Volume 23

23 Fla. L. Weekly Supp. 614b

Online Reference: FLWSUPP 2306EPINInsurance -- Discovery -- Depositions -- Corporate representative -- Insurer's motion for summary judgment shall not be heard until deposition of insurer's corporate representative has been completed

23 Fla. L. Weekly Supp. 66a

Online Reference: FLWSUPP 2301JORTInsurance -- Proposal for settlement -- Motion to extend time for response to proposal is denied

23 Fla. L. Weekly Supp. 604b

Online Reference: FLWSUPP 2306VALDNOT FINAL VERSION OF OPINION
Subsequent Changes at 27 Fla. L. Weekly Supp. 189aInsurance -- Pleadings -- Sham -- Insurer's third-party complaint against medical provider pleading indemnity, unjust enrichment, equitable estoppel, and detrimental reliance is stricken as sham pleading where allegations are inherently false and were clearly known to be false based on plain and conceded facts -- Court retains jurisdiction to award sanctions for frivolous litigation

23 Fla. L. Weekly Supp. 374a

Online Reference: FLWSUPP 2304JMARInsurance -- Personal injury protection -- Small claims -- Venue -- Where insurer failed to timely raise its challenge to venue under requirements of small claims rules, insurer waived any future challenges to venue -- Invocation of rules of civil procedure at pre-trial conference applied only to proceedings subsequent to pre-trial conference and did not provide insurer with additional opportunity to object to venue

23 Fla. L. Weekly Supp. 1074a

Online Reference: FLWSUPP 2310TROUInsurance -- Personal injury protection -- Settlement agreement -- Enforcement

23 Fla. L. Weekly Supp. 638a

Online Reference: FLWSUPP 2306CHAMInsurance -- Personal injury protection -- Workers' compensation lien -- Summary judgment is entered in favor of PIP insurer on claim for reimbursement of bills that form basis for workers' compensation lien paid by insured with funds received from personal injury settlement where neither insured nor medical providers timely submitted medical bills to insurer within 35 days of treatment, and insured did not serve pre-suit demand letter on insurer

23 Fla. L. Weekly Supp. 315c

Online Reference: FLWSUPP 2304SHUTInsurance -- Personal injury protection -- Exhaustion of benefits -- Absent showing of bad faith, PIP insurer not liable for benefits once exhausted -- There is no requirement to set aside reserve fund for disputed claims

23 Fla. L. Weekly Supp. 315b

Online Reference: FLWSUPP 2304BROWInsurance -- Personal injury protection -- Exhaustion of benefits -- Absent showing of bad faith, PIP insurer not liable for benefits once exhausted -- There is no requirement to set aside reserve fund for disputed claims

23 Fla. L. Weekly Supp. 881a

Online Reference: FLWSUPP 2308NEILInsurance -- Personal injury protection -- Examination under oath -- Failure to attend -- Insured that failed to attend three EUOs failed to satisfy condition precedent to receipt of PIP benefits -- Medical provider/assignee is not entitled to benefits due to insured's failure to satisfy condition precedent -- Failure to schedule EUO and make payment within thirty days did not deprive insurer of right to contest payment -- Questions certified: Whether Amador v. United Automobile Ins. Co., 748 So.2d 307 (Fla. 3rd DCA 1999) has been overruled by Statute or United Automobile Ins. Co. v. Rodriguez, 808 So.2d 82 (Fla. 2001); and whether Section 627.736(4)(b) requires a P.I.P. insurer to request an EUO within thirty days of written notice of a covered loss, when the policy of insurance incorporates the statutory condition precedent to receiving benefits as provided for in section 627.736(6)(g), or is it forever waived.

23 Fla. L. Weekly Supp. 65a

Online Reference: FLWSUPP 2301AROBInsurance -- Personal injury protection -- Evidence -- Insurer shall not mention and may not ask any witness what insurer paid for bills not at issue or what reduced amount insurer paid for bills at issue

23 Fla. L. Weekly Supp. 295c

Online Reference: FLWSUPP 2303TYREInsurance -- Personal injury protection -- Discovery -- Insurer's representative -- Provider entitled to conduct deposition of insurer's designated corporate representative and conduct inquiry regarding methodology, basis, facts, and calculations to determine reasonableness and payment of charges at issue -- Provider entitled to depose representative regarding reimbursement levels in same county where service was performed, as reflected by amounts insurer paid similarly placed providers for same CPT codes 10 days prior to and after date of service in instant case

23 Fla. L. Weekly Supp. 1060a

Online Reference: FLWSUPP 2310POSAInsurance -- Personal injury protection -- Discovery -- Agreement wherein plaintiff collection agency purchased receivables from medical provider is not discoverable -- Standing -- Absent privity, insurer cannot challenge assignment between plaintiff and provider

23 Fla. L. Weekly Supp. 266a

Online Reference: FLWSUPP 2303ENRIInsurance -- Personal injury protection -- Demand letter -- Sufficiency

23 Fla. L. Weekly Supp. 581a

Online Reference: FLWSUPP 2306RAHNInsurance -- Personal injury protection -- Complaint -- Amendment -- Medical provider is not required to send second demand letter in order to amend complaint to add three additional weeks of service that were not identified in original demand letter but were listed in patient history attached to that letter -- Motion to amend is granted

23 Fla. L. Weekly Supp. 557b

Online Reference: FLWSUPP 2306RAYMInsurance -- Personal injury protection -- Demand letter -- Medical provider is not required to send additional demand letter when seeking to amend complaint to add additional dates of service

23 Fla. L. Weekly Supp. 584b

Online Reference: FLWSUPP 2306CARRInsurance -- Personal injury protection -- Demand letter -- Pre-suit demand letter does not satisfy statutory condition precedent to suit where neither letter nor attached ledger reflect partial payments made by insurer -- No merit to medical provider's argument that letter substantially complied with notice requirements since insurer should be able to discern exact amount claimed to be due -- Strict compliance with notice requirements is required

23 Fla. L. Weekly Supp. 769a

Online Reference: FLWSUPP 2307COYLInsurance -- Personal injury protection -- Demand letter -- Abatement of PIP action is not proper remedy for filing demand letter that is defective for failing to account for prior payments made by insurer

23 Fla. L. Weekly Supp. 277a

Online Reference: FLWSUPP 2303WADEInsurance -- Personal injury protection -- Demand letter was defective where letter did not state exact amount due, or any amount due, and did not attach itemized statement from providers -- Fact that the only issue in dispute was whether insurer improperly limited benefits to $2500 does not change result -- Motion for summary judgment based on defective demand letter is granted

23 Fla. L. Weekly Supp. 549b

Online Reference: FLWSUPP 2306MWHAInsurance -- Personal injury protection -- Demand letter -- Sufficiency -- PIP statute does not require that demand letter calculate exact amount owed by insurer -- By attaching ledger to demand letter, medical provider satisfied section 627.736(10)

23 Fla. L. Weekly Supp. 281a

Online Reference: FLWSUPP 2303PRODInsurance -- Personal injury protection -- Demand letter -- Amended complaint -- Medical provider was required to send new demand letter prior to filing amended complaint seeking payment for additional dates of service that were not included in initial demand letter -- Amended complaint is stricken without prejudice

23 Fla. L. Weekly Supp. 389b

Online Reference: FLWSUPP 2305LGREInsurance -- Personal injury protection -- Wage loss -- Summary judgment -- Small claims -- Trial court did not err in proceeding under rule 1.510 regarding summary judgment in wage loss claim that had been transferred from circuit court to county court where parties continued to litigate case in county court under rules of civil procedure without objection -- Error to grant summary judgment in favor of insurer on basis that insured had not filed affidavit or other hard evidence in opposition to motion for summary judgment where complaint that included insured's ledger showing loss of income from his mobile barbeque business and admissions in which insured denied that he had not suffered any wage loss as result of accident were already filed with court when it heard motion -- Further, trial court erred in granting summary judgment when good faith discovery was still in progress

23 Fla. L. Weekly Supp. 653a

Online Reference: FLWSUPP 2306DOWAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- MRI -- Usual and customary charges -- Where policy required reimbursement of 80% of reasonable expenses, insurer erred in reducing claim based on usual and customary charges “in the community” and subsequently paying 80% of the reduced amount -- Language referencing usual and customary charges in the community is only located within statutory fee schedule, and policy did not unambiguously give notice of insurer's election to use statutory fee schedules -- Under circumstances, reasonableness of charges is no longer at issue, and provider's bill represents prima facie evidence of reasonable expense

23Fla. L. Weekly Supp. 260a

Online Reference: FLWSUPP 2303PATTInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Insurer's motion for summary judgment is procedurally deficient for failure to attach complete copy of policy -- Motion for summary judgment is denied due to ambiguity in policy that allows insurer to choose to reimburse according to permissive statutory fee schedule or reasonableness method

23 Fla. L. Weekly Supp. 683a

Online Reference: FLWSUPP 2307BLAKInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy providing that any amounts payable “shall be subject to any and all limitations” authorized by PIP statute “including, but not limited to, all fee schedules” does not provide clear and unambiguous notice of intent to limit reimbursement to Medicare Part B fee schedule

23 Fla. L. Weekly Supp. 751b

Online Reference: FLWSUPP 2307HSMIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that advises that medical benefits means 80% of all reasonable and medically necessary expenses at 200% of amount allowed under physician schedule of Medicare Part B clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

23 Fla. L. Weekly Supp. 1055a

Online Reference: FLWSUPP 2310MUSUInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that provides that insurer will pay lesser of 80% of actual charge or 80% of schedule of maximum charges contained in section 627.736(5)(a)2 clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

23 Fla. L. Weekly Supp. 487a

Online Reference: FLWSUPP 2305HARRInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy providing that insurer will pay 80% of reasonable expenses but also providing that amount payable “shall be subject to any and all limitations” authorized by PIP statute does not provide clear and unambiguous notice of intent to limit reimbursement to Medicare Part B fee schedule

23 Fla. L. Weekly Supp. 481a

Online Reference: FLWSUPP 2305ALVAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy providing that insurer will pay 80% of reasonable expenses but also providing that amount payable “shall be subject to any and all limitations” authorized by PIP statute does not provide clear and unambiguous notice of intent to limit reimbursement to Medicare Part B fee schedule

23 Fla. L. Weekly Supp. 154a

Online Reference: FLWSUPP 2302LEVIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that states that insurer will pay 80% of the rate of schedule of maximum charges pursuant to No-Fault Law and references Medicare, workers' compensation, and No-Fault Law schedule clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

23 Fla. L. Weekly Supp. 772a

Online Reference: FLWSUPP 2307TLEWInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that subjects payments to applicable fee schedules and states that methodology for determining amount insurer will pay shall be limited to 80% of 200% of Medicare Part B fee schedule or to 80% of maximum reimbursable allowance under workers' compensation if item is not reimbursable under Medicare Part B clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

23 Fla. L. Weekly Supp. 637b

Online Reference: FLWSUPP 2306WHITInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy providing that insurer will pay 80% of reasonable expenses but also providing that amount payable “shall be subject to any and all limitations” authorized by PIP statute does not provide clear and unambiguous notice of intent to limit reimbursement to Medicare Part B fee schedule -- Fact that policy was approved by Office of Insurance Regulation does not compel finding that policy correctly invokes fee schedule limitations where there is nothing in insurer's submission to OIR or in OIR's response to indicate that OIR is approving policy language as election to limit reimbursement to fee schedule

23 Fla. L. Weekly Supp. 793b

Online Reference: FLWSUPP 2307BAPTInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Both applicable 2013 version of PIP statute and amendatory endorsement to PIP policy allow insurer to apply Medicare Part B fee schedules and Outpatient Prospective Payment System cap to calculate reimbursement of claim

23 Fla. L. Weekly Supp. 1087a

Online Reference: FLWSUPP 2310DEROInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy providing that insurer will pay 80% of reasonable expenses but also providing that in no event will insurer pay more than 80% of No-Fault Act schedule of maximum charges does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule -- Approval of policy by Office of Insurance Regulation does not satisfy requirement that policy provide unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule where it is not clear from insurer's letter requesting approval or OIR's letter of approval that OIR was approving language as election to limit payment pursuant to fee schedule

23 Fla. L. Weekly Supp. 1052a

Online Reference: FLWSUPP 2310SIASInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that gives insurer unbridled discretion to consider various factors found in reasonable amount method of reimbursement and in permissive fee schedule method of reimbursement does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule -- Approval by Office of Insurance Regulation does not validate policy

23 Fla. L. Weekly Supp. 1043a

Online Reference: FLWSUPP 2310ROYInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that gives insurer unbridled discretion to consider various factors found in reasonable amount method of reimbursement and in permissive fee schedule method of reimbursement does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule -- Approval by Office of Insurance Regulation does not validate policy and notice or render them invulnerable to judicial invalidation

23 Fla. L. Weekly Supp. 1038a

Online Reference: FLWSUPP 2310STANInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy providing that insurer will pay 80% of reasonable expenses but also providing that in no event will insurer pay more than 80% of No-Fault Act schedule of maximum charges does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule -- Approval of policy by Office of Insurance Regulation or use of OIR sample form does not constitute per se compliance with requirement that policy provide unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule

23 Fla. L. Weekly Supp. 982b

Online Reference: FLWSUPP 2309RONDInsurance -- Personal injury protection -- Coverage -- Medical Expenses -- Where definition of “reasonable charge” in PIP policy is hybrid of factors found in reasonable amount method of reimbursement and provisions from fee schedule method of reimbursement, policy is ambiguous as to reimbursement method and did not specifically elect fee schedule method of reimbursement

23 Fla. L. Weekly Supp. 853a

Online Reference: FLWSUPP 2308MURPInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that includes fact-dependent factors in one policy endorsement and tracks Office of Insurance Regulation's sample fee schedule endorsement language in second conjunctive endorsement commingles payment methodologies and does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule

23 Fla. L. Weekly Supp. 550a

Online Reference: FLWSUPP 2306BROWInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Neither approval of PIP policy by Office of Insurance Regulation, nor use of OIR sample language in policy constitutes per se compliance with requirement that policy provide unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule -- PIP policy that includes fact-dependent factors in its definition of “reasonable charge” while also attempting to reimburse in accordance with statutory fee schedule commingles payment methodologies and does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule

23 Fla. L. Weekly Supp. 880a

Online Reference: FLWSUPP 2308WEBEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Policy endorsement providing that any and all amounts payable “shall be subject to any and all limitations authorized by section 627.736... or any other provisions of Florida Motor Vehicle No-Fault Law, ... including, but not limited to, all fee schedules” does not make it clear whether insurer is actually electing to limit its reimbursement to Medicare fee schedule or is simply reserving right to elect to do so -- Letter from Office of Insurance Regulation approving endorsement does not make endorsement a clear and specific election of fee schedule

