fla. L. Weekly Supp. 288b

Online Reference: FLWSUPP 2003RGONInsurance -- Personal injury protection -- Exhaustion of policy limits -- Failure to advise medical provider -- Sanctions -- Where there is no reasonable explanation for insurer's failure to notify medical provider and court of exhaustion of policy limits until eight months after exhaustion occurred, insurer acted in bad faith -- Motion for sanctions is granted

20 Fla. L. Weekly Supp. 174a

Online Reference: FLWSUPP 2002ARANInsurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- Affirmative defenses -- Exhaustion of benefits is not affirmative defense that is waived if not affirmatively pled by insurer -- Absent evidence of bad faith or gratuitous payment of bills, insurer is not liable for benefits once policy limits have been exhausted -- Questions certified: 1) Did Simon v. Progressive Insurance Company abrogate the English rule of priorities as announced by the Florida Supreme Court in Boulevard National Bank of Miami v. Air Metal Industries, Inc., and applied to PIP cases in State Farm Casualty Company v. Ray? and 2) In an action by an assignor for No Fault Insurance benefits founded on a claim for breach of contract, does a post-suit exhaustion of benefits absolve the insurer from any responsibility to pay an otherwise valid claim where the exhaustion occurred after the insured: (a) paid an amount that the provider claims is less than required by contact; (b) was served with a filed complaint; (c) had no basis to reduce or otherwise underpay the bills when it first received them; and (d) withdrew all of its defenses for underpayment or failed to present any defense for the underpayment (other than exhaustion)?

20 Fla. L. Weekly Supp. 1073a

Online Reference: FLWSUPP 2011WILLInsurance -- Personal injury protection -- Coverage -- Emergency services -- Exhaustion of policy limits -- Statute that requires insurer to reserve $5,000 for emergency medical service providers does not require insurer that paid bill of provider within that classification at reduced amount to reserve benefits for payment of disputed portion of bill

20 Fla. L. Weekly Supp. 697a

Online Reference: FLWSUPP 2007RODRInsurance -- Personal injury protection -- Coverage -- Emergency services -- Deductible -- Because insurer is mandated by statute to reserve $5,000 for emergency medical service providers, insurer should not have applied claim filed by medical provider within that classification to deductible -- However, emergency medical provider's bill would be paid only when deductible has been satisfied from claims of non-protected providers -- If no claims from non-protected providers are received, protected provider's bill would be applied to deductible

20 Fla. L. Weekly Supp. 689a

Online Reference: FLWSUPP 2007KARAInsurance -- Personal injury protection -- Coverage -- Emergency services -- Deductible -- Although insurer correctly applied deductible to full amount of plaintiff medical provider's bill, provider has standing to bring suit challenging calculation of deductible where insurer's application of deductible to allowable amount of bill submitted earlier by another provider resulted in more of deductible being applied to plaintiff provider's bill -- Insurer's incorrect reduction of other provider's bill by 25% before applying deductible resulted in underpayment to plaintiff provider -- Because insurer is mandated by statute to reserve $5,000 for emergency medical service providers, insurer should not have applied claim filed by plaintiff provider within that classification to deductible

20 Fla. L. Weekly Supp. 186a

Online Reference: FLWSUPP 2002COCHInsurance -- Personal injury protection -- Coverage -- Emergency services -- Deductible -- Fact that insurer is mandated by statute to reserve $5,000 for emergency medical service providers does not preclude insurer from applying claim filed by provider within that classification to deductible

20 Fla. L. Weekly Supp. 362a

Online Reference: FLWSUPP 2004GAVIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Trial court correctly denied provider's motion for directed verdict where the only issue at trial was whether treatment provided to claimant was related to accident, and there was conflicting evidence that indicated someone other than claimant occupied vehicle at time of accident

20 Fla. L. Weekly Supp. 428a

Online Reference: FLWSUPP 2004KPENInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Denial -- Misrepresentations -- Evidence does not support insurer's denial of coverage based on material misrepresentations by insured in connection with wage loss claim or insurer's assertion that insured failed to provide information necessary to verify insured's wage loss claim -- Ambiguity created by inclusion of two different employer names on wage-loss claim form was inadvertent and quickly corrected by insured and was not a material misrepresentation that justified voiding coverage

20 Fla. L. Weekly Supp. 425b

Online Reference: FLWSUPP 2004MELKInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Denial -- Misrepresentations -- Insured's material misrepresentations in examination under oath with respect to his claim for lost wages deprived him of entitlement to coverage for medical expenses, despite insured's contention that lost wages claim and medical expenses claim were separate claims and insured's withdrawal of claim for lost wages

20 Fla. L. Weekly Supp. 701a

Online Reference: FLWSUPP 2007PELAInsurance -- Personal injury protection -- Coverage -- Conditions precedent -- Examination under oath is not valid condition precedent to coverage under PIP policy

20 Fla. L. Weekly Supp. 1226a

Online Reference: FLWSUPP 2012MONTInsurance -- Personal injury protection -- Affirmative defenses -- Purported affirmative defense that merely denies allegations of complaint already denied in answer and affirmative defense that reserves right to amend defenses pending further discovery are stricken as legally insufficient

20 Fla. L. Weekly Supp. 120a

Online Reference: FLWSUPP 2002PINOInsurance -- Personal injury protection -- Denial of claim -- Valid medical report -- No abuse of discretion in declining to consider peer review report that contains mere conclusions as to reasonableness, relatedness and necessity of treatment and does not create factual issue precluding summary judgment -- Affirmative defenses -- Amendment -- No merit to claim that trial court exceeded appellate mandate requiring reconsideration of motion for summary judgment on issues of reasonableness, relatedness and necessity of treatment by allowing insurer to amend its affirmative defenses to assert claim that medical provider submitted false or misleading disclosure and acknowledgment form where court ruled on motion for summary judgment prior to considering motion to amend -- No abuse of discretion in allowing insurer to amend affirmative defenses where provider that did not require extensive preparation to prevail on affirmative defense was not prejudiced by amendment -- Trial court correctly found that D&A form defense was legally insufficient where insurer failed to bring deficiencies in form to provider's attention, and insurer chose not to raise defense of fraud under insurance fraud statute

20 Fla. L. Weekly Supp. 286a

Online Reference: FLWSUPP 2003ALAYInsurance -- Personal injury protection -- Insurer was not required by terms of policy to reimburse insured for mileage expenses or lost wages associated with attending independent medical examination

20 Fla. L. Weekly Supp. 442a

Online Reference: FLWSUPP 2004ESTRInsurance -- Personal injury protection -- Exhaustion of policy limits -- Insurer entitled to summary judgment in action brought by provider challenging insurer's payment of reduced amounts based on state fee scheduling guidelines where it is undisputed that benefits payable under policy were exhausted before suit was filed -- Absent any allegation or finding of bad faith on insurer's part when it exhausted benefits, insurer is not required to set aside a reserve fund with which to supplement reduced payments to a provider in the event those payments are subsequently challenged

20 Fla. L. Weekly Supp. 441a

Online Reference: FLWSUPP 2004MACHInsurance -- Personal injury protection -- Exhaustion of policy limits -- Insurer entitled to summary judgment in action brought by provider challenging insurer's payment of reduced amounts based on state fee scheduling guidelines where it is undisputed that benefits payable under policy were exhausted before suit was filed -- Absent any allegation or finding of bad faith on insurer's part when it exhausted benefits, insurer is not required to set aside a reserve fund with which to supplement reduced payments to a provider in the event those payments are subsequently challenged

20 Fla. L. Weekly Supp. 862a

Online Reference: FLWSUPP 2009LAUZInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Where insurer wrongly paid medical bills in accordance with permissive reimbursement limitation of section 627.736(5)(a)2.f despite fact that policy obligated it to pay 80% of reasonable medical expenses, insurer's exhaustion of benefits will not shield insurer from having to pay in excess of policy limits

