Volume 12

12 Fla. L. Weekly Supp. 483a

Insurance — Personal injury protection — Failure of provider to provide professional license number in space provided for “Signature of Physician or Supplier, Including Degree or Credentials” — Insurer’s motion for summary judgment granted

12 Fla. L. Weekly Supp. 152b

Insurance — Personal injury protection — Demand letter — Case is stayed until medical provider submits proper demand letter and insurer is given prescribed deadline for response

12 Fla. L. Weekly Supp. 83a

Insurance — Personal injury protection — Coverage — Affirmative defenses — Examination under oath — Failure to attend — Insurer is barred from using insured’s failure to attend EUO as reason for non-payment where insurer failed to timely schedule EUO within 30 days of notice of loss — Independent medical examination — Failure to attend — Where insurer rescheduled IME appointment, it waived right to suspend benefits as of first IME date — However, where insured unreasonably failed to attend rescheduled IME, medical bills received after that date are not payable by insurer — Claim form — Failure to properly complete box 31 of HCFA form is not legal basis to deny payment — Civil procedure — Motion to strike affidavit of medical provider’s office manager as untimely served is denied where affidavit was served by facsimile 14 days prior to hearing and insurer had ample opportunity to file affidavits in opposition thereto and did so — There is no requirement for moving party to file affidavit in support of motion for summary judgment 20 days prior to hearing — Motion for summary judgment is granted where provider complied with all conditions precedent to suit, and there do not exist any questions of material fact regarding reasonable, necessary, and related medical expenses incurred by insured and insurer’s failure to pay

12 Fla. L. Weekly Supp. 173a

Insurance — Personal injury protection — Claims — Disclosure and acknowledgment form — Medical provider that submitted copy of disclosure and acknowledgment form with initial bills substantially complied with statutory requirement, and insurer waived defense by not informing provider of need to submit original — Provider has substantially complied with requirement for provider’s signature on HCFA form

12 Fla. L. Weekly Supp. 483b

Insurance — Personal injury protection — Coverage — Notice of loss — Where insurer never received original and valid disclosure and acknowledgment form, it was never provided with written notice of covered loss and is not responsible for payment of benefits — Summary judgment granted in favor of insurer

12 Fla. L. Weekly Supp. 262a

Insurance — Personal injury protection — Demand letter — Motion for summary judgment on ground that demand letter was sent to wrong insurer is denied — Original claims were received and acted on without denial of coverage by incorrect insurer having similar name and same address, same registered agent, and the same person authorized to receive demand letters as correct insurer — Insurer cannot thwart intent of statute allowing resubmission of claim by not sending denial and then using failure to notice proper insurer as defense — Insurer’s motion for summary judgment on whether billing for separate CPT codes constituted unlawful unbundling is denied where no evidence was presented to dispute affidavit swearing services were properly coded — Bills were overdue when demand letter and suit were filed given fact that insurer’s written request for documentation was not dated until 51 days after notice of covered loss

12 Fla. L. Weekly Supp. 887c

Insurance — Personal injury protection — Coverage — Medical expenses — Physician’s sworn affidavit resolved issue of whether provider’s medical personnel were licensed at time they rendered treatment to insured — Physician was legally licensed as osteopathic physician at time he rendered treatment to insured — There is no requirement that provider provide proof of licensing when submitting written notice of covered loss — Claim form — Failure to comply with countersignature requirement not basis for denying coverage — Evidence — Hearsay — Insured’s statements to provider that he sustained injuries related to automobile accident fell within exception to hearsay for statements pertinent to medical diagnosis or treatment, and provider’s testimony was sufficient to establish that insured was involved in an automobile accident

12 Fla. L. Weekly Supp. 218b

Insurance — Personal injury protection — Claims — Medical bills — Countersignature by insured — No error in granting summary judgment holding that section 627.736 does not require medical bills attached to HCFA 1500 to be countersigned by insured where medical provider has accepted an assignment of benefits

12 Fla. L. Weekly Supp. 171a

Insurance — Personal injury protection — Standing — Assignment is valid — Claim form — Countersignature — There was no requirement for insured to countersign HCFA forms where medical provider has accepted assignment of benefits — Coverage — Magnetic resonance imaging — Insurer is not relieved of liability for MRI by fact that amount of bill exceeds fee schedule — Summary judgment is granted in favor of provider on issues of whether insured was involved in automobile accident, has submitted valid notice of claim, and was covered on date of loss by valid policy issued by insurer; whether provider timely billed for MRI; and whether insurer failed to timely pay bill — Peer review report precludes summary judgment on issue of whether MRI was reasonable, related, and necessary

12 Fla. L. Weekly Supp. 40a

Insurance — Personal injury protection — Complaint — Amendment — Denial — Abuse of discretion to deny medical provider’s motion to amend complaint where provider had filed only one original complaint which it sought to amend once, and there was no surprise or prejudice to insurer since allegations in amended complaint were identical to those of original complaint and proposed amendment was to assert valid cause of action for breach of contract to which insurer had already raised defenses in answer to original complaint — Claims — HCFA form — Countersignature — Error to enter summary judgment against provider on claim for declaratory relief on issue of necessity of countersignature on HCFA forms where courts have uniformly interpreted countersignature provision in section 627.736(5)(a) as permitted, not mandatory, mechanism that does not require insured’s signature when benefits have been assigned to provider