Volume 24

24 Fla. L. Weekly Supp. 927b

Online Reference: FLWSUPP 2411WARHInsurance -- Trial court abused its discretion by striking insurer's expert witness's testimony as sanction for discovery misconduct where there was no showing of prejudice to opposing party or willfulness or bad faith on part of insurer

24 Fla. L. Weekly Supp. 927a

Online Reference: FLWSUPP 2411HUDSInsurance -- Trial court abused its discretion by striking insurer's expert witness's testimony as sanction for discovery misconduct where there was no showing of prejudice to opposing party or willfulness or bad faith on part of insurer

24 Fla. L. Weekly Supp. 240a

Online Reference: FLWSUPP 2403FIGUInsurance -- Venue -- Where insurer that is foreign corporation has local office and in-house attorneys in Broward County, insurer has agent or other representative in county making venue proper there -- Forum non conveniens -- Affidavit averring that insurer's glass department manager lives in Georgia fails to establish that Broward County is substantially more inconvenient than any other Florida county

24 Fla. L. Weekly Supp. 436a

Online Reference: FLWSUPP 2406PROCInsurance -- Venue -- Venue of breach of contract action against insurer that is domestic corporation is not proper in county where insurer does not maintain office and payment was not due -- Motion to transfer venue is granted

24 Fla. L. Weekly Supp. 811b

Online Reference: FLWSUPP 2410PARKInsurance -- Uninsured motorist -- Scientific evidence -- Expert witnesses -- Testimony of insurer's biomechanical expert, opining that forces applied in rear end collision to vehicle in which plaintiff was passenger were not sufficient to create injury mechanism for claimed cervical spine injuries, is excluded under both Daubert standard and Frye analysis -- All three steps in expert's injury causation analysis were based on insufficient facts where expert did not personally examine plaintiff, vehicles or accident scene -- Further, expert's methodology lacks general acceptance in relevant scientific community, and expert lacks expertise to render medical opinions

24 Fla. L. Weekly Supp. 332a

Online Reference: FLWSUPP 2405JGUZInsurance -- Uninsured motorist -- Coverage -- Where liability portion of policy defined “covered auto” as including not only those vehicles owned by the named insured, but also autos owned by employees used in the insured's business, the president/owner of the named insured was entitled to UM coverage for accident that occurred when he was driving his personal vehicle within course and scope of his job duties with the named insured, although UM policy limited definition of “covered auto” for UM purposes to only those vehicles owned by named insured -- Where definition of “covered auto” was much broader for purposes of liability coverage, and employee's personal automobile fell within that broader definition, Florida law requires that it be deemed covered for UM coverages as well -- Because insurer defined “insured” for UM purposes as anyone occupying any covered auto, UM coverage was available so long as employee was operating vehicle within the course and scope of insured's business

24 Fla. L. Weekly Supp. 147c

Online Reference: FLWSUPP 2402DMILInsurance -- Standing -- Assignment -- Issues of fact regarding specific rights and benefits assigned to plaintiff and services performed preclude summary judgment in favor of insurer -- No merit to argument that subsequent assignments related to covered loss are invalid as matter of law

24 Fla. L. Weekly Supp. 329a

Online Reference: FLWSUPP 2405MALOInsurance -- Property -- Standing -- Error to grant motion to dismiss where amended complaint sufficiently alleges that assignor was acting as insured's authorized agent, not mere interloper

24 Fla. L. Weekly Supp. 104b

Online Reference: FLWSUPP 2402ARANInsurance -- Property -- Sinkhole claim -- Neutral evaluation process -- Petition for writ of mandamus seeking to compel Department of Financial Services to facilitate neutral evaluation process for sinkhole damage to petitioners' property is denied -- Mandamus may not be used to resolve dispute as to whether statute requires that neutral evaluation process be made available in absence of sinkhole report or to enforce right to evaluation process under contract

24 Fla. L. Weekly Supp. 768c

Online Reference: FLWSUPP 2409HARLInsurance -- Property -- Insurer's eleven affirmative defenses to complaint for property damage are stricken with leave to amend nine of those defenses

24 Fla. L. Weekly Supp. 697a

Online Reference: FLWSUPP 2409MITCInsurance -- Venue -- Where accident occurred, insured resides, and medical treatment was rendered in Brevard County, venue is transferred to Brevard County for convenience of witnesses and public's interest

24 Fla. L. Weekly Supp. 694a

Online Reference: FLWSUPP 2409GRACInsurance -- Personal injury protection -- Venue -- Where insurer does not maintain office in Orange County, and cause of action accrued in Ohio where medical provider demanded that payment to be sent, venue is not proper in Orange County -- Case to be transferred to county where insurer maintains office

24 Fla. L. Weekly Supp. 693b

Online Reference: FLWSUPP 2409MELOInsurance -- Personal injury protection -- Venue -- Where insurer does not maintain office in Orange County, and cause of action accrued in Ohio where medical provider demanded that payment to be sent, venue is not proper in Orange County -- Case to be transferred to county where insurer maintains office

24 Fla. L. Weekly Supp. 153a

Online Reference: FLWSUPP 2402PEREInsurance -- Personal injury protection -- Conditions precedent -- Demand letter -- Where insurer sent response to demand letter stating that it will not consider providing any payment on bill, insurer waived 30-day period for payment after receipt of demand letter afforded by section 627.736(10(d), and medical provider was not required to wait out 30-day period before filing lawsuit

24 Fla. L. Weekly Supp. 362a

Online Reference: FLWSUPP 2405KERNInsurance -- Personal injury protection -- Demand letter -- Sufficiency -- Demand letter seeking payment for treatment provided after insurer issued letter withdrawing payment for further treatment does not comply with statutory requirements where letter withdrawing payment for further treatment is not attached to demand letter and demand letter does not contain itemized statement of treatment

24 Fla. L. Weekly Supp. 671g

Online Reference: FLWSUPP 2409AMARInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Trial court erred in granting summary judgment in favor of insurer based on provider's failure to send demand letter to correct individual -- Appropriate remedy is dismissal without prejudice or abatement, not granting summary judgment

24 Fla. L. Weekly Supp. 882a

Online Reference: FLWSUPP 2410BANOInsurance -- Personal injury protection -- Demand letter -- Failure to include in demand letter amounts allegedly paid by insurer, but which medical provider denies having received, does not render demand letter deficient -- PIP statute does not require provider to calculate exact amount previously paid by insurer and amount due, and lack of accounting for prior payments did not prejudice insurer that made those payments by depriving it of opportunity to adjust claim for second time and avoid litigation

24 Fla. L. Weekly Supp. 972b

Online Reference: FLWSUPP 2411PROBInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Demand letter that failed to take into account prior partial payments made by insurer for the dates of services at issue did not meet requirements of statute

24 Fla. L. Weekly Supp. 302b

Online Reference: FLWSUPP 2404INMOInsurance -- Personal injury protection -- Demand letter that failed to account for payments made by insurer did not satisfy condition precedent to PIP suit

24 Fla. L. Weekly Supp. 824a

Online Reference: FLWSUPP 2410PALKInsurance -- Personal injury protection -- Demand letter -- Discrepancies in statement of amounts billed by medical provider and amounts paid by insurer do not render demand letter invalid

24 Fla. L. Weekly Supp. 449b

Online Reference: FLWSUPP 2406MACHInsurance -- Personal injury protection -- Demand letter -- Otherwise valid demand letter is not invalidated by $5.00 miscalculation in total of medical bills

24 Fla. L. Weekly Supp. 555c

Online Reference: FLWSUPP 2407VOLCInsurance -- Personal injury protection -- Demand letter in which medical provider failed to reduce unpaid charges to allowable amount under permissive statutory fee schedule elected in policy does not satisfy condition precedent to PIP suit -- Insurer did not waive affirmative defense of defective demand letter by explaining reasons for adjustments or denials of claim in response to demand letter without mentioning letter's deficiencies where insurer raised affirmative defense of defective demand letter in answer

24 Fla. L. Weekly Supp. 308b

Online Reference: FLWSUPP 2404WROBInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Timeliness of claim -- Where medical provider was apprised at time of service that there was PIP coverage for claimant who was injured as passenger in insured's vehicle and given means to ascertain insurance information from claimant's personal injury attorney, provider elected instead to send CMS claim form to claimant's attorney, attorney provided insurance information four months later, and provider submitted claim to insurer within 35 days of receipt of information, provider is not entitled to reimbursement for untimely submitted claim in absence of any evidence that either claimant or attorney provided erroneous information to provider

24 Fla. L. Weekly Supp. 828b

Online Reference: FLWSUPP 2410ROBIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Timeliness of claim -- Where insured submitted bills to workers' compensation carrier but did not submit bills to PIP insurer, bills were not overdue, and demand letter to PIP insurer was premature -- Because bills were not submitted to PIP insurer within 35 days, summary judgment is granted in favor of insurer

24 Fla. L. Weekly Supp. 236a

Online Reference: FLWSUPP 2403MMADInsurance -- Personal injury protection -- Coverage -- Medical expenses -- In calculating amount of PIP benefits to reimburse under permissive statutory fee schedule, insurer erred in failing to consider 2.2% update to 2010 Medicare Part B Physician fee schedule mandated by Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which is applicable to dates of service commencing on June 1, 2010

24 Fla. L. Weekly Supp. 100a

Online Reference: FLWSUPP 2402MORAInsurance -- 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 “all fee schedules” does not provide clear and unambiguous notice of intent to limit reimbursement to Medicare Part B fee schedule -- Mandate is withheld pending Florida Supreme Court's decision resolving conflict in district court of appeal opinions

24 Fla. L. Weekly Supp. 342a

Online Reference: FLWSUPP 2405OWENInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that provides that insurer will pay 80% of all reasonable medical expenses, considering any and all limitations authorized by PIP statute, and further provides that applicable fee schedule or payment limitation shall be under permissive payment methodology, clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 823b

Online Reference: FLWSUPP 2410POHLInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that provides that insurer will pay 80% of all reasonable medical expenses, considering any and all limitations authorized by section 627.736, and further states that applicable fee schedule or payment limitation shall be under the permissive payment methodology clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 823a

Online Reference: FLWSUPP 2410FOSTInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that provides that insurer will pay 80% of all reasonable medical expenses, considering any and all limitations authorized by section 627.736, and further states that applicable fee schedule or payment limitation shall be under the permissive payment methodology clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 822a

Online Reference: FLWSUPP 2410TOXIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that provides that insurer will pay 80% of all reasonable medical expenses, considering any and all limitations authorized by section 627.736, and further states that applicable fee schedule or payment limitation shall be under the permissive payment methodology clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 821a

Online Reference: FLWSUPP 2410GORDInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Policy read as a whole clearly and unambiguously permitted insurer to elect permissive payment method

24 Fla. L. Weekly Supp. 52b

Online Reference: FLWSUPP 2401FULCInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy providing that insurer will pay 80% of reasonable expenses and also stating that to determine whether a charge is reasonable insurer may consider any and all limitations authorized by PIP statute and will not pay more than 80% of 200% of Medicare Part B fee schedule provides clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 52a

Online Reference: FLWSUPP 2401BAGGInsurance -- 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, including all fee schedules, clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 624a

Online Reference: FLWSUPP 2408DUNNInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that states that insurer will pay 80% of all reasonable medical expenses considering all limitations authorized by PIP statute and that applicable fee schedule or payment limitation shall be under permissive payment methodology clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 714b

Online Reference: FLWSUPP 2409VILLInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that states that insurer will only pay reasonable medical expenses but in no event will pay more than 80% of No-Fault Act schedule of maximum charges provides legally sufficient notice of intent to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 368a

Online Reference: FLWSUPP 2405MCDEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy providing that insurer will pay 80% of reasonable expense 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

24 Fla. L. Weekly Supp. 81a

Online Reference: FLWSUPP 2401SERRInsurance -- 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 schedule of maximum charges does not provide clear and unambiguous notice of election to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 689a

Online Reference: FLWSUPP 2409IRVIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that defines “unreasonable and unnecessary benefit” to be anything in excess of maximum charges set forth in No-Fault Law and states that it will limit reimbursement of unreasonable and unnecessary benefits to no more than 80% of listed maximum charges, clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 694b

Online Reference: FLWSUPP 2409JOFFInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that states that insurer will pay 80% of medical expenses subject to applicable fee schedule and defines “medical expenses” as properly billed and lawfully rendered reasonable charges limited to the medical expense limitations schedule set forth in section 627.736(5)(a) clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 535a

Online Reference: FLWSUPP 2407HAMIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that defines “unreasonable or unnecessary medical benefits” to be anything in excess of maximum charges set forth in No-Fault Law and affirmatively states that insurer will limit reimbursement to no more than 80% of schedule of maximum charges clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 860a

Online Reference: FLWSUPP 2410LOUIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where PIP policy provides that insurer will limit reimbursement to 80% of fee schedule and also states that insurer retains right to reduce charges on any submitted bill it deems unreasonable and by any amount it chooses, policy commingles language from both payment methodologies and fails to make clear and unambiguous election of reimbursement method -- Fact that policy defines unreasonable charge as any charge that exceeds maximum charges in fee schedule does not create clear and unambiguous election

24 Fla. L. Weekly Supp. 731b

Online Reference: FLWSUPP 2409SALIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- PIP policy providing that insurer will calculate reimbursement pursuant to permissive statutory fee schedule while reserving insurer's right to adjust any payment to medical provider by amounts insurer deems to be unreasonable commingles statutory payment methodologies and does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 540c

Online Reference: FLWSUPP 2407FLANInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where PIP policy notifies insured that benefits will be paid at 80% of rate of schedule of maximum charges pursuant to PIP statute and will only be paid at 80% of reasonable amount billed if schedule does not apply to covered medical expenses or does not exist, policy clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 532a

Online Reference: FLWSUPP 2407PHARInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy providing that insurer will pay 80% of reasonable charges and that in no event will insurer pay more than 80% of PIP statute's schedules of maximum charges, but also incorporating reasonableness analysis in definition section of policy provides clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule despite commingling payment methodologies

24 Fla. L. Weekly Supp. 512a

Online Reference: FLWSUPP 2407MRIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that adopts hybrid method of calculating reimbursement that includes elements of both Medicare fee schedule and reasonable amount method does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 536a

Online Reference: FLWSUPP 2407WHEAInsurance -- Affirmative defenses -- Insurer's withdrawal of all affirmative defenses without prejudice rendered motion to strike affirmative defenses moot -- Insurer is under no affirmative duty to withdraw its affirmative defenses with prejudice