20 Fla. L. Weekly Supp. 934a

Online Reference: FLWSUPP 2009FLYNInsurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- Insurer is entitled to summary judgment in action brought by medical provider challenging insurer's payment of reduced amounts based on PPO agreement where benefits payable under policy were exhausted before suit was filed

20 Fla. L. Weekly Supp. 323a

Online Reference: FLWSUPP 2004HERNInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of benefits -- Trial court abused its discretion in denying insurer's second motion to amend its affirmative defenses to include that of exhaustion of benefits where motion was filed before trial date was set and before court ruled on motion for summary judgment -- Trial court not precluded from imposing costs incurred by insurer's belated discovery that it had exhausted available benefits should plaintiff sustain its burden of demonstrating those costs after remand

20 Fla. L. Weekly Supp. 678a

Online Reference: FLWSUPP 2007FLINInsurance -- Personal injury protection -- Affirmative defenses -- Amendment -- Motion to amend affirmative defenses is denied where insurer was aware of defense two years before filing original answer and medical provider would be prejudiced by allowing amendment

20 Fla. L. Weekly Supp. 936b

Online Reference: FLWSUPP 2009MOSEInsurance -- Personal injury protection -- Affirmative defenses -- Amendment -- Second motion to amend answer and affirmative defenses to assert defenses of deficient demand letter and exhaustion of benefits is denied where insurer filed motion seven months after exhaustion occurred and medical provider would be substantially prejudiced by amendment

20 Fla. L. Weekly Supp. 829b

Online Reference: FLWSUPP 2008HUBBInsurance -- Personal injury protection -- Complaint -- Amendment -- Substitution of insurer -- Motion to amend complaint to substitute insurer that is entirely separate and distinct legal entity from, but closely affiliated to, insurer against whom action had been pending is denied

20 Fla. L. Weekly Supp. 806a

Online Reference: FLWSUPP 2008JPHIInsurance -- Personal injury protection -- Complaint -- Amendment -- Medical provider's motion to amend complaint to correct name of insurer is granted -- Two insurers who have same addresses and contact person are sufficiently related, and provider moved to amend in timely manner

20 Fla. L. Weekly Supp. 1000b

Online Reference: FLWSUPP 2010SPEInsurance -- Personal injury protection -- Plaintiff granted leave to amend complaint to correct name of defendant -- Leave to amend was sought in timely manner, and amendment will result in no prejudice to defendant

20 Fla. L. Weekly Supp. 1239b

Online Reference: FLWSUPP 2012ALCIInsurance -- Personal injury protection -- Fraud -- False and misleading statement relating to claim or charges -- Where medical provider knowingly submitted claim forms that included name and license number of physician who had stopped working for provider prior to claimed dates of service, provider's entire claim is barred

Online Reference: FLWSUPP 2002GLOUInsurance -- Personal injury protection -- Standing -- Assignment -- Dissolved corporation -- Where medical provider was administratively dissolved for failure to file annual report on date it accepted assignments from insureds and during period of treatment but was not in pursuit of winding up its affairs and was subsequently reinstated by Department of State, insurer cannot rely on dissolution as defense to paying PIP claims -- Notice of covered loss -- Although some claim forms submitted by provider did not contain license number of person performing treatment, where insurer did not notify provider of missing numbers and continued to process claim by sending insured to independent medical examination, forms were substantially complete

20 Fla. L. Weekly Supp. 179a

Online Reference: FLWSUPP 2002HEALInsurance -- Personal injury protection -- Standing -- Assignment -- Dissolved corporation -- Where medical provider was administratively dissolved for failure to file annual report on date it accepted assignments from insureds and during period of treatment, but was not in pursuit of winding up its affairs and was subsequently reinstated by Department of State, insurer cannot rely on dissolution as defense to paying PIP claims -- Notice of covered loss -- Although some claim forms submitted by provider did not contain license number of person performing treatment, where insurer did not notify provider of missing numbers and continued to process claim by sending insured to independent medical examination, forms were substantially complete

20 Fla. L. Weekly Supp. 73a

Online Reference: FLWSUPP 2001ETIEInsurance -- Personal injury protection -- Affirmative defenses -- CPT coding -- Insurer was not entitled to deny payment of PIP benefits on ground that medical provider failed to submit claims coded in compliance with National Correct Coding Initiative -- Demand letter was not defective where letter stated amount of demand and insurer's response indicated it knew contents of demand

20 Fla. L. Weekly Supp. 1217a

Online Reference: FLWSUPP 2012BEARInsurance -- Personal injury protection -- Coverage -- Medical expenses -- CPT coding -- Insurer correctly downcoded CPT code which had been inappropriately upcoded by medical provider

20 Fla. L. Weekly Supp. 160a

Online Reference: FLWSUPP 2002TOWLInsurance -- Personal injury protection -- Motion to amend answer after two years of litigation to raise new affirmative defenses disputing standing based on final judgment in class action involving same claims is denied where insurer has no reasonable explanation for why it failed to timely notify medical provider of class action in response to demand letter

20 Fla. L. Weekly Supp. 804b

Online Reference: FLWSUPP 2008MOORInsurance -- Personal injury protection -- Affirmative defenses -- Amendment -- Motion to amend affirmative defenses to assert defense that medical provider's claim is barred by settlement agreement in class action suit since neither provider nor insured opted out of class action is denied where insurer filed motion to amend three years after provider filed suit and six years after it knew about class action settlement and provider would be substantially prejudiced by amendment

20 Fla. L. Weekly Supp. 873a

Online Reference: FLWSUPP 2009KOVANOT FINAL VERSION OF OPINION
Subsequent Changes at 20 Fla. L. Weekly Supp. 1152aInsurance -- Personal injury protection -- Answer -- Amendment -- Abuse of discretion to deny insurer's motion to amend answer to assert potentially conclusive defense of res judicata based on class action settlement where insurer had not previously sought to amend answer, amendment would not have been futile as motion was supported by settlement documents and would constitute complete defense if proven, and medical provider would not have been prejudiced by granting motion filed before trial and summary judgment hearing to add issue that had been raised numerous times before motion was filed

20 Fla. L. Weekly Supp. 889a

Online Reference: FLWSUPP 2009KJEAInsurance -- Personal injury protection -- Admissions -- No abuse of discretion in denying insurer's motion for relief from admissions where affidavit contradicting admissions was not filed until after motion for relief from admissions was denied, and medical provider argued that it would have suffered unfair prejudice from withdrawal of technical admissions -- Trial court did not err in striking affidavit offered solely to defeat provider's motion for summary judgment where affidavit contradicted insurer's technical admissions -- Final summary judgment in favor of provider is affirmed

20 Fla. L. Weekly Supp. 1201a

Online Reference: FLWSUPP 2012MANNInsurance -- Long-term care -- Where clear and unambiguous language of policies provides that controlling law is that of state where insureds reside on effective date, and it is undisputed that insureds who have since relocated to Florida resided in Connecticut on effective date, Connecticut premium rate rather than rate set by Florida Department of Insurance controls -- Connecticut law is also controlling under rule of lex loci contractus -- If Florida law did control, action would be time-barred under statute providing that each long-term care policy shall be incontestable after it has been in force for two years -- Complaint dismissed

20 Fla. L. Weekly Supp. 425a

Online Reference: FLWSUPP 2004TARRInsurance -- Personal injury protection -- Jurisdiction -- Nonresidents -- Substantial activity within state -- There is no basis for Florida court to exercise personal jurisdiction over insurer that is foreign corporation which does not operate, conduct or engage in business within state and which issued policy to nonresident insured who was involved in accident in Florida

20 Fla. L. Weekly Supp. 681b

Online Reference: FLWSUPP 2007GRAHInsurance -- Homeowners -- Payment for water mitigation services was not invalid for being issued in name of plaintiff repair service, insured homeowner, and mortgagee where additional payees were required to be listed on draft by terms of policy

