Volume 12

12 Fla. L. Weekly Supp. 375a

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Where insurer failed to establish it had reasonable proof it was not responsible for payment of medical bills within 30 days of receipt and has failed to establish that charges were not reasonable, related and necessary or that medical providers did not comply with any conditions precedent, summary judgment is granted as to all medical expenses except $450 waived by provider upon court’s finding that peer review raises genuine issue of material fact regarding those expenses

12 Fla. L. Weekly Supp. 867a

Insurance — Personal injury protection — Rehearing — Provider’s policy of giving 50% discount to patients who pay for medical treatment in cash rather than through insurance violates state law — Motion for rehearing in which provider seeks to introduce evidence that discount policy was not in effect on date of service at issue is denied — Final judgment with prejudice is appropriate as insurer or insured is not required to pay claim for service that was not lawful when rendered

12 Fla. L. Weekly Supp. 265a

NOT FINAL VERSION OF OPINION
Subsequent Changes at 12 Fla. L. Weekly Supp. 867a

Insurance — Personal injury protection — Provider’s policy of giving 50% discount to patients who pay for medical treatment in cash, rather than through insurance, violates state law — Although small percentage of reductions for cash payment might be understandable given cost of doing business with insurance companies, 50% reduction amounts to charging insurance companies an premium rate, which is illegal — Court notes that pro bono or reduced fee medical rates for indigents are not affected by ruling

12 Fla. L. Weekly Supp. 93b

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related or necessary treatment — Medical provider’s motion for summary judgment is granted where there is no genuine issue of material fact as to reasonableness, relatedness, and necessity of medical bills or as to issue of provider’s licensure to provide physical therapy

12 Fla. L. Weekly Supp. 668b

Insurance — Personal injury protection — Medical bills — Reduction — Needle electromyography procedure — Statutory limitation of charges to 200% of allowable amount under Medicare Part B reimbursement schedule applies only to medically necessary nerve conduction testing when done in conjunction with needle electromyography not to medically necessary electromyography testing procedure alone

12 Fla. L. Weekly Supp. 1175a

Insurance — Personal injury protection — Coverage — Medical benefits — MRI — Affidavit of treating physician that cervical and lumbar MRIs at issue were reasonble, medically necessary, and related to subject motor vehicle accident was not substantially impeached, and no countervailing evidence from licensed physician was presented — Accordingly, provider/assignee is entitled to summary judgment as a matter of law

12 Fla. L. Weekly Supp. 870a

Insurance — Personal injury protection — Medical expenses — Magnetic resonance imaging — Where testimony of medical provider that MRI was related and medically necessary was unrefuted by any contradictory medical evidence and not severely impeached on cross-examination, verdict for insurer is against manifest weight of evidence — Further, fact that insurer failed to submit any report by physician licensed under same chapter as provider stating MRI was not reasonable, related or necessary precludes insurer from denying payment — Notice of loss — Timeliness — Record fails to demonstrate that insurer was prejudiced by 68-day delay in receiving notice of accident where insurer set independent medical examination for one month after receipt of notice and set examination under oath nearly four months after receipt of notice, and insurer did not attempt to use surveillance to investigate claim, although insured was still undergoing treatment after notice of loss was provided, or attempt peer review — Judgment notwithstanding verdict is entered on issues of relatedness and medical necessity and verdict is directed on late notice issue that jury never reached

12 Fla. L. Weekly Supp. 384b

Insurance — Personal injury protection — Coverage — Where medical provider established prima facie case of necessity of MRI and authenticity of assignment of benefits, and insurer failed to carry burden of establishing question of fact and admits it has no basis to challenge authenticity of assignment, summary judgment is granted in favor of provider

12 Fla. L. Weekly Supp. 989a

Insurance — Personal injury protection — Demand letter — MRI — Amount in excess of statutory fee schedule — Demand letter for MRI which sought amount in excess of maximum compensable amount set by statute failed to satisfy statutory requirement for demand letter as matter of law — Summary judgment granted in favor of insurer

12 Fla. L. Weekly Supp. 1094b

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Where insurer paid MRI provider pursuant to participating fee schedule under Medicare Part B without any consumer price index increase, insurer is liable to provider for consumer price index increase