24 Fla. L. Weekly Supp. 863a

Online Reference: FLWSUPP 2410BACAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy providing that insurer will pay 80% of reasonable charges and 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 PIP 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

24 Fla. L. Weekly Supp. 857b

Online Reference: FLWSUPP 2410LHERInsurance -- 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 -- Neither approval of PIP policy by Office of Insurance Regulation nor incorporation of OIR sample form in policy is dispositive as to whether policy makes proper election for payment under permissive statutory fee schedule

24 Fla. L. Weekly Supp. 855a

Online Reference: FLWSUPP 2410UMBEInsurance -- 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 -- Neither approval of PIP policy by Office of Insurance Regulation nor incorporation of OIR sample form in policy is dispositive as to whether policy makes proper election for payment under permissive statutory fee schedule

24 Fla. L. Weekly Supp. 760b

Online Reference: FLWSUPP 2409LABBInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer -- Insurer failed to make, clear, exclusive, and unambiguous election that it would utilize permissive Medicare fee schedule of maximum charges contained in statutes to limit reimbursement of properly submitted bill for medical services -- Policy language indicating insured would pay both 80% of properly billed and documented reasonable charge and also stating that insurer would not pay more than 80% of certain No-Fault Act schedule of maximum charges created an impermissible hybrid methodology -- Stamped approval of policy by Office of Insurance Regulation did not establish unambiguous election of Medicare Fee Schedule Methodology by insurer

24 Fla. L. Weekly Supp. 715a

Online Reference: FLWSUPP 2409DTHONOT FINAL VERSION OF OPINION
Subsequent Changes at 25 Fla. L. Weekly Supp. 381aInsurance -- 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 -- Approval of notice form or PIP policy form by Office of Insurance Regulation does not automatically validate legal sufficiency or enforceability of contents of policy

24 Fla. L. Weekly Supp. 709a

Online Reference: FLWSUPP 2409BARRInsurance -- 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 -- Neither approval of PIP policy by Office of Insurance Regulation nor incorporation of OIR sample form in policy is dispositive as to whether policy makes proper election for payment under permissive statutory fee schedule

24 Fla. L. Weekly Supp. 253a

Online Reference: FLWSUPP 2403SIMIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Insurer did not clearly and unambiguously elect to limit reimbursement to statutory fee schedules where policy as a whole indicated that insurer could calculate reimbursement through either a fact dependent inquiry or through Medicare fee schedules -- Safe harbor -- 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

24 Fla. L. Weekly Supp. 622a

Online Reference: FLWSUPP 2408HIGGInsurance -- 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 commingles permissive and default payment options and does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule -- 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

24 Fla. L. Weekly Supp. 621a

Online Reference: FLWSUPP 2408SENGInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Office of Insurance Regulation memorandum containing multiple warnings is not explicit approval of insurer's policy as satisfying requirement to provide clear and unambiguous notice of election to use permissive statutory fee schedule -- PIP policy providing that insurer will pay 80% of reasonable charges, 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

24 Fla. L. Weekly Supp. 620a

Online Reference: FLWSUPP 2408PALMInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy providing that insurer will pay 80% of reasonable charges, 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 -- 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

24 Fla. L. Weekly Supp. 619b

Online Reference: FLWSUPP 2408RENEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Approval of PIP policy by Office of Insurance Regulation does not constitute de facto proper election to limit reimbursement to permissive statutory fee schedule -- PIP policy providing that insurer will pay 80% of reasonable charges, 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

24 Fla. L. Weekly Supp. 618a

Online Reference: FLWSUPP 2408RIZZInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy providing that insurer will calculate reimbursement pursuant to permissive statutory fee schedule, but also reserving insurer's right to determine whether charge is reasonable, commingles statutory payment methodologies and does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule -- 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

24 Fla. L. Weekly Supp. 616a

Online Reference: FLWSUPP 2408WESTInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that includes reasonableness factors of section 627.736(5)(a) as well as schedule of maximum charges of No-Fault Act and Medicare coding policies and payment methodologies in its definition of “reasonable charge” commingles payment methodologies and does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule -- Approval of PIP policy by Office of Insurance Regulation does not automatically validate contents of policy as providing unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 567a

Online Reference: FLWSUPP 2407ARTYInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy providing that insurer will pay 80% of reasonable charges and 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 PIP 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 there is nothing in insurer's submission to OIR or in OIR's response to insurer asserting that reason for approval was insurer's proper election of permissive statutory fee schedule

24 Fla. L. Weekly Supp. 536b

Online Reference: FLWSUPP 2407DAVIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that provides that insurer will pay 80% of reasonable charges and also provides that in no event will insurer pay more than 80% of 200% of Medicare Part B fee schedule does not unambiguously elect to limit reimbursement to statutory fee schedule -- 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

24 Fla. L. Weekly Supp. 159b

Online Reference: FLWSUPP 2402ACEVInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election -- 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

24 Fla. L. Weekly Supp. 533a

Online Reference: FLWSUPP 2407ALTEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Under 2012 amendments to PIP statute, insurer is only required to provide notice that it may limit reimbursement to permissive statutory fee schedule, not clear and unambiguous notice required by Virtual Imaging in respect to 2008 amendments to PIP statute -- PIP policy that provides that insurer will not pay charges deemed to be unreasonable, will determine to be unreasonable any charges in excess of maximum charges set forth in No-Fault Act, and will limit reimbursement to no more than 80% of 200% of Medicare Part fee schedule gave sufficient notice of intent to utilize permissive statutory fee schedule

24 Fla. L. Weekly Supp. 1002a

Online Reference: FLWSUPP 2411RAYHInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer

24 Fla. L. Weekly Supp. 996a

Online Reference: FLWSUPP 2411WOODInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer -- Policy language listed in insurer's 9811B policy clearly and unambiguously gave insurer the option of using “any fee specified in any fee schedule” in determining reasonable expenses and to reimburse the lowest amount for those medical services -- Summary judgment entered in favor of insurer

24 Fla. L. Weekly Supp. 995a

Online Reference: FLWSUPP 2411HICKInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that contains both reasonableness factors established under section 627.736(5)(a) and schedule of charges established under section 627.736(5)(a)1 elects both reimbursement methods simultaneously and fails to clearly and unambiguously elect fee schedule method of reimbursement

24 Fla. L. Weekly Supp. 991a

Online Reference: FLWSUPP 2411ROUSInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that states that insurer will limit reimbursement to 80% of properly billed reasonable charge but in no event will pay more than 80% of schedule of maximum charges clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 982a

Online Reference: FLWSUPP 2411FAUSInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where insurer placed notice on declaration page of renewed policy advising insured of limitation of payment to schedule of maximum charges and that policy form was filed with and approved by Office of Insurance Regulation, insurer satisfied requirements of section 627.736(5)(a)5 and may limit reimbursement based on permissive statutory fee schedule -- No merit to argument that insurer has impermissibly created “hybrid” payment methodology by agreeing to pay reasonable amount in one portion of policy while later limiting reimbursement to fee schedule where requirement of Virtual Imaging that insurer elect one reimbursement method to exclusion of the other is not applicable under new election procedure of section 627.736(5)(a)5

24 Fla. L. Weekly Supp. 980b

Online Reference: FLWSUPP 2411MERRInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that states that insurer will limit reimbursement to 80% of properly billed reasonable charge but in no event will pay more than 80% of schedule of maximum charges provided legally sufficient notice of intent to limit reimbursement to statutory fee schedule

24 Fla. L. Weekly Supp. 970a

Online Reference: FLWSUPP 2411HALLInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Approval of PIP policy by Office of Insurance Regulation does not constitute explicit approval of policy as properly electing to limit reimbursement to permissive statutory fee schedule -- 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, provides clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 969b

Online Reference: FLWSUPP 2411CLARInsurance -- 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, provides clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 969a

Online Reference: FLWSUPP 2411POLYInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy providing that insurer will pay 80% of reasonable medical expenses and also providing that in no event will insurer pay more than 80% of No-Fault Act schedule of maximum charges provides clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 964a

Online Reference: FLWSUPP 2411HERNInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Insurer could limit reimbursement to schedule of maximum charges found in PIP statute where insurer advised insured that in no event will it pay more than 80% of schedule of maximum charges

24 Fla. L. Weekly Supp. 962a

Online Reference: FLWSUPP 2411PRICInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election -- PIP policy that states that insurer will limit reimbursement to 80% of properly billed and documented reasonable charge and also reserves the right to make a reasonableness challenge to any charges, services or expenses provided legally sufficient notice of intent to limit reimbursement to statutory fee schedule, even though policy clearly commingles payment methodologies in PIP statute

24 Fla. L. Weekly Supp. 961a

Online Reference: FLWSUPP 2411WILKInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that states that insurer will limit reimbursement to 80% of properly billed and documented reasonable charge but in no event will pay more than 80% of schedule of maximum charges provided legally sufficient notice of election to limit reimbursement to statutory fee schedule

24 Fla. L. Weekly Supp. 861a

Online Reference: FLWSUPP 2410HARRInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Policy clearly and unambiguously permitted insurer to limit reimbursement by reference to schedule of maximum charges

24 Fla. L. Weekly Supp. 850a

Online Reference: FLWSUPP 2410MORAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Policy clearly and unambiguously permitted insurer to limit reimbursement by reference to schedule of maximum of charges

24 Fla. L. Weekly Supp. 828c

Online Reference: FLWSUPP 2410PALMInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Policy clearly and unambiguously permitted insurer to limit reimbursement by reference to schedule of maximum charges -- Insurer paid charges submitted by provider at appropriate reimbursable amount pursuant to policy

24 Fla. L. Weekly Supp. 640a

Online Reference: FLWSUPP 2408SANCInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer

24 Fla. L. Weekly Supp. 463a

Online Reference: FLWSUPP 2406CLARInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy does not provide unambiguous notice of intent to limit reimbursement to Medicare fee schedule

24 Fla. L. Weekly Supp. 456a

Online Reference: FLWSUPP 2406WARDInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that includes fact-dependent factors and permissive statutory fee schedules in definition of reasonable charge impermissibly commingles payment methodologies and does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule -- Neither approval of policy language by Office of Insurance Regulation nor incorporation of OIR sample language in policy rises to level of per se compliance with notice requirements

24 Fla. L. Weekly Supp. 177a

Online Reference: FLWSUPP 2402DORInsurance -- Personal injury protection -- Affirmative defenses -- Medical provider's agreement to waive right to be paid by claimant for unpaid balance of medical bills did not waive its right to be paid by, or to sue, insurer that was not party to agreement or effect accord and satisfaction of dispute between provider and insurer

24 Fla. L. Weekly Supp. 433b

Online Reference: FLWSUPP 2406HOPKInsurance -- Personal injury protection -- Settlement agreement -- Where assignment of benefits provides that insured is responsible for all services received and promises to pay regardless of insurance payments or lawsuit settlements, settlement agreement between medical provider and insured in which provider accepted payment from insured as full and final satisfaction of outstanding balance settled any claim by provider against PIP insurer -- No merit to argument that term “outstanding balance” is ambiguous and, therefore, parol evidence should be admissible to prove that intent of parties was to settle only 20% of bills not covered by PIP benefits

24 Fla. L. Weekly Supp. 297c

Online Reference: FLWSUPP 2404NBROInsurance -- Personal injury protection -- Standing -- Assignment -- No merit to argument that medical billing company that sent demand letter on behalf of plaintiff medical provider is consumer collection agency to whom provider's assignment from insured was transferred by operation of Florida Consumer Collection Practices Act -- Insurer's motion for summary judgment on issue of provider's standing is denied -- Insurer's motion for sanctions under section 57.105 is denied

24 Fla. L. Weekly Supp. 998a

Online Reference: FLWSUPP 2411MASIInsurance -- Personal injury protection -- Standing -- Assignee -- Document attached to assignee's complaint against insurer was a valid assignment of benefits and was sufficient to confer standing upon plaintiff

24 Fla. L. Weekly Supp. 23c

Online Reference: FLWSUPP 2401ACEVInsurance -- Personal injury protection -- Standing -- Error to dismiss PIP suit on ground that plaintiff is not medical provider that actually provided services at issue where deposition testimony supporting that finding is contradicted by documentary evidence -- Director of plaintiff that is dissolved corporation was entitled to appoint agent to bring PIP suit in plaintiff's name

24 Fla. L. Weekly Supp. 461a

Online Reference: FLWSUPP 2406RIERInsurance -- Personal injury protection -- Coverage -- Medical expenses -- “Special Report” is not service reimbursable under policy or No Fault Law -- Further, insurer is not liable for payment for conclusory report not signed by health care provider

24 Fla. L. Weekly Supp. 347a

Online Reference: FLWSUPP 2405MARSInsurance -- Personal injury protection -- Settlement agreement -- Enforcement -- Where medical provider brought suit for single date of service and voluntarily dismissed suit with prejudice as result of settlement, provider's subsequent suit for additional dates of service related to same accident is dismissed with prejudice

24 Fla. L. Weekly Supp. 466a

Online Reference: FLWSUPP 2406ADLEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where medical provider could have billed service as HCPCS code that is reimbursable under Medicare fee schedule but instead chose to bill service as CPT code that is not reimbursable under Medicare fee schedule, insurer correctly reimbursed code as billed pursuant to workers' compensation fee schedule

24 Fla. L. Weekly Supp. 894a

Online Reference: FLWSUPP 2410BRYAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Multiple Procedure Payment Reduction is payment methodology whose use is allowed by Section 627.736(5)(a)3, not utilization limit prohibited by that statute -- Policy that provides that insurer will apply MPPR when determining amount payable under Medicare fee schedule clearly and unambiguously provided notice of insurer's intent to rely upon MPPR in calculating reimbursement

24 Fla. L. Weekly Supp. 766b

Online Reference: FLWSUPP 2409DEYInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer -- Insurer that incorporated Medicare fee schedule into PIP policy may utilize Medicare coding policies and payment methodologies, including Multiple Procedure Payment Reduction, to determine appropriate amount of reimbursement so long as methodology applied is not utilization limit -- MPPR is payment methodology, not utilization limit

24 Fla. L. Weekly Supp. 171a

Online Reference: FLWSUPP 2402RREGInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Medicare Multiple Procedure Payment Reduction is payment methodology, not utilization limit, and may be relied upon in paying PIP claims -- PIP policy endorsement that states that charges will be subject to CMS coding policies and payment methodologies, including MPPR, clearly and unambiguously elects to rely on MPPR when calculating reimbursements -- Consistent with section 627.736(5)(a)2, insurer properly paid claim at 2007 fee schedule rate where that rate was higher than 2014 rate that was in effect at time services were rendered