23 Fla. L. Weekly Supp. 833a

Online Reference: FLWSUPP 2308BEALInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Neither approval of PIP policy by Office of Insurance Regulation, nor use of OIR sample language in policy constitutes per se compliance with requirement that policy provide unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule -- PIP policy that includes fact-dependent factors in its definition of “reasonable charge” while also attempting to reimburse in accordance with statutory fee schedule commingles payment methodologies and does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule -- Requirement of clear and unambiguous notice of election to use statutory fee schedule enunciated by Florida Supreme Court in Virtual Imaging relative to 2008 version of PIP statute is equally applicable to 2012 amendments to PIP statute

23 Fla. L. Weekly Supp. 776a

Online Reference: FLWSUPP 2307HAZLInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy providing that insurer will pay 80% of reasonable expenses but also providing that amount payable “shall be subject to any and all limitations” authorized by PIP statute does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule -- Approval of policy endorsement by Office of Insurance Regulation does not satisfy requirement that policy provide unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule where it is not clear from insurer's letter requesting approval or OIR's letter of approval that OIR was approving language as election to limit payment pursuant to fee schedule

23 Fla. L. Weekly Supp. 775a

Online Reference: FLWSUPP 2307PADRInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy does not provide clear and unambiguous notice of intent to limit reimbursement to Medicare fee schedule -- Insurer waived argument that policy language has been approved by Office of Insurance Regulation, and thus complies with 2012 amendment to PIP statute, where argument was not preserved in joint pretrial stipulation

23 Fla. L. Weekly Supp. 943a

Online Reference: FLWSUPP 2309ADAMInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Neither approval of PIP policy by Office of Insurance Regulation nor use of OIR sample language in policy constitutes per se compliance with requirement that policy provide unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule -- PIP policy that includes fact-dependent factors in its definition of “reasonable charge” while also attempting to reimburse in accordance with statutory fee schedule commingles payment methodologies and does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule -- Requirement of clear and unambiguous notice of election to use statutory fee schedule enunciated by Florida Supreme Court in Virtual Imaging relative to 2008 version of PIP statute is equally applicable to 2012 amendments to PIP statute

23 Fla. L. Weekly Supp. 637a

Online Reference: FLWSUPP 2306ROSEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Summary judgment -- Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider where affidavit is opinion of expert who was not disclosed in pretrial stipulation and who, consequently, is not permitted to testify at trial

23 Fla. L. Weekly Supp. 595a

Online Reference: FLWSUPP 2306MENAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that states unequivocally that medical benefits shall be payable at lesser of 80% of actual charges or 80% of schedule of maximum charges contained in section 627.736(5)(a)1 clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

23 Fla. L. Weekly Supp. 265a

Online Reference: FLWSUPP 2303SIKEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule

23 Fla. L. Weekly Supp. 62a

Online Reference: FLWSUPP 2301BALDInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy endorsement that states that insurer will pay benefits at 80% of maximum charges set forth by PIP law and 80% of other reasonable expenses clearly and unambiguously elects to limit reimbursement for services covered by statutory fee schedule to amount established by that fee schedule

23 Fla. L. Weekly Supp. 5a

Online Reference: FLWSUPP 2301HENDInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy provided sufficient notice of election to limit reimbursement to permissive statutory fee schedule

23 Fla. L. Weekly Supp. 61a

Online Reference: FLWSUPP 2301HENRInsurance -- Personal injury protection -- Standing -- Fictitious name -- Insurer's motion for summary judgment based on medical provider suing under registered fictitious name is denied where insurer did not make specific negative averment challenging provider's capacity to sue, invoice and explanation of reimbursement reveal that parties utilized provider's fictitious name in conducting their business, and Fictitious Name Act provides statutory basis for properly registered fictitious name to file suit

23 Fla. L. Weekly Supp. 360a

Online Reference: FLWSUPP 2304RENTInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where 2012 amendment to PIP statute and policy endorsement allow insurer to utilize Medicare coding policies and payment methodologies to limit payment of medical expenses, insurer did not breach policy by applying multiple procedure payment reduction to claim -- Application of multiple procedure payment reduction to claim to reduce payment for second MRI performed on same patient by same physician in same session is application of payment modifier, not utilization limit

23 Fla. L. Weekly Supp. 857b

Online Reference: FLWSUPP 2308ASSANOT FINAL VERSION OF OPINION
Subsequent Changes at 24 Fla. L. Weekly Supp. 163bInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Insurers were authorized to apply Medicare Multiple Procedure Payment Reduction to medical providers' bills where PIP statute authorizes use of Medicare coding policies, including MPPR, and insurers have placed insureds and providers on notice that MPPR will be utilized in determining appropriate reimbursement -- MPPR is not per se limitation on utilization prohibited by PIP statute

23 Fla. L. Weekly Supp. 855a

Online Reference: FLWSUPP 2308LOUIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Multiple Procedure Payment Reduction -- PIP policy that clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule and contains general references to Medicare coding policies and procedures does not clearly elect application of MPPR -- Moreover, MPPR is utilization limit prohibited by PIP statute, and even if MPPR were not prohibited by statute, insurer misapplied MPPR by superimposing 2013 MPPR on 2007 Medicare fee schedule -- Insurer that paid claims based on fee schedule without disputing relatedness or necessity of treatment pre-suit may not contest relatedness and necessity

23 Fla. L. Weekly Supp. 371a

Online Reference: FLWSUPP 2304CHARInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Affidavit filed by insurer in opposition to motion for summary judgment is rejected where affiant failed to establish his relationship to geographical area at issue, referred to table not attached to affidavit, rendered opinion on reasonableness of charges that directly contradicted his opinion in another PIP suit, used flawed methodology, and opined that charges were irrelevant

23 Fla. L. Weekly Supp. 357a

Online Reference: FLWSUPP 2304HOOKInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Opposing affidavits filed by insurer do not preclude partial summary judgment in favor of medical provider on issue of reasonableness of charges that insurer concedes are necessary and related where affidavits are conclusory and self-serving and rely on Medicare and workers' compensation fee schedules not elected in policy and negotiated contract rates that are irrelevant under section 627.736(5)(a)1

23 Fla. L. Weekly Supp. 370a

Online Reference: FLWSUPP 2304PEREInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary disposition -- Opposing affidavit filed by insurer does not preclude summary disposition in favor of medical provider on issue of reasonableness of charge for chiropractic services where affidavit is conclusory and lacks foundation, and affiant is not qualified to render opinion on reasonableness of charge

23 Fla. L. Weekly Supp. 368b

Online Reference: FLWSUPP 2304FERNInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of MRI charge where affidavit is conclusory and lacks foundation, and affiant is not qualified to render opinion on reasonableness of charge -- Fact that other MRI centers charged less and that Medicare and health insurance pay less than amount billed by provider does not, by itself, create factual issue as to reasonableness of charge

23 Fla. L. Weekly Supp. 869a

Online Reference: FLWSUPP 2308GOODInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Opposing affidavits filed by insurer do not preclude summary judgment in favor of medical provider on issue of reasonableness of charge -- Affidavit of claims representative that attempts to introduce documents retrieved from Internet purporting to show charges of other chiropractors in region seeks to introduce hearsay and does not raise issue of fact as to reasonableness of charge -- Affidavit of expert that excludes consideration of any amounts above 200% of Medicare fee schedule is not based on sufficient facts or data and is not product of reliable principles and methodologies

23 Fla. L. Weekly Supp. 169a

Online Reference: FLWSUPP 2302JOHNInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Opposing affidavits filed by insurer do not preclude summary judgment in favor of medical provider on issue of reasonableness of charges where one affiant omitted and ignored damaging information to render “expert” opinion, and second affiant premised her opinion on incorrect assumptions and insufficient data -- Where it is undisputed that insurer applied permissive statutory fee schedule that was not unambiguously elected in policy, PIP reductions made by insurer are unlawful -- Insurer also erred in denying reimbursement for compensable supply that was properly billed as separate code

23 Fla. L. Weekly Supp. 768a

Online Reference: FLWSUPP 2307RAMOInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of MRI charges where affiant's opinion is not based on sufficient facts or data, is not product of reliable principles and methods and is based on hearsay rather than first-hand knowledge and affiant did not apply principles and methods reliably to facts of case

23 Fla. L. Weekly Supp. 766a

Online Reference: FLWSUPP 2307ABALInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of MRI charge where affiant is not qualified to render opinion on reasonableness of charge and opinions are not based upon sufficient facts or data and are not product of reliable principles and methods -- Deposition filed by insurer also does not preclude entry of summary judgment where deposition substantiates reasonableness of charge

23 Fla. L. Weekly Supp. 199a

Online Reference: FLWSUPP 2302BELTInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Summary judgment -- Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of MRI charge where affiant is not qualified to render opinion on reasonableness of charge or reasonableness of reimbursement -- Provider is entitled to summary judgment on issue of relatedness of services where referring physician's affidavit regarding relatedness is not refuted by any competent evidence

23 Fla. L. Weekly Supp. 88a

Online Reference: FLWSUPP 2302ALONInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Trial court did not err in finding that opposing affidavits filed by insurer did not preclude summary judgment in favor of medical provider on issue of reasonableness of provider's charge where one affiant was not qualified to render opinion on reasonableness of charges and other affiant concluded that he needed more information in order to conclude that treatment was reasonable, related and medically necessary

23 Fla. L. Weekly Supp. 653b

Online Reference: FLWSUPP 2306PADIInsurance -- Personal injury protection -- Summary judgment -- Reasonableness of charges -- Medical provider met burden of establishing reasonableness of charges -- Opposing affidavit of insurer's expert is materially deficient where affidavit lacks information about reasonableness of charges and focuses on what reasonable reimbursement levels should be without explaining how that impacts reasonableness of charges -- Expert's opinion that nothing above 200% of Medicare rate would ever be reasonable is rejected where opinion renders ruling in Virtual Imaging meaningless -- Provider's motion for final summary judgment is granted

23 Fla. L. Weekly Supp. 626a

Online Reference: FLWSUPP 2306ELBAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Opposing affidavit filed by insurer does not preclude partial summary judgment in favor of medical provider on issue of reasonableness of charge where affidavit provided anecdotal evidence based on what affiant charged for services at his facilities and what his peers told him they charge and did not not satisfy requirements of section 90.702 or Daubert standard

23 Fla. L. Weekly Supp. 1077b

Online Reference: FLWSUPP 2310NAPOInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges is appropriate issue to be determined by summary judgment -- Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on reasonableness issue where affidavit lacks evidence of sufficient facts or data, reliable principles and methods, or scientific knowledge and is akin to pure opinion testimony

23 Fla. L. Weekly Supp. 1075a

Online Reference: FLWSUPP 2310CORPInsurance -- Personal injury protection -- Expert witness -- Insurer's expert witness on reasonableness of charges is stricken where insurer has not demonstrated that proffered opinion, that reimbursement rate of 80% of 200% of Medicare fee schedule is maximum reasonable charge, is based on sufficient facts or data and product of reliable principles and methods and that witness has reliably applied principles and methods to facts of case

23 Fla. L. Weekly Supp. 596a

Online Reference: FLWSUPP 2306HOOKInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Opposing affidavits filed by insurer do not preclude partial summary judgment in favor of medical provider on issue of reasonableness of charges where affiants rely on fee schedules that are irrelevant to insurer that did not elect use of fee schedules in its policy and opinions of affiants are conclusory, not based on sufficient facts or data, not product of reliable principles or methods and do not reflect reliable application of principles and methods to facts

23 Fla. L. Weekly Supp. 206b

Online Reference: FLWSUPP 2303CHERInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Error to enter summary judgment in favor of insurer where supporting affidavit and admissions submitted by insurer were insufficient to refute provider's allegations that the amount it charged for taking and reading x-rays was reasonable

23 Fla. L. Weekly Supp. 585a

Online Reference: FLWSUPP 2306OLKOInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Where insurer never alleged that it elected to limit reimbursement in accordance with statutory fee schedule but, instead, has challenged reasonableness of medical provider's charge, factual dispute as to reasonableness of charge precludes summary judgment -- Provider cannot rely on same medical bill that was rejected by insurer as unreasonable as prima facie evidence in support of its motion for summary judgment on reasonableness of charge

23 Fla. L. Weekly Supp. 1057a

Online Reference: FLWSUPP 2310MORAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Insurer that breached PIP policy by utilizing statutory fee schedule that was not clearly and unambiguously elected in policy when processing medical provider's bill is not entitled to challenge reasonableness of charges

23 Fla. L. Weekly Supp. 1049a

Online Reference: FLWSUPP 2310TMORInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where insurer waived all defenses to medical provider's action for PIP benefits, including right to challenge reasonableness of charge, and unilaterally determined reasonableness of charge by applying statutory fee schedule not elected in policy when processing provider's bill, reasonableness of charge is not at issue -- Final judgment is entered in favor of provider for balance of improperly reduced bill

23 Fla. L. Weekly Supp. 958a

Online Reference: FLWSUPP 2309MATOInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where insurer waived all defenses to medical provider's action for PIP benefits, including right to challenge reasonableness of charge, and unilaterally determined reasonableness of charge by applying statutory fee schedule not elected in policy when processing provider's bill, reasonableness of charge is not at issue -- Final judgment is entered in favor of provider for balance of improperly reduced bill

23 Fla. L. Weekly Supp. 957a

Online Reference: FLWSUPP 2309CHAMInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where insurer waived all defenses to medical provider's action for PIP benefits, including right to challenge reasonableness of charge, and unilaterally determined reasonableness of charge by applying statutory fee schedule not elected in policy when processing provider's bill, reasonableness of charge is not at issue -- Final judgment is entered in favor of provider for balance of improperly reduced bill

23 Fla. L. Weekly Supp. 954a

Online Reference: FLWSUPP 2309CMERInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where insurer waived all defenses to medical provider's action for PIP benefits, including right to challenge reasonableness of charge, and unilaterally determined reasonableness of charge by applying statutory fee schedule not elected in policy when processing provider's bill, reasonableness of charge is not at issue -- Final judgment is entered in favor of provider for balance of improperly reduced bill

23 Fla. L. Weekly Supp. 952a

Online Reference: FLWSUPP 2309TORRInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where insurer waived all defenses to medical provider's action for PIP benefits, including right to challenge reasonableness of charge, and unilaterally determined reasonableness of charge by applying statutory fee schedule not elected in policy when processing provider's bill, reasonableness of charge is not at issue -- Final judgment is entered in favor of provider for balance of improperly reduced bill

23 Fla. L. Weekly Supp. 950a

Online Reference: FLWSUPP 2309JPICInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where insurer waived all defenses to medical provider's action for PIP benefits, including right to challenge reasonableness of charge, and unilaterally determined reasonableness of charge by applying statutory fee schedule not elected in policy when processing provider's bill, reasonableness of charge is not at issue -- Final judgment is entered in favor of provider for balance of improperly reduced bill

23 Fla. L. Weekly Supp. 948a

Online Reference: FLWSUPP 2309COWEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where insurer waived all defenses to medical provider's action for PIP benefits, including right to challenge reasonableness of charge, and unilaterally determined reasonableness of charge by applying statutory fee schedule not elected in policy when processing provider's bill, reasonableness of charge is not at issue -- Final judgment is entered in favor of provider for balance of improperly reduced bill

