Volume 12

12 Fla. L. Weekly Supp. 96a

Insurance — Personal injury protection — Coverage — Medical expenses — Unreasonable, unrelated or unnecessary treatment — Summary judgment — Where medical provider filed affidavits of treating physicians which establish that all treatment was related to accident, reasonable, and necessary; and insurer failed to either substantially impeach medical expert testimony of treating physicians, present countervailing evidence from licensed physician, or establish that provider has not complied with conditions precedent; provider is entitled to summary judgment

12 Fla. L. Weekly Supp. 89a

Insurance — Personal injury protection — Civil procedure — Insurer’s reply to motion for summary judgment served one business day before motion hearing and affidavits of medical experts served on day of hearing are stricken as untimely served where insurer did not demonstrate that delay in service was excusable — Coverage — Reasonable, related or necessary medical expenses — Where medical provider presented affidavits of treating physician and insured to establish that medical expenses were reasonable, related, and necessary; insurer’s reply and affidavits have been stricken; and insurer has failed to establish that it had reasonable proof that it was not responsible for payment of medical bill within 30 days and failed to obtain report from physician in same licensing chapter as treating physicians stating no further treatment was medically necessary, all outstanding bills remain due and owing — Even if police report attached to insurer’s reply were considered, insured’s statements to police officer regarding subjective complaints are inadmissible hearsay — If statements were admissible as exception to hearsay rule, subjective statements regarding injuries at time of police report fail to create genuine issue of material fact regarding whether medical expenses were reasonable, related, and necessary — Summary judgment granted in favor of provider

12 Fla. L. Weekly Supp. 495a

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Summary judgment — Disputed issue of material fact as to reasonableness, relatedness or necessity of treatment is not created by insurer obtaining peer review stating not all treatment was reasonable, related and necessary after withdrawal or denial of medical payments — Where medical provider’s affidavit establishes that treatment was related to accident but does not offer opinion that treatment was reasonable and medically necessary, and this cannot be inferred from statement that provider examined insured and prescribed treatment she received, affidavit is not sufficient to eliminate all disputed issues of material fact — Insurer cannot challenge whether treatment was reasonable or medically necessary if provider is able to bring forth evidence that treatment was reasonable and medically necessary

12 Fla. L. Weekly Supp. 963a

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Where medical provider has submitted affidavit of physician attesting to reasonableness, relatedness and medical necessity of treatment and affidavit of provider’s officer manager attesting to reasonableness of charges, and insurer has filed nothing in response, provider’s motion for summary judgment is granted as to issue of whether expenses are reasonable, related and necessary — Provider’s motion for summary judgment is denied as to issue of whether insured provided insurer with written notice of accident because issue is question of fact for jury to determine

12 Fla. L. Weekly Supp. 376a

NOT FINAL VERSION OF OPINION
Subsequent Changes at 12 Fla. L. Weekly Supp. 485a

Insurance — Personal injury protection — Demand letter — Summary judgment is granted in favor of medical provider on defense of failure to furnish pre-suit demand letter where there is no factual dispute that provider did furnish letter, and provider’s obligation to provide letter dissipated when insurer suspended benefits — Coverage — Medical expenses — Reasonable, related and necessary expenses — There does not exist any question of material fact regarding reasonableness, relatedness and necessity of medical expenses and court grants motion for summary judgment where insurer failed to establish that it had reasonable proof it was not responsible for payment of bills within 30 days of receipt and failed to file properly authenticated and sworn report from physician licensed under same chapter as treating physicians stating no further treatment was medically necessary — Adjuster’s sworn answers to interrogatories referencing hearsay independent medical examination report is insufficient as matter of law to substantiate IME suspension date or otherwise support defense that expenses are not reasonable, related or necessary

12 Fla. L. Weekly Supp. 782a

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary expenses — Evidence — Accident report that does not include insured is not admissible evidence to defeat insured’s motion for partial summary judgment on issue of reasonableness, relatedness and medical necessity because report is not self-authenticating and neither statutes nor rules provide hearsay exception concerning accident reports — Where accident report was sole evidence relied upon by insurer at summary judgment hearing, motion for partial summary judgment granted

12 Fla. L. Weekly Supp. 532a

Insurance — Personal injury protection — Coverage — Evidence — Accident report privilege — Error to admit accident report into evidence because report is expressly inadmissible under section 316.066(4) and facts of case do not fall within exception to privilege — Error was harmless where treating physician’s testimony and insured’s medical records, to which insurer did not object, provided jury with substantial factual basis to conclude insured was involved in automobile accident for which he sought medical treatment — Treating physician’s testimony was admissible as exception to hearsay rule where he testified that he relied on automobile accident information for purposes of diagnosis and treatment

12 Fla. L. Weekly Supp. 33a

Insurance — Personal injury protection — Coverage — Unreasonable, unrelated or unnecessary medical expenses — Where insurer did not raise affirmative defense of excessiveness of amounts billed or present any evidence that individual amounts billed were excessive, medical provider met burden of proof on reasonableness and necessity of services through testimony of treating physician and was not required to present specific expert testimony addressing reasonableness of amounts billed — On cross-claim, summary judgment against third-party provider of MRI and CT-scan is reversed and remanded for trial on reasonableness and necessity of tests

12 Fla. L. Weekly Supp. 271a

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary expenses — Where both accident and treatment occurred during September 2001, policy on which claim is based could not have been classified as new or renewed on or after October 1, 2002 — Accordingly, court must examine verdict finding that motion x-ray was necessary relative to requirements for reimbursement of medical expenses prior to 2001 amendment that replaced common law standard of whether procedure was “reasonably necessary” with higher standard that procedure be “medically necessary” — Where fact finder determined that medical provider met burden on higher standard of “medically necessary,” appellate court can affirm verdict in light of correct lower standard of “reasonably necessary” as long as it too is supported by competent substantial evidence

12 Fla. L. Weekly Supp. 393a

Insurance — Personal injury protection — Coverage — Denial — Reasonable, related and necessary treatment — Where medical provider has presented competent that treatment provided to insured was reasonable, related and medically necessary, and insurer has presented competent sworn evidence of independent medical examination and peer review report to raise issue of material fact as to whether treatment that occurred after date of withdrawal of benefits was reasonable, related and necessary but has not presented any competent sworn evidence for treatment prior to that date, provider is entitled to partial summary judgment on issue of liability for treatment prior to withdrawal date