Volume 12

12 Fla. L. Weekly Supp. 88b

Insurance — Personal injury protection — Coverage — Lost wages — Insured is entitled to loss of gross income for time he was forced to take as paid vacation days due to injuries, and insurer does not receive credit in amount paid to insured by his employer for those vacation days — Unreasonable, unrelated or unnecessary medical expenses — Summary judgment on entitlement to payment for medical services is precluded by factual issue regarding reasonableness, relatedness, and necessity of services raised by peer review

12 Fla. L. Weekly Supp. 1035b

Insurance — Personal injury protection — Coverage — Pedestrian struck by rented vehicle — Appeal of judgment in favor of rental car company in action by injured pedestrian against both rental company and driver’s PIP insurer — Where rental car driver’s PIP policy covers any pedestrian struck by “covered vehicle,” policy defines “covered vehicle” as all vehicles owned by policyholder, and section 324.021(9)(b)(2) classifies lessor of rental vehicle as owner of vehicle for purposes of liability, injury to pedestrian struck by rented car is covered by PIP policy

12 Fla. L. Weekly Supp. 826c

Insurance — Personal injury protection — Error to enter summary judgment in favor of insurer where insurer’s failure to file answer necessarily created issues of fact — Further, competing affidavits of claims adjuster, insured and insured’s mother as to whether insured had notified insurer prior to accident of move to Florida from state without PIP benefits created genuine issue of fact precluding summary judgment — If trial court determined that insured had not properly framed cause of action, opportunity to amend complaint should have been granted where no answer had been filed and insured may have bona fide cause of action if she timely notified insurer’s agent of change of residence — Demand letter — Affirmance is not warranted on alternative basis that summary judgment should have been granted because insured failed to serve demand letter where neither party has raised or argued that issue on appeal

12 Fla. L. Weekly Supp. 377a

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — MRI — No merit to insurer’s claim that it is not obligated to make any payment for MRI because amount billed exceeded statutory maximum — Where treating physician’s testimony established that MRI was medically necessary and related to insured’s injuries; court cannot consider peer review report that was not obtained before MRI bill was denied; and independent medical examination report does not express any opinion concerning necessity of MRI or other care rendered prior to examination; there is no genuine issue of material fact regarding reasonableness, relatedness and necessity of MRI — Fraud — Affirmative defense of fraud is deemed waived where insurer has provided no facts in answer that would support defense — Demand letter — Where evidence establishes that pre-suit demand letter was mailed and was received by insurer, and demand letter was not required because insurer denied payment of medical bill, affirmative defense of failure to send sufficient demand letter fails — Provider’s motion for summary judgment granted

12 Fla. L. Weekly Supp. 1174a

Insurance — Personal injury protection — Explanation of benefits — Failure to provide — Motion for partial summary judgment as to count alleging breach of contract for failure to provide EOB is granted where insurer concedes it failed to provide EOB

12 Fla. L. Weekly Supp. 790a

Insurance — Personal injury protection — Coverage — Denial — Reasonable proof within thirty days — Claims adjuster’s deposition testimony that insurer down-coded CPT codes at issue without reasonable proof, in conjunction with medical provider’s motion for partial summary judgment, shows insurer failed to obtain reasonable proof within 30-day authentication period — Affidavit of president of coding consultant firm does not establish dispute of material fact as to CPT codes — Affidavit prepared for sole purpose of litigation and lacking trustworthiness is inadmissible — Exhaustion of policy limits — Insurer that failed to plead exhaustion of policy limits as defense before or during hearing on motion for partial summary judgment waived defense — Partial summary judgment granted in favor of provider

12 Fla. L. Weekly Supp. 486a

Insurance — Personal injury protection — Coverage — Medical expenses — Reduction — Exhaustion of policy limits — Subsequent claim for unpaid portion of medical bills — Summary judgment is precluded by factual issue of whether reduced amount paid by insurer prior to policy limits exhausting was reasonable amount for services provided

12 Fla. L. Weekly Supp. 567a

Insurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Subsequent claim for unpaid portion of bills — Where initial timely submission of bill to insurer prior to exhaustion of policy limits sufficiently placed insurer on notice that litigation may ensue if bill was not paid in full, insurer paid bill at reduced amount, and medical provider filed suit for unpaid portion of bill after policy limits were exhausted but prior to expiration of statute of limitations for breach of contract action, genuine issue of material fact as to whether provider’s charges were unreasonable or unnecessary prevents entry of summary judgment in favor of insurer

12 Fla. L. Weekly Supp. 75b

Insurance — Personal injury protection — Coverage — Medical expenses — Reduction — Claim for unpaid portion of bills subsequent to exhaustion of policy limits — Where policy limits were exhausted well before suit was filed, insurer is as matter of law not liable to provider for remainder of reduced benefits or denied benefits but may still be liable for statutory damages for lateness of reduced and denied payments, including interest and attorney’s fees — Insurer’s motion for summary judgment is granted in part and denied in part

12 Fla. L. Weekly Supp. 674b

Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — Subsequent claim for unpaid portion of bills — Motion for summary judgment is denied despite failure of medical provider to put insurer on notice of dispute regarding insurer’s reduction of bill prior to exhaustion of policy limits where issue of whether sufficient benefits were awarded to pay provider properly and in accordance with statute prior to benefits being exhausted is question for trier of fact