23 Fla. L. Weekly Supp. 945b

Online Reference: FLWSUPP 2309MFORInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where insurer waived all defenses to medical provider's action for PIP benefits, including right to challenge reasonableness of charge, and unilaterally determined reasonableness of charge by applying statutory fee schedule not elected in policy when processing provider's bill, reasonableness of charge is not at issue -- Final judgment is entered in favor of provider for balance of improperly reduced bill

23 Fla. L. Weekly Supp. 851b

Online Reference: FLWSUPP 2308LEWIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Insurer that breached contract by utilizing statutory fee schedule which was not incorporated in policy when processing medical provider's bill is not entitled to challenge reasonableness of MRI charge -- Even if insurer could challenge reasonableness of charge, opposing affidavit filed by insurer does not preclude summary judgment in favor of provider on reasonableness issue where affidavit fails to establish that affiant has any first-hand knowledge of MRI charges in county where services were rendered -- Insurer that paid claim without disputing relatedness or necessity of MRI may not thereafter challenge relatedness and necessity

23 Fla. L. Weekly Supp. 849b

Online Reference: FLWSUPP 2308AMITRInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where insurer waived all defenses to medical provider's action for PIP benefits, including right to challenge reasonableness of charge, and unilaterally determined reasonableness of charge by applying statutory fee schedule not elected in policy when processing provider's bill, reasonableness of charge is not at issue -- Final judgment is entered in favor of provider for balance of improperly reduced bill

23 Fla. L. Weekly Supp. 847b

Online Reference: FLWSUPP 2308SHOLInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where insurer waived all defenses to medical provider's action for PIP benefits, including right to challenge reasonableness of charge, and unilaterally determined reasonableness of charge by applying statutory fee schedule not elected in policy when processing provider's bill, reasonableness of charge is not at issue -- Final judgment is entered in favor of provider for balance of improperly reduced bill

23 Fla. L. Weekly Supp. 845a

Online Reference: FLWSUPP 2308AMEHInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where insurer waived all defenses to medical provider's action for PIP benefits, including right to challenge reasonableness of charge, and unilaterally determined reasonableness of charge by applying statutory fee schedule not elected in policy when processing provider's bill, reasonableness of charge is not at issue -- Final judgment is entered in favor of provider for balance of improperly reduced bill

23 Fla. L. Weekly Supp. 843a

Online Reference: FLWSUPP 2308AAPOInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where insurer waived all defenses to medical provider's action for PIP benefits, including right to challenge reasonableness of charge, and unilaterally determined reasonableness of charge by applying statutory fee schedule not elected in policy when processing provider's bill, reasonableness of charge is not at issue -- Final judgment is entered in favor of provider for balance of improperly reduced bill

23 Fla. L. Weekly Supp. 839a

Online Reference: FLWSUPP 2308MBEAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where insurer waived all defenses to medical provider's action for PIP benefits, including right to challenge reasonableness of charge, and unilaterally determined reasonableness of charge by applying statutory fee schedule not elected in policy when processing provider's bill, reasonableness of charge is not at issue -- Final judgment is entered in favor of provider for balance of improperly reduced bill

23 Fla. L. Weekly Supp. 783a

Online Reference: FLWSUPP 2307ADAMInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy stating that benefits shall be payable at lesser of 80% of actual charge or 80% of schedule of maximum charges contained in PIP statute, including 200% of Medicare Part B fee schedule, clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule -- Policy language stating that insurer may use various sources of information to decide if medical expense is reasonable and necessary and caused by accident is nullity based on clear and unambiguous election of statutory fee schedule as method of reimbursement

23 Fla. L. Weekly Supp. 759b

Online Reference: FLWSUPP 2307ALEXInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Insurer that breached contract by utilizing statutory fee schedule which was not incorporated in policy when processing medical provider's bill is not entitled to challenge reasonableness of charges

23 Fla. L. Weekly Supp. 473a

Online Reference: FLWSUPP 2305MCCOInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Insurer that breached contract by utilizing statutory fee schedule not incorporated in policy when processing medical provider's bill is not entitled to challenge reasonableness of charges

23 Fla. L. Weekly Supp. 622a

Online Reference: FLWSUPP 2306MCCAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where Medicare Part B fee schedule was not incorporated into PIP policy, insurer is not entitled to use that fee schedule as sole basis to limit reimbursement or as sole factor when determining reasonableness of MRI charge -- Where insurer elected to automatically reduce medical provider's charge to predetermined reasonable rate by applying Medicare fee schedule, insurer cannot retroactively change its position and claim that payment methodology was based on factors set forth in section 627.736(5)(a)1 -- Summary disposition in favor of provider

23 Fla. L. Weekly Supp. 63a

Online Reference: FLWSUPP 2301APPLInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of charge for orthopedic consultation where affidavit fails to refute provider's evidence of its usual and customary charges accepted during year at issue, reimbursement levels in community, and routine approval of same charge as reasonable by defendant insurer and five other insurers

23 Fla. L. Weekly Supp. 212a

Online Reference: FLWSUPP 2303WEINInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Fact that policy is silent as to reasonableness requirement does not preclude insurer from challenging charges as unreasonable -- PIP statute, which is incorporated in all PIP policies, requires only that reasonable expenses be paid

23 Fla. L. Weekly Supp. 362a

Online Reference: FLWSUPP 2304YARTInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Medical provider failed to meet its burden of proof for summary judgment on reasonableness of charges where provider's expert stated no opinion as to reasonableness of charges, and provider failed to file authenticated copy of medical bill in record -- Where PIP policy provides that insurer may consider “various federal and state medical fee schedules” to determine whether charge is reasonable, insurer and its experts may consider Medicare reimbursement rates in determining reasonableness of charges

23 Fla. L. Weekly Supp. 874a

Online Reference: FLWSUPP 2308MASTInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of MRI charge where affidavit is self-serving, conclusory, devoid of sufficient facts or data and based on inadmissible hearsay and lacks foundation for opinion that charge is unreasonable -- Insurer that did not unambiguously elect in policy to limit reimbursement to permissive statutory fee schedule cannot rely on fee schedule to suggest that it reimbursed reasonable amount by making payment in accord with fee schedule -- Fact that Medicare and private health insurance pay less than amount billed by provider does not, by itself, create factual issue as to reasonableness of charge

23 Fla. L. Weekly Supp. 871a

Online Reference: FLWSUPP 2308GONZInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of MRI charge where affidavit states that amount is excessive charge unless scan was performed at licensed facility, and provider is fully licensed facility -- Fact that provider accepts lower payments from cash paying patients on rare occasions does not create factual issue as to reasonableness of charge -- Insurer that did not unambiguously elect in policy to limit reimbursement to permissive statutory fee schedule cannot limit payment to fee schedule

23 Fla. L. Weekly Supp. 560a

Online Reference: FLWSUPP 2306ABREInsurance -- Personal injury protection -- Expert witness -- Insurer's actuary is not qualified to render opinion on reasonableness of medical charges where proposed witness has no experience in pricing of medical services and his opinion is based on data that includes factors, such as Medicare and workers' compensation fee schedules, that are irrelevant to determining whether PIP charges are reasonable

23 Fla. L. Weekly Supp. 776b

Online Reference: FLWSUPP 2307HOUSInsurance -- Personal injury protection -- Evidence -- Expert witnesses -- Proffered testimony of insurer's expert on reasonableness of charges is inadmissible where expert's opinions, which rely on application of Medicare Part B fee schedule and amounts expert accepts from HMOs and PPOs, are not based on sufficient facts or data and are not product of sufficient principles and methods -- Proposed expert is stricken

23 Fla. L. Weekly Supp. 785a

Online Reference: FLWSUPP 2307MOREInsurance -- Personal injury protection -- Evidence -- Expert witnesses -- Proffered testimony of insurer's expert on reasonableness of charges is inadmissible where expert's opinions, which are not based on factors set forth in section 627.736(5)(a)1, are not based on sufficient facts or data and are not product of sufficient principles and methods -- Proposed expert is stricken

23 Fla. L. Weekly Supp. 488a

Online Reference: FLWSUPP 2305LONGInsurance -- Personal injury protection -- Evidence -- Expert witnesses -- Where insurer's proposed expert regarding reasonableness of charges considered only what he personally accepts from insurer that pays him pursuant to Medicare and health insurance fee schedules in forming his opinion, expert's opinion is not based on sufficient facts or data and not product of reliable principles and methods -- Proposed expert is precluded from testifying

23 Fla. L. Weekly Supp. 60a

Online Reference: FLWSUPP 2301PANInsurance -- Personal injury protection -- Expert witness -- Insurer's actuary is not qualified to render opinion on reasonableness of MRI charge where actuary has no experience and knowledge concerning operation of medical provider and his opinions will not assist trier of fact, are not relevant to ultimate resolution of issues in case, are not based on sufficient facts or data, and are not product of reliable principles and methods

23 Fla. L. Weekly Supp. 1058a

Online Reference: FLWSUPP 2310IGNAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Insurer that breached PIP policy by utilizing statutory fee schedule that was not clearly and unambiguously elected in policy when processing medical provider's bill is not entitled to challenge reasonableness of charges -- No merit to argument that relatedness and medical necessity of services remain at issue where relatedness and necessity were admitted by insurer's action of making partial payment on claim

23 Fla. L. Weekly Supp. 890a Online Reference: FLWSUPP 2309BURGNOT FINAL VERSION OF OPINIONSubsequent Changes at 24 Fla. L. Weekly Supp. 197bInsurance -- Personal injury protection -- Small claims -- Summary disposition…

23 Fla. L. Weekly Supp. 615b

Online Reference: FLWSUPP 2306NATIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Inadequate record keeping by medical provider is not lawful basis for nonpayment of PIP benefits -- Affidavit attacking adequacy of provider's record keeping is not sufficient to preclude partial summary judgment on issues of relatedness and necessity of treatment

23 Fla. L. Weekly Supp. 977a

Online Reference: FLWSUPP 2309CASSInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Summary judgment -- Medical provider is entitled to summary judgment as to reasonableness of MRI charge based on insurer's technical admissions -- Opposing affidavits filed by insurer do not preclude summary judgment in favor of provider on reasonableness of charge where affidavits are conclusory and lack foundation for opinions -- Insurer cannot challenge medical necessity and relatedness of services where insurer made partial payment for services and did not assert lack of relatedness and necessity as affirmative defense -- Section 627.736(4)(b), which provides that insurer may assert that claim was unrelated or not medically necessary at any time, does not allow insurer to challenge relatedness and necessity where there is no record evidence of insurer having made any such assertion in case

23 Fla. L. Weekly Supp. 966a

Online Reference: FLWSUPP 2309SHAWInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Relatedness and medical necessity of services -- Summary disposition -- Opposing affidavit filed by insurer does not preclude summary disposition in favor of medical provider on issue of relatedness of MRI where insurer's expert relied on photographs of vehicle not associated with insured's accident, and affidavit is self-serving and conclusory -- Insurer cannot rely on documents shielded from discovery as work-product to dispute relatedness and necessity of MRI -- MRI used to determine whether accident was cause of injury and rule out rotator cuff injury is compensable

23 Fla. L. Weekly Supp. 484a

Online Reference: FLWSUPP 2305SHOLInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Insurer that has already made reduced payment on claim and is sued for balance of claim may raise relatedness and medical necessity of services as defense

23 Fla. L. Weekly Supp. 1050a

Online Reference: FLWSUPP 2310FINKInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where insurer placed insured's claim in “auto process” mode, in which system automatically pays bills in accordance with statutory fee schedule without any individual reviewing bills for reasonableness, relatedness or necessity, insurer waived its right to investigate medical provider's MRI bill and cannot challenge bill as unreasonable, unrelated or unnecessary in suit for unpaid balance of bill

23 Fla. L. Weekly Supp. 286a

Online Reference: FLWSUPP 2303FOXInsurance -- Personal injury protection -- Venue in medical provider's action against PIP insurer that is domestic corporation is proper either in county where insurer has office for transaction of its customary business or in county where payment was to be made to provider and cause of action accrued -- Fact that insurer conducts business in a county through agents is not sufficient basis for venue where insurer is domestic, not foreign, corporation -- Motion to transfer venue is granted

23 Fla. L. Weekly Supp. 970a

Online Reference: FLWSUPP 2309GUILInsurance -- Personal injury protection -- Complaint -- Amendment -- Substitution of plaintiff -- Motion to amend complaint to substitute medical provider that is entirely separate and distinct legal entity from plaintiff medical provider is denied -- Further, amendment would be futile since relation back doctrine of rule 1.190(c) does not apply and statute of limitations has elapsed

23 Fla. L. Weekly Supp. 575a

Online Reference: FLWSUPP 2306BILLInsurance -- Complaint -- Amendment -- Substitution of plaintiff -- Motion to amend complaint to substitute medical provider that is separate and distinct legal entity from plaintiff medical provider is denied

23 Fla. L. Weekly Supp. 112a

Online Reference: FLWSUPP 2302JLAMInsurance -- Personal injury protection -- Small claims -- Trial court erred in considering amount of claim stated in demand letter in ruling on motion to dismiss -- Doctrine of de minimis non curat lex does not preclude small claims action seeking less than $100 in PIP benefits -- Error to base dismissal in part on affirmative defense that medical provider did not bring action in good faith because it did not attempt to mitigate damages by reaching out to insurer before initiating litigation -- PIP statute only requires that claimant submit presuit demand letter, which provider did

23 Fla. L. Weekly Supp. 108a

Online Reference: FLWSUPP 2302PIERInsurance -- Personal injury protection -- Small claims -- Trial court erred in considering amount of claim stated in demand letter in ruling on motion to dismiss -- Doctrine of de minimis non curat lex does not preclude small claims action seeking less than $100 in PIP benefits -- Error to base dismissal in part on affirmative defense that medical provider did not bring action in good faith because it did not attempt to mitigate damages by reaching out to insurer before initiating litigation -- PIP statute only requires that claimant submit presuit demand letter, which provider did

23 Fla. L. Weekly Supp. 105b

Online Reference: FLWSUPP 2302DIAZInsurance -- Personal injury protection -- Small claims -- Trial court erred in considering amount of claim stated in demand letter in ruling on motion to dismiss -- Doctrine of de minimis non curat lex does not preclude small claims action seeking less than $100 in PIP benefits -- Error to base dismissal in part on affirmative defense that medical provider did not bring action in good faith because it did not attempt to mitigate damages by reaching out to insurer before initiating litigation -- PIP statute only requires that claimant submit presuit demand letter, which provider did

23 Fla. L. Weekly Supp. 610a

Online Reference: FLWSUPP 2306FILSInsurance -- Personal injury protection -- Coverage -- Medical expenses -- NCCI edits, which provide limits on number of treatments, are utilization limitations prohibited by PIP statute -- PIP policy that allows insurer to choose among list of CMS reimbursement limitations and methodologies does not clearly and unambiguously elect NCCI reimbursement methodology -- If NCCI edits were allowed to act as complete defense to payment, insurer would be able to circumvent obligations under PIP statute and under PIP policy that provides that insurer will reimburse 80% of maximum reimbursable allowance under workers' compensation when services are excluded under Medicare Part B