20 Fla. L. Weekly Supp. 564b

Online Reference: FLWSUPP 2006JAMEInsurance -- Homeowners -- Sinkhole damage -- Where homeowner made claim for sinkhole damage, insurer's engineer recommended remedial stabilization measures, homeowner retained own engineer who opined that stabilization measures recommended by insurer's engineer were insufficient, and homeowner entered into repair contract based on own engineer's report, insurer was not obligated by statute or policy to pay benefits for repairs -- Both statute and policy require homeowner to contract for repairs recommended by insurer's engineer and, if it is determined after repair has begun that additional repairs are required to stabilize land, insurer must either make additional repairs or tender policy limits without reduction for repair expenses already incurred

20 Fla. L. Weekly Supp. 1166a

Online Reference: FLWSUPP 2012WINDTorts -- Fraud -- Contracts -- Insurance -- Personal injury protection -- Action by PIP insurer for common law and statutory fraud, breach of contract, unjust enrichment and civil conspiracy against medical center and its owner for alleged business practice of waiving or not collecting deductibles and co-payments from insureds -- Jurisdiction -- Motion to dismiss for failure to meet jurisdictional threshold is denied where insurer that is not merely seeking restitution of PIP benefits paid but also seeking damages due to fraud alleges in good faith that amount involved in suit exceeds $15,000 -- Motion to dismiss fraud claims against owner of medical center on ground that complaint fails to plead sufficient facts to pierce corporate veil is denied where no piercing of veil is required since owner is being sued for his own alleged tortious acts, for which he may be liable even if they were committed within scope of his employment or office -- Motion to dismiss civil conspiracy claims against owner is granted where owner's alleged personal stake in achieving object of conspiracy is purely derivative of that of medical center -- Breach of contract claims are also dismissed as to owner who is not alleged to be party to any contract claimed to be breached -- Claim for declaratory relief seeking declaration that court agrees with insurer's factual and legal contentions is denied

20 Fla. L. Weekly Supp. 445a

Online Reference: FLWSUPP 2004PACHInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Dismissal -- Provider's action against insurer dismissed where plaintiff willfully and deliberately failed to comply with court order requiring plaintiff to file bills at issue within 15-days of date of order and still had not filed bills as of date of hearing on motion to dismiss

20 Fla. L. Weekly Supp. 1241a

Online Reference: FLWSUPP 2012JEANInsurance -- Personal injury protection -- Dismissal -- Failure to prosecute -- Filing of designation of electronic mail addresses is sufficient record activity to preclude dismissal for lack of prosecution -- Filing of medical provider's notice for trial precludes dismissal for lack of prosecution

20 Fla. L. Weekly Supp. 1176a

Online Reference: FLWSUPP 2012UDELInsurance -- Discovery -- Work product privilege -- Where claims file documents sought by plaintiffs were generated as part of insurer's adjustment of plaintiffs' claim and were not prepared in anticipation of litigation, documents are subject to production -- No merit to argument that materials are privileged simply because they reside in claims file -- Motion to compel is granted

20 Fla. L. Weekly Supp. 1146a

Online Reference: FLWSUPP 2012FORTInsurance -- Discovery -- Documents -- Work product privilege -- Trial court departed from essential requirements of law by ordering production of insurer's claims file without first reviewing privilege log, individually analyzing work product objections and conducting in camera inspection

20 Fla. L. Weekly Supp. 1229a

Online Reference: FLWSUPP 2012AGUIInsurance -- Personal injury protection -- Discovery -- Work product privilege -- Adjuster notes and investigative materials generated prior to demand letter were generated in ordinary course of business and not in response to event which foreseeably could be made the basis of a future claim -- Work product privilege does not apply to these documents

20 Fla. L. Weekly Supp. 822c

Online Reference: FLWSUPP 2008COLEInsurance -- Personal injury protection -- Discovery -- Work product -- Adjuster's notes that are part of ordinary claim process are not protected by work product privilege

20 Fla. L. Weekly Supp. 1240a

Online Reference: FLWSUPP 2012BURGInsurance -- Personal injury protection -- Discovery -- On in camera inspection of medical provider's preferred provider agreements, trial court overrules provider's objections to discovery of PPO agreements that contain confidential and proprietary information but are also relevant to insurer's position as to amount provider should be reimbursed for CPT codes at issue -- Agreements are to be produced subject to confidentiality agreement or other procedure designed to protect confidentiality -- Objection to agreement that does not contain confidential or proprietary information and may lead to discovery of admissible evidence is overruled -- Objections to documents that are not relevant or likely to lead to admissible evidence are sustained

20 Fla. L. Weekly Supp. 1095a

Online Reference: FLWSUPP 2011BURGInsurance -- Personal injury protection -- Discovery -- Interrogatories -- Reasonableness of charges -- Medical provider is ordered to provide better responses to discovery requests concerning usual and customary charges and payments accepted by provider

20 Fla. L. Weekly Supp. 629a

Online Reference: FLWSUPP 2006RAMIInsurance -- Personal injury protection -- Coverage -- Medical benefits -- Diagnostic services -- Reasonableness of charges -- Discovery -- Information regarding other types of insurance accepted by provider and reimbursement amounts that provider has agreed to accept from other insurance companies, including HMO and PPO agreements -- Amount a medical provider contracts for with other providers, such as HMO or PPO setting, may be logically probative of the reasonableness of what is charged or reimbursed -- Plaintiff ordered to provide for in camera inspection information regarding HMO and PPO agreements between plaintiff, or other entity through which plaintiff provided medical services, and any managed care provider, HMO, PPO, or others, in effect of dates of service at issue in this case

20 Fla. L. Weekly Supp. 811b

Online Reference: FLWSUPP 2008MARSInsurance -- Personal injury protection -- Discovery -- Motion to compel third party to produce information regarding payments made on behalf of insurer to physician who conducted independent medical examination is granted

20 Fla. L. Weekly Supp. 665a

Online Reference: FLWSUPP 2007MOREInsurance -- Personal injury protection -- Discovery -- Interrogatories -- Documents -- Insurer is entitled to discovery related to medical provider's MRI procedures, including lease agreements and Medicare and Medicaid reimbursements -- Fact that documents pertaining to lawsuits to which provider is party are public records is not proper basis for discovery objection -- Where provider has burden to prove that care rendered and amount charged were reasonable, related and necessary, information regarding amounts provider receives from other entities, billing procedures, and setting of charges is discoverable -- Request for all non-privileged documents referenced in provider's answer to interrogatories is not overbroad

20 Fla. L. Weekly Supp. 798a

Online Reference: FLWSUPP 2008FINLInsurance -- Personal injury protection -- Discovery -- Insurer is ordered to provide better responses to interrogatories relating to its use of workers' compensation fee schedule to adjust claims and to produce documents utilized in its decision to reduce medical provider's bills

20 Fla. L. Weekly Supp. 1091a

Online Reference: FLWSUPP 2011MANGInsurance -- Discovery -- Motion to compel better responses to discovery requests pertaining to payments medical provider accepts from other sources for CPT codes at issue is denied

20 Fla. L. Weekly Supp. 1157a

Online Reference: FLWSUPP 2012STARInsurance -- Discovery -- Financial relationship between insurer and expert witness

20 Fla. L. Weekly Supp. 237a

Online Reference: FLWSUPP 2003AGARInsurance -- Personal injury protection -- Discovery -- Trial court departed from essential requirements of law by denying motion to quash subpoenas requiring third-party vendors to produce copies of all payments made by vendors to insurer's expert for performance of independent medical examinations -- Subpoenas demand information that had no relevance to instant case or to relationship between instant insurer and expert -- Certiorari review of discovery order requiring information from third-party vendors is proper since vendors have no adequate remedy by appeal -- Remand for trial court to narrowly tailor an order directed to relationship between insurer and expert

