Volume 13

13 Fla. L. Weekly Supp. 1102a

Insurance — Personal injury protection — Explanation of benefits — Failure to provide — Because statutory requirement that insurer furnish claimant with EOB became part of insurance contract, breach of contract action is proper where insurer has failed to provide EOB to medical provider/assignee — No merit to argument that insurer was only obligated to furnish EOB to insured or that insurer was relieved of duty to provider by furnishing EOB to insured where statute clearly requires that EOB be furnished to entity making claim — Attorney’s fees and costs awarded to provider

13 Fla. L. Weekly Supp. 1098b

Insurance — Personal injury protection — Explanation of benefits — Failure to provide — Because statutory requirement that insurer furnish claimant with EOB became part of insurance contract, breach of contract action is proper where insurer has failed to provide EOB to medical provider/assignee — No merit to argument that insurer was only obligated to furnish EOB to insured or that insurer was relieved of duty to provider by furnishing EOB to insured where statute clearly requires that EOB be furnished to entity making claim — Attorney’s fees and costs awarded to provider

13 Fla. L. Weekly Supp. 1096b

Insurance — Personal injury protection — Explanation of benefits — Failure to provide — Insurer must furnish medical provider/assignee with EOB specifying each reduced or denied charge and reasons for non-payment, and provider who brings action to enforce statutory right is entitled to attorney’s fees and costs if it prevails — No merit to argument that insurer was only obligated to furnish EOB to insured or that insurer was relieved of duty to provider by furnishing EOB to insured where statute clearly requires that EOB be furnished to entity making claim — Attorney’s fees and costs awarded to provider

13 Fla. L. Weekly Supp. 1100a

Insurance — Personal injury protection — Explanation of benefits — Non-compliance letter quoting large portions of PIP statute does not satisfy requirement for EOB — Because statutory requirement that insurer furnish claimant with EOB became part of insurance contract, breach of contract action is proper where insurer has failed to provide EOB to medical provider/assignee — Attorney’s fees and costs awarded to provider

13 Fla. L. Weekly Supp. 1093b

Insurance — Personal injury protection — Explanation of benefits — Non-compliance letter does not satisfy requirement for EOB — Because statutory requirement that insurer furnish claimant with EOB became part of insurance contract, finding of breach of contract action is proper where insurer has failed to provide EOB to medical provider/assignee — Attorney’s fees and costs awarded to provider

13 Fla. L. Weekly Supp. 1051a

Insurance — Personal injury protection — Where insurer requested additional documentation within thirty days of receipt of claim, but explanation of benefits only generally requested “additional documentation,” without more, doubt remained as to whether EOB was specific enough to put provider on notice as to what additional information was needed — Trial court erred in granting insurer’s motion for summary judgment on ground that provider had failed to respond to insurer’s request for additional documentation

13 Fla. L. Weekly Supp. 37c

Insurance — Personal injury protection — Explanation of benefits — Trial court correctly found that insurer breached insurance contract by failing to provide written explanation of benefits required by statute

13 Fla. L. Weekly Supp. 1009b

Insurance — Personal injury protection — Explanation of benefits — Failure to provide — Insurer breached contract by failing to provide EOB requested by insured in pre-suit demand letter — No merit to argument that insurer was relieved of continuing obligation to provide EOB where benefits were exhausted prior to demand for EOB

13 Fla. L. Weekly Supp. 509a

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Faxed affidavit in opposition to motion for summary judgment is not legally sufficient to demonstrate disputed issues of material fact where fax did not contain cover sheet, indicate number of pages transmitted or include sender’s fax number — Traffic crash report is not sufficient to create disputed issue of material fact where report would not be admissible in evidence — Even if report were admissible, report that indicates on its face that officer did not witness crash would be hearsay — Fraud — Where insurer has insufficiently pled fraud, medical provider was not required to move to strike defense but could wait to test legal sufficiency at summary judgment — Medical provider has failed to establish absence of disputed issue of material fact as to relatedness of treatment where it is undisputed that insured was not driver of either vehicle involved in accident, and accident report lists no passengers in either vehicle — Physician’s affidavit stating that insured was injured in automobile accident is hearsay and its content is insufficient to establish foundation that statement is admissible under medical diagnosis exception to hearsay rule — Partial summary judgment granted in favor of provider on all issues except whether insured was involved in accident and defense of late notice

13 Fla. L. Weekly Supp. 1090a

Insurance — Personal injury protection — Coverage — Defenses — Accord and satisfaction — Where insurer asserts defense of accord and satisfaction based on agreement between provider and insured, and in opposition to insurer’s motion for summary judgment, medical provider asserts that agreement was not intended to waive provider’s rights under assignment from insured to seek recovery from insurer of any PIP benefits not paid directly by insured, disputed issue of fact regarding intent of parties precludes entry of summary judgment