23 Fla. L. Weekly Supp. 182a

Online Reference: FLWSUPP 2302VMARInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary disposition -- Opposing affidavit filed by insurer does not preclude summary disposition in favor of medical provider on issue of reasonableness of MRI charge where affidavit is conclusory and lacks foundation, and affiant is not qualified to render opinion on reasonableness of charge -- Fact that Medicare and health insurance pay less than amount billed by provider does not, by itself, create factual issue as to reasonableness of charge

23 Fla. L. Weekly Supp. 341b

Online Reference: FLWSUPP 2304KOLLInsurance -- Personal injury protection -- Dismissal -- Where medical provider filed and then dismissed first lawsuit against PIP insurer, and thereafter provider filed second lawsuit against insurer for different dates of service, some of which occurred prior to dismissal of first suit, claims for services rendered on or before date of dismissal of first lawsuit are dismissed -- Motion to dismiss is denied as to services rendered after dismissal of first lawsuit

23 Fla. L. Weekly Supp. 174b

Online Reference: FLWSUPP 2302TROCInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Lawfully rendered treatment -- It is outside purview of court to make determination that provider did not comply with Health Care Clinic Act, including medical or clinical director compliance, absent a finding from the Agency for Health Care Administration that the provider had been in violation of the statute at the time the services at issue were rendered -- Affirmative defense of noncompliance remains issue for trier of fact -- Defendant's motion for summary judgment denied

23 Fla. L. Weekly Supp. 563b

Online Reference: FLWSUPP 2306CALOInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Lawfully rendered services -- Where medical director of clinic was ignorant of what was required of him under Health Care Clinic Act and was noncompliant with those responsibilities, charges by clinic are unlawful and not compensable

23 Fla. L. Weekly Supp. 176b

Online Reference: FLWSUPP 2302MONSInsurance -- Personal injury protection -- Coverage -- Lawfully rendered services -- Where, during time that services were rendered to insured, medical provider falsely identified licensed massage therapist as its owner in order to circumvent licensure requirements of Health Care Clinic Act, services were not lawfully rendered and neither insurer nor insured is liable for charges -- Further, neither insurer nor insured is required to pay claim to provider that knowingly submitted false and misleading claims

23 Fla. L. Weekly Supp. 762a

Online Reference: FLWSUPP 2307PEREInsurance -- Personal injury protection -- Coverage -- Lawfully rendered services -- Evidence -- Judicial notice -- Insurer's request for compulsory judicial notice of final order of state board of medicine barring treating physician from practice of medicine is granted where medical provider has been given sufficient notice of request to enable it to meet request

23 Fla. L. Weekly Supp. 1061a

Online Reference: FLWSUPP 2310MEDIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Lawfully rendered services -- Insurer had no obligation to pay clinic whose medical director was not performing her statutorily mandated duties -- Court rejects plaintiff's position that only the Agency for Health Care Administration can find clinic in violation of statute

23 Fla. L. Weekly Supp. 571b

Online Reference: FLWSUPP 2306PINEInsurance -- Summary judgment -- Factual issues -- Insurer's motion for summary judgment as to late billing is denied -- Opposing affidavit based on personal knowledge and establishment of routine practice of medical provider created genuine issue of material fact regarding submission of bills

23 Fla. L. Weekly Supp. 571a

Online Reference: FLWSUPP 2306CUARInsurance -- Summary judgment -- Factual issues -- Insurer's motion for summary judgment as to late billing is denied -- Opposing affidavit based on personal knowledge and establishment of routine practice of medical provider created genuine issue of material fact regarding submission of bills

23 Fla. L. Weekly Supp. 910a

Online Reference: FLWSUPP 2309TOWLInsurance -- Personal injury protection -- Answer -- Amendment -- Abuse of discretion to deny insurer leave to amend answer and affirmative defenses where allowing amendment would not prejudice medical provider since no trial date had been set, insurer had only been afforded opportunity to amend once, and amendments were not futile -- Jurisdiction -- County court did not err in denying motion to dismiss for lack of subject matter jurisdiction where amount in controversy in PIP case is less than $900 -- Summary judgment -- Opposing affidavit -- Error to strike opposing affidavit of insurer's witness due to delay in disclosure of expert -- Supreme court precedent governing striking of witnesses testifying at trial not basis for striking affidavit in opposition to summary judgment -- Insurer that complied with requirements of rule 1.510 in serving opposing affidavit on provider should have been allowed to present affidavit, and summary judgment should not have been entered

23 Fla. L. Weekly Supp. 523c

Online Reference: FLWSUPP 2306CRUZInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Post-suit exhaustion of benefits extinguished medical provider's right to further payments

23 Fla. L. Weekly Supp. 872a

Online Reference: FLWSUPP 2308FRANInsurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- Where insurer sent global settlement check to medical provider's attorneys that intermixed benefits with attorney's fees, costs and interest without any explanation of how check would be apportioned, there is no evidence that benefits have been exhausted

23 Fla. L. Weekly Supp. 628b

Online Reference: FLWSUPP 2306MOORInsurance -- Personal injury protection -- Where there is no reasonable explanation for insurer's failure to advise medical provider and court of exhaustion of policy limits until one year after exhaustion, insurer is ordered to pay reasonable attorney's fees and costs incurred by provider due to its inaction

23 Fla. L. Weekly Supp. 479a

Online Reference: FLWSUPP 2305MARDInsurance -- Personal injury protection -- Where there was no reasonable or credible explanation for insurer's failure to advise medical provider and court of exhaustion of benefits until 17 months after exhaustion, and insurer contumaciously ignored provider's continuous requests for updated PIP log and ignored court order to provide log, insurer is ordered to pay attorney's fees and costs incurred by provider due to insurer's inaction

23 Fla. L. Weekly Supp. 891a

Online Reference: FLWSUPP 2309GARRInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Where medical provider submitted bill, without claim number, within 35 days of MRI, and insurer did not exercise due diligence to connect bill with insured's claim, lack of diligence by insurer did not render bill untimely -- Bill was rendered complete when provider submitted demand letter with correct claim number and became overdue when not paid within 30 days of receipt of letter -- Where benefits were not exhausted until 10 months after bill became overdue, trial court correctly entered judgment in provider's favor

23 Fla. L. Weekly Supp. 963a

Online Reference: FLWSUPP 2309PEREInsurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- Summary judgment based on exhaustion of benefits is precluded by evidence that insurer paid bills for unlawful medical services and may have made payment in bad faith

23 Fla. L. Weekly Supp. 287a

Online Reference: FLWSUPP 2303MCWAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Where insurer chose to pay bills that exhausted policy limits solely as “business decision” to avoid litigation and without making any determination that services billed were reasonable, related or medically necessary or attempting to settle claims, genuine issues of material fact as to whether payments were for valid claims and whether insurer acted in bad faith prevents entry of summary judgment in favor of insurer

23 Fla. L. Weekly Supp. 364c

Online Reference: FLWSUPP 2304GEORInsurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- Final summary judgment

23 Fla. L. Weekly Supp. 176a

Online Reference: FLWSUPP 2302ROBIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Where payment made by insurer to another medical provider was not gratuitous, PIP benefits were properly exhausted

23 Fla. L. Weekly Supp. 524b

Online Reference: FLWSUPP 2306BRIGInsurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- There is no requirement for PIP insurer to set aside reserve fund for disputed claims and, in absence of showing of bad faith, PIP insurer is not liable for benefits once exhausted

23 Fla. L. Weekly Supp. 524a

Online Reference: FLWSUPP 2306CARCInsurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- There is no requirement for PIP insurer to set aside reserve fund for disputed claims and, in absence of showing of bad faith, PIP insurer is not liable for benefits once exhausted

23 Fla. L. Weekly Supp. 533a

Online Reference: FLWSUPP 2306DWILInsurance -- Personal injury protection -- Exhaustion of benefits -- Florida law does not require party to set aside reserve fund for disputed claims -- In absence of bad faith, PIP insurer is not liable for benefits once exhausted

23 Fla. L. Weekly Supp. 524c

Online Reference: FLWSUPP 2306HORIInsurance -- Personal injury protection -- Coverage -- Emergency services -- Exhaustion of policy limits -- Despite statutory mandate that insurer reserve $5,000 for emergency service providers, insurer was not required to reserve funds for emergency service provider's claim reduced through erroneous application of statutory fee schedule and, absent showing of bad faith, is not liable for balance of reduced claim after exhaustion of benefits

23 Fla. L. Weekly Supp. 513a

Online Reference: FLWSUPP 2306LOCKInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Emergency services -- Exhaustion of policy limits -- Insurer was required to hold in reserve beyond 30 days that portion of a emergency provider's claim that was disputed and remained unpaid at end of 30-day reserve period -- Exhaustion of benefits is not defense to payment of disputed portion of emergency provider's claim

23 Fla. L. Weekly Supp. 302b

Online Reference: FLWSUPP 2304MAUGInsurance -- Personal injury protection -- Coverage -- Medical benefits -- Emergency services -- Exhaustion of benefits -- PIP insurer was primary payor for emergency services provider's claim where provider filed substantially completed claim form within 30-day period during which insurer was required to reserve funds for payment of claims by providers of emergency services or care -- Fact that secondary insurer paid claim did not relieve PIP insurer of its obligation to pay -- Provider's motion for summary judgment granted

23 Fla. L. Weekly Supp. 490b

Online Reference: FLWSUPP 2305SKYLInsurance -- Personal injury protection -- Coverage -- Emergency medical condition -- Where qualified medical provider had not determined prior to filing of suit that insured suffered emergency medical condition, insurer did not breach PIP policy by limiting benefits to $2,500 -- Post-suit determination of emergency medical condition does not create disputed issue of material fact preventing entry of summary judgment

23 Fla. L. Weekly Supp. 482a

Online Reference: FLWSUPP 2305BLAIInsurance -- Personal injury protection -- Coverage -- Emergency medical condition -- Under amendments to PIP statute requiring PIP insurer to pay benefits up to $10,000 if qualified medical provider has determined that claimant had emergency medical condition and limiting reimbursement to $2,500 if qualified provider has determined that claimant did not have emergency medical condition, insurer properly limited benefits to $2,500 where qualified provider has not determined that insured suffered emergency medical condition -- Motion to stay case pending resolution of cases pending before district court of appeal concerning issue of when benefits above $2,500 become available when there has been determination of emergency medical condition is denied where facts in appealed cases are different from facts in instant case, and stay would result in inordinate delay -- Motion to abate case pending resolution of appealed cases is denied -- Abatement is not appropriate when cases do not involve same parties

23 Fla. L. Weekly Supp. 372a

Online Reference: FLWSUPP 2304HENRInsurance -- Personal injury protection -- Coverage -- Emergency medical condition -- Under provisions of PIP statute requiring PIP insurer to pay benefits up to $10,000 if qualified medical provider has determined that claimant had emergency medical condition and limiting reimbursement to $2,500 if qualified provider has determined that claimant did not have emergency medical condition, insurer properly limited benefits to $2,500 where qualified provider had not determined that insured suffered emergency medical condition

23 Fla. L. Weekly Supp. 247a

Online Reference: FLWSUPP 2303STEVInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Emergency medical condition -- Unless medical provider, as expressly defined by statute, makes affirmative determination that injured party had emergency medical condition, benefits are limited to $2500 -- No merit to plaintiff's argument that insurer was required to pay out full $10,000 in PIP benefits unless a medical provider expressly stated or determined that claimant did not have an emergency medical condition

23 Fla. L. Weekly Supp. 565a

Online Reference: FLWSUPP 2306MOYAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where PIP policy includes endorsement that states that insurer will pay 80% of reasonable expenses as well as endorsement that limits reimbursement to permissive statutory fee schedule, policy does not clearly and unambiguously elect to apply fee schedule -- No merit to insurer's argument that Office of Insurance Regulation's approval of policy form satisfies requirement for notice of intent to apply statutory fee schedule and eliminates any need for analysis of ambiguity and clarity of policy -- Fraud -- Insured's deposition testimony does not establish that medical provider or insured knowingly perpetrated fraud and does not create direct conflict with supervising physician's opinions as to relatedness and medical necessity of services rendered -- Where supervising physician's affidavit is sufficient to establish reasonableness of charges, and insurer did not present any evidence to contradict affidavit, summary judgment is entered in favor of provider

23 Fla. L. Weekly Supp. 762b

Online Reference: FLWSUPP 2307MACHInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Examination under oath -- Where PIP statute authorizes insurers to require submission to EUO as condition precedent to receipt of benefits, and PIP policy incorporated EUO provision of PIP statute by reference and specifically set forth EUO requirement, insured's failure to attend EUOs on three separate occasions bars recovery of benefits by insured or medical provider/assignee

23 Fla. L. Weekly Supp. 617a

Online Reference: FLWSUPP 2306GALDInsurance -- Personal injury protection -- Requests for documentation of relatedness and necessity of MRI that were made more than 30 days after insurer's receipt of MRI bill are untimely -- MRI provider was not required to supply requested documentation that was not in its possession or inform insurer that it did not possess documents -- Total forfeiture of PIP benefits is not remedy for failure to provide documentation; insurer's remedy in face of refusal to provide documentation is to petition court for entry of order permitting discovery

23 Fla. L. Weekly Supp. 117a

Online Reference: FLWSUPP 2302ARNOInsurance -- Personal injury protection -- Insurer has waived defense asserting that insured's claim is governed by Texas law rather than Florida law by insisting on satisfaction of demand letter requirement of Florida PIP statute -- Demand letter -- Sufficiency -- Demand letter is not deficient for failing to delineate CPT codes -- Insured was not required to attach re-assignment of benefits to demand letter -- Standing -- Where insured made unqualified assignments of PIP benefits to medical providers, she is without standing to initiate action against insurer for those benefits -- Demand letter from insured that lists charges that add up to more than amount demanded, includes charges for which insured has assigned benefits to medical providers, and does not indicate which assigned charges remain unpaid is invalid

23 Fla. L. Weekly Supp. 264a

Online Reference: FLWSUPP 2303PAREInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible is to be applied to 100% of expenses and losses incurred

23 Fla. L. Weekly Supp. 1063b

Online Reference: FLWSUPP 2310WEEMInsurance -- Personal injury protection -- Confession of judgment -- Summary judgment -- Factual issue -- Medical provider's motion for summary judgment seeking determination that insurer has confessed judgment is denied where there exists genuine issue of fact as to whether payment made by insurer constitutes confession of judgment

23 Fla. L. Weekly Supp. 753a

Online Reference: FLWSUPP 2307BROOInsurance -- Personal injury protection -- Coverage -- Emergency medical condition -- Demand letter and suit for benefits above the $2500 paid by insurer was prematurely filed before medical provider responded to insurer's requests for documentation that insured had emergency medical condition -- Insurer's post-suit payment of additional amount upon receipt of the requested documentation did not amount to confession of judgment -- Insurer's motion for summary judgment is granted -- Medical provider's motion for attorney's fees is denied