20 Fla. L. Weekly Supp. 5a

Online Reference: FLWSUPP 2001GARCNOT FINAL VERSION OF OPINION
Subsequent Changes at 20 Fla. L. Weekly Supp. 237aInsurance -- Discovery -- Subpoenas duces tecum filed by medical provider against vendor companies that hire physicians on behalf of insurance companies to perform medical record reports and independent medical examinations on claimants, seeking records of payments to physician used by insurer were too broad where subpoenas did not limit information sought to payments for reports or IMEs conducted for insurer

20 Fla. L. Weekly Supp. 285a

Online Reference: FLWSUPP 2003COLOInsurance -- Discovery -- Failure to comply -- Sanctions -- Dismissal

20 Fla. L. Weekly Supp. 1039a

Online Reference: FLWSUPP 2011EDMOInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Discovery -- Accountant-client privilege -- Trial court did not depart from essential requirements of law by denying motion for protective order and motion to quash subpoena duces tecum served on corporate plaintiff's accountant, seeking financial documents, including corporate tax returns, bank statements, withdrawals and deposits, wage and hourly reports, cash receipts, and ledgers pertaining to the plaintiff and other entities and employees affiliated with the plaintiff -- Insurer's affirmative defense that services for which plaintiff sought payment were not lawfully rendered because corporate plaintiff was not wholly owned by a chiropractic physician and was not properly licensed warrant insurer's inquiry through discovery as to ownership and licensure of provider and the other entities and persons involved in treating insureds and billing for services in this case -- Because deposition testimony was unclear and nebulous with regard to ownership of facility and chiropractic equipment and the relationship between plaintiff and persons allegedly involved in providing medical services billed in this case, documents sought by insurer are relevant and necessary -- Accountant-client privilege applies only to communication between accountant and client, and court record does not reveal that any of the subpoenaed documents contained privileged communication, such as notes, which warranted redaction

20 Fla. L. Weekly Supp. 764b

Online Reference: FLWSUPP 2008JORGInsurance -- Discovery -- Depositions -- Protective order preventing insurer from having second chance to take deposition was not based on good cause

20 Fla. L. Weekly Supp. 804a

Online Reference: FLWSUPP 2008BATIInsurance -- Discovery -- Depositions -- Failure to comply -- Sanctions -- Mere filing of motion to stay does not allow insurer to ignore requests for deposition dates -- Moreover, where motion to stay was not filed until after medical provider made multiple requests for dates, unilaterally scheduled deposition and filed motion to compel, plaintiff is entitled to attorney's fees and costs

20 Fla. L. Weekly Supp. 66a

Online Reference: FLWSUPP 2001DORCInsurance -- Discovery -- Depositions -- Pre-suit adjuster and litigation adjuster

20 Fla. L. Weekly Supp. 165b

Online Reference: FLWSUPP 2002SIRKInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer violated order to produce for deposition an adjuster with personal knowledge of how amount paid was actually determined by producing witness with no personal knowledge of methodology used by insurer to determine amount paid, insurer is precluded from telling jury the amount it paid and is ordered to pay fees and costs associated with deposition

20 Fla. L. Weekly Supp. 1072b

Online Reference: FLWSUPP 2011BAKEInsurance -- Discovery -- Deposition of notary who verified sworn signatures of person who signed medical provider's interrogatory responses may proceed where evidence that same signature and notary page were used in other cases raises legitimate issue of falsification of legal documents

20 Fla. L. Weekly Supp. 265a

Online Reference: FLWSUPP 2003PEREInsurance -- Personal injury protection -- Discovery -- Depositions -- Non-party medical provider is required to produce person with most knowledge of billing, payments and status of patient accounts for deposition in insured's action against insurer -- Provider is required to produce for deposition person with most knowledge of amounts charged by and accepted for litigation versus non-litigation patients and person with most knowledge of “letter of protection” program, subject to confidentiality provisions of order

20 Fla. L. Weekly Supp. 931a

Online Reference: FLWSUPP 2009KEYEInsurance -- Personal injury protection -- Discovery -- Depositions -- Treating physician is expert witness entitled to be compensated for deposition testimony

20 Fla. L. Weekly Supp. 919c

Online Reference: FLWSUPP 2009GRANInsurance -- Personal injury protection -- Discovery -- Depositions -- Treating physician is expert witness entitled to be compensated for deposition testimony

20 Fla. L. Weekly Supp. 420a

Online Reference: FLWSUPP 2004ADAMInsurance -- Discovery -- Depositions -- Treating physician is not entitled to prepayment of expert witness fees under rule 1.280(b)(5) -- Treating physician will be entitled to fees, if at all, under rule 1.390, depending whether physician has been called upon to testify about subject of which he is an expert

20 Fla. L. Weekly Supp. 419a

Online Reference: FLWSUPP 2004BABAInsurance -- Discovery -- Depositions -- Treating physician is not entitled to prepayment of expert witness fees under rule 1.280(b)(5) -- Treating physician will be entitled to fees, if at all, under rule 1.390, depending on whether physician has been called upon to testify about subject of which he is an expert

20 Fla. L. Weekly Supp. 117a

Online Reference: FLWSUPP 2002HEDDInsurance -- Personal injury protection -- Discovery -- Depositions -- Treating physician is not an expert witness entitled to be compensated for deposition testimony

20 Fla. L. Weekly Supp. 1070a

Online Reference: FLWSUPP 2011WHITInsurance -- Homeowners -- Discovery -- Depositions -- Expert witness fees -- Public adjusters

20 Fla. L. Weekly Supp. 880a

Online Reference: FLWSUPP 2009ALVAInsurance -- Personal injury protection -- Examination under oath -- Failure to attend -- Error to enter summary judgment in favor of medical provider on insurer's EUO no-show defense where question of whether insured's failure to attend EUO was unreasonable and whether insured otherwise cooperated to sufficient level that nonattendance was not material breach of policy are fact questions for jury -- Independent medical examination -- Error to enter summary judgment in favor of provider on insurer's IME no-show defense where question of whether failure to appear was unreasonable is fact question for jury -- Discovery -- Depositions -- Expert witness fee -- Provider's owner/medical director, who was not treating physician but who consulted with treating physician and helped create treatment plan, was entitled to expert witness fee for deposition testimony

20 Fla. L. Weekly Supp. 622a

Online Reference: FLWSUPP 2006HARDInsurance -- Personal injury protection -- Declaratory judgment -- Claim seeking determination of existence of rescinded policy is not appropriate for declaratory action where insured has adequate remedy at law in action for breach of contract -- Count seeking recovery of lost wages is dismissed where PIP statute provides for disability benefits, not lost wages

20 Fla. L. Weekly Supp. 143a

Online Reference: FLWSUPP 2002SUPEInsurance -- Personal injury protection -- Medical payments -- Coverage -- Mobile x-rays -- Declaratory judgment -- Jurisdiction -- Insurer seeking declaration that it is not required to pay PIP and/or MP benefits for mobile x-rays rendered to 37 patients because it was not impractical for these insureds to travel to a stationary facility to have x-rays performed as required by administrative rule -- Where provider has admitted that the statute of limitations has run on all its claims, provider has no right to recover any of the benefits at issue, and there is no longer a bona fide, actual, present need for declaration sought by insurer

20 Fla. L. Weekly Supp. 287a

Online Reference: FLWSUPP 2002BETAInsurance -- Personal injury protection -- Declaratory judgment -- Medical provider's petition for declaratory relief seeking only advisory opinion as to insurer's liability for denied claim for PIP benefits is dismissed

20 Fla. L. Weekly Supp. 390a

Online Reference: FLWSUPP 2004GARQInsurance -- Costs -- Appellate -- Rule requires immediate taxation of appellate court costs, including execution thereon, following appellate court's remand for further proceedings unless appellate court orders otherwise -- County court in instant case erred in not making judgment for appellate costs subject to immediate execution -- Appellant entitled to costs incurred in filing instant motion seeking review of county court's order