24 Fla. L. Weekly Supp. 165b

Online Reference: FLWSUPP 2402ABROInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Insurer was authorized to apply Medicare Multiple Procedure Payment Reduction to medical provider's bills where PIP statute authorizes use of Medicare coding policies -- MPPR is not utilization limit prohibited by PIP statute -- No merit to claim that insurer misapplied MPPR by imposing 2013 MPPR on 2007 Medicare fee schedule where PIP statute's requirement that allowable amount may not be less than 2007 Medicare fee schedule refers to base reimbursement amount and does not require substitution of 2007 coding policies and payment methodologies if those would result in higher amounts than use of current policies and methodologies

24 Fla. L. Weekly Supp. 165a

Online Reference: FLWSUPP 2402ASSAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Motion for relief from erroneous findings -- Trial court will issue amended order to correct its erroneous assumption that medical providers stipulated that insurers properly elected to limit reimbursement to permissive statutory fee schedule when litigating insurers' authorization to apply Medicare Multiple Procedure Payment Reduction to providers' bills, but rejects assertions of possible fraud on court

24 Fla. L. Weekly Supp. 163b

Online Reference: FLWSUPP 2402YASSInsurance -- 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 on notice that MPPR will be utilized in determining appropriate reimbursement -- MPPR is not per se limitation on utilization prohibited by PIP statute

24 Fla. L. Weekly Supp. 977a

Online Reference: FLWSUPP 2411JLOGInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Insurer was permitted to apply Multiple Procedure Payment Reductions to secondary codes as outlined in its explanation of benefits -- Application of MPPR is not a utilization limit

24 Fla. L. Weekly Supp. 306a

Online Reference: FLWSUPP 2404REYEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Medical provider's motion for summary judgment on issue of reasonableness of x-ray charges is denied where affidavit filed by provider expresses opinion premised solely on what other providers charge and does not take into consideration reimbursements accepted by provider, reimbursement levels in community, or federal and state medical fee schedules, and opposing affidavit filed by insurer presents opinion that is based on all of those factors -- Fact that insurer previously issued payment on claim does not preclude it from disputing reasonableness of charges

24 Fla. L. Weekly Supp. 990c

Online Reference: FLWSUPP 2411MEROInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Affidavit of medical provider that merely tracks language of section 627.736(5)(a)1 and attaches bills submitted to insurer without addressing any specifics of treatment and rates in community fails to establish that no genuine issue of fact exists as to reasonableness of charges -- Motion for summary judgment is denied

24 Fla. L. Weekly Supp. 787a

Online Reference: FLWSUPP 2410SANCInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- In granting motion for summary judgment in favor of medical provider, trial court erred in considering affidavits that contained conclusions relying on hearsay without conducting Daubert hearing to determine if affiants were expert witnesses who could properly render opinions -- Further, reasonableness of charges is factual issue for jury, and trial court should act with caution in granting motion for summary judgment on issue

24 Fla. L. Weekly Supp. 343a

Online Reference: FLWSUPP 2405NMARInsurance -- 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 charges where affiant relied on Medicare and pre-negotiated health insurer rates that were not relevant to determination of reasonableness of PIP charges

24 Fla. L. Weekly Supp. 370a

Online Reference: FLWSUPP 2405BAJOInsurance -- 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 medical charges where affidavit is conclusory and does not provide opinion that is derived by scientific method

24 Fla. L. Weekly Supp. 563a

Online Reference: FLWSUPP 2407KEITNOT FINAL VERSION OF OPINION
Subsequent Changes at 24 Fla. L. Weekly Supp. 644aInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Affidavits of medical provider's operations and billing manager stating that charges billed to insurer were charged to all patients and insurance carriers and explaining how charges were set through phone calls to various medical providers who render similar services in community and consultation with provider's medical director are not sufficient to establish non-existence of disputed issue of material fact regarding reasonableness of charges where affidavits fail to establish which providers were called, when they were called, what charges they reported, and content of medical director's recommendation

24 Fla. L. Weekly Supp. 644a

Online Reference: FLWSUPP 2408KEITInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Affidavit billing clerk filed in support of provider's motion for summary judgment on issue of reasonableness of charge was sufficient to shift burden to defendant to come forward with evidence sufficient to establish existence of factual dispute -- Opposing affidavit of insurer's litigation adjuster was not supported by sufficient facts -- Mere existence of Medicare, HMO, and PPO rates that are lower than actual charges in community does not create issue of fact as to reasonableness of a medical provider's charge that exceeds such reimbursement rates -- Provider's motion for summary judgment granted

24 Fla. L. Weekly Supp. 441a

Online Reference: FLWSUPP 2406ROMEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Opposing affidavit and transcript of expert's testimony at Daubert hearing in another case filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of CT scan charges where expert's opinion lacked sufficient facts or data as to charges and reimbursement in PIP industry and failed to explain how personal experience on which expert relied leads to his opinion of unreasonableness of provider's charges, why his experience is sufficient basis for opinion, and how experience is reliably applied to facts

24 Fla. L. Weekly Supp. 705a

Online Reference: FLWSUPP 2409ALLIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable expenses -- Summary judgment -- Notice of summary judgment evidence on which opposing party intends to rely -- Insurer did not satisfy rule 1.510(c) requirement to provide notice of evidence on which it intends to rely in opposition to motion for summary judgment by filing, before medical provider's motion for summary judgment was filed, affidavit accompanied by notice stating insurer's intent to rely on affidavit in support of or in opposition to any motion for summary judgment -- Motion for summary judgment is granted

24 Fla. L. Weekly Supp. 72a

Online Reference: FLWSUPP 2401RHERInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Insurer that breached contract by utilizing statutory fee schedule that 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 failed to establish that affiant has any experience or qualification regarding MRI charges in county where services were rendered

24 Fla. L. Weekly Supp. 106b

Online Reference: FLWSUPP 2402AYERInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Trial court did not err in entering summary judgment in favor of medical provider on issue of reasonableness of MRI charge where opposing affidavit failed to include amounts other providers charge and accept as full payment for MRI services and failed to provide facts establishing that affiant is qualified to render opinion on reasonableness of MRI charges

24 Fla. L. Weekly Supp. 989a

Online Reference: FLWSUPP 2411BARRInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Genuine issue of material facts exists as to whether amount sought by provider for CPT code at issue was reasonable -- Plaintiff's motion for summary judgment denied

24 Fla. L. Weekly Supp. 750a

Online Reference: FLWSUPP 2409PLOUInsurance -- Personal injury protection -- Expert witnesses -- Reasonableness of charges -- Where proffered expert on reasonableness of charges fails to take into consideration usual and customary charges of medical provider or community or reimbursement amounts accepted by provider and merely opines that reasonable amount is up to 135% to 145% of covered amount under Medicare Part B fee schedule, testimony constitutes prohibited pure opinion testimony -- Further, expert's opinions based on fee schedules alone are not based on sufficient facts or data and are not product of sufficient principles and methods to satisfy admissibility requirements for expert testimony

24 Fla. L. Weekly Supp. 83b

Online Reference: FLWSUPP 2401MARTInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Reasonableness of charges is jury question that can be resolved through 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 expert's opinion is based on his experience and what his own facility charges -- Affidavit of claims adjuster opining that insurer's reimbursement was reasonable does not create factual issue as to reasonableness of charges

24 Fla. L. Weekly Supp. 71c

Online Reference: FLWSUPP 2401ROJAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Evidence -- Scientific opinion -- Testimony of physician cannot be considered expert testimony on reasonableness of MRI charges where physician's opinion is based on his own experience and what his own facilities charge -- Motion to strike witness is granted

24 Fla. L. Weekly Supp. 20a

Online Reference: FLWSUPP 2401VALIInsurance -- Personal injury protection -- Scientific evidence -- Abuse of discretion to find that opinion of treating physician concerning reasonableness of charges was expert witness testimony that satisfied Daubert standard where physician relied primarily on his own experience in formulating opinion and did not explain how his experience led to his opinion, why his experience was sufficient basis for his opinion, or how his experience was reliably applied to facts

24 Fla. L. Weekly Supp. 20a

Online Reference: FLWSUPP 2401VALIInsurance -- Personal injury protection -- Scientific evidence -- Abuse of discretion to find that opinion of treating physician concerning reasonableness of charges was expert witness testimony that satisfied Daubert standard where physician relied primarily on his own experience in formulating opinion and did not explain how his experience led to his opinion, why his experience was sufficient basis for his opinion, or how his experience was reliably applied to facts

24 Fla. L. Weekly Supp. 237b

Online Reference: FLWSUPP 2403ESQUInsurance -- Personal injury protection -- Reasonableness of charges -- Evidence -- Expert -- Plaintiff's amended motion to strike affidavit of defendant's expert regarding reasonableness of charges denied -- Discussion of factors underlying court's decision

24 Fla. L. Weekly Supp. 851a

Online Reference: FLWSUPP 2410RRODInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable, related and necessary treatment -- Summary judgment -- Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness, relatedness and necessity of x-ray charges where basis of affiant's opinion is deficiencies in medical record-keeping, and affiant offers only conclusory opinion that charges were not reasonable -- No merit to argument that summary judgment is precluded by provider's failure to produce actual x-ray films where x-ray reports are in medical record, and production of actual x-ray films is not condition of coverage under PIP statute

24 Fla. L. Weekly Supp. 437c

Online Reference: FLWSUPP 2406HUYNInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Provider's motion for summary judgment with respect to reasonableness, relatedness, and necessity of treatment and charge is denied -- Affidavit in support of motion failed to establish affiant's scientific, technical, or other specialized knowledge and provided insufficient facts and data to establish basis for affiant's ultimate opinion -- Further, although affiant opined on issue of reasonableness, affidavit failed to state where affiant was employed, where he was employed in the past, or the basis for his knowledge of plaintiff's billing process -- Where expert is relying primarily on experience, expert must explain how that experience leads to expert's opinion, why experience is sufficient basis for opinion, and how that experience is reliably applied to facts, which affiant failed to do

24 Fla. L. Weekly Supp. 103a

Online Reference: FLWSUPP 2402LEONInsurance -- Personal injury protection -- Summary judgment -- Error to enter summary judgment in favor of medical provider on issue of reasonableness, relatedness and necessity of treatment where, even assuming provider's conclusory affidavit is sufficient to prove non-existence of factual dispute, affidavit of insurer's expert that court erroneously declined to consider demonstrates factual dispute -- Error to refuse to consider expert's affidavit pursuant to Ellison rule where affidavit stating that treatment was not reasonable, related and necessary as of one date did not baldly repudiate affidavit of insurer's other expert stating that treatment was not reasonable, related and necessary as of later date

24 Fla. L. Weekly Supp. 763a

Online Reference: FLWSUPP 2409SOTOInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Necessary and related expenses -- Where insurer conceded medical necessity and relatedness of MRI by making partial payment for services, did not assert lack of necessity or relatedness as affirmative defense, and stated in response to interrogatories that it is not disputing necessity or relatedness, MRI is deemed necessary and related

24 Fla. L. Weekly Supp. 758b

Online Reference: FLWSUPP 2409ASANInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Necessity and relatedness of services -- Insurer cannot challenge medical necessity and relatedness of services where insurer paid claim, albeit at reduced amount -- Section 627.736(4)(b)6, which provides that insurer may assert that claim was unrelated and not medically necessary at any time, allows insurer to challenge relatedness and necessity only when insurer has not previously determined through claim adjustment process and in consideration of terms of policy that services were related and necessary

24 Fla. L. Weekly Supp. 754a

Online Reference: FLWSUPP 2409CONNInsurance -- 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 charges -- Affidavit of physician presented as fact witness rather than expert is not admissible and does not create triable issue as to reasonableness of charges -- Affidavit would not preclude summary disposition if offered as expert opinion where affidavit is conclusory and lacks foundation, and affiant is not qualified to render opinion on reasonableness of charges -- 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 and 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

24 Fla. L. Weekly Supp. 264a

Online Reference: FLWSUPP 2403CEDEInsurance -- 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 charges -- Affidavit of physician presented as fact witness rather than expert is not admissible and does not create triable issue as to reasonableness of charges -- Affidavit would not preclude summary disposition if offered as expert opinion where affidavit is conclusory and lacks foundation, and affiant is not qualified to render opinion on reasonableness of charges -- 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

24 Fla. L. Weekly Supp. 260a

Online Reference: FLWSUPP 2403YOUNInsurance -- 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 -- Affidavit of physician presented as fact witness rather than expert is not admissible and does not create triable issue as to reasonableness of charges -- Affidavit would not preclude summary judgment if offered as expert opinion where affidavit is conclusory and lacks foundation, and affiant is not qualified to render opinion on reasonableness of charges -- 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

24 Fla. L. Weekly Supp. 255b

Online Reference: FLWSUPP 2403POWEInsurance -- 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 affidavit of physician presented as fact witness rather than expert is not admissible and does not create triable issue as to reasonableness of charges -- Affidavit would not preclude summary judgment if offered as expert opinion where affidavit is conclusory and lacks foundation, and affiant is not qualified to render opinion on reasonableness of charges -- 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

24 Fla. L. Weekly Supp. 249a

Online Reference: FLWSUPP 2403MASSInsurance -- 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 charges -- Affidavit of physician presented as fact witness rather than expert is not admissible and does not create triable issue as to reasonableness of charges -- Affidavit would not preclude summary disposition if offered as expert opinion where affidavit is conclusory and lacks foundation, and affiant is not qualified to render opinion on reasonableness of charges -- 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

24 Fla. L. Weekly Supp. 245a

Online Reference: FLWSUPP 2403ALONInsurance -- 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 charges -- Affidavit of physician presented as fact witness rather than expert is not admissible and does not create triable issue as to reasonableness of charges -- Affidavit would not preclude summary disposition if offered as expert opinion where affidavit is conclusory and lacks foundation, and affiant is not qualified to render opinion on reasonableness of charges -- 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

24 Fla. L. Weekly Supp. 240b

Online Reference: FLWSUPP 2403KWILInsurance -- 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 -- Affidavit of physician presented as fact witness rather than expert is not admissible and does not create triable issue as to reasonableness of charges -- Affidavit would not preclude summary judgment if offered as expert opinion where affidavit is conclusory and lacks foundation, and affiant is not qualified to render opinion on reasonableness of charges -- 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