23 Fla. L. Weekly Supp. 282b

Online Reference: FLWSUPP 2303RRIVInsurance -- Personal injury protection -- Coverage -- Emergency medical condition -- Insurer's payment of additional benefits in response to receipt of determination of emergency medical condition after medical provider filed suit did not constitute confession of judgment where insurer did not wrongfully deny or withhold benefits resulting in filing of suit

23 Fla. L. Weekly Supp. 110a

Online Reference: FLWSUPP 2302LAMAInsurance -- Personal injury protection -- Small claims -- Issue of whether trial court erred in considering amount of claim stated in demand letter in ruling on motion to dismiss was not preserved for appeal where medical provider did not object to introduction of demand letter into evidence and did not argue to trial court that it could not consider amount stated in letter -- Doctrine of de minimis non curat lex does not preclude small claims action seeking less than $100 in PIP benefits -- Error to base dismissal in part on affirmative defense that provider did not bring action in good faith because it did not attempt to mitigate damages by reaching out to insurer before initiating litigation -- PIP statute only requires that claimant submit presuit demand letter, which provider did

23 Fla. L. Weekly Supp. 208a

Online Reference: FLWSUPP 2303CHAVInsurance -- Personal injury protection -- Affirmative defenses -- Tender -- Error to enter summary judgment in favor of medical provider where insurer raised affirmative defense of tender, and alleged tender was ambiguous -- On remand, insurer has burden to prove that it made absolute and unconditional delivery of payment for five bills at issue and did not make non-payment of bills for other dates of service a condition of acceptance of payment

23 Fla. L. Weekly Supp. 644a

Online Reference: FLWSUPP 2306CONSInsurance -- Personal injury protection -- Med pay -- Exhaustion of policy limits -- Motion to amend affirmative defenses to plead either exhaustion of PIP benefits or exhaustion of Med pay benefits is denied where PIP benefits and Med pay benefits were exhausted 1,245 days and 62 days, respectively, before filing of motion to amend, and no credible explanation was given for delay

23 Fla. L. Weekly Supp. 779a

Online Reference: FLWSUPP 2307LHOUInsurance -- Personal injury protection -- Affirmative defenses -- Amendment -- Denial -- Motion to amend answer to assert additional affirmative defense is denied where insurer filed motion over four years after suit was filed, nothing in record demonstrates that defense was not available to insurer at time original answer was filed, and allowing new defense would prejudice medical provider and inject new issue into case that is calculated to thwart provider's motion for summary judgment -- Even if motion to amend were not untimely, amendment violates parties' pretrial stipulation of issues

23 Fla. L. Weekly Supp. 643a

Online Reference: FLWSUPP 2306MENDInsurance -- Personal injury protection -- Affirmative defenses -- Abandonment -- Insurer abandoned affirmative defense alleging that certain services were not medically necessary where litigation adjuster stated in sworn interrogatory that insurer was not making claim that services were unnecessary, and insurer admitted in response to admissions that services were related and medically necessary -- Insurer's responses to request for admissions conclusively establish relatedness and medical necessity of services -- Further, affidavit filed by insurer is legally insufficient to create question of fact as to necessity of services where affidavit attempts to repudiate insurer's prior sworn position on that issue

23 Fla. L. Weekly Supp. 219b

Online Reference: FLWSUPP 2303WARNInsurance -- Personal injury protection -- Small claims -- Doctrine of de minimis non curat lex does not preclude small claims action seeking less than $100 in PIP benefits -- Error to base dismissal in part on affirmative defense that medical provider did not bring action in good faith because it did not attempt to mitigate damages by reaching out to insurer before initiating litigation -- PIP statute only requires that claimant submit presuit demand letter, which provider did

23 Fla. L. Weekly Supp. 654a

Online Reference: FLWSUPP 2306BERNInsurance -- Personal injury protection -- Coverage -- Emergency medical condition -- Where no qualified medical provider has determined that claimant suffered emergency medical condition, insurer properly limited benefits to $2,500

23 Fla. L. Weekly Supp. 820a

Online Reference: FLWSUPP 2308TATAInsurance -- Personal injury protection -- Reimbursement by insurer of commercial vehicle -- Sedan is private passenger vehicle within meaning of PIP statute, notwithstanding that it was used as taxicab

23 Fla. L. Weekly Supp. 587a

Online Reference: FLWSUPP 2306JFRAInsurance -- Personal injury protection -- Answer -- Amendment -- Timeliness -- Motion to amend answer and affirmative defenses is denied -- PIP action has been pending for four years, insured has incurred deposition costs and has filed motion for summary judgment, trial date is set, and insurer was unable to advise court of legitimate reason for significant delay in case

23 Fla. L. Weekly Supp. 343a

Online Reference: FLWSUPP 2304CWILInsurance -- Personal injury protection -- Coverage -- Timeliness of claim -- Claim originally submitted to wrong carrier -- Medical provider's actions and submittals fell within exception to 30-day billing requirement applicable when providers have been furnished incorrect insurance information by a patient where provider/assignee of uninsured passenger injured in rental car originally submitted claims to two PIP insurers, who denied coverage; provider instituted declaratory action to determine coverage and added rental car company as co-defendant in action when it also denied coverage; during litigation rental car company became aware of reasons why provider had not previously sent statement of charges to company and eventually admitted coverage; and provider sent claim forms to rental car company within 35 days of its admission of coverage

23 Fla. L. Weekly Supp. 570a

Online Reference: FLWSUPP 2306PEREInsurance -- Personal injury protection -- Coverage -- Lawfully rendered services -- Medical provider's submission of claim that included bills with rendering provider identification number of individual who had been barred from practicing medicine over one year prior to dates of treatment amounts to unlawful treatment or false and misleading statement, thus invalidating entire claim

23 Fla. L. Weekly Supp. 1a

Online Reference: FLWSUPP 2301THOMInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Video fluoroscopy -- Trial court entering summary judgment in favor of medical provider seeking balance of reduced claims for video fluoroscopies erred in relying on holdings in Kingsway, Virtual Imaging, and DCI MRI to determine that insurer improperly applied permissive statutory fee schedule where those cases involve applicability of permissive fee schedule of 2008 PIP statute and present cases are controlled by 2002 and 2003 versions of PIP statute that contain mandatory cap limiting payment for video fluoroscopy charges to maximum reimbursement allowed by workers' compensation fee schedule

23 Fla. L. Weekly Supp. 98a

Online Reference: FLWSUPP 2302MARQInsurance -- Personal injury protection -- Coverage -- Medical expenses -- CPT coding -- Unbundling -- Affidavit of insurer's expert regarding unbundling defense did not create genuine issue of material fact precluding summary judgment where affidavit merely offered different legal conclusion as to unbundling defense based on undisputed facts -- Medical provider inappropriately unbundled and billed separately for x-ray readings that were performed as part of comprehensive evaluation component of evaluation and management CPT code that was billed for same day of service

23 Fla. L. Weekly Supp. 121a

Online Reference: FLWSUPP 2203STATInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Notice of claim -- Claim form -- CPT Code -- Video fluoroscopy -- No-Fault Law requires that provider comply with AMA CPT coding in submission of bills for payment of insureds' PIP benefits -- Insurer is not required to pay claim or charges with respect to bill that does not meet requirements of statute -- Court must turn to AMA CPT coding requirements and statutorily-referenced AMA promulgated guides when interpreting appropriate CPT code -- Since 2003, proper CPT code to be used when billing for video fluoroscopic procedures is 76120 -- AMA has specifically referenced that video fluoroscopic procedures performed under trade name Digital Motion X-Ray or by the procedural technology being described or utilized in the performance of a digital motion x-ray should be billed under 76120 -- By failing to use appropriate AMA CPT Code, provider failed to place insurer on notice of a covered loss -- Judgment granted in favor of insurer on its declaratory requests -- Provider's counterclaim seeking declaration that insurer acted improperly in its reimbursement determinations is denied -- Under policies at issue, insurer elected to reimburse 80% of reasonable expenses and provided that insurer could consider various federal and state medical fee schedules in determining reimbursement amount -- Evidence established that insurer was not limiting its reimbursement to an amount set by fee schedule, but rather considered fee schedule in determining reasonableness -- Provider failed to prove by greater and more persuasive standard that its $900 charge was reasonable -- Court declines to declare that insurer engaged in practice of downcoding provider's bills, and provider failed to prove by greater and more persuasive standard any bad faith on part of insurer -- Provider's counterclaim for declaration that insurer was required to contact provider prior to correcting what it believed to be a misrepresentative CPT code each time a bill was submitted by provider for Digital Motion X-ray, beginning in October 2003, is denied

23 Fla. L. Weekly Supp. 522e

Online Reference: FLWSUPP 2306FAHIInsurance -- Personal injury protection -- Partial payment -- Penalties -- PIP insurer that partially paid claim upon receipt of pre-suit demand letter is obligated to also pay statutory penalty and postage costs

23 Fla. L. Weekly Supp. 648a

Online Reference: FLWSUPP 2306ETORInsurance -- Small claims -- Jury trial -- Insurer in small claims case waived right to jury trial where medical provider did not demand jury trial at time it commenced case, and insurer did not demand jury trial within 5 days of service of complaint or at pretrial conference

23 Fla. L. Weekly Supp. 1031a

Online Reference: FLWSUPP 2310JAVEInsurance -- Homeowners -- Motion for directed verdict arguing that insurer's payment of its adjuster's estimate of actual cash value of insureds' loss satisfied as matter of law insurer's contractual obligation to pay “at least” actual cash value of loss is denied -- No merit to argument that insurer is not obligated to make additional payments until and unless repairs to property are undertaken where insurer's obligation to pay at least true actual cash value of loss exists irrespective of whether insureds elect to use payment for repairs

23 Fla. L. Weekly Supp. 535a

Online Reference: FLWSUPP 2306SKYBInsurance -- Fidelity bonds -- Coverage -- Loss resulting from dishonest or fraudulent acts committed by employee acting alone or in collusion with others and committed with manifest intent to cause insured to sustain such loss or to obtain financial benefit for employee or another person or entity -- Action against insurer by insured, which operated a “fund of funds” in the business of investing its clients' capital with third-party investment advisors, who would select and manage the ultimate investments -- Managers of funds in which insured invested were “employees” as defined by bond, which incorporated parties' express agreement that “underlying managers” would fit within definition of “employees” -- Standard of proof governing question of whether employee acted with “manifest intent” to cause loss is satisfied either by proof that it was employee's purpose or desire to cause the insured to sustain a loss or by proof that the employee knew the loss was substantially certain to result from the employee's conduct -- Lack of due diligence is not a defense to coverage -- Financial benefit -- Language in bonds stating that financial benefit does not include salaries, commissions, fees bonuses, promotions, awards, profit sharing, pensions or other employee benefits earned in normal course of business does not encompass compensation secured by employees as direct consequence of their fraudulent conduct, even if it is of “type” an employee would earn in normal course of business -- Discovery of employee dishonesty claims during bond period -- Under policy language at issue, relevant question is not whether insured actually discovered its dishonesty claims during bond period, but whether, during the bond period, insured possessed facts which would cause a reasonable person to assume that a covered loss had been or will be incurred -- Insurer not entitled to summary judgment on basis of insured's admission that it did not discover its employee dishonesty claims until after the policy had terminated because factual issues exist as to what facts insured possessed during bond period which, when viewed objectively, would cause reasonable person to assume employee dishonesty -- Proof of loss -- If insured breached notice provision, prejudice to insurer will be presumed, but may be rebutted by showing that insurer has not been prejudiced by lack of notice -- Because insurer argued only that insured's failure to file proof of loss, standing alone, precluded suit, insurer is not entitled to summary judgment on proof of loss issue -- Loss arising out of wire transfers -- Although bonds provided that coverage arising out of wire transfers on behalf of employee would arise only if the wire transfers requested were approved in writing by an employee of the named insured listed on the declaration page, and employees in this case engaged in fraudulent conduct by, in part, “use” of the wires, that does not mean insured's loss was one “arising out of” those transactions -- Compensable damages -- Insurer not entitled to summary judgment based on its contention that insured failed to prove compensable damages where insurer failed to affirmatively establish the absence of any genuine issue of material fact on the question of whether insured suffered any covered loss -- Claim to setoff for collateral recoveries can be fully addressed post-trial if verdict is rendered in favor of insured

23 Fla. L. Weekly Supp. 316b

Online Reference: FLWSUPP 2304MARCInsurance -- Personal injury protection -- Coverage -- Injuries sustained by claimant while occupying insured's motor vehicle -- Exclusions -- Claimant was not owner of motor vehicle with respect to which security was required by No-Fault Law at time of accident where accident occurred during sunset or gap period when PIP law had expired and PIP coverage was not required, but optional -- Trial court erred in entering final judgment in favor of insurer

23 Fla. L. Weekly Supp. 1012b

Online Reference: FLWSUPP 2310COUTInsurance -- Homeowners -- Motions for directed verdict or new trial following jury verdict in favor of insured who suffered damage to wood flooring due to broken water supply line under house are denied -- Verdict form -- No merit to argument that new trial is required because trial court used verdict form that did not refer to policy exclusion for loss due to constant or repeated seepage or leakage over 14 or more days where verdict form proposed by insurer that asked first if loss was due to sudden or accidental release of water and, if response to first question was yes, then asked if loss was due to constant and repeated seepage for more than 14 days would have been confusing and posed risk of inconsistent verdict -- Moreover, there is no reasonable probability that claimed error in verdict form contributed to verdict where insurer failed to prove that damage, which was caused by burst water supply line, was caused by seepage or leakage within meaning of policy exclusion or that loss could only have occurred over period of 14 or more days -- Evidence -- Trial court asking insurer's expert to clarify his opinion as to whether loss was sudden or occurred over extended period does not warrant new trial -- Work product -- No merit to argument that trial court erred in admitting damage estimate prepared by insurer's adjuster into evidence where adjuster testified that estimate was prepared in ordinary course of business and not in anticipation of litigation, and admission of estimate did not prejudice insurer -- No merit to argument that jury's verdict is contrary to parties' stipulation that due to broken supply line home was exposed to water for 14 or more days where policy exclusion does not apply simply because home was exposed to water for more than 14 days, it applies only if loss resulted from one of specified seepage or leakage conditions, which was not proven

23 Fla. L. Weekly Supp. 364a

Online Reference: FLWSUPP 2304SUGAInsurance -- Evidence -- Judicial notice is taken of records of previously filed lawsuit involving same claimant, medical provider and date of loss

23 Fla. L. Weekly Supp. 283a

Online Reference: FLWSUPP 2303CARDInsurance -- Evidence -- Judicial notice taken of definitions of “emergency” and “attending provider” in National Uniform Billing Committee manual

23 Fla. L. Weekly Supp. 468c

Online Reference: FLWSUPP 2305OLIVInsurance -- Evidence -- Judicial notice -- Motion to take compulsory judicial notice of amendatory policy endorsement and associated dates is granted

23 Fla. L. Weekly Supp. 468b

Online Reference: FLWSUPP 2305ZUNIInsurance -- Evidence -- Judicial notice -- Motion to take compulsory judicial notice of amendatory policy endorsement and associated dates is granted

23 Fla. L. Weekly Supp. 468a

Online Reference: FLWSUPP 2305CRUZInsurance -- Evidence -- Judicial notice -- Motion to take compulsory judicial notice of amendatory policy endorsement and associated dates is granted

23 Fla. L. Weekly Supp. 364b

Online Reference: FLWSUPP 2304SGARInsurance -- Dismissal -- Where medical provider has filed duplicate lawsuits, second filed suit is dismissed without prejudice to continuing litigation of first filed suit

23 Fla. L. Weekly Supp. 963b

Online Reference: FLWSUPP 2309SOTOInsurance -- Dismissal -- Failure to prosecute -- Where medical provider failed to prosecute case for period in excess of one year, failed to submit notice of good cause prior to hearing on motion to dismiss for failure to prosecute and failed to show good cause at hearing, case is dismissed

23 Fla. L. Weekly Supp. 83a

Online Reference: FLWSUPP 2302GOLDInsurance -- Discovery -- Appeals -- Certiorari -- Contention that discovery order creates undue burden not appropriately resolved by writ of certiorari where degree of burden is controverted -- Even if burden were not controverted, insurer is not entitled to relief where it has not shown that discovery would cause anything more than unwarranted effort and expense -- Insurer is likewise not entitled to certiorari relief on claim that discovery order compels disclosure of privileged materials where discovery order was made subject to in camera review and redaction and protection of privileged and proprietary information, but insurer has not submitted any material to trial court for its review

23 Fla. L. Weekly Supp. 769c

Online Reference: FLWSUPP 2307SHUPInsurance -- Discovery -- Documents -- Non-party -- Discovery limited to documents regarding insured's claim and documents reviewed and prepared by non-party in making emergency medical condition determination

VIRTUAL IMAGING SERVICES, INC., A/A/O JORGE VALDEZ, Appellant, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Appellee.

