Volume 11

11 Fla. L. Weekly Supp. 203a

Insurance — Personal injury protection — Preferred providers — Section 627.736(10) does not prohibit insurer from making payment for healthcare services covered by PIP benefits at reduced preferred provider organization rates to healthcare provider who has entered into valid and enforceable contract to accept payment at PPO rates

11 Fla. L. Weekly Supp. 216a

Insurance — Personal injury protection — Preferred provider rates — Medical provider’s action against insurer for unpaid balance of bills paid by insurer at reduced preferred provider rates — No abuse of discretion in granting insurer’s motion for directed verdict where medical provider who belonged to preferred provider organization sued insurer as assignee of insured’s PIP benefits but offered no evidence that insured was obligated to provider for any of the unpaid portion of claim and, therefore, provider could not collect that amount from insurer

11 Fla. L. Weekly Supp. 449b

Insurance — Personal injury protection — Coverage — Reduction — Preferred provider rates — Where insurer does not have PPO agreement with provider/assignee or insured, insurer’s reduction of medical bills on basis of provider’s PPO agreement with Beech Street Corporation not applicable to PIP claims was unlawful — Summary judgment granted in favor of provider

11 Fla. L. Weekly Supp. 306b

Insurance — Personal injury protection — Medical bills — Reduction — Preferred provider organization rates — No-fault law does not prohibit insurer from making payment for healthcare services covered by PIP benefits at reduced PPO rates — Remand to address issues regarding scope and validity of PPO agreements

11 Fla. L. Weekly Supp. 922a

Insurance — Personal injury protection — Coverage — Denial — Unreasonable, unnecessary or unrelated medical expenses — Where medical provider filed affidavit of treating physician in support of motion for summary judgment, and insurer did not file anything in opposition to motion but relied on testimony of litigation adjuster that expenses were above usual and customary, insurer has failed to substantially impeach medical expert testimony of physician or present countervailing evidence from licensed physician to dispute reasonableness, relatedness or necessity of medical expenses — Summary judgment granted in favor of provider

11 Fla. L. Weekly Supp. 1010b

Insurance — Personal injury protection — Plaintiff who complied with all conditions precedent to suit is entitled to summary judgment as matter of law regarding payment of medical bills at 80% minus deductible, plus interest from 30 days after receipt of each bill up to and including the present where defendant had no basis under contract or statute for denying responsibility for medical expenses, and there was no question of material fact regarding these reasonable, related, and necessary medical expenses

11 Fla. L. Weekly Supp. 619a

Insurance — Personal injury protection — Coverage — Passenger not maintaining PIP coverage on own vehicle — Trial court did not err in entering partial summary judgment in favor of provider/assignee on grounds that passenger’s uninsured vehicle was inoperable where insurer did not contest assertion that vehicle was inoperable — Unreasonable, unnecessary or unrelated medical expenses — However, court did err in entering final summary judgment in favor of provider on grounds that insurer had not raised issue of whether treatment rendered was reasonable, related, and necessary as affirmative defense or in discovery — By granting final summary judgment on reasonableness, relatedness, and necessity of treatment without requiring provider to present any evidence on issue, trial court improperly shifted burden of proof on issue from provider to insurer — Trial court properly denied insurer’s motion for judgment on pleadings, which argued that complaint that did not allege treatment rendered was reasonable, related, and necessary did not allege prima facie case, since PIP statute does not require that provider plead that issue

11 Fla. L. Weekly Supp. 735a

Insurance — Personal injury protection — Coverage — Medical bills — Unreasonable, unnecessary or unrelated medical expenses — Provider’s motion for directed verdict is granted where testimony of provider’s medical expert which established that medical expenses were reasonable, related and necessary was unrebutted — Testimony of insurer’s litigation adjuster was legally insufficient to refute medical expert’s testimony on reasonableness, relatedness, and necessity of medical expenses — No genuine issue of material fact remains as to reasonable, usual, and customary charges where provider agreed to accept amounts that litigation adjuster testified were reasonable — Attorney’s fee awarded to insured

11 Fla. L. Weekly Supp. 620a

Insurance — Personal injury protection — Coverage — Denial — Medical bills — Unreasonable, unnecessary or unrelated medical expenses — Error to not award to insured bills of medical provider where evidence showing that insured’s health insurer paid provider’s bills was sufficient to establish that charge was reasonable and necessary, and nothing in record disputes that evidence

11 Fla. L. Weekly Supp. 310a

Insurance — Personal injury protection — Liability — Summary judgment — Doctor’s notes making marginal references to probability that plaintiff’s symptomatology was related to trauma and that planned treatment protocol was medically necessary and independent medical examination report which is signed, certified, and affirmed but not notarized or signed under penalty of perjury were insufficient to support partial summary judgment as to liability — Self-serving answers of claims adjuster who did not establish that allegations in her interrogatory answers were facts within her personal knowledge were insufficient to raise material issue of fact — Reversed and remanded