24 Fla. L. Weekly Supp. 187a

Online Reference: FLWSUPP 2402ORTIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where Medicare Part B fee schedule was not incorporated into PIP policy, and insurer withdrew its expert witness on reasonableness of MRI charge and presented no other evidence to oppose motion for summary judgment on issue, medical provider is entitled to summary judgment -- Relatedness and medical necessity -- Insurer that paid claim at reduced amount without disputing relatedness or necessity of service and failed to raise relatedness or necessity as affirmative defense cannot challenge relatedness or necessity in opposing motion for summary judgment

24 Fla. L. Weekly Supp. 185a

Online Reference: FLWSUPP 2402WILLInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where Medicare Part B fee schedule was not incorporated into PIP policy, and insurer withdrew its expert witness on reasonableness of MRI charge and presented no other evidence to oppose motion for summary disposition on issue, medical provider is entitled to summary disposition -- Relatedness and medical necessity -- Insurer that paid claim at reduced amount without disputing relatedness or necessity of service and failed to raise relatedness or necessity as affirmative defense cannot challenge relatedness or necessity in opposing motion for summary disposition

24 Fla. L. Weekly Supp. 182a

Online Reference: FLWSUPP 2402MAXAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where Medicare Part B fee schedule was not incorporated into PIP policy, and insurer withdrew its expert witness on reasonableness of MRI charge and presented no other evidence to oppose motion for summary disposition on issue, medical provider is entitled to summary disposition -- Relatedness and medical necessity -- Insurer that paid claim at reduced amount without disputing relatedness or necessity of service and failed to raise relatedness or necessity as affirmative defense cannot challenge relatedness or necessity in opposing motion for summary disposition

24 Fla. L. Weekly Supp. 180a

Online Reference: FLWSUPP 2402MCGUInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where Medicare Part B fee schedule was not incorporated into PIP policy, and insurer withdrew its expert witness on reasonableness of MRI charge and presented no other evidence to oppose motion for summary disposition on issue, medical provider is entitled to summary disposition -- Relatedness and medical necessity -- Insurer that paid claim at reduced amount without disputing relatedness or necessity of service and failed to raise relatedness or necessity as affirmative defense cannot challenge relatedness or necessity in opposing motion for summary disposition

24 Fla. L. Weekly Supp. 174b

Online Reference: FLWSUPP 2402NFIGInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Where Medicare Part B fee schedule was not incorporated into PIP policy, and insurer presented no evidence to oppose motion for summary disposition on issue, medical provider is entitled to summary disposition -- Relatedness and medical necessity -- Insurer that paid claim at reduced amount without disputing relatedness or necessity of service and failed to raise relatedness or necessity as affirmative defense cannot challenge relatedness or necessity in opposing motion for summary disposition

24 Fla. L. Weekly Supp. 463b

Online Reference: FLWSUPP 2406IRVIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Medical provider established prima facie showing of reasonableness of MRI charges through affidavit of provider's owner, publications, and geozip report -- Reasonableness of charges is undisputed where insurer withdrew affidavit of its expert and offered no other evidence on issue -- 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

24 Fla. L. Weekly Supp. 472a

Online Reference: FLWSUPP 2407BURGInsurance -- Personal injury protection -- Demand letter -- Trial court did not err in finding that substantial compliance with demand letter requirement satisfied PIP statute -- Coverage -- Medical expenses -- Error to enter summary judgment in favor of medical provider where there are genuine issues of material fact regarding reasonableness of charges -- Trial court erred in concluding that insurer waived right to contest relatedness and medical necessity of services by failing to plead lack of relatedness and necessity as affirmative defense or contest those issues in handling of claim -- Small claims rules do not require filing of answer or affirmative defenses, and section 627.736(4)(b) allows insurer to contest reasonableness, relatedness or necessity at any time

24 Fla. L. Weekly Supp. 378a

Online Reference: FLWSUPP 2405VINCInsurance -- 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 of physician presented as fact witness rather than expert is not admissible and does not create triable issue as to reasonableness of charge -- Affidavit would not preclude summary judgment if offered as expert opinion where affidavit is conclusory and lacks foundation, and affiant is not qualified to render opinion on reasonableness of charge -- 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

24 Fla. L. Weekly Supp. 374a

Online Reference: FLWSUPP 2405CADEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charge -- 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 of physician presented as fact witness rather than expert is not admissible and does not create triable issue as to reasonableness of charge -- Affidavit would not preclude summary judgment if offered as expert opinion where affidavit is conclusory and lacks foundation, and affiant is not qualified to render opinion on reasonableness of charge -- Insurer's technical admissions admit medical necessity and relatedness of charge -- Even if admissions were disregarded, 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 -- Even if insurer had timely contested relatedness and necessity of services, affidavit filed by insurer on issue was untimely and was legally and factually insufficient to raise disputed issue of material fact

24 Fla. L. Weekly Supp. 704a

Online Reference: FLWSUPP 2409GARCInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable, related and necessary treatment -- Summary judgment is granted in favor of medical provider on issues of relatedness and medical necessity of x-rays where opposing affidavits fail to create genuine issue of material fact -- Affidavit of provider's owner and records custodian that establishes that charges were usual and customary for provider's facility but fails to provide information on payments accepted by provider and reimbursement levels in community is insufficient to establish prima facie showing of reasonableness of charges -- Provider's motion for summary judgment as to reasonableness of charges is denied

24 Fla. L. Weekly Supp. 559a

Online Reference: FLWSUPP 2407LSANInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Timeliness of claim -- Insurer that issued payment in response to bill that it now claims was untimely submitted more than 35 days after date of treatment waived untimely billing defense -- Reasonableness of charges -- Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of charges where affiant's opinion is not based on sufficient facts, lacks data analysis, and erroneously relies on fee schedules and payments by HMOs and PPOs -- Relatedness and medical necessity of treatment -- Affidavit alleging deficiencies in medical provider's record-keeping does not create genuine issue of material fact regarding relatedness or necessity of treatment

24 Fla. L. Weekly Supp. 444a

Online Reference: FLWSUPP 2406GSANInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Summary judgment -- Relatedness and medical necessity of services -- Insurer's pre-suit decision to pay for medical services, albeit at reduced rate, is confession that services are medically necessary, related to accident, and otherwise payable -- Reasonableness of charges -- Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of charges where affiant considered only Medicare and workers' compensation fee schedules

24 Fla. L. Weekly Supp. 161a

Online Reference: FLWSUPP 2402PIERInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Medical provider's motion for summary judgment on issue of relatedness of treatment is denied where affidavit of insurer's expert, stating that insured was injured in previous motor vehicle accident and only suffered minor sprains in subject accident that were not ameliorated by provider's passive treatment, demonstrates existence of genuine disputed issue of material fact regarding relatedness of treatment

24 Fla. L. Weekly Supp. 191b

Online Reference: FLWSUPP 2402MIRAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Medical provider's motion for summary judgment regarding relatedness, reasonableness and medical necessity of charge for electrodes is granted where provider met prima facie burden of proof, and opposing affidavits raise issue of improper billing and coding that was not preserved in affirmative defenses

24 Fla. L. Weekly Supp. 190a

Online Reference: FLWSUPP 2402GUELInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Medically necessary treatment -- Where insurer's expert did not apply statutory definition of “medically necessary” in rendering opinion on medical necessity of treatment, expert's opinion fails to create issue of fact on medical necessity -- Medical provider's motion for directed verdict is granted

24 Fla. L. Weekly Supp. 871a

Online Reference: FLWSUPP 2410POSAInsurance -- Personal injury protection -- Summary judgment -- Insurer is entitled to summary judgment on issues of whether medical services were actually rendered to insured and whether services were related to accident and medically necessary -- Opposing affidavit of medical provider's alleged records custodian is stricken for lack of trustworthiness and lack of personal knowledge -- In absence of authentication, attached medical records cannot be considered -- Affidavit that was written in English, although affiant did not speak or understand English, violated section 117.107(6) -- Moreover, affiant denied being records custodian in her deposition testimony

24 Fla. L. Weekly Supp. 881a

Online Reference: FLWSUPP 2410JPARInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable, related, and necessary treatment -- With two exceptions, factual issues exist as to whether certain treatments were related to accident and medically necessary -- Insured failed to demonstrate by competent evidence that disputed issue of material fact existed as to reasonableness of price -- Provider's motion for summary judgment granted in part and denied in part

24 Fla. L. Weekly Supp. 299a

Online Reference: FLWSUPP 2404BROOInsurance -- Personal injury protection -- Stay -- PIP case is stayed to allow time for district court of appeal to rule on same issue of statutory interpretation in pending appeal

24 Fla. L. Weekly Supp. 491a

Online Reference: FLWSUPP 2407MDMCivil procedure -- Dismissal -- Matters outside four corners of complaint -- Trial court erred in dismissing with prejudice a provider's complaint against an insurer seeking to recover benefits stemming from the same automobile accident as that which was at issue in a prior suit based on defense of res judicata where defense was not apparent on face of complaint -- Rule permitting movant to assert affirmative defenses appearing on face of a “prior pleading” as grounds for a motion or defense does not permit a trial court to consider a prior complaint filed in a different case -- Trial court could not properly take judicial notice of earlier case in considering insurer's motion to dismiss where nothing in record indicates that party requested judicial notice -- Remand for further proceedings -- Appellate attorney's fees awarded, conditioned upon provider ultimately prevailing at trial level

24 Fla. L. Weekly Supp. 847a

Online Reference: FLWSUPP 2410PINOInsurance -- Personal injury protection -- Demand letter -- Insurer waived right to assert any deficiencies in demand letter as affirmative defense to suit where insurer failed to note any deficiencies in two pre-suit demand letters sent by provider -- Where insurer failed to avail itself of opportunity to make payment without liability for fees and costs during additional thirty-day period afforded by provider's service of third demand letter after suit was filed; thereafter, insurer secured additional abatement of action to allow provider to serve fourth demand letter with “agreed order” that provided for dismissal in event insurer made complete payment; and insurer made payment of sums demanded in third demand letter during abatement period, despite fact that provider did not serve another demand letter, but paid penalty and postage to incorrect attorney, insurer is not entitled to dismissal of action -- Complete payment was not made due to error in payment of penalty and postage -- No merit to argument that dismissal is warranted under maxim of de minimis non curat lex

24 Fla. L. Weekly Supp. 721a

Online Reference: FLWSUPP 2409SCOIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Nurse practitioner -- Assuming PIP policy properly elects to limit reimbursement to permissive statutory fee schedule, insurer was not entitled to reimburse for services provided by nurse practitioner at 85% of 80% of 200% of allowable amount under participating physicians fee schedule of Medicare Part B rather than at 80% of 200% of allowable amount under fee schedule

24 Fla. L. Weekly Supp. 753a

Online Reference: FLWSUPP 2409BEADInsurance -- Personal injury protection -- Coverage -- Where Centers for Medicare and Medicaid Services instructed Medicare contractors to reprocess Medicare claims retroactive to 2010 in manner that would result in increase in Medicare reimbursements under revised payment files, PIP insurer that has elected to reimburse claims in accordance with permissive statutory fee schedule cannot pay less than 200% of Medicare fee schedule, including revised payment files retroactive to 2010

24 Fla. L. Weekly Supp. 764c

Online Reference: FLWSUPP 2409PAINInsurance -- Personal injury protection -- Coverage -- Lawfully rendered services -- Section 627.736(1)(a)5, which provides that medical benefits do not include massage regardless of person providing massage and prohibits licensed massage therapist from being reimbursed for medical benefits, does not bar medical provider from being reimbursed for physical therapy regimen rendered by employees of its facility who hold massage therapy licenses

24 Fla. L. Weekly Supp. 439a

Online Reference: FLWSUPP 2406ESANInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Lawfully rendered services -- Where medical provider had medical director at time services were rendered, it is outside purview of county court to determine whether director performed his duties so as to establish that services for which PIP benefits are claimed were lawfully rendered absent prior finding from Agency for Health Care Administration that provider had violated Health Care Clinic Act -- If court has power to review compliance with Act, it determines that provider was substantially compliant

24 Fla. L. Weekly Supp. 131a

Online Reference: FLWSUPP 2402IMPERInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Lawfully rendered services -- Medical clinic that is wholly owned by licensed massage therapist does not qualify for exemptions from licensure delineated in PIP statute and, therefore, was required to obtain health care clinic license as condition precedent to receiving reimbursement of PIP benefits -- Services provided to insureds by unlicensed clinic are unlawful and noncompensable

24 Fla. L. Weekly Supp. 206a

Online Reference: FLWSUPP 2403PROGInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Lawfully rendered services -- Where plaintiff clinic failed to register with Department of Health after divorce of clinic owners disqualified it from exemption from registration requirement for clinics wholly owned by health care practitioner and spouse, services provided after date of divorce were not lawfully rendered, and PIP insurer is not required to pay for those services -- Trial court erred in finding that date of divorce was date of rendition of amended final judgment vacating and superceding earlier final dissolution judgment, rather than date of that earlier dissolution judgment, where amended judgment related only to asset distribution

24 Fla. L. Weekly Supp. 889b

Online Reference: FLWSUPP 2410MOREInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy does not clearly and unambiguously elect permissive statutory fee schedule -- Exhaustion of policy limits -- Where insurer did not plead exhaustion of benefits as affirmative defense and raised issue for first time in motion for summary judgment, insurer cannot prevail on that basis -- Additionally, affidavit in support of insurer's motion for summary judgment is legally insufficient where affidavit does not lay foundation to authenticate attached business records and, therefore, does not establish exhaustion of benefits

24 Fla. L. Weekly Supp. 691cO

nline Reference: FLWSUPP 2409HAMMInsurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- In absence of any evidence of bad faith, where benefits were exhausted through payment of valid claims, insurer has no liability for medical provider's claim -- Provider lacks standing to argue that benefits would be available if insurer had not paid untimely submitted prescription claim -- Moreover, although PIP statute provides that insurer is not required to pay untimely submitted claim, insurer can elect to do so

24 Fla. L. Weekly Supp. 697b

Online Reference: FLWSUPP 2409HAMEInsurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- Motion to sanction insurer for providing medical provider with PIP log indicating incorrect total loss paid and failing to provide presuit notice that benefits had been exhausted is denied -- PIP statute does not require insurer to maintain or provide PIP log or to provide presuit notice of exhaustion of benefits -- Insurer's motion to sanction provider for filing motion for sanctions that it knew or should have known was not supported by necessary material facts or application of existing law is denied -- Provider had good faith belief that it was entitled to notice of exhaustion of benefits in response to demand letter and to accurate PIP log

