Volume 12

12 Fla. L. Weekly Supp. 925d

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Evidence — Hearsay — Medical diagnosis or treatment — Insured’s medical record and treating physician’s testimony that he relied on accident information to diagnose and treat insured is admissible to establish existence of accident

12 Fla. L. Weekly Supp. 116a

Insurance — Personal injury protection — Coverage — Usual and customary charges — Summary judgment — Factual issues — No error in granting summary judgment in favor of medical provider where only affidavit on file at time of hearing on motion for summary judgment was affidavit filed by provider which swore that bill was usual and customary, and insurer filed mere denial unsupported by affidavit, testimony, or other evidence disputing amount of bill — Affidavit of insurer’s adjuster filed 27 days after summary judgment hearing, which did not contain any documentation demonstrating what insurer would consider to be reasonable amount for bill, assert that affiant was licensed physician, or give reason why bill was denied in its entirety, cannot be considered competent substantial evidence — Other affidavit filed by adjuster relates to another claim and suit and cannot be considered competent reasonable proof in case — Motion for rehearing was properly denied where it was based on late affidavit and failed to bring to attention of court any matter overlooked or misunderstood

12 Fla. L. Weekly Supp. 254c

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Summary judgment — Medical provider’s motion for summary judgment is granted where insurer failed to support answer and affirmative defenses asserting that medical services were not reasonable, related and necessary with affidavit; provider filed affidavit of physician swearing that services were reasonable, related and necessary, and insurer did not offer counter affidavit or otherwise respond to provider’s affidavit

12 Fla. L. Weekly Supp. 244b

Insurance — Personal injury protection — Coverage — Defenses — Failure to attend examination under oath — Where insurer did not schedule EUO within 30 days of receipt of notice of loss, insurer breached insurance policy by failing to pay PIP claim within 30 days after notice or establish that it had reasonable proof it was not liable for payment; and insurer is barred from using insured’s failure to attend EUO as defense or reason for nonpayment — Independent medical examination — Cutoff of benefits based on IME report by chiropractor only affects chiropractic benefits and is inapplicable to bills from orthopedic medical provider — Demand letter — Requirement to send pre-suit demand letter was obviated by insurer’s denial of benefits based on alleged failure to attend EUO — Summary judgment granted in favor of providers where insurer failed to substantially impeach medical expert testimony of treating physicians or present countervailing evidence from licensed physician to dispute reasonableness, relatedness, and necessity of medical services and expenses

12 Fla. L. Weekly Supp. 984b

Insurance — Personal injury protection — Coverage — Withdrawal — Failure to obtain medical report — Where insurer failed to obtain medical report prior to deciding not to pay claim, medical provider is entitled to summary judgment — No merit to argument that requirement of medical report prior to “withdrawal” of benefits applies only when insurer has decided to pay claim and then later changes its mind

12 Fla. L. Weekly Supp. 969a

Insurance — Personal injury protection — Coverage — Medical expenses — Unreasonable, unrelated or unnecessary treatment — Failure to obtain medical report within 30 days — Insurer cannot defend suit for denial of benefits on grounds of reasonableness, necessity or relatedness where peer review was not obtained until after bills became due and owing

12 Fla. L. Weekly Supp. 877a

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary services — Insurer created jury issue as to whether treatment was reasonable, related and necessary where insurer severely impeached medical provider during cross-examination with respect to provider’s inability to determine when accident occurred from clinical evaluation of insured who presented for treatment one month after accident, provider’s failure to include insured’s physical labor in prior history, and provider’s inability to tell how insured’s cyst came about or logically relate cyst to accident, and jury issues were also presented by insured’s testimony with respect to delay in seeking treatment and lack of physical injury in accident — Renewed motion for directed verdict and motion for judgment notwithstanding verdict in insurer’s favor is denied

12 Fla. L. Weekly Supp. 430a

Insurance — Personal injury protection — Coverage — Medical expenses — Relation to accident — Evidence — Hearsay — Exceptions — Double hearsay of medical provider’s records containing insured’s statement to physician that she was in automobile accident was properly admitted to prove insured’s injuries were related to accident where provider’s records were introduced by records custodian who satisfied all predicate requirements for business records exception, and statement to physician without mention of identity or fault falls within hearsay exception for statements made for purposes of medical treatment

12 Fla. L. Weekly Supp. 669c

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable charges — Summary judgment is precluded where genuine issue of material fact as to whether database accurately assessed reasonableness of medical provider’s charges remains to be determined

12 Fla. L. Weekly Supp. 126b

Insurance — Personal injury protection — Summary judgment — Factual issues — Error to enter summary judgment where there are factual issues as to whether medical expenses were reasonable, necessary or related