Volume 13

13 Fla. L. Weekly Supp. 183a

Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — Where medical provider did not dispute reduced amounts paid prior to benefits being exhausted, provider is not entitled to any additional benefits, including Medpay benefits

13 Fla. L. Weekly Supp. 177a

Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — Summary judgment — Factual issues — Where medical provider resubmitted claim after partial payment was made and prior to exhaustion of benefits, there remains question of fact as to whether insurer fulfilled obligation to make prompt payment of claims — If claim was not handled competently, insurer would be liable for additional money plus interest

13 Fla. L. Weekly Supp. 421a

Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — Trial court erred in granting summary judgment in favor of medical provider whose claim was denied on ground that benefits were exhausted in payment of another provider’s untimely claim — Although Section 627.736(5)(b) allows insurers to deny claims submitted more than 30 days from date of service, it does not prohibit an insurer from paying such bills

13 Fla. L. Weekly Supp. 1108a

Insurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Insurer’s motion for summary judgment based on exhaustion of benefits subsequent to reduced payment of medical provider’s bills is denied where deposition testimony of litigation adjuster, which does not establish that adjuster has personal knowledge of how independent review company determined what is usual and customary rate, failed to show that insurer had reasonable proof to make reduced payment — Further, summary judgment cannot be granted because jury would have to determine whether medical provider’s charges were reasonable within meaning of statute and whether insurer’s reductions were based on reasonable proof — Summary judgment is also improper because insurer is liable for statutory interest and attorney’s fees if jury finds that provider’s charges were reasonable or decides that insurer did not have reasonable proof to reduce bills

13 Fla. L. Weekly Supp. 355a

Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — Where insurer elected not to pay PIP benefits for amounts billed and otherwise payable to medical provider, and there were sufficient benefits remaining under policy to pay full amount billed at time of billing, but insurer ignored provider’s priority claim and exhausted benefits in payments to providers having subordinate claims, insurer owes provider compensatory damages in amount equal to benefits that would have been paid if insurer had properly paid claim prior to exhaustion of benefits, as well as statutory interest and penalties, attorney’s fees and costs — Insurer’s failure to recall receipt of entire HCFA form is insufficient to rebut presumption that entire form was received where insurer acknowledges receiving portion of form

13 Fla. L. Weekly Supp. 903b

Insurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where PIP benefits were exhausted after insured filed suit for bills denied by insurer, and there is no allegation that insurer acted in bad faith, insurer satisfied statutory and contractual obligations to insured — Insurer has no duty to escrow funds pending resolution of contested claim

13 Fla. L. Weekly Supp. 502a

Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — Insurer was not required to set aside reserve fund for denied or reduced claims, and provider who filed suit for denied claim shortly before policy limits were exhausted is not entitled to additional PIP benefits beyond policy limits — Summary judgment granted in favor of insurer

13 Fla. L. Weekly Supp. 501b

Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — Where PIP benefits were exhausted after suit was filed, medical provider is not entitled to recover any monies from insurer

13 Fla. L. Weekly Supp. 830c

Insurance — Personal injury protection — Coverage — Medical expenses — Failure to pay or investigate within 30 days — Exhaustion of policy limits — Insurer’s failure to respond to medical provider’s claim within 30 days does not mandate that insurer is responsible for payment of claim after exhaustion of policy limits — Where insurer decided to deny provider’s claim based on peer review and to settle other claims submitted on behalf of insured until policy limits were exhausted, and there is no showing of bad faith on part of insurer, insurer has satisfied obligations under PIP statute and contractual obligations to insured — Provider/assignee could reserve right to recover payment from insured in event claim is not paid by insurer — Insurer has no duty to escrow funds pending resolution of contested claim

13 Fla. L. Weekly Supp. 367a

Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — Escrow of disputed benefits — Where there is no provision in PIP statute permitting request to reserve disputed benefits, and medical provider is not sure of amount it is requesting be escrowed as request includes unspecified amount of interest, court refuses to exercise discretion to create requirement that insurer escrow any disputed benefits