20 Fla. L. Weekly Supp. 291a

Online Reference: FLWSUPP 2003ALEMInsurance -- Civil procedure -- Answer -- Failure to serve -- Sanctions -- Motion for default or sanctions against insurer that served answer to complaint only after provider moved for entry of default, despite being notified by medical provider that answer was overdue and being provided with additional time for compliance -- Insurer's dilatory conduct of failing to serve answer or seek extension of time to serve answer rises to level of bad faith and warrants imposition of sanctions -- Motion for default is moot since answer was served prior to entry of default

20 Fla. L. Weekly Supp. 924b

Online Reference: FLWSUPP 2009BJORInsurance -- Complaint -- Amendment -- Motion to amend complaint to add count for violation of Unfair Insurance Trade Practices Act is granted

20 Fla. L. Weekly Supp. 892a

Online Reference: FLWSUPP 2009RAMOInsurance -- Personal injury protection -- Coverage -- Despite fact that insured no longer owned vehicle insured under his PIP policy on date of accident in which he was injured while driving vehicle belonging to girlfriend's father, insured's policy provided PIP coverage where transfer of ownership of vehicle did not automatically render entire PIP policy unenforceable under terms of policy, and insurer did not exercise discretion to cancel policy upon learning of vehicle sale

20 Fla. L. Weekly Supp. 810a

Online Reference: FLWSUPP 2008LEIVInsurance -- Personal injury protection -- Motion for rehearing of order denying motion to amend statement of claim to add counts for declaratory relief and breach of implied covenant of good faith and fair dealing is denied -- Allegations that insurer refused to pay PIP benefits despite medical provider's compliance with PIP statute are foundation for breach of contract action and do not demonstrate bona fide, actual and present need for declaration -- Claim for breach of implied covenant of good faith and fair dealing is not permissible in action for PIP benefits

20 Fla. L. Weekly Supp. 662a

Online Reference: FLWSUPP 2007ROSEInsurance -- Homeowners -- Bad faith -- Citizen's Property Insurance Corporation has statutory immunity from bad faith claims -- Florida law does not recognize claim for breach of covenant of good faith and fair dealing in insurance context -- Motion to amend complaint denied

20 Fla. L. Weekly Supp. 977a

Online Reference: FLWSUPP 2010THOMTorts -- Automobile accident -- Subrogation action by insurer against driver who negligently caused accident that resulted in total loss of insured's vehicle -- Evidence -- Hearsay -- Exceptions -- Business records -- Auto repair shop owner's testimony as to what it would have cost to repair vehicle is hearsay where shop owner based testimony on estimating program, and testimony was not sufficient to lay predicate for admission of program as business record -- Further, repair estimate would be insufficient to establish recoverable damages in absence of proof that repair cost did not exceed fair market value of vehicle -- Where insurer's appraisal of value of vehicle is based on report of valuation program using data from sales of comparable vehicles, but insurer's witness had no knowledge of how sales information was recorded or how valuation program worked, insurer failed to lay predicate for admission of valuation report under business records exception to hearsay rule -- Where insurer did not offer competent substantial evidence of fair market value of vehicle on date of accident, insurer's recovery is limited to rental car expenses, medical benefits and litigation costs

20 Fla. L. Weekly Supp. 932b

Online Reference: FLWSUPP 2009ARIOInsurance -- Automobile -- Declaratory action -- Amended petition for declaratory relief which alleges that there is dispute over coverage for automobile accident that occurred after cancellation of plaintiff's policy but does not contest sufficiency of notice of cancellation or allege that plaintiff fulfilled statutory obligation to file appeal with Department of Financial Services fails to demonstrate bone fide, actual, present need for declaration -- Motion to dismiss granted

20 Fla. L. Weekly Supp. 769c

Online Reference: FLWSUPP 2008DRODInsurance -- Personal injury protection -- Attorney's fees -- Withdrawing attorney -- Law firm is entitled to pre-conflict attorney's fees after voluntarily withdrawing from representation of medical providers where firm withdrew to avoid future ethical violation after hiring attorney who had previously done legal work for insurer

20 Fla. L. Weekly Supp. 433a

Online Reference: FLWSUPP 2004HARPInsurance -- Personal injury protection -- Attorney's fees -- Prevailing insured -- Thirty-day period for filing motion for attorney's fees was not triggered by insurer's confession of judgment -- Motion to strike plaintiff's motion for attorney's fees and costs is denied

20 Fla. L. Weekly Supp. 444b

Online Reference: FLWSUPP 2004FLORInsurance -- Personal injury protection -- Attorney's fees awarded to insurer as sanction for delay in dismissing claims for late bills

20 Fla. L. Weekly Supp. 668b

Online Reference: FLWSUPP 2007JCASInsurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- In absence of any evidence of bad faith, where benefits were exhausted in payment of other medical providers before plaintiff medical provider filed suit, insurer is entitled to summary judgment -- Insurer was not required to reserve funds for claim reduced through erroneous application of fee schedule in 2008 PIP statute and is not liable for payment of balance of reduced claim after exhaustion of benefits -- As matter of law, provider is barred from seeking interest, penalties or attorney's fees on disputed benefits that will never be paid due to exhaustion of benefits

20 Fla. L. Weekly Supp. 1086b

Online Reference: FLWSUPP 2011FGOMInsurance -- Personal injury protection -- Attorney's fees -- Recovery of statutory penalty for overdue benefits does not entitle medical provider to award of attorney's fees and costs under section 627.428

20 Fla. L. Weekly Supp. 333a

Online Reference: FLWSUPP 2004IRIZInsurance -- Personal injury protection -- Attorney's fees -- Medical provider who brought action against PIP insurer was not a prevailing party entitled to attorney's fees under section 627.428 where provider rejected insurer's presuit offer to settle for over $1200 and final judgment received by provider was for just over $500

20 Fla. L. Weekly Supp. 808a

Online Reference: FLWSUPP 2008PEACInsurance -- Personal injury protection -- Attorney's fees -- Absence of justiciable issues -- Litigation against insurer over unpaid bills which, in fact, had been returned to plaintiff by postal service with notation that address was invalid -- Sanctions imposed against plaintiff only, not plaintiff's counsel

20 Fla. L. Weekly Supp. 41a

Online Reference: FLWSUPP 2001STATInsurance -- Personal injury protection -- Attorney's fees -- PIP statute does not authorize medical provider to recover attorney's fees incurred in responding to insurer's pre-suit requests for documents and information under section 627.736(6)(b)

20 Fla. L. Weekly Supp. 761a

Online Reference: FLWSUPP 2008KIRKInsurance -- Personal injury protection -- Attorney's fees -- Medical provider was entitled to award of attorney's fees and costs associated with litigating issue of whether provider's failure to file written motion with court barred it from recovering fees and costs incurred prior to insurer's confession of judgment -- Insurer's procedural challenge amounted to a dispute over entitlement to fee award -- Appellate attorney's fees awarded to provider

20 Fla. L. Weekly Supp. 69c

Online Reference: FLWSUPP 2001COKEInsurance -- Personal injury protection -- Attorney's fees -- Where, after PIP case had been in litigation approximately ten months, defendant insurer sought leave to amend its answer to include defense that plaintiff medical provider was a member of a class action which had been settled, and was therefore precluded from filing suit, plaintiff was entitled to be compensated in county court PIP case for time spent in obtaining order from circuit court allowing plaintiff to belatedly opt out of class action based upon showing that plaintiff had not received notice of the class action -- Work in circuit court case was intertwined with county court case and was necessitated by defendant's conduct in not advising plaintiff at the outset of the county court action of the pendency of the class action

20 Fla. L. Weekly Supp. 702b

Online Reference: FLWSUPP 2007GRIMInsurance -- Personal injury protection -- Attorney's fees -- Amount -- Thirty hours is not reasonable number of hours expended for case that was settled prior to initial pre-trial conference and before discovery commenced -- Contingency risk multiplier of 1.0 is appropriate where medical provider's counsel opined at commencement of case that chance of recovery was excellent, case settled at early stage, and there was nothing rare or extraordinary about case -- Expert witness fee, costs and prejudgment interest awarded

