Volume 13

13 Fla. L. Weekly Supp. 629c

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Medical provider’s motion for summary judgment is denied where affidavit of insurer’s medical expert is sufficient to create genuine issue of fact — Section 627.736(4)(b) permits insurer to raise defense of reasonableness at any time, even after 30-day period for payment has expired

13 Fla. L. Weekly Supp. 1160c

Insurance — Personal injury protection — No error in and directing verdict that office visits and treatment in dispute were medically necessary and related to accident where medical provider’s expert testified that charges were medically necessary and related, and testimony of insurer’s expert supported that contention

13 Fla. L. Weekly Supp. 439a

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable charges — Where reasonableness of charges for treatment, not reasonableness of treatment itself, was in dispute between parties, and medical provider filed affidavit of treating physician in support of motion for summary judgment which addressed reasonableness of treatment but failed to submit any proof as to reasonableness of charges, provider failed to satisfy burden for granting summary judgment

13 Fla. L. Weekly Supp. 344b

Insurance — Personal injury protection — Coverage — Medical expenses — Absence of reasonable proof of covered loss

13 Fla. L. Weekly Supp. 194a

Insurance — Personal injury protection — Coverage — Medical expenses — Medical provider has made prima facie showing of entitlement to recovery of PIP benefits where provider has established through affidavits and examination under oath that insured was involved in motor vehicle accident, there is no dispute that insured was covered by insurer’s PIP policy, and provider has established through physicians’ affidavits that treatment was reasonable, related and necessary — Affirmative defenses — Notice of loss — Defense of untimely notice of loss fails where insured testified in EUO that she called insurance agent on date of accident

13 Fla. L. Weekly Supp. 903a

Insurance — Personal injury protection — Coverage — Medical expenses — Overdue bills — Request for documentation/information — Failure to respond — Medical provider was not entitled to bring action to collect on claim for nerve conduction testing where provider had not responded to insurer’s request for documentation or information regarding medical necessity of testing and, therefore, claim was not yet overdue

13 Fla. L. Weekly Supp. 842a

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Summary judgment — Opposing affidavit — Affidavit of doctor who performed peer review is legally insufficient and may not be relied upon to rebut prima facie case that services rendered were reasonable, related and necessary and that charges were reasonable in amount where records or peer review report referenced in affidavit are not attached thereto, peer review is not supported by physical examination of insured, affidavit relies on hearsay peer review and makes conclusory allegations that charges were not correctly coded and exceeded usual and customary amounts, and affidavit presents double hearsay problem by relying on peer review not admissible as business record because prepared for purpose of litigation — Claim — Mailbox rule — Where medical provider attested that it is provider’s general practice to send copy of invoice after receiving request for invoice from insurer, and copy of invoice is in file for claim, presumption is raised that invoice was mailed to insurer — Adjuster’s testimony that he did not receive invoice is insufficient to rebut presumption of mailing where insurer failed to establish chain of custody of invoice between Tampa office where mail is received and adjuster located in Fort Lauderdale

13 Fla. L. Weekly Supp. 825a

Insurance — Personal injury protection — Notice of claim — Disclosure and acknowledgment form which differed from standard form promulgated by Office of Insurance Regulation only by rewording of acknowledgment phrase substantially complies with promulgated form and cannot be used to preclude payment of claim

13 Fla. L. Weekly Supp. 826a

Insurance — Personal injury protection — Notice of claim — Where medical provider wrote “See Attached” on lines of standard disclosure and acknowledgment form provided for description of treatment rendered and attached documents describing treatment, form substantially complies with standard form and statute — Independent medical examination — Failure to attend — Insurer cannot use opinion of medical doctor to suspend benefits where all treatment is chiropractic, and insurer failed to notify insured of intent to suspend benefits as result of non-attendance at IME — Insurer cannot use insured’s nonattendance at IME with chiropractor to suspend benefits where insured’s attorney requested that unilaterally scheduled IME be reset at mutually convenient time, but insurer never rescheduled IME, and insurer failed to notify insured of intent to suspend benefits as result of non-attendance at IME — Examination under oath — Insured was not required to attend EUO where insurer failed to provide insured with requested copy of insurance policy on which EUO defense is premised — Further, where insurer gave two alternative dates for EUO, only date insured can contend insured did not appear at EUO is second date and, since that date fell after effective date of benefits cutoff, insured’s duties under policy had been discharged and insured had no duty to attend EUO — Summary judgment — Peer review — Timeliness — Insurer is precluded from relying on untimely filed peer review in opposition to summary judgment — Where insurer had no evidence other than untimely peer review to dispute provider’s contention that bills were reasonable, related and necessary, summary judgment is granted in favor of provider

13 Fla. L. Weekly Supp. 1213a

Insurance — Personal injury protection — Coverage — Examination under oath — Failure to attend — Where there is no evidence that insurer scheduled EUO, which insured failed to attend, within 30 days after receiving first two bills from medical provider, neither provider nor insured breached insurance contract for those bills, and insurer failed to establish reasonable proof for denying claims regarding those bills — Affidavit of non-appearance for EUO scheduled within 30 days of receipt of third bill raises factual issue as to whether insured was properly scheduled for EUO with respect to third bill — Insurer’s argument that bills were not compliant with section 627.736 fails where insurer failed to provide explanation of benefits regarding deficiencies for 11 months after first bill was submitted — Partial summary judgment entered in favor of provider