24 Fla. L. Weekly Supp. 972c

Online Reference: FLWSUPP 2411RICKInsurance -- Personal injury protection -- Coverage -- Medical benefits -- Notice of claim -- CMS 1500 form or medical bill submitted within 21 days of service does not qualify as “a notice of initiation of treatment” for purposes of statute stating that statement of charges may not include charges for treatment or services rendered more than 35 days before postmark date or electronic transmission date of the statement unless provider submits to the insurer a notice of initiation of treatment within 21 days of first examination or treatment of claimant, in which case the statement may include charges for treatment or services rendered up to 75 days before postmark date of statement -- Payments made by insurer in response to untimely statement were gratuitous and did not count as benefits paid under PIP policy when determining whether policy limits were exhausted

24 Fla. L. Weekly Supp. 891a

Online Reference: FLWSUPP 2410TYNAInsurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- Insurer's payment of bill submitted more than 35 days after date of service was gratuitous payment that does not count toward limit of benefits payable under policy -- Medical provider's motion for summary judgment regarding exhaustion of benefits is granted

24 Fla. L. Weekly Supp. 101a

Online Reference: FLWSUPP 2402MAYEInsurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- Trial court's finding that benefits were not exhausted is affirmed -- Case remanded for recalculation of amount of remaining benefits after deduction of gratuitous payments

24 Fla. L. Weekly Supp. 305a

Online Reference: FLWSUPP 2404HERNInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Where insurer acted in good faith in exhausting policy limits by allocating portion of global settlement reached with another of insured's assignees to PIP benefits in amount equal to that assignee's original demand, benefits are exhausted notwithstanding unilateral actions of counsel representing both plaintiff medical provider and other assignee that allocated lesser amount of settlement to PIP benefits so as to not exhaust policy limits

24 Fla. L. Weekly Supp. 530a

Online Reference: FLWSUPP 2407TLCInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where ledger indicates that insured made payment to medical provider that resulted in zero balance due, provider no longer has claim against insurer for PIP benefits -- Provider's arguments that it intended to return monies to insured if it prevailed in suit against insurer and that insured's payment was intended only to reduce outstanding balance, not to be payment in full, are not supported by admissible evidence

24 Fla. L. Weekly Supp. 832b

Online Reference: FLWSUPP 2410LOSOInsurance -- Personal injury protection -- Coverage -- Emergency services -- Exhaustion of policy limits -- Insurer waived right to argue that medical provider sued wrong entity by arguing at same time that it has properly exhausted all benefits under policy -- Where insurer had no knowledge of basis/data to support reduction of provider's bill, but instead relied on third-party vendor to process bill through utilization of undisclosed database supplied by another third-party vendor, insurer reduced payment without having reasonable basis for doing so and acted in bad faith when it subsequently exhausted benefits in payments to other providers -- Once insurer reduced bill without reasonable proof, bill became overdue, provider obtained priority rights to benefits, and insurer's payment of benefits to other providers violated plaintiff provider's right to priority payment -- Insurer also acted in bad faith by failing to reserve disputed portion of emergency service provider's bill under section 627.736(4)(c) until statute of limitations period expired or suit was filed and concluded

24 Fla. L. Weekly Supp. 877c

Online Reference: FLWSUPP 2410DOCInsurance -- 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 was required to extend benefits to $10,000 where qualified provider determined that insured suffered emergency medical condition -- There is no statutory basis for insurer to challenge qualified provider's determination that emergency medical condition exists with opinion from defense expert who performed peer review or compulsory medical examination; statute limits class of medical professionals who may determine that emergency medical conditions does not exist to those who provided initial treatment or follow-up care to insured

24 Fla. L. Weekly Supp. 558a

Online Reference: FLWSUPP 2407GUTIInsurance -- 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 had right to limit benefits to $2,500 where qualified provider had not determined that insured suffered emergency medical condition -- Insurer's payment of benefits in excess of $2,500 cap was gratuitous payment and does not constitute waiver which would obligate insurer to pay up to $10,000

24 Fla. L. Weekly Supp. 41a

Online Reference: FLWSUPP 2401DAVIInsurance -- Personal injury protection -- Coverage -- Emergency medical condition -- Declaratory action -- Insurer's right to challenge EMC determination -- Section 627.736(7) permits insurer to review and challenge physicians' diagnosis of EMC by conducting independent medical examination and, by extension, peer review

24 Fla. L. Weekly Supp. 373a

Online Reference: FLWSUPP 2405CEREInsurance -- 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 had not determined that insured suffered emergency medical condition -- No merit to argument that insurer was required to pay benefits up to $10,000 unless there was determination of absence of emergency medical condition -- Where medical provider first provided insurer with documentation potentially establishing existence of emergency medical condition after provider had filed suit for benefits above $2,500 limitation, documentation was legally insufficient to establish emergency medical condition -- Insurer did not have duty to investigate whether insured had emergency medical condition or to request additional information from provider prior to limiting benefits to $2,500

24 Fla. L. Weekly Supp. 487a

Online Reference: FLWSUPP 2407SIMMInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Emergency medical condition -- Where at time of payment insured had not been diagnosed with emergency medical condition, insurer did not wrongfully withhold payments by limiting benefits to $2500 and explaining to provider that benefits were exhausted -- Post-suit payment of remaining balance after provider obtained a positive EMC diagnosis did not amount to confession of judgment -- Insurer was not required to propound discovery request under §627.736(6)(b) to toll 30-day time-to-pay period and protect itself from liability for fees

24 Fla. L. Weekly Supp. 366a

Online Reference: FLWSUPP 2405MCDOInsurance -- 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 at time suit was filed -- Where provider ignored insurer's requests for information regarding whether emergency medical condition existed, claims never became overdue and demand letter was premature -- Confession of judgment -- Insurer's payment of benefits above $2,500 upon receipt of determination of emergency medical condition during litigation is not confession of judgment where insurer did not wrongfully withhold payment and premature suit was not catalyst for payment

24 Fla. L. Weekly Supp. 999a

Online Reference: FLWSUPP 2411APHIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Emergency medical condition -- Insurer entitled to limit reimbursement to $2500 in absence of determination by qualified physician that insured had emergency medical condition -- Provider seeking $1000 in benefits had obligation to establish legal entitlement to those benefits prior to initiating litigation

24 Fla. L. Weekly Supp. 764a

Online Reference: FLWSUPP 2409JBELInsurance -- Personal injury protection -- Coverage -- Emergency medical condition -- Where insured had emergency medical condition, medical provider is entitled to seek up to $10,000 in PIP benefits

24 Fla. L. Weekly Supp. 163a

Online Reference: FLWSUPP 2402GILBInsurance -- Personal injury protection -- Coverage -- Conditions precedent -- Examination under oath -- Notice -- Insurer properly notified insured of EUO by providing notice to insured's attorney -- Where insured's attorney only requested that insurer reschedule EUO, insured could not later challenge location of EUO -- Summary judgment is entered in favor of insurer

24 Fla. L. Weekly Supp. 152a

Online Reference: FLWSUPP 2402CHERInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Examination under oath -- Failure to attend -- Where insurer did not request EUO until more than thirty days after receipt of medical provider's bills and did not send letter to provider required to extend time for investigation under section 627.736(4)(i), insured's failure to attend EUO did not breach PIP policy

24 Fla. L. Weekly Supp. 169a

Online Reference: FLWSUPP 2402ZAPAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where CPT code for drug administered in non-emergency office setting is not reimbursable under Medicare Part B fee schedule or workers' compensation fee schedule, CPT code is not reimbursable under PIP statute and PIP policy that limits reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 768b

Online Reference: FLWSUPP 2409KELLInsurance -- Coverage -- Medical expenses -- Plaintiff to amend complaint or, alternatively, file statement of particulars specifying exact date or dates of services and CPT codes plaintiff contends are at issue

24 Fla. L. Weekly Supp. 724b

Online Reference: FLWSUPP 2409ESPIInsurance -- Personal injury protection -- Complaint -- Amendment -- Where mid-suit demand letter requesting reimbursement for additional dates of service not covered in original complaint was procedurally invalid for having been sent to insurer that was represented by counsel without service or notice to counsel, and medical provider's subsequent motion for leave to amend complaint was filed shortly before hearing on insurer's motion for summary judgment on original complaint, court abates action for 30 days to allow insurer and its counsel to confer on response to new demand letter -- Any additional payment on claim made by insurer within 30-day period will not constitute confession of judgment or otherwise create right to attorney's fees -- Provider has leave to file amended complaint after 30-day period

24 Fla. L. Weekly Supp. 462a

Online Reference: FLWSUPP 2406FERNInsurance -- Personal injury protection -- Arbitration -- Where parties did not request trial de novo within deadline for such request, trial court must enter judgment in accordance with arbitrator's decision despite insurer's claim that its failure to timely request trial de novo was result of mistake or inadvertence

24 Fla. L. Weekly Supp. 840a

Online Reference: FLWSUPP 2410LEONInsurance -- Personal injury protection -- Answer -- Amendment -- Denial -- Motion to amend answer to assert affirmative defense relating to PIP statute's 35-day billing requirement is denied -- Amendment would be futile because requirement is not applicable to plaintiff hospital

24 Fla. L. Weekly Supp. 993b

Online Reference: FLWSUPP 2411JOHNInsurance -- Personal injury protection -- Provider's motion to strike insurer's affirmative defense that insurer was not placed on notice of covered loss in accordance with statute is denied -- Defense presents a bona fide question of fact as to reasonableness of charge -- Assertion that facts of case do not support affirmative defense is not appropriately considered when ruling on motion to strike

24 Fla. L. Weekly Supp. 564b

Online Reference: FLWSUPP 2407MRODInsurance -- Personal injury protection -- Coverage -- Conditions precedent -- Examination under oath -- Child -- Where PIP statutes and policy required ten-year-old child, as omnibus insured, to submit to EUO and child failed to appear for three scheduled EUOs, material breach of policy relieves insurer of any further obligation to child or medical provider/assignee -- Mother's fears that child is shy or introverted and that participation in EUO may be detrimental to child's mental or emotional well-being are not summary judgment evidence establishing that child is not competent to testify at EUO

24 Fla. L. Weekly Supp. 844a

Online Reference: FLWSUPP 2410CORDInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Condition precedent -- Examination under oath -- Where both PIP statute and policy provide that EUO is condition precedent to receipt of benefits, neither insured who failed to appear at two scheduled EUOs nor medical provider/assignee is entitled to benefits -- Insurer that scheduled EUOs to occur more than thirty days after receipt of provider's bills did not thereby waive right to notice EUO -- Further, where PIP policy contains “no action clause” that states that lawsuit against insurer is precluded until insured complies with all portions of policy, policy bars suit until EUO requirement is met

24 Fla. L. Weekly Supp. 15a

Online Reference: FLWSUPP 2401EICHInsurance -- Personal injury protection -- Affirmative defenses -- Amendment -- In absence of transcript of hearing on insurer's first request to amend affirmative defenses or written order denying request, record is insufficient to establish abuse of discretion by trial court -- No abuse of discretion in denying renewed request to amend where request was made near entry of final judgment

24 Fla. L. Weekly Supp. 1000b

Online Reference: FLWSUPP 2411HENNInsurance -- Personal injury protection -- Claims -- Timeliness -- Where insured mistakenly advised medical provider that she had no PIP coverage, and provider did not discover that insured was covered under relative's PIP policy and bill insurer until more than 35 days after date of service, insurer is not liable for charges -- Statutory provision extending 35-day deadline when claim has been submitted to wrong carrier is not applicable

24 Fla. L. Weekly Supp. 927c

Online Reference: FLWSUPP 2411NORTInsurance -- Personal injury protection -- Trial court erred in granting summary judgment in favor of insurer pursuant to section 627.736(5)(b)1.c. where there were material issues of fact as to whether provider knowingly submitted false or misleading statements

24 Fla. L. Weekly Supp. 371a

Online Reference: FLWSUPP 2405RAMIInsurance -- Personal injury protection -- Offer of judgment -- Although offer of judgment statute does not apply in actions seeking both damages and equitable relief, it may be used in PIP case containing counts for breach of contract and for declaratory relief where true relief sought by both counts is monetary since answers sought in declaratory relief count will be dispositive of breach of contract claim -- Motion to strike offer of judgment is denied -- Motion for enlargement of time to respond to offer is denied where medical provider filed timely motion but did not schedule hearing on motion until after expiration of time to respond -- Filing of motion did not toll 30-day deadline for acceptance of offer

24 Fla. L. Weekly Supp. 304c

Online Reference: FLWSUPP 2404WESTInsurance -- Personal injury protection -- Reconsideration -- Successor judge has authority to reconsider rulings made by disqualified predecessor judge, but parties are not entitled to have order entered by predecessor judge voided as matter of right -- Demand letter -- No error in predecessor judge's ruling that demand letter that failed to account for amounts already paid by insurer was insufficient to satisfy PIP statute

24 Fla. L. Weekly Supp. 521a

Online Reference: FLWSUPP 2407ALBUInsurance -- Property -- Sinkhole loss -- Evidence -- Scientific opinion -- Where principles of original horizontality and gravitational compaction relied upon by insured's expert to opine that there is sinkhole activity on insured's property are not applicable to limestone and sandy/clay soils found on property, and application of these principles to sinkhole analysis is not generally accepted or used by professional engineering or geological community, opinions of expert based on these principles do not satisfy requirements for admissibility -- Expert's testimony regarding N-values he would expect to see if property does not have sinkhole activity is inadmissible where computation of expected N-values is based on equation applicable to pure sand material that cannot be applied to mixed soils and limestone present on property, and calculation has error rate greater than 50% -- Expert's opinion that circular depression on property is sinkhole, based on two borings made 50 feet away from depression, is inadmissible because opinion is based on insufficient facts and data

24 Fla. L. Weekly Supp. 229a

Online Reference: FLWSUPP 2403JRODInsurance -- Homeowners -- Coverage -- Water seepage and leakage -- Policy endorsement limiting coverage for water seepage and leakage to $1,000 is clear, and insurer is entitled to have it applied as written -- No merit to argument that limitation cannot be applied because it was not included within exclusion section of policy -- Coverage limitation is not an exclusion -- Fact that endorsement has heading of “Additional Coverages” does not render limitation ambiguous where endorsement title states that it is limitation and definitions within endorsement clearly define limits

24 Fla. L. Weekly Supp. 308a

Online Reference: FLWSUPP 2404OCTAInsurance -- Evidence -- Judicial notice -- Medicare Part B fee schedule and federal government website, CMS.gov