23 Fla. L. Weekly Supp. 56a

Online Reference: FLWSUPP 2301WHITInsurance -- Personal injury protection -- Discovery -- Negotiated contract rates and Medicare and Medicaid reimbursements accepted by provider are not discoverable -- Insurer is entitled to discover reimbursement amounts accepted by provider from other PIP carriers and third-party payors that do not have negotiated rate contracts with provider

23 Fla. L. Weekly Supp. 54a

Online Reference: FLWSUPP 2301JBOWInsurance -- Personal injury protection -- Discovery -- Negotiated contract rates, Medicare reimbursements and patient co-payments accepted by medical provider are not discoverable where these are not enumerated in PIP statute as factors to be considered in determining reasonableness of charges, and information sought is not reasonably calculated to lead to relevant evidence -- Reimbursements accepted by provider from other PIP carriers are relevant and discoverable

23 Fla. L. Weekly Supp. 52a

Online Reference: FLWSUPP 2301CAMEInsurance -- Personal injury protection -- Discovery -- Negotiated contract rates, Medicare and Medicaid reimbursements and patient co-payments accepted by medical provider are not discoverable -- Reimbursements accepted by provider from other PIP carriers and from third-party payors with which provider does not have negotiated contract rates are relevant and discoverable

23 Fla. L. Weekly Supp. 398a

Online Reference: FLWSUPP 2305NGARInsurance -- Personal injury protection -- Discovery -- Interrogatories -- Certiorari challenge to order requiring medical provider to produce matrix indicating prices it has agreed to accept from private health insurers and amounts received from cash-paying patients for CPT codes at issue is dismissed -- Order that only requires disclosure of price terms without identification of private insurers or disclosure of formula used to determine prices does not require disclosure of privileged trade secrets

23 Fla. L. Weekly Supp. 250a

Online Reference: FLWSUPP 2303FJACInsurance -- Personal injury protection -- Discovery -- Where medical provider is not seeking payment in excess of 80% of 200% of Medicare Part B fee schedule that is statutory minimum allowed to be reimbursed by PIP insurer, evidence of lower reimbursement rates accepted by provider from other insurance carriers is not relevant -- Motion to compel production of contract between provider and other carrier is denied

23 Fla. L. Weekly Supp. 394a

Online Reference: FLWSUPP 2305DTORInsurance -- Personal injury protection -- Discovery -- Medical provider -- Trade secrets -- Insurer is entitled to discover reimbursement rates accepted by medical provider as reimbursement from other insurance carriers and identity of those carriers -- Although trial court reached implicit conclusion that information sought was not protected by trade secret privilege or that reasonable necessity justifying disclosure outweighed provider's interest in maintaining confidentiality of trade secrets, particularized findings are required -- Discovery order is quashed, and case is remanded for further findings

23 Fla. L. Weekly Supp. 516a

Online Reference: FLWSUPP 2306CEDEInsurance -- Personal injury protection -- Discovery -- Interrogatories -- Trade secrets -- Error to require medical providers to disclose reimbursement rates from other insurers without determining whether requested information is relevant when insurer used statutory fee schedule to limit reimbursement and without conducting in camera inspection to make required determination of whether information constitutes trade secret -- If on remand trial courts determine information involves trade secrets or confidential information, it must be ascertained whether insurer has demonstrated reasonable necessity for information and whether safeguards are required to prevent unnecessary dissemination

23 Fla. L. Weekly Supp. 515a

Online Reference: FLWSUPP 2306LEONInsurance -- Personal injury protection -- Discovery -- Reimbursement amounts accepted by provider from contracted payors -- Order issued by trial court subsequent to in camera inspection of documents was insufficient and departed from essential requirements of law where order did not set forth findings specific to instant case

23 Fla. L. Weekly Supp. 837a

Online Reference: FLWSUPP 2308HAYWInsurance -- Personal injury protection -- Discovery -- Medical provider -- Negotiated rate contracts and reimbursement rates are not discoverable -- Reimbursements from Medicare and Medicaid and private co-payments are not discoverable -- Reimbursements from other PIP carriers and third-party payors with which medical provider has no negotiated rate contracts are discoverable

23 Fla. L. Weekly Supp. 58b

23 Fla. L. Weekly Supp. 836aOnline Reference: FLWSUPP 2308MILLInsurance -- Personal injury protection -- Discovery -- Negotiated rate contracts and reimbursement rates are not discoverable -- Reimbursements from Medicare and Medicaid are not discoverable -- Reimbursements from other PIP carriers and third-party payors with which medical provider has no negotiated rate contracts are discoverable

23 Fla. L. Weekly Supp. 58b

Online Reference: FLWSUPP 2301MCNAInsurance -- Personal injury protection -- Discovery -- Insurer that allowed full amount of charge when applying charge to deductible without notice that services were unrelated or unnecessary or that charges were unreasonable, cannot dispute reasonableness, relatedness or medical necessity of charge and is not entitled to discovery on those issues

23 Fla. L. Weekly Supp. 338a

Online Reference: FLWSUPP 2304WYNDInsurance -- Personal injury protection -- Summary judgment -- Outstanding discovery does not preclude entry of summary judgment where further discovery cannot create disputed issue of fact -- Where insurer paid amounts demanded in demand letter, including PIP benefits calculated in accordance with statutory fee schedule elected in policy, insurer is entitled to final summary judgment

23 Fla. L. Weekly Supp. 172a

Online Reference: FLWSUPP 2302VILLInsurance -- Personal injury protection -- Discovery -- Interrogatories -- Motion to compel better responses to interrogatories regarding co-payments received by medical provider from insured and other patients is denied -- Amount of co-payments is not relevant to reasonableness of charges

23 Fla. L. Weekly Supp. 342a

Online Reference: FLWSUPP 2304WALLInsurance -- Personal injury protection -- Discovery -- Medical provider is required to produce computer generated procedure report reflecting amounts billed and accepted by provider for CPT codes at issue from all payors for one year before and after dates of service -- Provider may identify payors by abbreviations to prevent release of proprietary information or trade secrets

23 Fla. L. Weekly Supp. 345a

Online Reference: FLWSUPP 2304GALLInsurance -- Personal injury protection -- Discovery -- Medical provider is required to produce computer generated procedure report reflecting amounts billed and accepted by provider for CPT codes at issue from all payors for one year before and after dates of service -- If provider provides sufficient evidence that it is unable to provide computer generated report, it will be required to produce explanations of benefit or other documents showing amounts billed and accepted for CPT codes at issue from each and every payor

23 Fla. L. Weekly Supp. 341a

Online Reference: FLWSUPP 2304BRISInsurance -- Discovery -- Medical provider is required either to produce procedure report reflecting each time CPT codes at issue were billed and payments accepted from all insurers and cash paying patients during 2010 or to file objection to producing report -- If provider objects that production of report is unduly burdensome, determination of issue will be made in separate hearing -- If court concludes that production of report would be unduly burdensome, provider will be required to produce at least one document evidencing amounts billed and accepted for each CPT code at issue from all insurers and cash paying patients during 2010

23 Fla. L. Weekly Supp. 339a

Online Reference: FLWSUPP 2304WHITInsurance -- Personal injury protection -- Discovery -- Medical provider is required to produce documents reflecting amounts accepted by provider for CPT codes at issue from in-network health insurers, out of network health insurers and cash paying patients for six months before first date of service through six months after last date of service -- Provider must also produce complete medical file on insured, including records prior to accident

23 Fla. L. Weekly Supp. 261b

Online Reference: FLWSUPP 2303RIVEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Insurer unilaterally determined “reasonableness” when it calculated reimbursement according to statutory schedule -- Discovery related to this issue is denied

23 Fla. L. Weekly Supp. 312c

Online Reference: FLWSUPP 2304WEILInsurance -- Personal injury protection -- Discovery -- Reasonableness of charges -- Broad language of section 627.736(5)(a) allows for discovery of HMO and PPO contracts rates received by medical provider for CPT code at issue in six months surrounding insured's treatment -- Provider has not established that order compelling discovery causes irreparable harm due to trial court's failure to conduct in camera inspection regarding claim of trade secret privilege where court never ruled on motion for in camera inspection and indicated that it was prepared to conduct inspection

23 Fla. L. Weekly Supp. 304a

Online Reference: FLWSUPP 2304ALFOInsurance -- Personal injury protection -- Discovery -- Reasonableness of charges -- Trade secrets -- Trial courts in multiple cases departed from essential requirements of law in ordering provider to disclose reimbursement rates from other insurers, including those with whom provider had entered into negotiated rate contracts that had confidentiality clauses, without reviewing materials in camera to determine whether requested material constituted trade secret, as provider contended, or whether provider had waived privilege -- Moreover, it was unclear from records in the cases at issue whether requested discovery was relevant where policies at issue indicated insurer would pay 80% of all reasonable charges for medically necessary expenses but also referenced fee schedules, and provider claimed that insurer's explanations of benefits showed payment was based on fee schedule, not on reasonableness of charges -- Remand for further proceedings

23 Fla. L. Weekly Supp. 834a

Online Reference: FLWSUPP 2308BROWInsurance -- Personal injury protection -- Discovery -- Interrogatories -- Insurer that elected to calculate reimbursement utilizing statutory fee schedule is not entitled to discovery on matters related to reasonableness of charges -- Provider is required to answer interrogatory inquiring about any prior treatment of insured by provider where response may lead to information relevant to issue of medical necessity of treatment

23 Fla. L. Weekly Supp. 189a

Online Reference: FLWSUPP 2302DEHOInsurance -- Personal injury protection -- Discovery -- All discovery regarding relatedness and medical necessity of charges is stayed pending resolution of issues of whether policy language clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule and whether insurer can challenge relatedness and necessity of charges after it has paid bills

23 Fla. L. Weekly Supp. 187b

Online Reference: FLWSUPP 2302DWASInsurance -- Personal injury protection -- Discovery -- All discovery regarding relatedness and medical necessity of charges is stayed pending resolution of issues of whether policy language clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule and whether insurer can challenge relatedness and necessity of charges after it has paid bills

23 Fla. L. Weekly Supp. 185a

Online Reference: FLWSUPP 2302LIBEInsurance -- Personal injury protection -- Discovery -- All discovery regarding relatedness and medical necessity of charges is stayed pending resolution of issues of whether policy language clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule and whether insurer can challenge relatedness and necessity of charges after it has paid bills

23 Fla. L. Weekly Supp. 639a

Online Reference: FLWSUPP 2306CASTInsurance -- Personal injury protection -- Discovery -- Interrogatories -- Insurer is not entitled to discover cost to medical provider of providing care at issue where cost is not relevant to whether charges are reasonable

23 Fla. L. Weekly Supp. 67a

Online Reference: FLWSUPP 2301ARODInsurance -- Personal injury protection -- Discovery -- Documents -- Trade secrets -- Although contracts between medical provider and HMO/PPO carriers are trade secrets, reimbursement amounts contained in contracts are not -- Provider is directed to reveal reimbursement amounts without identifying carriers involved -- Provider is also directed to produce information on any patient's payment of 20% co-payment for CPT codes at issue without revealing any patient information

23 Fla. L. Weekly Supp. 632a

Online Reference: FLWSUPP 2306GONZInsurance -- Discovery -- Interrogatories -- Objections to interrogatories regarding identity of person who made decision to sue insurer, other suits to which provider is party, average amount accepted by provider as full and final payment for CPT codes at issue for six-month period surrounding dates of service, identity of other entities that provider billed for CPT codes at issue in six-month period and payments accepted from those providers, calculation and payment of 20% co-payment, billing procedures and receipt of letter of protection are sustained -- Documents -- Objections to requests to produce documentation regarding payments accepted from other payors, amounts billed to other payors, identity and credentials of persons who participated in setting provider's fee schedule or pricing, evidence of methods of setting fees and ensuring that they comport with laws and guidelines, contracts between provider and other payors and letters of protection are sustained -- Provider is required to produce schedules indicating fees that it considers to be within usual and customary range for CPT codes at issue

23 Fla. L. Weekly Supp. 639b

Online Reference: FLWSUPP 2306CABRInsurance -- Personal injury protection -- Discovery -- Insurer is not entitled to discover agreements reflecting amounts accepted by medical provider as reimbursement from any payor, but must produce matrix reflecting amounts accepted for CPT codes at issue for six months surrounding dates of service and identifying payors by category and number -- Provider need not produce documents evidencing amount, method of payment, and date of any patient's 20% co-payment for CPT codes at issue

23 Fla. L. Weekly Supp. 368a

Online Reference: FLWSUPP 2304MURRInsurance -- Discovery -- Documents -- Insurer is directed to produce report including every claim from medical providers in geozip for CPT codes at issue for six months surrounding dates of service

23 Fla. L. Weekly Supp. 187a

Online Reference: FLWSUPP 2302WASEInsurance -- Discovery -- Insurer is required to produce geozips for CPT codes at issue for 60 days before and after dates of service and all recommended reimbursements it has paid to MRI providers in that period for CPT codes at issue that are equal to or higher than 80% of medical provider's charge

