Volume 12

12 Fla. L. Weekly Supp. 652a

Insurance — Personal injury protection — Coverage — Medical provider — Unregistered medical provider — Where medical provider was required to register as clinic but failed to comply with registration requirements, insurer is entitled to reimbursement of expenses paid to provider from insureds’ PIP policies — Insurer is permitted to seek and obtain reimbursement at any time, even if investigation into charges did not commence within thirty days from date bill was submitted to insurer

12 Fla. L. Weekly Supp. 959a

Insurance — Personal injury protection — Coverage — Medical expenses — Reduction — Reasonableness — Medical provider’s motion for summary judgment is denied where issue of reasonableness of usual and customary reduction remains in dispute

12 Fla. L. Weekly Supp. 693a

Insurance — Personal injury protection — Deductible — Appeal of judgment in favor of insurer in action by medical provider seeking amount of reductions to bills applied to deductible at 80% of reduced amount — Where total amount of bills at issue as originally billed is less than amount of deductible and bills were submitted before deductible was met, insurer was under no obligation to pay bills in whole or in part, and provider was not entitled to recover amount of reductions from insurer — Insurer correctly applied reduced medical bills rather than original amount to deductible

12 Fla. L. Weekly Supp. 985b

Insurance — Personal injury protection — Coverage — Medical expenses — Reduction — Preferred provider — Insurer not party to PPO contract — Medical provider’s motion for summary judgment is granted where provider has provided substantial record evidence that insurer is not party to contract or affiliate of parties to contract, insurer acknowledges it is not named party to contract, and insurer’s conclusory affidavit which fails to set forth source of affiant’s information or establish that affiant was competent to testify on issue is insufficient to create disputed issue of material fact as to whether insurer is affiliate of parties to contract

12 Fla. L. Weekly Supp. 230b

Insurance — Personal injury protection — Coverage — Medical expenses — Reduction — Preferred provider

12 Fla. L. Weekly Supp. 936a

Insurance — Personal injury protection — Failure to pay benefits — Error to grant insured’s motion for summary judgment where twelve affirmative defenses, all replete with numerous issues of fact, remained pending and where opposing party had not yet completed discovery — Reduced payments made by an insurer in accordance with a preferred provider agreement do not violate section 627.736(10)

12 Fla. L. Weekly Supp. 1102a

Insurance — Personal injury protection — Coverage — Medical expenses — Usual and customary charges — Judgment of insurer’s adjuster as to whether charges are usual and customary based on software “Fees on Disc” and AMA CPT code book cannot substitute for physician’s report required before withdrawal of benefits — Where adjuster does not know basis for amount given as ususal and customary charges by software, adjuster’s testimony is incompetent evidence insufficient to raise genuine issue of material fact — Where insurer obtained chiropractor’s report based on independent medical examination to withdraw further benefits, but treating chiropractor’s affidavit established that insurer received requests for payment for treatment prior to date of IME report, medical provider is entitled to partial summary judgment on issue of liability for treatment prior to IME date

12 Fla. L. Weekly Supp. 1098a

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Summary judgment — Where medical provider’s motion for summary judgment with supporting affidavit establishes prima facie entitlement to relief on issue of whether treatment provided to insured was reasonable, related and necessary, and insurer’s affidavit in opposition to motion was untimely served, summary judgment is granted in favor of provider — No merit to argument that summary judgment cannot be granted because insurer has filed motion to amend answer and affirmative defenses to allege misrepresentation — Court will not condone insurer’s dilatory conduct in waiting nine months after insurer became aware of possible misrepresentation to file motion to amend

12 Fla. L. Weekly Supp. 937a

Insurance — Personal injury protection — Coverage — No abuse of discretion in refusing to consider peer review notice when entering summary judgment in favor of medical providers where affidavit was untimely filed, and trial court found absence of any compelling reasons or exigent circumstances which might excuse tardiness

12 Fla. L. Weekly Supp. 1103a

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Police report stating no apparent injuries were observed does not create disputed issue of material fact regarding whether insured was injured in accident where officer’s statement is not inconsistent with insured’s examination under oath and affidavit stating that injuries were internal — Police report unsupported by affidavit fails to meet requirements of rule 1.510(e) and would not be admissible at trial as evidence of officer’s observations — Partial summary judgment granted in favor of medical provider