20 Fla. L. Weekly Supp. 807a

Online Reference: FLWSUPP 2008EDOUInsurance -- Personal injury protection -- Attorney's fees -- Amount

20 Fla. L. Weekly Supp. 294a

Online Reference: FLWSUPP 2003GAMBInsurance -- Personal injury protection -- Attorney's fees -- Amount -- Expert witness fees, costs and prejudgment interest awarded

20 Fla. L. Weekly Supp. 288a

Online Reference: FLWSUPP 2003OBETInsurance -- Personal injury protection -- Attorney's fees

20 Fla. L. Weekly Supp. 1041a

Online Reference: FLWSUPP 2011MERCInsurance -- Personal injury protection -- Attorney's fees -- Proposal for settlement -- No merit to argument that proposal for settlement served nine days before summary judgment hearing was untimely because it did not afford medical provider thirty days to accept proposal where summary judgment order was not rendered until two months after hearing

20 Fla. L. Weekly Supp. 1232a

Online Reference: FLWSUPP 2012PEREInsurance -- Personal injury protection -- Attorney's fees -- Proposal for settlement -- Language of rule 1.442(d) and section 768.79(3) providing that proposal for settlement shall not be filed “unless necessary to enforce” provisions of rule and statute does not mandate that party must file proposal for settlement prior to time it seeks to enforce entitlement to attorney's fees -- Fact that insurer did not file proposals for settlement until day after hearing on motion for entitlement to attorney's fees does not invalidate proposals -- Ambiguity -- Proposal that specified how much insurer was offering for each of two counts was not ambiguous for failing to include a total amount offered for both counts -- Good faith offer -- $100 settlement proposal was made in good faith where insurer had reasonable basis to believe that it was not liable for loss based on fact that vehicle that insured was driving at time of accident belonged to her mother and was not covered under insured's PIP policy, case law and grant of insurer's original motion for summary judgment on coverage issue by predecessor judge

20 Fla. L. Weekly Supp. 369a

Online Reference: FLWSUPP 2004URBAInsurance -- Personal injury protection -- Attorney's fees -- Offer of judgment -- Where offer of judgment, which was accepted, clearly stated that attorney's fees were to be paid up until date of service of offer of judgment, trial court erred by granting attorney's fees after date of service of offer

20 Fla. L. Weekly Supp. 687c

Online Reference: FLWSUPP 2007WHITInsurance -- Personal injury protection -- Attorney's fees -- Justiciable issues -- Medical provider should have known that suit based on assignment of benefits to unregistered fictitious name was frivolous -- No merit to claims that insurer's proposal for settlement was vague for failing to differentiate between offer for benefits and offer for fees and that lump sum proposal creates conflict between attorney and client

20 Fla. L. Weekly Supp. 919a

Online Reference: FLWSUPP 2009HARMInsurance -- Personal injury protection -- Attorney's fees -- Justiciable issues -- Suit brought against insurer that is distinct corporate entity from insurance company that issued policy under which medical provider claims coverage

20 Fla. L. Weekly Supp. 692a

Online Reference: FLWSUPP 2007PUTNInsurance -- Personal injury protection -- Attorney's fees -- Justiciable issues -- Suit brought against insurer that is distinct corporate entity from insurance company that issued policy under which medical provider claims coverage

20 Fla. L. Weekly Supp. 1071a

Online Reference: FLWSUPP 2011RANDInsurance -- Attorney's fees -- Proposal for settlement -- Prevailing insurer is entitled to attorney's fees based on $1.00 proposal for settlement -- Justiciable issues -- Insurer is entitled to fees under section 57.105 where medical provider knew or should have known that it could not prevail on insurer's claim that purported assignment was mere direction to pay at time insurer filed notice of intent to seek sanctions, yet provider failed to dismiss case during safe harbor period

20 Fla. L. Weekly Supp. 1091b

Online Reference: FLWSUPP 2011NERNInsurance -- Personal injury protection -- Attorney's fees -- Justiciable issues -- Insurer has failed to prove that voluntarily dismissed case warrants fee award under section 57.105(1) where insurer claims that medical provider was procedurally barred from bringing suit due to its failure to opt out of class action, but insurer presented no evidence that provider actually received notice of class action

20 Fla. L. Weekly Supp. 1218b

Online Reference: FLWSUPP 2012VANNInsurance -- Attorney's fees -- Justiciable issues -- Insurer is entitled to award of attorney's fees and costs where medical provider filed voluntary dismissal after expiration of 21-day safe harbor period

20 Fla. L. Weekly Supp. 1228a

Online Reference: FLWSUPP 2012PENDAttorney's fees -- Justiciable issues -- Insurance -- Personal injury protection -- Defendant's motion to tax fees and costs pursuant to section 57.105 is denied based upon finding that neither plaintiff nor plaintiff's attorney knew or should have known that plaintiff's claim of assignment was not supported by material facts necessary to establish claim or by the application of then-existing law to those material facts -- Moreover, claim was initially presented to court as a good faith argument for extension, modification, or reversal of existing law or the establishment of new law, as it applied to the material facts, with a reasonable expectation of success -- Finally, losing party's attorney acted in good faith, based on representations of client as to material facts

20 Fla. L. Weekly Supp. 589b

Online Reference: FLWSUPP 2006BAEZInsurance -- Personal injury protection -- Attorney's fees -- Justiciable issues -- Where medical provider pursued claim against insurer in spite of knowing that it had no standing to sue because insured had revoked assignment of benefits, insurer is entitled to award of attorney's fees

20 Fla. L. Weekly Supp. 141a

Online Reference: FLWSUPP 2002ORTAInsurance -- Homeowners -- Attorney's fees -- Homeowner who filed suit after appraisal clause was invoked by insurer is entitled to attorney's fees under totality of circumstances, including passage of six years between claim and final payment, effect of turn-over of insurer's employees handling claim, multiple times homeowner sent documentation of claim, insurer's conduct in allowing claim to remain dormant despite pending expiration of statute of limitations, and numerous threats by homeowner to resort to litigation

20 Fla. L. Weekly Supp. 713a

Online Reference: FLWSUPP 2007SPENInsurance -- Personal injury protection -- Attorney's fees -- Prevailing insured -- Reasonable hours expended -- Time claimed by insured's attorney is reduced to delete travel time, time spent on clerical tasks, vague and duplicative entries, excessive billing and hours spent due to mistrial declared at request of insured on issue on which insurer ultimately prevailed -- Reasonable hourly rate -- Rate is capped at rate agreed to by insured and her counsel in original contract -- Rate cannot be increased to higher rate agreed to by insured during litigation where agreement was not reduced to writing as required by original contract -- Insurer's request for downward adjustment of lodestar fee based on fact that jury only awarded one-third of damages sought is denied where it is not possible to separate investigation and prosecution of successful claims from unsuccessful claims that all involved treatment with same medical provider for same injuries -- Contingency risk multiplier -- Where application of contingency risk multiplier would result in fee that is manifestly unjust given amount in dispute, and case presents no rare or unique circumstances that weigh in favor of discounting that disparity, application of multiplier is not appropriate -- Fees of attorney's fees experts are reduced to reflect testimony disallowed or portions of testimony on which court did not rely -- Where presentation of testimony by two fee experts was not necessary, each expert's fee is reduced by half -- Expert witness fee of treating physician is taxable cost -- Claimed paralegal costs not supported by evidence are disallowed

20 Fla. L. Weekly Supp. 346a

Online Reference: FLWSUPP 2004ALFOInsurance -- Attorney's fees -- No abuse of discretion in refusing to dismiss claims for attorney's fees for fraud on court based, in part, on attorney's submission of timesheets which included work performed by less experienced attorneys

