Volume 11

11 Fla. L. Weekly Supp. 155a

Insurance — Personal injury protection — Standing — Assignment — Validity — Where only benefit being assigned by purported assignment is payment, document amounts to no more than directive to pay — Where clear and unambiguous language of document attached as exhibit to complaint, and on which medical provider relies to establish standing to sue, does not as matter of law amount to assignment of benefits, action may be disposed of in motion to dismiss

11 Fla. L. Weekly Supp. 791d

Insurance — Medpay — Coverage — Denial — Where medical provider failed to give timely notice of claim for MRI to insurer, provider forfeited right to PIP benefits, insured was relieved of obligation to pay to provider charges that were unpaid due to provider’s failure to give timely notice of claim, and insurer was not legally responsible to pay those PIP benefits to insured — However, unavailability of PIP benefits does not preclude availability of medpay benefits, and statute does not dictate time for making medpay claims — Where medpay benefits are available to pay portion of MRI bill insured was legally obligated to pay, and insured was relieved of obligation to pay portion of bill that would have been paid by PIP benefits if claim had been timely submitted, medpay benefits are due for balance of MRI bill for which insured is still obligated — Summary judgment in favor of insurer reversed

11 Fla. L. Weekly Supp. 660a

Insurance — Medpay — Where insurer issued check for ambulance service under medpay portion of policy after suit for medpay and personal injury protection benefits was filed, but prior to insurer having knowledge of suit, payment constituted confession of judgment — Insurer’s motion for summary judgment denied

11 Fla. L. Weekly Supp. 825b

Insurance — Personal injury protection — Service of process — Delay — Where small claims rules contemplate that summons/notice to appear should be served within 45 days from date of filing of action, but rules of civil procedure allow court to excuse failure to serve for good cause or excusable neglect, court finds that attempts to negotiate settlement of this and 70 other simultaneously-filed suits constitute good cause or excusable neglect for delay in effecting service — Motion to dismiss denied

11 Fla. L. Weekly Supp. 1029a

Insurance — Personal injury protection — Medical provider who sought payment in individual capacity improperly submitted HFCA form and patient letter which contained tax identification number for corporation — Box 25 of HFCA form must contain true federal identification number of health care provider/supplier who rendered service, and Box 33 must contain name, address and telephone number of provider/supplier who is billing for actually rendering the medical services to the insured — However, insurer waived this defense by previously paying three bills when provider submitted HCFA forms with corporation’s federal tax identification number without notifying provider that they believed that the I.D. number did not belong to provider as an individual

11 Fla. L. Weekly Supp. 1020b

Insurance — Personal injury protection — Claim forms — Provider/assignee that submitted HCFA forms that indicated that separate, distinct corporation with different federal taxpayer identification number from provider/assignee rendered billed services submitted fraudulent, misleading, and patently deceptive request for PIP benefits to prejudice of insurer and has no standing to prosecute claim — Coverage — Conditions precedent — Independent medical examination — Where insured failed to attend IME based on excuse that insured received IME notice in English and insured and/or aunt authorized to receive insured’s mail was only literate in Spanish, insurer is relieved of liability for PIP benefits

11 Fla. L. Weekly Supp. 33a

Torts — Health maintenance organizations — Action brought by physician and medical association against HMOs arising out of termination of provider contract — Deceptive and unfair trade practices — HMOs are exempted from Florida Deceptive and Unfair Trade Practices Act as entities regulated by the Department of Insurance — Civil conspiracy claim alleging HMOs conspired to commit deceptive and unfair trade practices fails for lack of underlying actionable wrong — Common law fraud — Count alleging that misrepresentations induced physician into continuing contract with HMOs, and not alleging that misrepresentations were made at time contract was entered into and induced physician to enter into contract, is barred by economic loss rule — Tortious interference with doctor-patient relationship — Claim for tortious interference cannot lie for HMOs’ interference with plaintiffs’ relationship with HMO members where HMOs were party to relations between plaintiffs and members, and plaintiffs have not shown that malice was sole basis for the interference — Even if privilege to interfere did not apply to HMOs, court would find that plaintiffs failed to state cause of action for tortious interference with doctor-patient relationship where complaint does not allege interference with a specific relationship, but only interference with such relationships as an indirect consequence of termination of provider contract

11 Fla. L. Weekly Supp. 1097b

Insurance — Personal injury protection — Affirmative defenses in answer stricken with leave to reallege with more particularity

11 Fla. L. Weekly Supp. 749a

Insurance — Personal injury protection — Coverage — Medical bills — Unreasonable, unnecessary or unrelated medical expenses — Medical provider’s motion for partial summary judgment on reasonable, necessary, and related issue is granted where affidavit of treating physician attesting that treatment was reasonable, necessary, and related was legally sufficient and independent medical exam report reached same conclusion — Opposing affidavit of president of company that specializes in medical file reviews is legally insufficient because affiant was not qualified to render opinion on reasonableness of treatment, and affidavit does not opine that charges are not reasonable, usual or customary — Affirmative defenses — Striking — Lack of specificity

11 Fla. L. Weekly Supp. 1079a

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related, and necessary treatment — Insurer that presented deposition testimony of adjuster and insured’s examination under oath failed to either impeach medical expert testimony of treating physician or present countervailing evidence from licensed physician to dispute reasonable, related, and necessary medical services and expenses — Medical provider is entitled to summary judgment where there does not exist any question of material fact regarding reasonableness, relatedness, and necessity of medical expenses and insurer’s failure to pay medical bills at full 80% — Affirmative defenses — Fraud — Insurer failed to specifically state fraud claim where insurer failed to state that it relied on billings and was damaged by expenses incurred in investigating fraudulent claim, insurer that did not pay bills did not sustain damage or rely to its detriment on claims for payment, and insurer has not shown or specified that provider had knowledge that alleged misrepresentation is false and intended that insurer rely upon it