23 Fla. L. Weekly Supp. 188d

Online Reference: FLWSUPP 2302DHOPInsurance -- Discovery -- Insurer is required to produce geozips for CPT codes at issue for 60 days before and after dates of service and all recommended reimbursements it has paid to MRI providers in that period for CPT codes at issue that are equal to or higher than 80% of medical provider's charge

23 Fla. L. Weekly Supp. 188c

Online Reference: FLWSUPP 2302HOPEInsurance -- Discovery -- Insurer is directed to produce geozips and decision point litigation reports

23 Fla. L. Weekly Supp. 188b

Online Reference: FLWSUPP 2302KOGAInsurance -- Discovery -- Insurer is required to produce geozips for CPT codes at issue for 60 days before and after dates of service and all recommended reimbursements it has paid to MRI providers in that period for CPT codes at issue that are equal to or higher than 80% of medical provider's charge

23 Fla. L. Weekly Supp. 188a

Online Reference: FLWSUPP 2302LEITInsurance -- Discovery -- Insurer is required to produce geozips for CPT codes at issue for 60 days before and after dates of service and all recommended reimbursements it has paid to MRI providers in that period for CPT codes at issue that are equal to or higher than 80% of medical provider's charge

23 Fla. L. Weekly Supp. 187c

Online Reference: FLWSUPP 2302SANDInsurance -- Discovery -- Insurer is required to produce geozips for CPT codes at issue for 60 days before and after dates of service and all recommended reimbursements it has paid to MRI providers in that period for CPT codes at issue that are equal to or higher than 80% of medical provider's charge

23 Fla. L. Weekly Supp. 185b

Online Reference: FLWSUPP 2302ALIBInsurance -- Discovery -- Insurer is required to produce GeoZips for CPT codes at issue and all recommended reimbursements it has paid to MRI providers for CPT codes at issue that are equal to or higher than 80% of medical provider's charge

23 Fla. L. Weekly Supp. 181d

Online Reference: FLWSUPP 2302ADELInsurance -- Discovery -- Insurer is required to produce geozips for CPT codes at issue for 60 days before and after dates of service and all recommended reimbursements it has paid to MRI providers in that period for CPT codes at issue that are equal to or higher than 80% of medical provider's charge

23 Fla. L. Weekly Supp. 181c

Online Reference: FLWSUPP 2302ORIGInsurance -- Discovery -- Insurer is directed to produce geozips and decision point litigation reports

23 Fla. L. Weekly Supp. 181b

Online Reference: FLWSUPP 2302SMORInsurance -- Discovery -- Insurer is required to produce geozips for CPT codes at issue for 60 days before and after dates of service and all recommended reimbursements it has paid to MRI providers in that period for CPT codes at issue that are equal to or higher than 80% of medical provider's charge

23 Fla. L. Weekly Supp. 181a

Online Reference: FLWSUPP 2302MOREInsurance -- Discovery -- Insurer is directed to produce geozips and decision point litigation reports

23 Fla. L. Weekly Supp. 310b

Online Reference: FLWSUPP 2304FARMInsurance -- Personal injury protection -- Discovery -- Reasonableness of charges -- Trial court did not depart from essential requirements of law by ordering insurer to provide reports evidencing charges submitted by other providers to insurer and agreements used by insurer to assist in adjusting bills -- Materials sought were not irrelevant -- Work product privilege -- Where trial court made it clear that it was prepared to conduct in camera review to screen for privilege and confidential materials once the materials were provided to court, and record indicates that insurer never availed itself and withdrew its motion seeking stay pending in camera review on day after submission, certiorari relief based on claim that order caused irreparable harm by requiring discovery of privileged materials would be premature -- Certiorari review of claim that production is inappropriate because order required discovery from third parties is likewise premature because trial court has not had opportunity to craft protections suggested by insurer

23 Fla. L. Weekly Supp. 415a

Online Reference: FLWSUPP 2305PALMInsurance -- Homeowners -- Wind and hail damage to roof -- Discovery -- Non-parties -- Work product privilege does not apply to file containing documents pertaining to inspection of insured residence by non-party that had contracted with insured for inspection of home where documents were not prepared in anticipation of litigation

23 Fla. L. Weekly Supp. 631b

Online Reference: FLWSUPP 2306GCASInsurance -- Discovery -- Documents -- Insurer is required to produce geozip report reflecting medical providers in community that have performed CPT codes at issue during relevant period in 2009, amounts charged by providers and amounts allowed and paid by insurer -- Objection to request to produce geozip report for December 2007 is sustained -- Insurer is required to produce certified copy of PIP policy and declarations page

23 Fla. L. Weekly Supp. 615a

Online Reference: FLWSUPP 2306RODRInsurance -- Discovery -- Geozip report and decision point report

23 Fla. L. Weekly Supp. 1085a

Online Reference: FLWSUPP 2310FERRInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer has deliberately failed to comply with multiple orders requiring production of geozip information and has made substantial misrepresentations to court and attempted to use results of its own bad faith conduct as excuse for noncompliance with orders, and insurer's conduct has prejudiced medical provider in its attempts to obtain discoverable evidence and prosecute action, insurer's pleadings are stricken and default judgment is entered

23 Fla. L. Weekly Supp. 1083a

Online Reference: FLWSUPP 2310FLOWInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer has deliberately failed to comply with multiple orders requiring production of geozip information and has made substantial misrepresentations to court and attempted to use results of its own bad faith conduct as excuse for noncompliance with orders, and insurer's conduct has prejudiced medical provider in its attempts to obtain discoverable evidence and prosecute action, insurer's pleadings are stricken and default judgment is entered

23 Fla. L. Weekly Supp. 865a

Online Reference: FLWSUPP 2308KOGAInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Striking of pleadings and entry of default is appropriate sanction for insurer's failure to comply with multiple orders requiring production of geozip information where noncompliance was willful, deliberate and contumacious, insurer's failure to comply with discovery has become norm in cases and has previously been sanctioned, insurer was personally involved in disobedience and has offered no reasonable justification for noncompliance, and conduct has prejudiced medical provider's prosecution of case and created significant problem of judicial administration

23 Fla. L. Weekly Supp. 1081a

Online Reference: FLWSUPP 2310TICHInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer has deliberately failed to comply with multiple orders requiring production of geozip information and has made substantial misrepresentations to court and attempted to use results of its own bad faith conduct as excuse for noncompliance with orders, and insurer's conduct has prejudiced medical provider in its attempts to obtain discoverable evidence and prosecute action, insurer's pleadings are stricken and default judgment is entered

23 Fla. L. Weekly Supp. 1079a

Online Reference: FLWSUPP 2310HERNInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer has deliberately failed to comply with multiple orders requiring production of geozip information and has made substantial misrepresentations to court and attempted to use results of its own bad faith conduct as excuse for noncompliance with orders, and insurer's conduct has prejudiced medical provider in its attempts to obtain discoverable evidence and prosecute action, insurer's pleadings are stricken and default judgment is entered

23 Fla. L. Weekly Supp. 1072a

Online Reference: FLWSUPP 2310WILLInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer has deliberately failed to comply with multiple orders requiring production of geozip information and has made substantial misrepresentations to court and attempted to use results of its own bad faith conduct as excuse for noncompliance with orders, and insurer's conduct has prejudiced medical provider in its attempts to obtain discoverable evidence and prosecute action, insurer's pleadings are stricken and default judgment is entered

23 Fla. L. Weekly Supp. 1070a

Online Reference: FLWSUPP 2310ORTIInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer has deliberately failed to comply with multiple orders requiring production of geozip information and has made substantial misrepresentations to court and attempted to use results of its own bad faith conduct as excuse for noncompliance with orders, and insurer's conduct has prejudiced medical provider in its attempts to obtain discoverable evidence and prosecute action, insurer's pleadings are stricken and default judgment is entered

23 Fla. L. Weekly Supp. 1068a

Online Reference: FLWSUPP 2310HOUSInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer has deliberately failed to comply with multiple orders requiring production of geozip information and has made substantial misrepresentations to court and attempted to use results of its own bad faith conduct as excuse for noncompliance with orders, and insurer's conduct has prejudiced medical provider in its attempts to obtain discoverable evidence and prosecute action, insurer's pleadings are stricken and default judgment is entered

23 Fla. L. Weekly Supp. 1066b

Online Reference: FLWSUPP 2310SITEInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer has deliberately failed to comply with multiple orders requiring production of geozip information and has made substantial misrepresentations to court and attempted to use results of its own bad faith conduct as excuse for noncompliance with orders, and insurer's conduct has prejudiced medical provider in its attempts to obtain discoverable evidence and prosecute action, insurer's pleadings are stricken and default judgment is entered

23 Fla. L. Weekly Supp. 876a

Online Reference: FLWSUPP 2308CRODInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer's failure to comply with multiple orders requiring production of geozip information was willful, deliberate and contumacious, information contained in geozips is taken to be established, and court will find medical provider's charge to be within range of reasonableness if geozip report contains even one charge at or above provider's charge

23 Fla. L. Weekly Supp. 864a

Online Reference: FLWSUPP 2308DELGInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer's failure to comply with multiple orders requiring production of geozip information was willful, deliberate and contumacious, information contained in geozips is taken to be established, and court will find medical provider's charge to be within range of reasonableness if geozip report contains even one charge at or above provider's charge

23 Fla. L. Weekly Supp. 867a

Online Reference: FLWSUPP 2308WASEInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Striking of pleadings and entry of default is appropriate sanction for insurer's failure to comply with multiple orders requiring production of geozip information where noncompliance was willful, deliberate and contumacious, insurer's failure to comply with discovery has become norm in cases and has previously been sanctioned, insurer was personally involved in disobedience and has offered no reasonable justification for noncompliance, and conduct has prejudiced medical provider's prosecution of case and created significant problem of judicial administration

23 Fla. L. Weekly Supp. 973a

Online Reference: FLWSUPP 2309COLLInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer has deliberately failed to comply with multiple orders requiring production of geozip information, and failure has prejudiced medical provider in its attempts to obtain discoverable evidence and prosecute action, provider's charge is deemed reasonable

23 Fla. L. Weekly Supp. 968a

Online Reference: FLWSUPP 2309JEANInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer has deliberately failed to comply with multiple orders requiring production of geozip information, and failure has prejudiced medical provider in its attempts to obtain discoverable evidence and prosecute action, insurer's pleadings are stricken and default judgment is entered

23 Fla. L. Weekly Supp. 964b

Online Reference: FLWSUPP 2309HINCInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer has deliberately failed to comply with multiple orders requiring discovery, insurer's pleadings are stricken and default judgment is entered

23 Fla. L. Weekly Supp. 629a

Online Reference: FLWSUPP 2306LIBEInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer has deliberately failed to comply with multiple orders requiring production of geozip information, and failure has prejudiced medical provider in its attempts to obtain discoverable evidence and prosecute action, insurer's pleadings are stricken and default judgment is entered -- Insurer's claim that third-party is entitled to trade-secret privilege or confidentiality over insurer's own information is frivolous

23 Fla. L. Weekly Supp. 576a

Online Reference: FLWSUPP 2306OSPIInsurance -- Discovery -- Failure to comply -- Sanctions

23 Fla. L. Weekly Supp. 485a

Online Reference: FLWSUPP 2305SAVAInsurance -- Discovery -- Sanctions -- Where insurer did not respond to overtures from medical provider advising that insurer's discovery responses were deficient and seeking opportunity to resolve and narrow discovery issues, monetary sanctions are imposed on insurer for actions that were willful and in bad faith

23 Fla. L. Weekly Supp. 262a

Online Reference: FLWSUPP 2303BARRInsurance -- Personal injury protection -- Discovery -- Where insurer unilaterally, albeit improperly, elected to use permissive statutory fee schedule to calculate reimbursement rate, reasonableness of charges is not at issue -- Medical provider may depose insurer's corporate representative on facts supporting affirmative defenses, explanation of review, receipt of bills and demand letters and responses thereto, payment of CPT codes at issue, PIP policy and processing of provider's bills

23 Fla. L. Weekly Supp. 982a

Online Reference: FLWSUPP 2309TRAEInsurance -- Provider's action against insurer -- Discovery -- Adjuster notes/documentation generated prior to receipt of notice of intent to initiate litigation, with attorney-client privileged communications redacted

GEICO INDEMNITY COMPANY, Petitioner, vs. PHOENIX EMERGENCY SERVICES OF INVERNESS a/a/o JOSEPH TRAESTER, Respondent.

23 Fla. L. Weekly Supp. 213a

Online Reference: FLWSUPP 2303SATUInsurance -- Discovery -- Trial court erred in ordering insurer to produce adjuster's notes where insured is not pursuing bad faith claim

23 Fla. L. Weekly Supp. 614a

Online Reference: FLWSUPP 2306LATEInsurance -- Discovery -- Depositions -- Non-parties -- Insurer lacks standing to seek protective order as to deposition of insurance agency that issued insurance policy

23 Fla. L. Weekly Supp. 604a

Online Reference: FLWSUPP 2306SALOInsurance -- Discovery -- Depositions -- Motion for consolidation of depositions granted -- Medical provider's corporate representative/treating physician is not entitled to compensation for deposition testimony

23 Fla. L. Weekly Supp. 556a

Online Reference: FLWSUPP 2306CALDInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer that utilized statutory fee schedule when processing medical provider's bill is not entitled to depose provider's corporate representative regarding reasonableness of charges

23 Fla. L. Weekly Supp. 165a

Online Reference: FLWSUPP 2302BURRInsurance -- Personal injury protection -- Discovery -- Insurer that utilized statutory fee schedule when processing medical provider's bill is not entitled to depose provider's corporate representative or conduct other discovery regarding reasonableness of charges -- Scope of inquiry for deposition of insurer's corporate representative is established

23 Fla. L. Weekly Supp. 162a

Online Reference: FLWSUPP 2302FORSInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer that utilized statutory fee schedule when processing medical provider's bill is not entitled to depose provider's corporate representative regarding reasonableness of charges

23 Fla. L. Weekly Supp. 161a

Online Reference: FLWSUPP 2302APONInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer that utilized statutory fee schedule when processing medical provider's bill is not entitled to depose provider's corporate representative regarding reasonableness of charges

23 Fla. L. Weekly Supp. 160a

Online Reference: FLWSUPP 2302PICCInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer that utilized statutory fee schedule when processing medical provider's bill is not entitled to depose provider's corporate representative regarding reasonableness of charges

23 Fla. L. Weekly Supp. 159a

Online Reference: FLWSUPP 2302MATOInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer that utilized statutory fee schedule when processing medical provider's bill is not entitled to depose provider's corporate representative regarding reasonableness of charges

23 Fla. L. Weekly Supp. 158a

Online Reference: FLWSUPP 2302HAMMInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer that utilized statutory fee schedule when processing medical provider's bill is not entitled to depose provider's corporate representative regarding reasonableness of charges

23 Fla. L. Weekly Supp. 156a

Online Reference: FLWSUPP 2302OWENInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer that utilized statutory fee schedule when processing medical provider's bill is not entitled to depose provider's corporate representative regarding reasonableness of charges