24 Fla. L. Weekly Supp. 237a

Online Reference: FLWSUPP 2403MADAInsurance -- Evidence -- Judicial notice -- Medicare Part B fee schedule and federal government website, CMS.gov

24 Fla. L. Weekly Supp. 235b

Online Reference: FLWSUPP 2403CHANInsurance -- Evidence -- Judicial notice -- Medicare Part B Physician fee schedule

24 Fla. L. Weekly Supp. 815a

Online Reference: FLWSUPP 2410APARInsurance -- Uninsured motorist -- Claims for injuries sustained when vehicle in which she was passenger was struck from behind by a vehicle operated by an uninsured motorist -- Striking of insurer's expert witnesses as sanction for failure to comply with court order requiring insurer to provide responsive answers to plaintiff's expert interrogatories

24 Fla. L. Weekly Supp. 311a

Online Reference: FLWSUPP 2404LAZOInsurance -- Personal injury protection -- Expert witness -- Motion to strike insurer's expert on reasonableness of charges is denied where expert has sufficiently explained his knowledge regarding range of charges and reimbursement amounts for MRIs in relevant communities and correctly applied his knowledge to facts of case

24 Fla. L. Weekly Supp. 746a

Online Reference: FLWSUPP 2409MIRNInsurance -- Relief from judgment -- Motion to vacate notice of voluntary dismissal that was intended to dismiss suit only as to two of three plaintiffs, but mistakenly dismissed case as to all plaintiffs, is granted and clerk is ordered to reinstate case

24 Fla. L. Weekly Supp. 731a

Online Reference: FLWSUPP 2409DINHInsurance -- Personal injury protection -- Dismissal -- Lack of prosecution -- Where there is no evidence to dispute medical provider's claim that it did not receive service of notice of lack of prosecution in PIP case in which insurer had confessed judgment, order of dismissal is set aside for limited purpose of conducting hearing to determine reasonable attorney's fees and costs to be awarded to provider

24 Fla. L. Weekly Supp. 711b

Online Reference: FLWSUPP 2409ELVIInsurance -- Dismissal -- Lack of prosecution -- Pleadings filed more than 60 days after notice of lack of prosecution do not amount to record activity that would prevent dismissal -- Notice of good cause that was not sworn and that alleged only that provider had overlooked pleading deadline does not establish good cause to avoid dismissal -- Supplemental notice of good cause that was not filed five days before either original hearing date or date on which parties agreed to reset hearing was not timely filed and need not be considered -- Case dismissed without prejudice

24 Fla. L. Weekly Supp. 79a

Online Reference: FLWSUPP 2401HEInsurance -- Dismissal -- Failure to appear for pre-trial conference -- Motion to set aside order of dismissal based on excusable neglect should have been set for hearing where motion did not contain sworn statements or affidavits relative to the alleged excusable neglect and circumstances surrounding the p retrial conference appear to be in conflict -- Prior order setting aside dismissal, which was entered without a hearing, is granted

24 Fla. L. Weekly Supp. 421b

Online Reference: FLWSUPP 2406POLKInsurance -- Homeowners -- Discovery -- Work product -- Objection to production of entire file that was compiled by forensic engineer hired by insurer to inspect homeowners' damaged roof and used to prepare report relied upon by insurer in denying claim is denied -- In camera inspection does not manifestly reveal that documents were prepared in anticipation of litigation

24 Fla. L. Weekly Supp. 849a

Online Reference: FLWSUPP 2410FJOSInsurance -- Personal injury protection -- Discovery -- Trade secret privilege -- Contract between PIP insurer and billing review company is protected by trade secret privilege -- However, where necessity of production of two sections of contract that clarify role of billing review company in processing medical bills and directives from insurer to company outweighs interest in confidentiality, court orders production of those sections subject to protections to prevent disclosure of privileged information

24 Fla. L. Weekly Supp. 711a

Online Reference: FLWSUPP 2409JUMOInsurance -- Personal injury protection -- Discovery -- Motion to compel medical provider to produce documents detailing amounts charged to other payors and amounts accepted as payment is denied where provider has already produced reimbursement matrices that detail its charges to other insurers for CPT code at issue and amounts paid by those insurers

24 Fla. L. Weekly Supp. 303b

Online Reference: FLWSUPP 2404PHILInsurance -- Personal injury protection -- Discovery -- Medical provider is ordered to produce evidence of payments accepted for CPT codes at issue from Medicare, Medicaid, workers' compensation, private insurance carriers, private pay, and any other payors -- Provider is not required to produce evidence of amounts accepted pursuant to HMO or PPO contracts or private carriers' contractual reductions

24 Fla. L. Weekly Supp. 435b

Online Reference: FLWSUPP 2406GAINInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges was not at issue where insurer applied statutory fee schedule, and discovery as to reasonableness of provider's charge is irrelevant, immaterial, and not reasonably calculated to lead to discovery of admissible evidence on the sole issue before the court, which is whether policy provided sufficient notice to insured

24 Fla. L. Weekly Supp. 435a

Online Reference: FLWSUPP 2406WRIGInsurance -- Personal injury protection -- Discovery -- Medical records or Explanations of Benefits for providers other than plaintiff -- Insurer's failure to comply -- Sanctions

24 Fla. L. Weekly Supp. 752a

Online Reference: FLWSUPP 2409TRAPInsurance -- Personal injury protection -- Discovery -- Interrogatories -- Better answers are required to interrogatories concerning methods used by insurer to determine amount payable for medical bills, reimbursement levels in community and usual and customary charges; facts and witnesses in support of affirmative defenses; and persons involved in review of medical bills

24 Fla. L. Weekly Supp. 178b

Online Reference: FLWSUPP 2402MUSSInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer has repeatedly failed to comply with discovery orders and has offered no justification for its noncompliance, resulting delay has prejudiced medical provider in prosecution of case, and court concludes that monetary sanctions would be inadequate, insurer is precluded from placing any expert opinions into evidence

24 Fla. L. Weekly Supp. 571a

Online Reference: FLWSUPP 2407MALDInsurance -- Discovery -- Failure to comply -- Sanctions -- Medical provider is ordered to pay sanctions for serving discovery responses after court-ordered deadline and to provide better responses to discovery

24 Fla. L. Weekly Supp. 49a

Online Reference: FLWSUPP 2401RODRInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Insurer is required to pay sanctions where its failure to comply with obligation to provide discovery as to factual basis for its denial of relatedness and necessity of treatment unnecessarily prolonged discovery process -- Insurer cannot deny discovery request seeking factual basis for its defenses on ground of “burden shifting”

24 Fla. L. Weekly Supp. 486b

Online Reference: FLWSUPP 2407FEIJInsurance -- Personal injury protection -- Discovery -- Error to require production of claim file documents in first party non-bad faith PIP suit

24 Fla. L. Weekly Supp. 202a

Online Reference: FLWSUPP 2403SANGInsurance -- Discovery -- Trial court departed from essential requirements of law in ordering insurer to produce documents from its claim file to medical provider in first party non-bad-faith case -- Further, documents trial court ordered produced were shielded from discovery either by attorney-client privilege, work product privilege, or both

24 Fla. L. Weekly Supp. 273d

Online Reference: FLWSUPP 2404CASTInsurance -- Discovery -- Trial court departed from essential requirements of law in ordering insurer to produce portions of its adjuster's notes to medical provider in first-party non-bad-faith case

24 Fla. L. Weekly Supp. 579a

Online Reference: FLWSUPP 2407HOFFInsurance -- Personal injury protection -- Discovery -- Depositions -- Motion for protective order to prevent depositions of physician and nurse regarding determination that insured suffered emergency medical condition is granted -- PIP statute does no permit insurer to dispute or challenge emergency medical condition determination

24 Fla. L. Weekly Supp. 443a

Online Reference: FLWSUPP 2406RODRInsurance -- Personal injury protection -- Lawfully rendered services -- Discovery -- Depositions -- Motion for protective order barring PIP insurer from deposing owner of medical provider regarding qualification for exemption from licensing is granted -- Lawfulness of services rendered is not issue where insurer failed to assert it as affirmative defense -- Further, although insurer may address whether provider has license or has received exemption from licensing, it does not have ability to contest whether provider meets requirements for licensing or for exemption

24 Fla. L. Weekly Supp. 159a

Online Reference: FLWSUPP 2402BARRInsurance -- Personal injury protection -- Discovery -- Depositions -- Billing clerk -- Where insurer has attempted to limit reimbursement to permissive statutory fee schedule, deposition of medical provider's billing clerk for purposes of inquiring into reasonableness of bills is improper

24 Fla. L. Weekly Supp. 727a

Online Reference: FLWSUPP 2409FERGInsurance -- Personal injury protection -- Discovery -- Depositions -- Scope of inquiry and documents that are required to be produced at deposition of insurer's corporate representative

24 Fla. L. Weekly Supp. 638a

Online Reference: FLWSUPP 2408SALOInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer's corporate representative -- Approval of form of notice of taking videotaped deposition duces tecum -- Scope of inquiry -- Documents to be produced

24 Fla. L. Weekly Supp. 449c

Online Reference: FLWSUPP 2406WILNInsurance -- Personal injury protection -- Discovery -- Depositions -- Scope of inquiry in deposition duces tecum of insurer's corporate representative -- Medical provider may inquire into method of determining usual and customary charges in community and reasonableness of provider's charges -- Insurer is required to produce entire PIP claim file and documents relating to all medical reports and bills received from provider, auto-processing of claim, damage to vehicle, and calculation of reasonable amount for services rendered and methodology used -- Insurer must also produce documents relied upon to dispute amount charged by provider, geo-zip report, and any executed agreements between insurer and any third-party auditing vendor used to adjust claim

24 Fla. L. Weekly Supp. 68a

Online Reference: FLWSUPP 2401HAYEInsurance -- Personal injury protection -- Discovery -- Depositions -- Scope of inquiry at deposition of insurer's corporate representative

24 Fla. L. Weekly Supp. 544a

Online Reference: FLWSUPP 2407NARCInsurance -- Discovery -- Depositions -- Motion for reconsideration of order regarding insurer's failure to cooperate in scheduling deposition of its corporate representative is denied where motion contains arguments that should have been, could have been or were raised at hearing

24 Fla. L. Weekly Supp. 342b

Online Reference: FLWSUPP 2405DOTTInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions are awarded where insurer failed to produce medical records and explanations of reimbursement from other medical providers to insured, asserting requirements of Health Insurance Portability and Accountability Act that were found not to be applicable to insurer in three prior cases -- Motions to compel production of documents and deposition of insurer's corporate representative are granted

24 Fla. L. Weekly Supp. 557b

Online Reference: FLWSUPP 2407AUGUInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer that paid claim in accordance with permissive statutory fee schedule is entitled to depose insured to verify that services were in fact provided, but may not depose insured about reasonableness of charges

24 Fla. L. Weekly Supp. 994b

Online Reference: FLWSUPP 2411PEREInsurance -- Discovery -- Depositions -- Failure to provide deposition dates and attend noticed deposition -- Sanctions

24 Fla. L. Weekly Supp. 692a

Online Reference: FLWSUPP 2409POHEInsurance -- Personal injury protection -- Discovery -- Depositions -- Owner of medical provider deposed as treating physician is not entitled to expert witness fee

24 Fla. L. Weekly Supp. 445a

Online Reference: FLWSUPP 2406HERNInsurance -- Discovery -- Depositions -- Expert witness fee -- Treating physician is expert witness entitled to fee for deposition testimony

24 Fla. L. Weekly Supp. 990b

Online Reference: FLWSUPP 2411SEIJInsurance -- Personal injury protection -- Discovery -- Depositions -- Insurer is ordered to provide last known address of pre-litigation adjuster that is no longer employed by insurer

24 Fla. L. Weekly Supp. 156a

Online Reference: FLWSUPP 2402MOSTInsurance -- Breach of contract claim filed against insurer after insurer paid claim submitted by insured in 2009 -- Insurer's motion for summary judgment based on prior payment is denied where genuine issues of material fact exist as to whether insurer's conduct in response to claim constituted performance of its obligation under policy

24 Fla. L. Weekly Supp. 748a

Online Reference: FLWSUPP 2409HARRInsurance -- Small claims -- Default -- Excusable neglect -- Insurer has failed to establish excusable neglect warranting vacation of default entered when it failed to appear at pretrial conference in small claims case where, although parties had agreement to invoke rules of civil procedure and avoid appearance at pretrial conference, court had denied motion to invoke rules and waive appearance, and insurer failed to submit fully compliant waiver of appearance at pretrial conference under rule 7.090(e)

24 Fla. L. Weekly Supp. 758a

Online Reference: FLWSUPP 2409FUDGCivil procedure -- Default -- Insurance -- Personal injury protection -- Default entered after insurer failed to appear for pretrial conference vacated based upon finding that there was excusable neglect, insurer acted in timely manner to address default, and vacation of default would not result in prejudice to plaintiff

24 Fla. L. Weekly Supp. 546a

Online Reference: FLWSUPP 2407FREEInsurance -- Personal injury protection -- Coverage -- Emergency services -- Deductible -- Insurer improperly processed medical bills out of order by applying deductible to bill from emergency medical provider, which was sixth bill received, instead of applying deductible to first bill received -- Standing -- Assignment -- Insurer has waived any right to contest provider's standing based on provider's failure to attach assignment to demand letter where insurer did not apprise provider of deficiency when it received bill and subsequent demand letter, but instead applied bill to deductible and made reduced payment on remaining balance -- Provider has standing as real party in interest where provider was required by law to treat insured, insured has not made claim for provider's services, and insurer issued reduced payment directly to provider -- As member of class of persons that legislature intended to protect by enacting section 627.736(4)(c) requirement that PIP insurers reserve benefits for emergency service providers, provider has standing to enforce that statute

24 Fla. L. Weekly Supp. 64a

Online Reference: FLWSUPP 2401RAINInsurance -- 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 second bill received, instead of applying deductible to first bill received -- Standing -- Assignment -- Insurer has waived any right to contest provider's standing based on provider's failure to attach written assignment to demand letter where insurer did not apprise provider of deficiency when it received bill and subsequent demand letter, but instead applied bill to deductible and made reduced payment on remaining balance -- Provider has standing as real party in interest where provider was required by law to treat insured, insured has not made claim for provider's services, and insurer issued reduced payment directly to provider -- As member of class of persons that legislature intended to protect by enacting section 627.736(4)(c) requirement that PIP insurers reserve benefits for emergency service providers, provider has standing to enforce that statute