20 Fla. L. Weekly Supp. 814a

Online Reference: FLWSUPP 2008JAKUInsurance -- Personal injury protection -- Attorney's fees -- Amount -- Contingency risk multiplier -- Cases litigating permissive fee schedule issue are public policy enforcement cases in which court may award contingency risk multiplier irrespective of whether availability of multiplier was necessary to obtain competent counsel -- Where evidence shows that relevant market requires multiplier to obtain competent counsel, medical providers were unable to mitigate risk of loss, and cases involved important legal issue, providers are entitled to multiplier -- In cases filed prior to dispositive Kingsway decision, multiplier of 2.0 is appropriate; in cases filed after Kingsway decision, multiplier of 1.25 is appropriate -- Expert witness fee awarded

20 Fla. L. Weekly Supp. 164a

Online Reference: FLWSUPP 2002LUCKInsurance -- Personal injury protection -- Attorney's fees -- Amount -- Number of hours claimed by attorney and paralegals is reduced to eliminate time spent on secretarial and clerical work -- Continency risk multiplier was required to obtain competent counsel in PIP cases and chance of success in case was even at outset -- Multiplier of 1.5 is appropriate

20 Fla. L. Weekly Supp. 138a

Online Reference: FLWSUPP 2002STEWInsurance -- Automobile -- Attorney's fees -- Amount -- Contingency risk multiplier of 1.5 is appropriate where insureds experienced difficulty in obtaining competent counsel and counsel was required to expend significant efforts to overcome insurer's claim that vehicle, which had transponder key, could not have been stolen without insureds' participation and to overcome challenges to venue and settlement agreement -- Costs and expert witness fees awarded

20 Fla. L. Weekly Supp. 1157b

Online Reference: FLWSUPP 2012ALLFAttorney's fees -- Class actions -- Counsel for intervenor -- Incentive award -- Contingency risk multiplier -- Insurance -- Personal injury protection -- Dispute over PIP insurer's use of Medicare's Outpatient Prospective Payment System as basis for payments to MRI providers, which was ultimately expanded to include as class members all Florida health care providers who received other types of allegedly unlawful underpayments pursuant to certain statutory provisions -- Intervenor in class action entitled to incentive award in view of intervenor's successful efforts to improve settlement agreement for other class members and assumption of risks of undertaking those efforts -- Intervenor also awarded reasonable fees and costs pursuant to sections 627.736(8) and 627.428 -- Overwhelming evidence confirms that intervenor's efforts in instant case and in appeal to district court substantially improved original settlement, conferred significant benefit on class, and significantly enhanced class's recovery -- Attorney's fees are properly awardable for Intervenor's ongoing efforts in litigating entitlement to attorney's fees -- Fees awarded for efforts in separate class action previously filed by intervenor in a different circuit involving the same expanded class of health care providers and the same broad fee schedule issue that was now covered by the settlement agreement in this action -- Discussion of reasonable attorney's fee lodestar and costs concerning instant case and appeal to district court -- Lodestar multipliers -- Reasonable expert witness fees awarded

20 Fla. L. Weekly Supp. 448b

Online Reference: FLWSUPP 2004BIDEInsurance -- Attorney's fees -- Appellate fees -- Amount -- Expert witness fees, costs and prejudgment interest awarded

20 Fla. L. Weekly Supp. 448a

Online Reference: FLWSUPP 2004DRIGInsurance -- Attorney's fees -- Appellate fees -- Amount -- Expert witness fees, costs and prejudgment interest awarded

20 Fla. L. Weekly Supp. 446a

Online Reference: FLWSUPP 2004RADEInsurance -- Attorney's fees -- Appellate fees -- Amount -- Expert witness fees, costs and prejudgment interest awarded

20 Fla. L. Weekly Supp. 822a

Online Reference: FLWSUPP 2008GUNInsurance -- Attorney's fees -- Amount

20 Fla. L. Weekly Supp. 137b

Online Reference: FLWSUPP 2002STALInsurance -- Attorney's fees -- Amount

20 Fla. L. Weekly Supp. 599a

Online Reference: FLWSUPP 2006MAYOInsurance -- Personal injury protection -- Standing -- Assignment -- There is no legal distinction between direction to pay and assignment of benefits -- Document that “assigns benefits of insurance” confers standing on medical provider -- Provider is real party in interest -- Insurer has no standing to challenge assignment

20 Fla. L. Weekly Supp. 521b

Online Reference: FLWSUPP 2005MAYOInsurance -- Personal injury protection -- Standing -- Assignment -- There is no legal distinction between direction to pay and assignment of benefits -- Document that “assigns benefits of insurance” confers standing on medical provider -- Provider is real party in interest -- Insurer has no standing to challenge assignment

20 Fla. L. Weekly Supp. 422a

Online Reference: FLWSUPP 2004CIMEInsurance -- Personal injury protection -- Standing -- Assignment -- Validity -- Document entitled “Assignment of Benefits” which contains instruction to pay PIP benefits to medical provider is valid assignment conferring standing on provider -- There is no legal distinction between assignment of benefits and direction to pay -- Medical provider is real party in interest -- Insurer has no standing to challenge assignment of benefits

20 Fla. L. Weekly Supp. 649a

Online Reference: FLWSUPP 2007FORBInsurance -- Personal injury protection -- Standing -- Assignment -- Document that assigns benefits of insurance to medical provider for services rendered to insured and covered by PIP coverage “and in accordance with section 627.736(5)” creates valid assignment -- Second clause stating that there has been compliance with statute does not alter first clause creating assignment -- Where provider was not in compliance with fictitious name statute at time action was filed but subsequently came into compliance, noncompliance was cured, and provider could maintain suit from that point forward

20 Fla. L. Weekly Supp. 115b

Online Reference: FLWSUPP 2002LAUDInsurance -- Personal injury protection -- Standing -- Assignment -- Error to enter summary judgment in favor of medical provider where provider did not present competent evidence of existence of assignment that provider claims to have sent to insurer, but insurer denied receiving -- Genuine issue of material fact exists as to whether proper assignment of benefits occurred

20 Fla. L. Weekly Supp. 1101b

Online Reference: FLWSUPP 2011BECKInsurance -- Personal injury protection -- Standing -- Assignment -- Issues of standing and validity of assignment are matters to be raised as affirmative defenses, not in motion to dismiss

20 Fla. L. Weekly Supp. 1085a

Online Reference: FLWSUPP 2011AGRAInsurance -- Personal injury protection -- Standing -- Assignment -- Validity -- Document that assigns PIP benefits is valid assignment -- Even if express assignment did not exist, equitable assignment confers standing on medical provider

20 Fla. L. Weekly Supp. 1082a

Online Reference: FLWSUPP 2011JEANInsurance -- Personal injury protection -- Standing -- Assignment -- Document that assigns benefits but fails to transfer insured's rights in PIP policy is direction to pay, not assignment -- No merit to argument that insurer lacks standing to challenge assignment where insurer is not challenging validity of agreement between insured and medical provider, but contesting that agreement constitutes assignment -- Motion to dismiss is granted

20 Fla. L. Weekly Supp. 700a

Online Reference: FLWSUPP 2007TELSInsurance -- Personal injury protection -- Standing -- Assignment -- Motion to dismiss is not proper means to challenge standing -- Where intent of insured and medical provider to enter into assignment is clear from provider's action in bringing suit for PIP benefits and insured's failure to bring suit or object to provider's suit, there is equitable assignment -- Assignment need not be signed by provider where provider accepted terms of assignment through provision of services -- Document that authorizes insurer to make payments directly to provider, but states that insured remains responsible for any amounts not paid, is unqualified assignment

20 Fla. L. Weekly Supp. 1093a

Online Reference: FLWSUPP 2011VOCKInsurance -- Personal injury protection -- Standing -- Assignment -- Document that authorizes direct payment but does not fully assign any and all rights and benefits under insurance contract does not constitute assignment -- Insurer's motion for judgment on pleadings is granted

20 Fla. L. Weekly Supp. 797a

Online Reference: FLWSUPP 2008DAVIInsurance -- Personal injury protection -- Standing -- Assignment -- Validity

