Volume 12

12 Fla. L. Weekly Supp. 671a

Insurance — Personal injury protection — Coverage — Medical bills — Late-submitted bill — Action by insured against PIP carrier for satisfaction of liens claimed by Medicare and health insurance carrier for medical bills originally submitted to and paid by health insurer and Medicare — Where bills were not submitted to PIP insurer within 30 days of rendition of treatment, bills are neither payable nor enforceable

12 Fla. L. Weekly Supp. 663a

Insurance — Personal injury protection — Medical expenses — Functional capacity testing — Patient brokering — Kickbacks — Where technician employed by plaintiff mobile diagnostic business traveled to medical provider’s office to perform FCEs in provider’s treatment room, technician used plaintiff’s marketing method to obtain referral of insured by instructing provider he could bill for professional component of FCEs, marketing materials described to provider that referral would increase provider’s revenues by ability to bill substantial professional component, plaintiff’s method for soliciting referral of insured is unlawful as billing of professional component acted as improper financial consideration that induced referral — Billing of technical component and professional component for same FCEs is unlawful and violates spirit of statutes prohibiting patient brokering and kickbacks — Plaintiff that engaged in unlawful billing practices has failed to lawfully render reimbursable service pursuant to PIP statute

12 Fla. L. Weekly Supp. 1036a

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Fee-splitting — Patient brokering — Global billing by medical provider which performed technical component of MRI but contracted with independent radiologist to perform professional component — Where provider billed $250 for professional component of MRI services, and only professional services rendered were by independent radiologist who charged provider $50, payment sought by provider would result in fee-splitting and patient brokering — Remand with instructions to enter judgment in favor of insurer

12 Fla. L. Weekly Supp. 787a

Insurance — Personal injury protection — Coverage — Denial — Reasonable proof within 30 days — Insurer is not barred from contesting claim for PIP benefits by failing to pay claim or schedule EUO within 30 days of receipt of written notice of covered loss — Medical provider’s motion for summary judgment on issue of reasonableness, relatedness and necessity of medical expenses is denied although insurer has not presented any proof disputing reasonableness, relatedness or necessity, because affidavit submitted by provider which states that affiant is responsible for ensuring that charges are reasonable, properly coded and timely submitted fails to establish prima facie case that charges are reasonable, related and medically necessary — Examination under oath — Failure to attend — Where insurer itself breached PIP policy by failing to pay bills or schedule EUO within 30-day authentication period, motion for summary judgment based on insured’s failure to attend EUO is denied

12 Fla. L. Weekly Supp. 835b

Insurance — Personal injury protection — Examination under oath — Failure to attend — Where insurer scheduled EUO outside thirty-day investigatory period following receipt of first set of bills, but within thirty-day period after receipt of second set of bills, medical provider was entitled to summary judgment as to first set of bills only

12 Fla. L. Weekly Supp. 789a

Insurance — Personal injury protection — Coverage — Medical bills — Failure to authenticate within thirty days — Insurer’s attempts to toll time for authentication of medical bills through submission of explanation of benefits forms stating that bills were delayed were in clear violation of PIP statute — Since insurer was required to obtain peer review report as condition precedent to denial of payment for medical bills, insurer may not rely on report obtained after denial of payments — Partial summary judgment granted in favor of medical provider REVERSED at 14 Fla. L. Weekly Supp. 339a

12 Fla. L. Weekly Supp. 172a

Insurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Subsequent claim for unpaid bills — Summary judgment — Where benefits were available at time provider’s bills were received and thirty days after receipt of bills when liability for overdue PIP benefits was established, insurer is precluded from raising defense of subsequent exhaustion of benefits — Provider’s motion for partial summary judgment is granted

12 Fla. L. Weekly Supp. 938a

Insurance — Personal injury protection — Coverage — Medical expenses — Evidence — Harmful error to strike medical records relating to NCVs admitted into evidence during medical provider’s case, which were admissible under evidence code — With records in evidence, error to grant motion for directed verdict on NCV issue at close of provider’s case — Error to grant motion for directed verdict on issue of non-payment for MRIs where provider had arguable position of substantial compliance with statutes relating to form and substance of bills and predicate for arguing that preparation and submission of bills complied with tradition, custom and commonly accepted business practice in PIP community

12 Fla. L. Weekly Supp. 1097b

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Peer review obtained after insurer decided not to pay claim and to withdraw benefits was not timely obtained — No merit to argument that requirement to obtain medical report before withdrawal of benefits applies only when insurer had decided to pay claim and later changed mind

12 Fla. L. Weekly Supp. 161b

Insurance — Personal injury protection — Coverage — Denial — Explanation of benefits — Sufficiency — Where, rather than setting forth precise reason for denial of claim, insurer’s letters set forth verbatim roster of statutes, letters failed to meet statutory requirements for EOB — In failing to comply with statutory requirement to provide itemized specification for declined claims, insurer breached insurance contract — Partial summary judgment entered in favor of medical provider as to liability