Volume 11

11 Fla. L. Weekly Supp. 1112b

Insurance — Personal injury protection — MRI — Assignment executed by insured in favor of plaintiff was legally valid and sufficient to confer standing — Florida law does not require patient to countersign legally assigned invoice, bill or health insurance claim form as condition precedent to payment of claim — Bill for MRI is not invalid merely because amount charged exceeds amount of applicable MRI Fee Schedule — MRI was reasonable and necessary diagnostic test which was related to injuries sustained in motor vehicle accident, and bill for MRI was submitted to insurer within 30 days of MRI — Plaintiff’s motion for summary judgment granted

11 Fla. L. Weekly Supp. 1098b

Insurance — Personal injury protection — Standing — Assignment — Validity — Document irrevocably assigning rights under policy is valid assignment — Claim form — Countersignature — Insured is not required to countersign HCFA forms as condition precedent to insurer paying assigned claim — HCFA form constitutes valid notice of loss — Coverage — Medical expenses — Magnetic resonance imaging — Statute does not invalidate MRI bill where amount of charge exceeds MRI fee schedule, but payment of PIP benefits for bill is limited to fee schedule amount — Medical provider is entitled to summary disposition where unrefuted evidence indicates that insured was involved in automobile accident, insured was covered by policy which included PIP benefits at time of accident, MRI was reasonable and necessary diagnostic test related to injuries sustained by insured in accident, bill for MRI was timely submitted to insurer within 30 days of treatment, and insurer failed to make any payment of PIP benefits in response to MRI bill — Reasonable, related, and necessary treatment — Evidence — Affidavit of insurer’s medical expert is insufficient to counter provider’s evidence of reasonableness, relatedness, and necessity of treatment, where expert is not licensed under same chapter as treating chiropractor, affidavit does not indicate that expert meets requirement of being in active practice unless physically disabled, affidavit was not filed until day of summary disposition hearing, and affidavit alters insurer’s previous position that only basis for denial of MRI bill was excessiveness of bill

11 Fla. L. Weekly Supp. 196b

Insurance — Personal injury protection — Application — Misrepresentations — Where insured misrepresented self by failing to inform insurer that he was married and that wife was member of his household, nullification of policy with return of entire premium and denial of coverage was within discretion of insurer — Error to award summary judgment in favor of insured

11 Fla. L. Weekly Supp. 936b

Insurance — Personal injury protection — Standing — Assignment is valid and enforceable — Claim form — Countersignature — Insured is not required to countersign HCFA forms as condition precedent to insurer paying PIP benefits — Magnetic resonance imaging — Amount billed for MRI in excess of preset fee schedule does not relieve insurer from paying reimbursable amount — HCFA bill is valid notice of claim — Provider is entitled to summary disposition on issue of whether insured was involved in automobile accident where insured’s affidavit states he was involved in accident, and insurer has presented no evidence to reveal genuine issue of fact — Application — Misrepresentation — Materiality — No merit to claim that insured committed material misrepresentation where insurer has presented no evidence that additional premium would have been applicable to insured

11 Fla. L. Weekly Supp. 878a

Insurance — Personal injury protection — Error to set aside verdict based on insured’s failure to personally appear at trial where attorney appeared on behalf of insured and was prepared to prosecute case through insured’s deposition and response to interrogatories, testimony of expert and records custodians of medical providers, and insured’s medical bills — Coverage — Late submitted bill — Error to grant judgment notwithstanding verdict based on submission of some medical bills more than thirty days after services were rendered where, even if five untimely bills were excluded, there were still timely bills in evidence — Even though 2001 revision to statute that extends time for filing bills which are originally filed with wrong carrier is inapplicable, reason and intent of statute compels court to find that where diligent effort was made to comply with statutory requirements in as timely a fashion as possible equity should prevail and medical providers should be compensated as determined by jury — Further, insurer suffered no prejudice since untimely receipt of bills did not prevent timely examination of insured — Insurer waived enforcement of statutory time limits by continuing to investigate accident and conducting examination under oath, independent medical examination, and peer review of all bills — Appellate attorney’s fees awarded to prevailing insured

11 Fla. L. Weekly Supp. 251a

Insurance — Personal injury protection — Insurer to furnish to plaintiff an itemized specification of unpaid charges — Plaintiff awarded reasonable attorney’s fees and costs

11 Fla. L. Weekly Supp. 1109a

Insurance — Personal injury protection — Settlement agreement — Statutory interest began accruing at rate of 12% where settlement payment was not tendered within 20 days of date settlement was reached and settlement was not conditioned upon execution of release — Accord and satisfaction — Plaintiff did not waive right to statutory interest when it cashed settlement check indicating that it was in full payment/final lawsuit settlement

11 Fla. L. Weekly Supp. 262b

Insurance — Personal injury protection — Assignment of benefits attached to second amended complaint is valid and, accordingly, insured did not have standing to bring suit against insurer for PIP benefits — Although caption was changed to add “for the use and benefits of” provider, insured remains the only plaintiff to lawsuit — Defendant’s motion for summary judgment granted

11 Fla. L. Weekly Supp. 238a

Insurance — Personal injury protection — Standing — Assignment — Where insured assigned all causes of action under policy to medical provider, assignment is irrevocable as to services at issue in case, and insured has presented nothing to indicate assignment was revoked, insured has no cause of action against insurer

11 Fla. L. Weekly Supp. 830a

Insurance — Personal injury protection — Coverage — Denial — Independent medical examination — Motion for summary judgment based on claim that notice of IME was defective for identifying only first of two dates of accident while denial letter sent to insured as result of IME contained only second date of accident is denied where neither statute nor insurance policy contain particular requirements for IME notice and referral form for IME, IME report, and explanation of benefits sent to insured address both dates of accident — Motion for summary judgment is denied on claim that IME is null and void because IME doctor was selected by third party vendor which scheduled IME, rather than by insurer, in contravention of insurance policy provision and statutory requirement that IME be upon request of insurer where there is evidence that IME was requested by insurer, insurer complied with statutory requirements in conducting IME, and insurance policy contains express provision conforming policy to statutory requirements