Volume 11

11 Fla. L. Weekly Supp. 94c

Insurance — Personal injury protection — Although noting that it appears inequitable to penalize medical provider for failure to submit claims within thirty days of treatment when failure was due to insured providing misinformation regarding identity of PIP carrier, appellate court affirms trial court ruling that medical provider is precluded from recovering payment for treatment — Court is bound by district court opinion holding that section 627.736(5)(b) was constitutional — Statutory amendment allowing providers who were given incorrect information to resubmit bills to correct carrier is not retroactive to date medical provider rendered treatment to insured

11 Fla. L. Weekly Supp. 729b

Insurance — Personal injury protection — Provider may amend complaint to add claims for benefits not in demand letter without submitting additional demand letter where amended complaint seeks benefits for reduction of approximately same amount for same type of treatment and from same provider as initial complaint

11 Fla. L. Weekly Supp. 835a

Insurance — Personal injury protection — Coverage — Medical expenses — Insurer failed to create genuine issue of material fact regarding whether medical expenses were reasonable, related or necessary where provider/assignee filed deposition of treating physician establishing that physician is licensed and all treatment was reasonable, related, and medically necessary, and insurer filed affidavit of litigation adjuster stating that bills were not paid due to lack of countersignature and affidavit of physician who conducted independent medical examination after last date of service claimed — Claims — Countersignature by insured — Assigned claim — Insured’s failure to countersign medical bills does not relieve insurer of liability for payment of PIP benefits to medical provider who has accepted assignment of benefits — Fraud — Affirmative defense of fraud is stricken where insurer failed to plead fraud properly and has failed to provide any record evidence of fraud — No merit to affirmative defense of lack of proper licensing of medical provider where there is no requirement that provider submit licenses with bills, and insurer has failed to offer any evidence to rebut physician’s affidavit asserting proper licensing — Summary judgment granted in favor of provider

11 Fla. L. Weekly Supp. 452b

Insurance — Personal injury protection — Coverage — Medical bills

11 Fla. L. Weekly Supp. 675b

Insurance — Personal injury protection — Wage loss — Claimant is obligated to give actual notice of lost wage claim to insurer constituting reasonable proof of wage loss and amount of wage loss claim in form not requiring insurer to speculate concerning dates, times, and amount of lost wages — Amount of wage loss claim is not reasonably established by mere submission of HCFA forms by providers treating insured — Final summary judgment granted in favor of insurer

11 Fla. L. Weekly Supp. 6b

Insurance — Personal injury protection — Lost wages — Where insured’s treating physician and insurer’s medical expert gave diametrically opposed medical opinions as to whether insured’s injuries prevented her from working, error to enter summary judgment on issue of liability for lost wages — Statute does not mandate that insurer’s medical expert be same speciality as insured’s treating physician where issue is lost wages rather than payment for medical treatment — Appeals — Presumption of correctness can be disturbed in absence of transcript where record paints complete picture of error below

11 Fla. L. Weekly Supp. 852a

Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — Insurer cannot claim as defense to ongoing litigation the subsequent exhaustion of PIP benefits by paying bills to other providers whose bills were received subsequent to bill from plaintiff assignee — Where insurer did not make payment on assignee’s bill within 30 days of receipt, made request for information regarding reasonableness and relatedness of services more than 30 days after receiving bill, continued to pay other medical providers thereby nearly exhausting policy limits, and conceded bill to assignee after assignee filed suit, assignee’s bill should have been paid without limitation as to amount of benefits remaining at time when insurer conceded that payment was improperly withheld

11 Fla. L. Weekly Supp. 258a

Insurance — Personal injury protection — Coverage — Denial — Exhaustion of policy limits on subsequent bills is not a defense to payment of timely filed reasonable, related, and necessary claim for medical services — Stay — Motion to stay case pending resolution of appeals of similar cases in three other circuits is denied — Summary judgment granted in favor of medical provider on exhaustion defense

11 Fla. L. Weekly Supp. 113a

Insurance — Personal injury protection — Exhaustion of benefits — Action against insurer by provider/assignee whose bills were reduced by insurer — Insurer’s motion for summary judgment on ground that benefits were exhausted prior to suit is denied on ground that issues of fact, and maybe of law, remain

11 Fla. L. Weekly Supp. 1092a

Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — Subsequent claim for unpaid portion of bills — Where uncontradicted affidavit of PIP litigation specialist states that insurer made reasonable payments to different providers including plaintiff until such time as benefits were exhausted, there is no genuine issue of fact as to whether insurer acted in good faith in making payments, and summary judgment is granted in favor of insurer