23 Fla. L. Weekly Supp. 155a

Online Reference: FLWSUPP 2302MERCInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer that utilized statutory fee schedule when processing medical provider's bill is not entitled to depose provider's corporate representative regarding reasonableness of charges

23 Fla. L. Weekly Supp. 58a

Online Reference: FLWSUPP 2301TORRInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer that utilized statutory fee schedule when processing medical provider's bill is not entitled to depose provider's corporate representative regarding reasonableness of charges

23 Fla. L. Weekly Supp. 177a

Online Reference: FLWSUPP 2302BUTLInsurance -- Personal injury protection -- Discovery -- Depositions -- Motion to compel deposition of physician who made determination that insured suffered emergency medical condition is denied where it is undisputed that physician is qualified medical provider, and PIP statute does not permit insurer to challenge determination of qualified provider that insured had emergency medical condition

23 Fla. L. Weekly Supp. 1063a

Online Reference: FLWSUPP 2310LOVEInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer is not allowed to depose nurse practitioner regarding her determination that insured suffered emergency medical condition -- PIP statute does not permit insurer to challenge determination of qualified provider that insured had emergency medical condition

23 Fla. L. Weekly Supp. 1062a

Online Reference: FLWSUPP 2310BUTLInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer is not allowed to depose nurse practitioner regarding her determination that insured suffered emergency medical condition -- PIP statute does not permit insurer to challenge determination of qualified provider that insured had emergency medical condition

23 Fla. L. Weekly Supp. 640a

Online Reference: FLWSUPP 2306JCABInsurance -- Personal injury protection -- Discovery -- Scope of deposition of insurer's designated corporate representative -- Insurer to produce for in camera inspection copy of executed agreements/contracts between insurer and third-party auditors if utilized to adjust, process, or facilitate the adjusting or processing of claim and in effect during relevant period -- Delineation of additional documents to be produced pursuant to notice of deposition duces tecum -- Protective order granted with regard to documents containing the business rule that was applied to plaintiff's bills, pursuant to which insurer determined the allowed amount for a relevant CPT code based upon 200 percent of allowable amount under participating physicians Medicare Part B schedule

23 Fla. L. Weekly Supp. 399b

Online Reference: FLWSUPP 2305BENJInsurance -- Personal injury protection -- Discovery -- Depositions -- Petition for writ of certiorari challenging order denying insurer's motion seeking to prevent deposition of insurer's corporate representative on topics alleged to be privileged is denied where insurer has failed to show that order caused it irreparable harm -- If corporate representative is asked to testify to privileged information or is required to produce privileged materials at deposition, insurer may raise contemporaneous objection to be dealt with by trial court

23 Fla. L. Weekly Supp. 356a

Online Reference: FLWSUPP 2304LOZAInsurance -- Personal injury protection -- Discovery -- Where insurer utilized statutory fee schedule when processing medical provider's bill, discovery regarding reasonableness of charges is not allowed

23 Fla. L. Weekly Supp. 354a

Online Reference: FLWSUPP 2304MITRInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer that utilized statutory fee schedule when processing medical provider's bill is not entitled to depose provider's corporate representative regarding reasonableness of charges

23 Fla. L. Weekly Supp. 352a

Online Reference: FLWSUPP 2304BEAKInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer that utilized statutory fee schedule when processing medical provider's bill is not entitled to depose provider's corporate representative regarding reasonableness of charges

23 Fla. L. Weekly Supp. 351a

Online Reference: FLWSUPP 2304HOLNInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer that utilized statutory fee schedule when processing medical provider's bill is not entitled to depose provider's corporate representative regarding reasonableness of charges

23 Fla. L. Weekly Supp. 350a

Online Reference: FLWSUPP 2304MORIInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer that utilized statutory fee schedule when processing medical provider's bill is not entitled to depose provider's corporate representative regarding reasonableness of charges

23 Fla. L. Weekly Supp. 349a

Online Reference: FLWSUPP 2304MEHLInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer that utilized statutory fee schedule when processing medical provider's bill is not entitled to depose provider's corporate representative regarding reasonableness of charges

23 Fla. L. Weekly Supp. 1040b

Online Reference: FLWSUPP 2310NORIInsurance -- Personal injury protection -- Discovery -- Requests for identification of every person who accessed claim file and every fact known to insurer about claim are overbroad -- Medical provider may depose claims representative to determine if there were other individuals with decision making authority, and insurer must disclose information relied upon in making decision about claim -- Insurer is not required to respond to interrogatories or requests to produce seeking information and documents claimed to be privileged until it is determined whether privilege exists and, if so, provider makes required showing of necessity and inability to obtain information through other means -- Insurer is not required to provide claim information that provider already possesses -- Insurer is not required to produce all information transmitted to medical providers

23 Fla. L. Weekly Supp. 489a

Online Reference: FLWSUPP 2305HONDInsurance -- Personal injury protection -- Discovery -- Depositions -- Pre-litigation adjuster

23 Fla. L. Weekly Supp. 474a

Online Reference: FLWSUPP 2305MESAInsurance -- Personal injury protection -- Discovery -- Depositions -- Pre-litigation adjuster

23 Fla. L. Weekly Supp. 173c

Online Reference: FLWSUPP 2302CRODInsurance -- Personal injury protection -- Discovery -- Depositions -- Pre-litigation adjuster -- Medical provider has right to depose pre-litigation adjuster who made determination as to why provider's bills were reduced or denied -- Insurer's argument that provider should depose litigation adjuster rather than pre-litigation adjuster is rejected

23 Fla. L. Weekly Supp. 552a

Online Reference: FLWSUPP 2306JOHNInsurance -- Discovery -- Depositions -- Motion to compel deposition of adjustor who has assumed duties of original adjuster, who is no longer employed by insurer, is granted where deposition appears to be reasonably calculated to lead to discovery of admissible evidence, and there is no evidence of bad faith in seeking deposition or any indication that deposition would harass or annoy insurer

23 Fla. L. Weekly Supp. 374b

Online Reference: FLWSUPP 2304VALCInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer's admission and representation that its payment of MRI charges in accordance with permissive statutory fee schedule was pursuant to its PIP policy constituted admission that services were related and medically necessary -- Insurer may not depose insured and treating physician on those issues

23 Fla. L. Weekly Supp. 798a

Online Reference: FLWSUPP 2307DMEDInsurance -- Personal injury protection -- Discovery -- Depositions -- Expert witness fee -- Treating physician is entitled to expert witness fee for deposition testimony

23 Fla. L. Weekly Supp. 603e

Online Reference: FLWSUPP 2306GBERInsurance -- Discovery -- Depositions -- Expert witness fee -- Treating physician is entitled to expert witness fee for deposition testimony

23 Fla. L. Weekly Supp. 603d

Online Reference: FLWSUPP 2306ELAUInsurance -- Discovery -- Depositions -- Expert witness fee -- Treating physician is entitled to expert witness fee for deposition testimony

23 Fla. L. Weekly Supp. 603c

Online Reference: FLWSUPP 2306SEVEInsurance -- Discovery -- Depositions -- Expert witness fee -- Treating physician is entitled to expert witness fee for deposition testimony

23 Fla. L. Weekly Supp. 603b

Online Reference: FLWSUPP 2306BERMInsurance -- Discovery -- Depositions -- Expert witness fee -- Treating physician is entitled to expert witness fee for deposition testimony

23 Fla. L. Weekly Supp. 344a

Online Reference: FLWSUPP 2304MITCInsurance -- Personal injury protection -- Discovery -- Depositions -- Treating physician is entitled to reasonable expert witness fee for his deposition -- Physician's affiliation with named plaintiff does not preclude award of expert witness fee

23 Fla. L. Weekly Supp. 191a

Online Reference: FLWSUPP 2302SKIDInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible -- Standing -- Medical provider has standing to challenge manner in which insurer calculated and applied deductible -- PIP policy providing that insurer will pay 80% of reasonable expenses does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule -- Because insurer's usage of permissive fee schedule to reduce provider's charges was impermissible, question of whether deductible should be applied before or after making fee schedule adjustments is moot

23 Fla. L. Weekly Supp. 168a

Online Reference: FLWSUPP 2302EMARInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible -- Proper formula for payment of PIP claim requires that deductible be applied to 100% of total amount billed prior to any percentage reductions

23 Fla. L. Weekly Supp. 167a

Online Reference: FLWSUPP 2302PEREInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible -- Proper formula for payment of PIP claim requires that deductible be applied to 100% of total amount billed prior to any percentage reductions

23 Fla. L. Weekly Supp. 980a

Online Reference: FLWSUPP 2309ROMEInsurance -- Personal injury protection -- Coverage -- Emergency services -- Deductible -- Insurer improperly processed medical bills out of order by applying deductible to bill from emergency service provider, which was third bill received, instead of applying deductible to first bill received -- Standing -- Assignment -- Document that assigns insured's PIP benefits to “facility” and “provider” confers standing on emergency room physicians as providers

23 Fla. L. Weekly Supp. 157a

Online Reference: FLWSUPP 2302VANDInsurance -- Personal injury protection -- Coverage -- Emergency services -- Deductible -- Because insurer is mandated by statute to reserve $5,000 for emergency service providers, insurer should not have applied claim by plaintiff provider within that classification to deductible -- Emergency service provider's bill will be held until such time as deductible is satisfied by non-protected providers' bills

23 Fla. L. Weekly Supp. 913b

Online Reference: FLWSUPP 2309BUNDInsurance -- Personal injury protection -- Coverage -- Emergency services -- Deductible -- Although insurer is mandated by statute to reserve $5,000 for emergency service providers, insurer correctly applied claim by provider within that classification to deductible

23 Fla. L. Weekly Supp. 204a

Online Reference: FLWSUPP 2303DAMUInsurance -- Personal injury protection -- Coverage -- Emergency services -- Deductible -- Statute lacks language exempting emergency service providers, for whom insurer is mandated to reserve $5,000, from application to deductible and does not specify how insurer is to apply claims to deductible -- Trial court did not err in enforcing legislative intent to afford full reimbursement to emergency service providers -- Where insurer received claims from emergency service provider and from other medical providers on same date, insurer improperly applied claim from emergency service provider to deductible

23 Fla. L. Weekly Supp. 985a

Online Reference: FLWSUPP 2309BARDNOT FINAL VERSION OF OPINION
Subsequent Changes at 24 Fla. L. Weekly Supp. 383aInsurance -- Personal injury protection -- Deductible -- PIP insurer improperly applied statutory fee schedule to reduce bills before applying those bills to deductible -- Pursuant to both PIP statute and policy terms, fee schedule may only be applied to bills for which benefits are actually paid

23 Fla. L. Weekly Supp. 841a

Online Reference: FLWSUPP 2308BOUCInsurance -- Personal injury protection -- Deductible -- PIP insurer that clearly and unambiguously elected to reimburse in accordance with permissive statutory fee schedule correctly applied Medicare Part B fee schedule to medical provider's charges to determine reasonableness of charges and then applied 100% of those reduced amounts to deductible

23 Fla. L. Weekly Supp. 771a

Online Reference: FLWSUPP 2307FRAZInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy providing that insurer will pay 80% of reasonable expenses but also providing that reasonable expenses shall mean lesser of amount provided by any fee schedule, whether mandatory or permissive, contained in PIP statute improperly seeks to utilize both reasonable amount method and fee schedule method of reimbursement and does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule method -- Deductible -- Even assuming insurer properly elected to use statutory fee schedule, it improperly applied fee schedule reductions prior to subtracting deductible

23 Fla. L. Weekly Supp. 588a

Online Reference: FLWSUPP 2306DIAZInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Insurer that breached contract by utilizing statutory fee schedule not incorporated in policy when processing medical provider's bill is not entitled to challenge reasonableness of charges -- Deductible -- Insurer's application of deductible to reduced charges does not comply with requirement of PIP statute that deductible be applied to 100% of expenses and losses -- Insurer breached policy by applying deductible of $1.001.34 when policy provides for $1,000.00 deductible

23 Fla. L. Weekly Supp. 355a

Online Reference: FLWSUPP 2304PENAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible -- Insurer is not permitted to apply statutory fee schedule to medical provider's bills that fall under deductible -- Reduction is only permitted as to bills for which insurer is paying benefits under policy

23 Fla. L. Weekly Supp. 708a

Online Reference: FLWSUPP 2307MCCLInsurance -- Personal injury protection -- Coverage -- Deductible -- Where PIP policy clearly defines “reasonable fees” in accordance with statutory fee schedule, insurer properly determined reasonable fee for medical provider's services under fee schedule, applied deductible to that amount and reduced resulting difference by 80% -- Policy language providing that deductible will be deducted from total amount of medical benefits before application of any percentage limitation did not require insurer to apply deductible before application of statutory fee schedule where policy specifically defines medical benefits as “reasonable fees,” which are in turn defined by policy by use of statutory fee schedule

23 Fla. L. Weekly Supp. 707a

Online Reference: FLWSUPP 2307CHRIInsurance -- Personal injury protection -- Deductible -- Proper formula for payment of PIP claim under policy that elects usage of permissive statutory fee schedule requires that insurer determine reasonable expense per statutory fee schedule, apply deductible to that reasonable expense, and pay 80% of that amount

23 Fla. L. Weekly Supp. 373a

Online Reference: FLWSUPP 2304GWILInsurance -- Personal injury protection -- Declaratory action -- Medical provider is entitled to determination of its rights under PIP contract -- Motion to dismiss counts seeking declaratory relief is denied

23 Fla. L. Weekly Supp. 145a

Online Reference: FLWSUPP 2302NORTInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Declaratory action -- Bona fide dispute -- Amended class action complaint seeking declaration that insurer's decision to limit reimbursement under its PIP policies according to permissive statutory fee schedule without electing that methodology in its policies is improper does not state cause of action for declaratory relief where there is no bona fide dispute since requested relief has been determined by Florida Supreme Court in Virtual Imaging case

23 Fla. L. Weekly Supp. 602a

Online Reference: FLWSUPP 2306APPLInsurance -- Personal injury protection -- Coverage -- Declaratory actions -- Complaint seeking declaration that insurer must reimburse medical provider at rate of 200% of Medicare Part B fee schedule in effect at time service was rendered, including 2.2% update to fee schedule provided by Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, or at 2007 rate, if greater, states cause of action for declaratory relief -- Motion to dismiss or for more definite statement is denied

23 Fla. L. Weekly Supp. 174a

Online Reference: FLWSUPP 2302CHAVInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Declaratory judgment -- Insurer is entitled to summary judgment as to count for declaratory relief alleging that medical provider is in doubt as to rights under policy and law due to contrary information provided in explanation of review -- Because EOR is extrinsic to policy and cannot alter rights and obligations under policy, any alleged doubt created by EOR is not sufficient to create bona fide present controversy requiring declaratory relief

23 Fla. L. Weekly Supp. 627a

Online Reference: FLWSUPP 2306HUSEInsurance -- Personal injury protection -- Declaratory action -- Coverage -- Motion to dismiss count of medical provider's complaint seeking declaration as to whether insured's policy failed to clearly and unambiguously elect to limit reimbursement to statutory fee schedule and whether insurer misapplied deductible is denied