Volume 11

11 Fla. L. Weekly Supp. 665b

Insurance — Personal injury protection — Coverage — Denial — Unreasonable, unnecessary or unrelated medical expenses — Partial summary judgment is granted in favor of provider/assignee on issue of reasonableness, relatedness, and necessity of treatment rendered and billed prior to independent medical examination of insured where treating physician’s affidavit supports necessity of treatment and affidavit of provider’s billing expert attests that charges are reasonable within community — Insurer’s ore tenus motion to continue hearing on motion is denied where insurer had ample opportunity to prepare for or move to continue hearing in four months since service of motion — Counter-affidavit filed day before hearing is untimely — Affirmative defenses — Striking — Conclusory affirmative defenses are stricken

11 Fla. L. Weekly Supp. 531b

Insurance — Personal injury protection — Coverage — Conditions precedent — Examination under oath — Error to enter partial summary judgment on issue of whether insured was required to submit to EUO — Whether contract language requiring insured to give written proof of claim and/or submit to EUO was ambiguous was issue of material fact that should have been left to jury — Error to enter directed verdict on issue of whether bills were reasonable, related, and necessary where ruling was based on weight of insurer’s evidence

11 Fla. L. Weekly Supp. 202c

Insurance — Personal injury protection — Coverage — Denial — Unreasonable, unrelated or unnecessary medical expenses — Error to grant directed verdict for medical bills incurred up to date insurer provided notification of termination of benefits based on results of independent medical examination where treating physician and IME physician gave conflicting evidence as to whether insured’s gallbladder surgery contributed to pain insured claimed was result of accident, insured admitted she was given treatment not prescribed by treating physician, and there was conflicting testimony as to billing discrepancies

11 Fla. L. Weekly Supp. 299a

Insurance — Personal injury protection — Coverage — Denial — Unreasonable, unrelated or unnecessary medical expenses — No abuse of discretion in granting summary judgment in favor of insured on claim for PIP benefits for medical treatment preceding date insurer suspended payment of further benefits based on independent medical examination which resulted in opinion that further treatment would not be reasonable where motion for summary judgment was supported by affidavit of physician who concluded that treatment provided to insured for period prior to suspension of benefits was reasonable, related, and necessary and insurer failed to produce countervailing evidence that claimed medical expenses were not reasonable, related, and necessary — IME report failed to create genuine issue of material fact as to treatment rendered prior to suspension of benefits — Appellate attorney’s fees awarded to insured

11 Fla. L. Weekly Supp. 457a

Insurance — Personal injury protection — Summary judgment — Factual issue — Insurer’s motion for summary judgment is denied where motion alleges that provider/assignee submitted bills in excess of allowable amounts that are not reasonable per se and not payable under statute, and provider provided opposing affidavit stating that bills were reasonable and that provider billed all patients same price for services but accepted reimbursement of lesser allowable amounts imposed by contractual limitations and statutory fee schedules

11 Fla. L. Weekly Supp. 115b

Insurance — Personal injury protection — Coverage — Denial — Unreasonable, unrelated or unnecessary medical expenses — Although insured’s medical history proved that insured had experienced certain back problems for quite some time and that his condition did not improve during course of treatment from plaintiff medical provider and others, it did not overcome proof that insured suffered new and aggravating injuries in motor vehicle accident and that those injuries remain with insured to this day, necessitating at least palliative care — Bills for chiropractic care are found reasonable, necessary and related to accident

11 Fla. L. Weekly Supp. 1041a

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related, and necessary treatment — Directed verdict — Trial court correctly directed verdict in medical provider’s favor where insurer failed to present evidence sufficient to contradict or discredit treating physician’s opinion that treatment was reasonable, related, and necessary — Statutory requirement that insurer have medical report stating treatment was not reasonable, related or necessary as condition precedent to withdrawing payment of PIP benefits does not alter burden of proof in PIP suit — Appellate attorney’s fees awarded to provider

11 Fla. L. Weekly Supp. 649b

Insurance — Personal injury protection — Coverage — Medical expenses — Premature suit — Where insurer receiving claims for TENS unit and related supplies sent provider/assignee Explanation of Benefits requesting invoice from supplier to determine proper payment unit and supplies, and provider did not send invoice prior to filing suit, claims were not overdue at time of filing suit since EOB tolled time for payment of claims — Summary judgment is granted in favor insurer

11 Fla. L. Weekly Supp. 366a

Insurance — Personal injury protection — Coverage — Reasonable and necessary expenses — Documentation — Where insurer receiving claim for Flex L.S.O. Support sent medical provider Explanation of Benefits within 30 days requesting invoice indicating amount provider paid to supplier for device, provider did not provide insurer with invoice until over 22 months into litigation, and insurer paid full amount of disputed bill plus interest within ten days of receipt of invoice, summary judgment is entered in favor of insurer

11 Fla. L. Weekly Supp. 476b

Insurance — Personal injury protection — Coverage — Medical expenses — Lawfully rendered treatment — Where chiropractor referred insured to plaintiff diagnostic company for nerve conduction testing, plaintiff is located at same address as chiropractor’s office and is wholly owned by chiropractor, plaintiff owns no diagnostic testing equipment and did not conduct testing, but instead contracted with another diagnostic company to provide equipment and technician to perform test and physician to interpret test, and plaintiff and diagnostic company performing test had agreement by which plaintiff was to receive 51% of amount charged for testing, plaintiff and other diagnostic company violated statutory prohibitions against split-fee arrangements, kickbacks, and commissions — Insurer is absolved of liability for treatment not lawfully rendered, and summary judgment is entered in its favor