Volume 12

12 Fla. L. Weekly Supp. 754b

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Claimant which did not perform any service to or for insureds other than billing for services that were contracted out was not entitled to recover PIP benefits for services allegedly provided to insureds — Claimant concealed fact that it was billing for services performed by other companies and/or independent contractors when it checked “no” in box 20 of HCFA form indicating that no outside lab was used — Claimant knowingly submitted HCFA forms requesting direct payment from insurer for professional component of MRI services in excess of the maximum amount permitted by statute — Insurer was not furnished with notice of a covered loss for bills where bills were not truthfully and accurately completed in accordance with statute and HCFAs — Intentional misrepresentations in any part of claim voids all coverage for claims — Further, by accepting irrevocable assignment of benefits, claimant became third-party beneficiary of insurance contract, and was bound by terms and conditions of policy — Intentional misrepresentations violated policy’s misrepresentation provision and, accordingly, claimant was not entitled to any benefits under assignment of benefits — Claimant was proprietary clinic and was required by statute to register and have a medical director, and insurer is entitled to recover all amounts paid during period when claimant was not in compliance with statute — Claimant could not recover directly from insurer when it presented or caused to be presented HCFA form that was not signed in box 31 by health care provider certifying that services were actually rendered and medically necessary — Term “render” as used in section 627.736 requires that person who executes box 31 of HCFA and submits HCFA claim form must be the medical provider/supplier to have actually physically performed the medical services or directly supervised the performance of such services, and a clinic may not under this statute subcontract or retain another corporation or independent contractor to perform these services — Fee arrangement between claimant and interpreting physician’s company contemplated impermissible fee-splitting arrangement — Insurer may recover payments made to claimant, together with post judgment and prejudgment interest

12 Fla. L. Weekly Supp. 1034b

Insurance — Personal injury protection — Medical benefits — MRI — There was sufficient conflicting evidence to create factual question for jury on issue of reasonableness of MRI charge, and trial court did not err in denying motion for directed verdict on this issue — Abuse of discretion to deny motion for mistrial based on opposing counsel’s prejudicial and inflammatory remarks in closing argument that insurer did not know what a reasonable charge was because “they don’t pay,” and that insurer was a “fighting machine” — Comments were so inflammatory that they were incurable and resulted in denial of fair trial

12 Fla. L. Weekly Supp. 399a

Insurance — Personal injury protection — Coverage — Denial — Misrepresentations — Where insured misrepresented to insurer investigating claim of plaintiff that he was injured while working on insured’s vehicle in insured’s garage that alleged accident did not occur, policy relieves insurer of liability for plaintiff’s claim despite fact that plaintiff was not person who committed misrepresentation — No merit to argument that PIP statute, which at time of incident contained no fraud provisions, superseded fraud provisions of policy and required payment of PIP benefits

12 Fla. L. Weekly Supp. 770a

Insurance — Medpay — Demand letter — Insured is not required to send demand letter to insurer prior to filing suit for overdue or unpaid benefits under medical payment insurance

12 Fla. L. Weekly Supp. 256a

Insurance — Personal injury protection — Medpay — Demand to escrow PIP and Medpay benefits is stricken — Discovery — Motion to compel better answers to interrogatories and better response to request to produce is granted

12 Fla. L. Weekly Supp. 865c

Insurance — Personal injury protection — Med pay — Escrow of benefits — Request for reservation of benefits in amount sufficient to cover claims denied

12 Fla. L. Weekly Supp. 153b

Insurance — Personal injury protection — Limitation of actions — Statute of limitations did not begin to run on date insurer provided notice that it would no longer pay PIP benefits or on date of first treatment after insurer’s general denial of benefits, but on each new date of treatment after general denial — Motion for summary judgment is denied for services received within five years of filing of complaint

12 Fla. L. Weekly Supp. 149b

Insurance — Liability — Subcontractor’s general liability policy — Coverage — Where subcontractor’s general liability policy affords coverage to any other person or entity that subcontractor is required by agreement to add to policy, certificate of insurance stating general contractor is to be named as additional insured on subcontractor’s policy with regard to certain project is effective to add general contractor as additional insured under terms of policy only if there was agreement requiring subcontractor to add general contractor as named insured — Where record does not establish why language was added to certificate of insurance, if named project is site where subcontractor’s employee was injured, or amount of coverage required if subcontractor was required to add general contractor as named insured, motion for summary judgment is denied

12 Fla. L. Weekly Supp. 690a

Insurance — Personal injury protection — Default — Vacation — Jurisdiction — Service of process — Trial court denying motion to vacate default had insufficient proof to determine that jurisdiction had been established over insurer where court had return receipt for service of process on Department of Insurance but lacked proof of compliance with statutory procedures for forwarding copy of process to insurer

12 Fla. L. Weekly Supp. 853a

Insurance — Homeowners — Claim for water loss/damage to condominium unit’s bathroom — Summary judgment — On rehearing, order granting summary judgment finding loss excluded under policy is vacated where trial court failed to rule on ore tenus motion to amend reply and affirmative defenses to assert waiver and estoppel prior to granting summary judgment — Motion to amend granted