20 Fla. L. Weekly Supp. 1214a

Online Reference: FLWSUPP 2012CARTInsurance -- Homeowners -- Standing -- Assignment -- Company that provided water removal and construction services on homeowner's property does not have standing to bring action against insurer where purported assignment of benefits clearly provides that insured retains all insurance rights, benefits and proceeds under policy -- Complaint is dismissed without leave to amend

20 Fla. L. Weekly Supp. 1002a

Online Reference: FLWSUPP 2010DEFRInsurance -- Homeowners -- Standing -- Assignment -- Company that provided water remediation services on homeowner's property has standing to bring action against insurer for breach of contract -- Anti-assignment provision in homeowner's policy does not apply to assignment after loss -- Motion to dismiss is denied

20 Fla. L. Weekly Supp. 798b

Online Reference: FLWSUPP 2008PSMIInsurance -- Homeowners -- Standing -- Assignment -- Company that provided water extraction service on homeowner's flooded property has standing to bring action against insurer for unpaid balance of claim for company's services -- Anti-assignment provision in homeowner's policy does not apply to assignment after loss -- Motion to dismiss is denied

20 Fla. L. Weekly Supp. 865a

Online Reference: FLWSUPP 2009CHILInsurance -- Homeowners -- Assignment -- Water mitigation company/assignee action against insurer that paid benefits to insured -- Assignment of homeowner's rights under policy after property loss was incurred is valid irrespective of policy provision prohibiting assignment without consent of insurer -- Assignment of all insurance rights, benefits and proceeds is full assignment, not partial assignment -- Insurer that had notice of valid assignment is liable for payment of services rendered by water mitigation company despite having already paid policy limits for water damage to insured

20 Fla. L. Weekly Supp. 933a

Online Reference: FLWSUPP 2009JRODInsurance -- Dismissal -- Assignment -- Attachment of assignment of benefits to complaint of medical provider claiming benefits pursuant to written assignment is not required by rule 1.130 -- Motion to dismiss is denied

20 Fla. L. Weekly Supp. 709a

Online Reference: FLWSUPP 2007FREEInsurance -- Arbitration -- Where parties did not request trial de novo within deadline for such request, trial court must enter judgment in accordance with arbitrator's decision

20 Fla. L. Weekly Supp. 947a

Online Reference: FLWSUPP 2010TELUInsurance -- Personal injury protection -- Independent medical examination -- Failure to attend -- Appeals -- Law of case -- No merit to insurer's claim that summary judgment should have been granted in its favor on remand from appellate panel of circuit court that reversed summary judgment, which had been granted in favor of medical provider on basis that insurer failed to allege or establish that insured's nonattendance at IME was unreasonable refusal, where issue of reasonableness of refusal to attend IME has not been determined as law of case since circuit court did not remand with instructions to grant summary judgment in favor of insurer and district court's subsequent denial of petition for second-tier certiorari review is not opinion on merits -- Error to again enter summary judgment in favor of provider on remand where there is factual dispute about reasonableness of insured's refusal to attend IME

Add New Post Edit with Elementor Save draft Preview Publish Add title DOCTOR REHAB CENTER, INC. (Kristen Moorehead), Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. 20 Fla. L. Weekly Supp. 997b Online Reference: FLWSUPP 2010MOORInsurance -- Affirmative defenses -- Purported affirmative defense reserving right to amend defenses pending further discovery is stricken as legally insufficient

20 Fla. L. Weekly Supp. 491a

Online Reference: FLWSUPP 2005SILVInsurance -- Personal injury protection -- Affirmative defenses -- Accord and satisfaction -- Error to enter summary judgment for medical provider where there is disputed issue of fact as to intent of parties and whether check was accord and satisfaction of specific bills or of all bills related to accident

20 Fla. L. Weekly Supp. 603a

Online Reference: FLWSUPP 2006CASTInsurance -- Personal injury protection -- Affirmative defenses -- Accord and satisfaction -- Common law defense of accord and satisfaction, which is inconsistent with statutory accord and satisfaction, must yield to statutory defense -- Insurer's motion for partial summary judgment on statutory accord and satisfaction defense is denied where there is no evidence that insurer made good faith tender as required by statute, there is no evidence that medical provider's claim is unliquidated, there is no evidence of bona fide dispute between parties, and there is no evidence that payment tendered contained conspicuous statement that payment was in full satisfaction of claim

20 Fla. L. Weekly Supp. 551a

Online Reference: FLWSUPP 2006SALIInsurance -- Personal injury protection -- Coverage -- Affirmative defenses -- Accord and satisfaction -- Medical provider's acceptance of check indicating it was “Full and Final Payment” created accord and satisfaction as matter of law -- Rehearing -- Fact that court opinion addresses only some points on appeal does not mean that court has failed to consider points not addressed

20 Fla. L. Weekly Supp. 337a

Online Reference: FLWSUPP 2004SALINOT FINAL VERSION OF OPINION
Subsequent Changes at 20 Fla. L. Weekly Supp. 551aInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Accord and satisfaction -- Explanation of benefits and check to provider, which indicated it was for full and final payment, were sufficient to prove insurer's intent to effect settlement -- By cashing tendered check, rather than responding in writing within five-day period provided for in EOB, provider intended to effect settlement -- Provider failed to provide any evidence refuting fact that mutual agreement to effect settlement arose between parties

20 Fla. L. Weekly Supp. 223a

Online Reference: FLWSUPP 2003PANTInsurance -- Personal injury protection -- Affirmative defenses -- Accord and satisfaction -- No merit to arguments that insurer is precluded from relying on common law accord and satisfaction on appeal when it asserted statutory accord and satisfaction in trial court or that insurer has abandoned statutory defense by arguing only common law defense in brief -- Error to deny insurer's motion for summary judgment on affirmative defense of accord and satisfaction where letter accompanying check for benefits indicated that further treatment would not be payable based on independent medical examination, conspicuous statement on face of check indicated that it was full and final payment of PIP benefits for dates of service, and medical provider cashed check

20 Fla. L. Weekly Supp. 163b

Online Reference: FLWSUPP 2002PEREInsurance -- Accord and satisfaction -- Conspicuous statement -- Writing was not conspicuous where it appeared in capital letters in font smaller than other writing on check, was included as part of two other lines of similar font, and was not in contrasting color or set off by symbols or marks

20 Fla. L. Weekly Supp. 447a

Online Reference: FLWSUPP 2004PINEInsurance -- Personal injury protection -- Affirmative defenses -- Accord and satisfaction -- Where no dispute existed between insurer and medical provider regarding amount of benefits payable prior to insurer's payment of reduced amount pursuant to statutory fee schedule, payment did not result in accord and satisfaction

20 Fla. L. Weekly Supp. 438a

Online Reference: FLWSUPP 2004BUREInsurance -- Personal injury protection -- Accord and satisfaction -- Explanation of Review combined with check containing, among other language, the phrase “Full and Final Payment of PIP Benefits” in the “Pay to the Order” line did not constitute accord and satisfaction -- Insurer cannot simultaneously assert common law and statutory accord and satisfaction defenses -- Accordingly, common law defense must yield to statute -- Insurer failed to establish requisite elements of statutory accord and satisfaction where presented no evidence that it made a “good faith” tender when it calculated claim by applying fee schedule reductions, although policy required payment of 80% of all medically necessary expenses -- Further, evidence did not show that plaintiff's claim was unliquidated, as required for statutory accord and satisfaction, and insurer offered no evidence of a “bona fide” dispute existing between the parties -- Finally, insurer provided no evidence that payment tendered contained a conspicuous statement, as required by statute -- Court notes, that while moot, disputed issues of material fact exist that would also preclude finding of common law accord and satisfaction as a matter of law -- Defendant's motion for summary judgment based on accord and satisfaction denied

20 Fla. L. Weekly Supp. 1236a

Online Reference: FLWSUPP 2012RAMOInsurance -- Affirmative defenses -- Accord and satisfaction