24 Fla. L. Weekly Supp. 58a

Online Reference: FLWSUPP 2401HIGHInsurance -- Personal injury protection -- Coverage -- Emergency services -- Deductible -- Where insurer received bills from other medical providers prior to bill from plaintiff emergency service provider, insurer should have applied deductible to other providers' bills, thereby extinguishing deductible before payment of plaintiff's bill -- No merit to argument that because insurer is mandated by statute to reserve $5,000 for emergency service providers deductible was properly applied to plaintiff's bill as “first compensable bill” even though plaintiff's bill was third bill received -- Insurer cannot dispute reasonableness of charge or relatedness and medical necessity of services after it allowed full amount of charge when applying charge to deductible and conceded reasonableness, relatedness and necessity at deposition of its corporate representative -- Standing -- Assignment -- Document assigning insured's rights, benefits and causes of action to plaintiff provider conferred standing on plaintiff

24 Fla. L. Weekly Supp. 890b

Online Reference: FLWSUPP 2410ALFOInsurance -- Personal injury protection -- Coverage -- Deductible -- Clear and unambiguous language of PIP statute and PIP policy do not allow insurer to make any reductions to bills applied to deductible

24 Fla. L. Weekly Supp. 888a

Online Reference: FLWSUPP 2410HUAIInsurance -- Personal injury protection -- Deductible -- PIP insurer properly applied statutory fee schedule to reduce bills before applying those bills to deductible

24 Fla. L. Weekly Supp. 838a

Online Reference: FLWSUPP 2410MLOPInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible -- PIP statute requires that deductible be applied to 100% of expenses and losses incurred before application of fee schedule reductions -- Insurer was free to challenge that loss was not compensable or that charges were not reasonable, related and medically necessary at time charges were submitted, but it cannot raise those challenges after it has applied bill to deductible

24 Fla. L. Weekly Supp. 825a

Online Reference: FLWSUPP 2410WOLFInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible -- Amount to be applied to PIP policy deductible is 100% of reasonable expenses, not 100% of amount billed by medical provider

24 Fla. L. Weekly Supp. 1000a

Online Reference: FLWSUPP 2411CELEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible -- Insurer correctly applied statutory fee schedule to amount billed by medical provider before applying reduced amount to deductible

24 Fla. L. Weekly Supp. 964b

Online Reference: FLWSUPP 2411GHERInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible -- PIP statute requires insurer to apply deductible to 100% of reasonable, related and necessary medical expenses rather than to entire amount billed by medical provider irrespective of compensability -- Reasonableness of charges is issue for factfinder in instant case -- Insurer's initial decision to reimburse provider according to a fee-schedule-based formula did not preclude it from subsequently challenging reasonableness of charges

24 Fla. L. Weekly Supp. 766a

Online Reference: FLWSUPP 2409DUMEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy that provides that insurer will pay no more than 80% of 200% of allowable amount under Medicare Part B fee schedule clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule -- Deductible -- Proper formula for payment of PIP claim requires that statutory reductions be applied to charges before deductible is subtracted from resulting amount

24 Fla. L. Weekly Supp. 739a

Online Reference: FLWSUPP 2409MOREInsurance -- 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 -- Question certified: Pursuant to Fla. Stat. §627.739, is an insurer required to apply the deductible to 100% of an insured's expenses and losses prior to applying any permissive fee schedule payment limitation found in §627.736(5)(a)(1), Fla. Stat. (2013)?

24 Fla. L. Weekly Supp. 732a

Online Reference: FLWSUPP 2409SIFOInsurance -- 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 -- No merit to argument that insurer was required to pay benefits up to $10,000 unless there was determination of absence of emergency medical condition -- Deductible -- PIP insurer properly applied statutory fee schedule that was clearly elected in policy to reduce medical provider's bill before applying bill to deductible

24 Fla. L. Weekly Supp. 631b

Online Reference: FLWSUPP 2408COOKInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible was properly applied to amount remaining after claim was reduced by percentage described in PIP statute -- Policy language provided sufficient notice to insured that insurer would use statutory fee schedules to determine reasonableness of medical expenses

24 Fla. L. Weekly Supp. 541a

Online Reference: FLWSUPP 2407GRAYInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible -- Insurer correctly applied statutory fee schedule to amount billed by medical provider before applying reduced amount to deductible -- PIP policy that provides that, in determining whether charges for medical expenses are reasonable, insurer may reduce payments for amounts that are billed to any lesser amount that results from application of any schedule of charges or alternative reimbursement method that is expressly referenced or authorized under No Fault Law clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 467b

Online Reference: FLWSUPP 2406CHARInsurance -- Personal injury protection -- Coverage -- Deductible -- Insurer improperly applied fee schedule reductions to medical provider's charges prior to applying deductible to charges -- Insurer should have applied deductible to 100% of expenses

24 Fla. L. Weekly Supp. 467a

Online Reference: FLWSUPP 2406EADAInsurance -- Personal injury protection -- Coverage -- Deductible -- Insurer improperly applied fee schedule reductions to medical provider's charges prior to applying deductible to charges -- Insurer should have applied deductible to total charges billed

24 Fla. L. Weekly Supp. 462b

Online Reference: FLWSUPP 2406ADAMInsurance -- Personal injury protection -- Coverage -- Deductible -- Insurer improperly applied fee schedule reductions to medical provider's charges prior to applying deductible to charges -- Insurer should have applied deductible to total charges billed

24 Fla. L. Weekly Supp. 383a

Online Reference: FLWSUPP 2405BARDInsurance -- 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 -- Question certified: Pursuant to Fla. Stat. §627.739, is an insurer required to apply the deductible to 100% of an insured's expenses and losses prior to applying any permissive fee schedule payment limitation found in §627.736(5)(a)1, Fla. Stat. (2013)?

24 Fla. L. Weekly Supp. 936a

Online Reference: FLWSUPP 2411DOCTInsurance -- Personal injury protection -- Deductible -- 2008 version of statute requires that PIP deductible be applied to 100% of expenses before medical bills can be reduced by an insurance company

24 Fla. L. Weekly Supp. 318a

Online Reference: FLWSUPP 2405PAREInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible is to be applied to 100% of expenses and losses incurred -- Insurer erred in applying fee schedule reimbursement limitation found in statute and then applying deductible to that limitation amount

24 Fla. L. Weekly Supp. 200a

Online Reference: FLWSUPP 2403LPENInsurance -- Personal injury protection -- Deductible -- Trial court did not err in concluding that PIP insurer improperly applied statutory fee schedule to reduce bills before applying those bills to deductible

24 Fla. L. Weekly Supp. 966a

Online Reference: FLWSUPP 2411WIGFInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible -- PIP statute requires insurer to apply deductible to 100% of reasonable, related and necessary medical expenses -- Where reasonableness, relatedness, and necessity of charges incurred following accident that did not result in any visible damage to either school bus in which insured was passenger or truck with which bus collided is in dispute, question of fact exists as to whether charges at issue were applicable to policy deductible as compensable charges and, if so, to what extent

24 Fla. L. Weekly Supp. 994c

Online Reference: FLWSUPP 2411LOPEInsurance -- Personal injury protection -- Deductible

24 Fla. L. Weekly Supp. 304a

Online Reference: FLWSUPP 2404PARRInsurance -- Deductible

24 Fla. L. Weekly Supp. 460a

Online Reference: FLWSUPP 2406ORAMInsurance -- Personal injury protection -- Proposal for settlement -- Defendant in action for declaratory relief was entitled to submit proposal for settlement, although claim raised was equitable on its face, where affirmative answer to either of the questions raised in complaint had no independent value separate and apart from serving as precursor for plaintiff to establish that defendant breached insurance contract by underpaying PIP benefits -- Motion to strike offer of judgment is denied -- Motion for enlargement of time to respond to proposal for settlement until after plaintiff takes deposition of defendant's PIP litigation adjuster is denied -- Although plaintiff timely filed request for enlargement of time before 30-day period for acceptance expired, it did not file notice of hearing until well after 30-day period expired -- Filing of rule 1.090(b) motion to enlarge time to accept proposal for settlement does not automatically toll 30-day period for accepting that proposal until motion to enlarge is decided

24 Fla. L. Weekly Supp. 147d

Online Reference: FLWSUPP 2402PASCInsurance -- Personal injury protection -- Coverage -- Deductible -- Declaratory action -- Availability of remedy through action for breach of contract does not preclude action for declaratory relief regarding application of deductible

24 Fla. L. Weekly Supp. 455a

Online Reference: FLWSUPP 2406GUZMInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Declaratory judgment -- Motion to dismiss count of amended complaint seeking declaratory judgment as to whether insurance policy clearly and unambiguously notified insureds of insurer's election of a single method of calculating PIP benefits and whether insurance policy unlawfully elected to rely on Medicare Multiple Procedure Payment Reduction in violation is denied

24 Fla. L. Weekly Supp. 365a

Online Reference: FLWSUPP 2405DECKInsurance -- Personal injury protection -- Declaratory action -- Motion to dismiss count seeking declaration as to whether PIP policy clearly and unambiguously elected use of permissive fee schedule method of reimbursement, whether insurer is authorized to reimburse claim pursuant to hybrid method or fee schedule method rather than reasonable amount method and whether insurer is authorized to rely on Medicare Multiple Procedure Payment Reduction is denied -- Issue of preemption and merits of declaratory questions are not appropriately raised in motion to dismiss

24 Fla. L. Weekly Supp. 995b

Online Reference: FLWSUPP 2411DBROInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Declaratory judgment -- Provider's complaint for declaratory relief as to whether insurer was permitted to pay claims with the limitations found in its 9810A policy and whether policy would preclude provider from balance billing its patient alleged all the elements of declaratory judgment action -- Motion to dismiss denied

24 Fla. L. Weekly Supp. 364b

Online Reference: FLWSUPP 2405SOLOInsurance -- Personal injury protection -- Declaratory actions -- Motion to dismiss count seeking declaratory relief is granted where medical provider does not allege any true uncertainty as to whether it possesses rights under PIP contract, but merely seeks declaration as to whether policy is ambiguous as to payment method

24 Fla. L. Weekly Supp. 707a

Online Reference: FLWSUPP 2409ALFAInsurance -- Personal injury protection -- Med pay -- Declaratory actions -- Motion to dismiss complaint seeking declaration as to whether insurer paid claims pursuant to hybrid method rather than reasonable amount method of reimbursement or statutory fee schedule and was entitled to do so and whether insurer was authorized to rely on Medicare Multiple Procedure Payment Reduction is denied -- No merit to argument that medical provider has failed to specify any right under policy in doubt and is actually seeking advice from court on what course of action to employ to enforce its rights -- Provider is entitled to have threshold legal question as to its rights under policy and PIP statute answered where answer may resolve case without expenditure of resources on litigating issues of reasonableness, relatedness and necessity of charges that may become moot

24 Fla. L. Weekly Supp. 866b

Online Reference: FLWSUPP 2410LAPOInsurance -- Personal injury protection -- Declaratory actions -- Action for declaratory judgment is improper in first-party PIP case where judgment on breach of contract count of complaint will provide full, adequate, and complete relief

24 Fla. L. Weekly Supp. 866a

Online Reference: FLWSUPP 2410BUILInsurance -- Standing -- Dissolved corporation -- Medical provider dissolved as result of failure to file annual report with Florida Department of State is ordered to file report to reinstate active status within 30 days -- If provider fails to reinstate, case will be dismissed

24 Fla. L. Weekly Supp. 867a

Online Reference: FLWSUPP 2410EXPOInsurance -- Summary judgment -- Affidavit in opposition to motion for summary judgment creates genuine issue of material fact as to whether medical provider knowingly submitted false or misleading statement related to claim or charges -- Insurer's motion for summary judgment denied

24 Fla. L. Weekly Supp. 562a

Online Reference: FLWSUPP 2407POLAInsurance -- Personal injury protection -- Complaint -- Amendment -- Medical provider is granted leave to amend complaint to correct misnomer in name of plaintiff where there is no doubt as to identity of intended plaintiff, and amendment is not attempt to substitute different party into litigation -- Insurer is granted leave to amend answer to challenge provider's standing on basis that name of plaintiff differs from name of entity in assignment

24 Fla. L. Weekly Supp. 147a

Online Reference: FLWSUPP 2402BARNInsurance -- Complaint -- Amendment -- Plaintiff is required to file amended complaint attaching policy and alleging policy provisions believed to be breached and how they were breached

24 Fla. L. Weekly Supp. 146e

Online Reference: FLWSUPP 2402BLACInsurance -- Complaint -- Amendment -- Plaintiff is required to file amended complaint attaching policy and alleging policy provisions believed to be breached and how they were breached

24 Fla. L. Weekly Supp. 146d

Online Reference: FLWSUPP 2402ENGInsurance -- Complaint -- Amendment -- Plaintiff is required to file amended complaint attaching policy and alleging policy provisions believed to be breached and how they were breached

24 Fla. L. Weekly Supp. 146c

Online Reference: FLWSUPP 2402RAMOInsurance -- Complaint -- Amendment -- Plaintiff is required to file amended complaint attaching policy and alleging policy provisions believed to be breached and how they were breached

24 Fla. L. Weekly Supp. 146b

Online Reference: FLWSUPP 2402LEWIInsurance -- Complaint -- Amendment -- Plaintiff is required to file amended complaint attaching policy and alleging policy provisions believed to be breached and how they were breached

24 Fla. L. Weekly Supp. 146a

Online Reference: FLWSUPP 2402REEDInsurance -- Complaint -- Amendment -- Plaintiff is required to file amended complaint attaching policy and alleging policy provisions believed to be breached and how they were breached

24 Fla. L. Weekly Supp. 31a

Online Reference: FLWSUPP 2401URSCInsurance -- Commercial general liability -- Coverage -- Commercial general liability insurer's duty to defend landscaping subcontractor whose president died in construction site accident against third party complaint and cross-claims brought against subcontractor by general contractor and construction site owner in wrongful death action that was brought by estate of deceased president -- Where complaint and cross-claims contain indemnity/contribution claims that fairly and potentially fall within scope of coverage afforded by subcontractor's commercial general liability policy, insurer has duty to defend subcontractor -- Exclusion for obligations of subcontractor under workers' compensation and similar laws is not applicable to claims brought by non-employees -- Contractual liability and employer's liability exclusions are not applicable where both except from their scope tort liability assumed by subcontractor under an insured contract, and subcontract between subcontractor and general contractor is an insured contract

