Volume 12

12 Fla. L. Weekly Supp. 539c

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Insurer is not relieved of liability for payment of benefits for an otherwise payable MRI bill because bill submitted reflects amount in excess of amount allowed under statutory scheme — Insurer remains obligated to pay amount allowed under statutory fee scheme based on percentage of coverage afforded under policy

12 Fla. L. Weekly Supp. 480a

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Insurer’s affidavit with unauthenticated paper independent medical examination report attached is stricken because IME report is inadmissible evidence — Obtaining paper IME report over one year after receipt of bills, long after denial or refusal of payment and after medical provider filed suit for breach of contract to pay PIP benefits, is not in compliance with statutory requirement to obtain medical report stating treatment is not reasonable, related or necessary as condition precedent to withdrawing or refusing payment — Fact that HCFA form submitted to insurer sets forth amount greater than MRI fee schedule does not provide defense to payment — Final summary judgment is entered in favor of provider

12 Fla. L. Weekly Supp. 444b

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — No merit to argument that trial court erred in granting summary disposition in favor of medical provider when it was never established that MRI bill was reasonable where provider agreed to insurer’s request to move scheduled summary disposition hearing to later date subject to proviso that record would be frozen as of original hearing date, and issue of reasonableness of MRI bill raised in peer review was not disclosed prior to original hearing date — Although statute limits what may be charged for MRI service, MRI charge in excess of fee schedule amount does not provide absolute defense to payment — No error in entering summary judgment in favor of provider where affidavit of treating physician indicated why MRI was ordered, affidavits of provider’s corporate representative and records custodian verified that MRI was performed, authenticated billing records and indicated how provider credits patient and insurer under fee schedule, and insurer failed to present contrary evidence sufficient to reveal genuine issue

12 Fla. L. Weekly Supp. 102b

Insurance — Personal injury protection — Coverage — Magnetic resonance imaging — Charges for MRI are subject to statutory fee schedule irrespective of amount of charge on HCFA form — Insurer’s motion for summary judgment denied

12 Fla. L. Weekly Supp. 715b

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Where original language of section 627.736(5)(b)(5) did not define “medical Consumer Price Index for Florida” to be used to adjust amount to be charged to PIP insurer for MRI and no index by that exact name exists, but Medical Care Item of CPI for all Urban Consumers in South Region is only CPI that fits within parameters set forth in statute, and clarifying amendment plainly evinces legislature’s intent that medical CPI for Florida means CPI for Urban Consumers in South Region, trial court erred in not considering adjustment to MRI payment based on that CPI — Demand letter — Medical provider was not required to furnish demand letter as condition precedent to filing suit involving claim that was reduced

12 Fla. L. Weekly Supp. 725d

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Trial court properly ruled on claim, applying precedent holding that allowable amount under Medicare Part B refers to Medicare’s participating fee schedule

12 Fla. L. Weekly Supp. 153a

Insurance — Personal injury protection — Coverage — Magnetic resonance imaging — Medicare fee schedule adjustment — Prior to effective date of amendment to PIP statute, appropriate fee schedule to compensate medical provider for MRI was based on Medicare Part B schedule, not limiting charge — Where Consumer Price Index for Florida, named in statute prior to amendment as basis for determining amount to calculate adjustment for consumer price index for MRI does not exist, insurer properly paid for MRI services by paying 200% of Medicare Part B schedule without adjustment

12 Fla. L. Weekly Supp. 335c

Insurance — Personal injury protection — Coverage — Medical expenses — MRI

12 Fla. L. Weekly Supp. 590a

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Unlicensed medical provider — Defense that medical provider’s treatment was unlawful for failure to have required medical license fails where provider’s affidavits were sufficient to shift burden of going forward on defense to insurer, and insurer proffered nothing — Peer review report concluding that MRI was not necessary is not valid report required prior to withdrawing treatment authorization where peer review physician did not examine insured and report fails to mention report of physician who conducted independent medical examination and rendered no opinion on necessity of MRI — 2001 amendment to section 627.736(7) evinces legislative intent to end practice of peer review physicians opining merely on basis of records review by requiring that such conclusions be supported by physical examination — Summary judgment granted in favor of provider

12 Fla. L. Weekly Supp. 494b

Insurance — Personal injury protection — Coverage — Medical providers — Failure of medical provider to obtain occupational license does not operate as bar to recovery of PIP benefits — Medical treatment is “lawfully rendered” despite lack of occupational license since county occupational license law is not law related to provision of medical services and treatment