24 Fla. L. Weekly Supp. 840b

Online Reference: FLWSUPP 2410RAMPInsurance -- Bad faith -- Count alleging violation of Florida Unfair Insurance Trade Practices Act is abated pending resolution of other count in complaint

24 Fla. L. Weekly Supp. 303a

Online Reference: FLWSUPP 2404HEARInsurance -- Complaint -- Amendment -- Leave is granted to amend complaint to add count alleging violation of Florida Unfair Insurance Trade Practices Act -- Bad faith claim will be abated pending resolution of breach of contract claim

24 Fla. L. Weekly Supp. 302a

Online Reference: FLWSUPP 2404ISAAInsurance -- Complaint -- Amendment -- Leave is granted to amend complaint to add count alleging violation of Florida Unfair Insurance Trade Practices Act -- Bad faith claim will be abated pending resolution of breach of contract claim

24 Fla. L. Weekly Supp. 501a

Online Reference: FLWSUPP 2407SANTInsurance -- Automobile liability -- Third-party bad faith claim -- Plaintiff who was involved in motor vehicle accident with insured, resolved dispute with insured confidentially, and agreed to order dismissing case against insured with prejudice cannot bring third-party bad faith claim against insured's liability insurer where plaintiff holds no judgment against insured -- Trial court did not have jurisdiction to vacate order of dismissal and enter final judgment more than two years after entry of order of dismissal -- Although insurer was not party to action between plaintiff and insured, it may challenge validity of void judgment since its rights are affected by that judgment

24 Fla. L. Weekly Supp. 194a

Online Reference: FLWSUPP 2402ZOGLInsurance -- Automobile -- Windshield repair -- Venue -- Where insurer is foreign corporation that does not have agent in Lee County and there is no property that is subject of litigation, venue in repair shop's action against insurer is proper in county where cause of action accrued -- Place of payment rule is not applicable to determination of place of accrual of action where there is no debtor-creditor relationship between parties, and sum sought by repair shop is unliquidated -- Cause of action arose in county where insurer was to make payment, which is county where insured resides -- Where insured, repair shop, adjuster, and all other likely witnesses reside outside of Lee County, convenience of parties weighs in favor of transferring venue -- Case is transferred to county where insured resides

24 Fla. L. Weekly Supp. 112a

Online Reference: FLWSUPP 2402DELAInsurance -- Automobile -- Windshield repair -- Venue -- Where insurer's claim that venue was not proper in Lee County because plaintiff repair shop does not have corporate office in that county was never substantiated with evidence, only by photocopies of documents attached to unsworn motion, trial court did not err in denying motion to transfer venue on that basis -- Forum non conveniens -- However, trial court abused it discretion in denying motion to transfer venue to Palm Beach County where it is undisputed that all critical witnesses reside and do business in that county

24 Fla. L. Weekly Supp. 744a

Online Reference: FLWSUPP 2409LESCInsurance -- Automobile -- Windshield repair -- Coverage -- Where term “prevailing competitive price,” which policy defines as price insurer can secure from competent and conveniently located repair facility, can be interpreted both as allowing insurer to limit reimbursement to amount it has previously authorized to pay for same type of repair and as price quoted by plaintiff repair shop so long as insurer is able to obtain same price and plaintiff's shop is competent and conveniently located, term is ambiguous and must be interpreted in manner most favorable to plaintiff -- Insurer failed to produce admissible evidence that it can secure price it reimbursed for repair where affidavit submitted as evidence had attachments that were hearsay and not properly authenticated

24 Fla. L. Weekly Supp. 473b

Online Reference: FLWSUPP 2407GEICInsurance -- Automobile -- Windshield replacement or repair -- Prevailing competitive price -- Language of policy limiting insurer's liability for cost of windshield repair to prevailing competitive price is not ambiguous and supports insurer's assertion that term means an amount that would be accepted by at least one competent glass facility conveniently located to the insured at the time of the repairs -- However, genuine issues of material fact exist as to whether costs quoted by insurer to determine prevailing competitive price were from “competent glass repair facilities” as required by policy language -- Affidavit in support of insurer's motion for summary judgment was faulty in that it attempted to establish the existence of competent glass repair facilities, but not on the date that the repairs were done

24 Fla. L. Weekly Supp. 884a

Online Reference: FLWSUPP 2410ADAMInsurance -- Automobile -- Windshield repair -- Coverage -- Where term “prevailing competitive price,” which policy defines as price insurer can secure from competent and conveniently located repair facility, can be interpreted both as allowing insurer to limit reimbursement to amount it has previously authorized to pay for same type of repair and as price quoted by plaintiff repair shop so long as insurer is able to obtain same price and plaintiff's shop is competent and conveniently located, term is ambiguous and must be interpreted in manner most favorable to plaintiff -- Insurer failed to produce admissible evidence that it can secure price it reimbursed for repair where affidavit submitted as evidence had attachments that were hearsay and not properly authenticated

24 Fla. L. Weekly Supp. 869a

Online Reference: FLWSUPP 2410MONTInsurance -- Automobile -- Windshield repair -- Where automobile insurance policy provides that, except in emergency circumstances, insurer will only pay for damage it is able to inspect prior to repair, and neither insured nor repair shop/assignee provided insurer with notice of damage and opportunity for inspection before repairs were made, there is no coverage under policy for claim

24 Fla. L. Weekly Supp. 761a

Online Reference: FLWSUPP 2409SBUSInsurance -- Automobile -- Windshield repair or replacement -- Small claims action against insurer by repair shop's assignee seeking to collect balance claimed to be due from insurer -- Plaintiff's motion for final summary disposition granted -- Limitation of liability provision of insurance policy was affirmative defense which was waived when insurer did not raise defense by deadline set by court -- Insurer's argument that it did not file affirmative defenses because, if it did so, it would be waiving right to appraisal is rejected

24 Fla. L. Weekly Supp. 179a

Online Reference: FLWSUPP 2402WHITInsurance -- Automobile -- Windshield repair -- Default -- Vacation -- Insurer's motion to vacate final default judgment is denied where motion was not made under oath -- Moreover, insurer did not act diligently in seeking relief where motion was submitted six months after entry of judgment

24 Fla. L. Weekly Supp. 173a

Online Reference: FLWSUPP 2402ALTLInsurance -- Automobile -- Windshield repair -- Motion to dismiss count seeking declaration as to interpretation and implementation of policy term “prevailing competitive price” is denied -- Motion to dismiss count for breach of insurance contract is denied -- Motion to transfer venue is denied where supporting affidavit does not present sufficient information to enable court to properly weigh convenience of key witnesses

24 Fla. L. Weekly Supp. 27c

Online Reference: FLWSUPP 2401LIRAInsurance -- Automobile -- Uninsured motorist -- Exclusions -- Insured who was the “first person shown” as a named insured on the policy and who was injured while riding motorcycle owned by h er when motorcycle was rear-ended by vehicle not owned by the insured or her spouse was entitled to coverage under policy -- Although policy excluded coverage for bodily injury to insured while occupying a vehicle owned by the insured or any resident relative if the vehicle was not the insured's car or a newly acquired car, policy contained an exception to the exclusion for circumstance in which the named insured and that named insured's spouse were injured while occupying or being struck by a motor vehicle not owned by one or both of them -- No merit to argument that exception was intended to apply only when first named insured or spouse was injured in or by vehicle owned by resident relative where exception does not even mention resident relatives -- Argument that it is unreasonable to interpret exception in manner that swallows exclusion is legally irrelevant and factually incorrect

24 Fla. L. Weekly Supp. 569a

Online Reference: FLWSUPP 2407TANKInsurance -- Personal injury protection -- Discovery -- In action seeking declaration that insurer cancelled or failed to renew PIP policy based on arbitrary or capricious reasons, insured is entitled to discovery of underwriting file, underwriting requirements and guidelines; underwriting requirements and guidelines that support non-renewal of insured's policy; and all documents considered in deciding not to renew policy -- Precedent holding that underwriting file is only discoverable in bad faith claim is not applicable since statute governing bad faith claims does not include claim for wrongful cancellation or non-renewal of policy

24 Fla. L. Weekly Supp. 126a

Online Reference: FLWSUPP 2402SEWEInsurance -- Attorney's fees -- Timeliness of motion -- Motion seeking sanctions pursuant to section 57.105 which was filed after action was dismissed with prejudice was untimely -- Motion denied for lack of jurisdiction

24 Fla. L. Weekly Supp. 150b

Online Reference: FLWSUPP 2402ISMAInsurance -- Discovery -- Failure to comply -- Sanctions -- Attorney's fees and costs

24 Fla. L. Weekly Supp. 67a

Online Reference: FLWSUPP 2401LEADInsurance -- Attorney's fees -- Amount

24 Fla. L. Weekly Supp. 432a

Online Reference: FLWSUPP 2406AMICInsurance -- Attorney's fees -- Proposal for settlement -- Small claims -- Defendant's motion to invoke Rules of Civil Procedure is granted -- Invocation of rule 1.442, which applies to proposals for settlement, is appropriate in order to give full effect to section 627.736(8)

24 Fla. L. Weekly Supp. 299b

Online Reference: FLWSUPP 2404PROCInsurance -- Personal injury protection -- Declaratory actions -- Attorney's fees -- Insured is not entitled to award of attorney's fees under section 627.428 in action seeking declaration regarding insured's entitlement to insurance coverage under policy but not alleging that insurer has improperly failed to make payments under policy

24 Fla. L. Weekly Supp. 458a

Online Reference: FLWSUPP 2406PINEInsurance -- Personal injury protection -- Attorney's fees -- Declaratory action -- Recovery of attorney's fees under section 627.428 is not limited to cases in which plaintiff recovers insurance benefits -- Attorney's fees are available to medical provider in declaratory action seeking determination of whether insurer's policy properly incorporates permissive statutory fee schedule -- Request to strike demand for attorney's fees is premature where court has not yet rendered judgment or decree

24 Fla. L. Weekly Supp. 457b

Online Reference: FLWSUPP 2406BENDInsurance -- Personal injury protection -- Attorney's fees -- Declaratory action -- Recovery of attorney's fees under section 627.428 is not limited to cases in which plaintiff recovers insurance benefits -- Attorney's fees are available to medical provider in declaratory action seeking determination of whether insurer's policy properly incorporates permissive statutory fee schedule -- Request to strike demand for attorney's fees is premature where court has not yet rendered judgment or decree

24 Fla. L. Weekly Supp. 980a

Online Reference: FLWSUPP 2411LAWRAttorney's fees -- Proposal for settlement -- Nominal offer -- Good faith -- Where prevailing defendants always contended that they did not have any liability in contract action, there is nothing in record to support plaintiff's argument that $100 proposal for settlement was not made in good faith, and defendants are entitled to award of attorney's fees and costs -- Fact that proposed settlement would not have even covered plaintiff's filing fee does not establish bad faith

24 Fla. L. Weekly Supp. 639a

Online Reference: FLWSUPP 2408PEREInsurance -- Personal injury protection -- Attorney's fees -- Proposal for settlement -- Where insurer made good faith nominal proposal for settlement, amendment of affirmative defenses during pendency of proposal to add defense on which insurer ultimately prevailed did not moot proposal

24 Fla. L. Weekly Supp. 785a

Online Reference: FLWSUPP 2410GERLInsurance -- Personal injury protection -- Attorney's fees -- Proposal for settlement -- In absence of transcript of pertinent proceedings below, appellate court cannot conclude that trial court abused its discretion in denying motion for attorney's fees based on finding that insurer's proposal for settlement, which totaled $500 for medical benefits and attorney's fees and which was rejected by plaintiff, was not made in good faith, notwithstanding fact that jury ultimately returned verdict for insurer, finding that injuries were not related to accident

24 Fla. L. Weekly Supp. 760a

Online Reference: FLWSUPP 2409REGOAttorney's fees -- Proposal for settlement that included offer of attorney's fees but failed to state whether attorney's fees were part of plaintiff's legal claim did not strictly comply with rule 1.442 and is, therefore, invalid and unenforceable

24 Fla. L. Weekly Supp. 21c

Online Reference: FLWSUPP 2401LUISInsurance -- Personal injury protection -- Proposal for settlement -- Timeliness of acceptance -- Section 768.79(1) and rule 1.442(f)(1) require that proposal for settlement be accepted within 30 days -- Medical provider's motion for enlargement of time to respond to proposal did not toll time for acceptance where insurer did not agree to enlargement of time and provider did not obtain order granting enlargement of time prior to expiration of time for acceptance -- Order enforcing settlement is reversed

24 Fla. L. Weekly Supp. 71b

Online Reference: FLWSUPP 2401DIAZInsurance -- Proposal for settlement -- Extension of time to respond

24 Fla. L. Weekly Supp. 708b

Online Reference: FLWSUPP 2409LINDInsurance -- Personal injury protection -- Attorney's fees -- Proposal for settlement -- Where medical provider rejected proposal for settlement and thereafter filed notice of voluntary dismissal, insurer is entitled to award of attorney's fees and costs -- Burden is on provider to prove that insurer did not make proposal in good faith -- Issue of whether provider acted reasonably in rejecting proposal has no bearing on insurer's entitlement to fee award

24 Fla. L. Weekly Supp. 75a

Online Reference: FLWSUPP 2401LEONInsurance -- Personal injury protection -- Attorney's fees -- Proposal for settlement -- Where medical provider voluntarily dismissed prior PIP case and years later filed identical claim in new case, insurer served $100 proposal for settlement in new case, and thereafter plaintiff dismissed new case, insurer is entitled to award of attorney's fees and costs

24 Fla. L. Weekly Supp. 868a

Online Reference: FLWSUPP 2410MOLIInsurance -- Personal injury protection -- Attorney's fees -- Where medical provider recovered only penalties and postage as result of insurer's confession of judgment, and all PIP benefits were paid pre-suit, provider is not entitled to award of attorney's fees under section 627.428

24 Fla. L. Weekly Supp. 725a

Online Reference: FLWSUPP 2409SAINInsurance -- Personal injury protection -- Attorney's fees -- Medical provider that obtained confession of judgment as to statutory penalty and postage after pre-suit payment of full PIP benefits and interest was not entitled to award of attorney's fees and costs under section 627.428

24 Fla. L. Weekly Supp. 167a

Online Reference: FLWSUPP 2402SUZAInsurance -- Personal injury protection -- Attorney's fees -- Declaratory action -- Insured who prevailed in declaratory action determining that insurer is obligated to provide PIP and medical payment coverage is entitled to award of attorney's fees under section 627.428(1) notwithstanding fact that insured did not seek money damages