Volume 13

13 Fla. L. Weekly Supp. 645a

Insurance — Personal injury protection — Pleadings — Answer — Amendment — Timeliness — Motion to amend answer and affirmative defenses is denied — PIP suit had been pending for more than recommended resolution standard of 18 months at time insurer served motion to amend, case involves relatively small amount in dispute, medical provider already has been required to come to court several times on pretrial matters at behest of insurer and has incurred expenses of preparing for and attending mediation and arbitration, and insurer is unable to advise court as to legitimate reasons for significant delay in case

13 Fla. L. Weekly Supp. 162b

Insurance — Personal injury protection — Complaint — Amendment — Motion to amend complaint one year after settlement of underlying claim to name as plaintiff medical provider to whom insured assigned bad faith claim after settlement is denied where insured has provided no justification for delay in seeking amendment

13 Fla. L. Weekly Supp. 1016a

Insurance — Personal injury protection — Standing — Issues of lack of standing and defective assignment not raised in pleadings are not impediment to summary judgment — Notice of loss — HCFA form — Signature of medical provider — Where provider provided all information on HCFA form necessary to process claim, form is substantially complete and substantially accurate as to all material elements despite typewritten signature of provider — No merit to argument that earlier version of statute, which required complete and accurate completion of all provisions of form, not merely material provisions, applies because policy was issued prior to statutory amendment where legislature made it clear that amendment applies to treatment and services occurring on or after effective date — Summary judgment — Where adjuster stated in deposition that bills were not paid because they were applied to deductible, and in affidavits opposing motion for summary judgment insurer averred that treatment was not reasonable, related or necessary, insurer did not impermissibly alter position since positions are not inconsistent — Affidavit of adjuster, which attempted to authenticate independent medical examination report that was hearsay, is disregarded as hearsay — Where IME physician refers to and attaches hearsay IME report to his affidavit, but also independently sets forth findings as result of examination and opinion that further treatment would not be reasonable, related or necessary, affidavit is not hearsay — As there remains disputed issue of material fact as to reasonableness, relatedness and necessity of treatment after IME date, provider’s motion for summary judgment is granted in part on all issues except that treatment

13 Fla. L. Weekly Supp. 184a

Insurance — Personal injury protection — Claim form — Signature of medical provider — Where provider gave oral authorization for billing company to affix signature to claim form, insurer’s defense of lack of notice due to provider’s failure to personally sign form fails

13 Fla. L. Weekly Supp. 190a

Insurance — Personal injury protection — Notice of loss — Claim form — Insurer’s motion for summary judgment on ground that HCFA-1500 was not proper notice of loss, as plaintiff did not include signature on Box 31, but instead typed “Signature in File,” denied

13 Fla. L. Weekly Supp. 1092a

Insurance — Personal injury protection — Notice of loss — HCFA form — Where medical provider failed to include professional license number on HCFA forms, insurer was not provided with notice of loss

13 Fla. L. Weekly Supp. 369a

Insurance — Personal injury protection — Demand letter — Where demand letter identifies provider of services as physician, but services were actually rendered by professional association in which physician is sole shareholder, provider failed to satisfy condition precedent to filing suit — Claim form — Where demand letter and assignment of benefits identified physician as provider of services, HCFA form which identified professional association as service provider and reflected tax identification number of association was not properly completed

13 Fla. L. Weekly Supp. 608b

Insurance — Personal injury protection — Demand letter — Sufficiency — Demand letter with attached patient ledger which contained all dates of service but was not marked in any way to indicate which charges medical provider was disputing as having been improperly reduced or denied was not sufficiently specific to satisfy statutory demand letter requirement — No merit to claim that demand letter was deficient due to misspelling of insured’s name where attached assignment of benefits containing correct spelling dispelled any ambiguity as to name of insured — Claim forms — Defense that HCFA forms lacking insured’s signature and containing wrong accident date were false, misleading, incomplete or patently deceptive was waived by insurer’s payment of prior HCFA submissions without raising objection

13 Fla. L. Weekly Supp. 637a

Insurance — Personal injury protection — Claim form — HCFA — Defects — Taxpayer identification number — Waiver — Mere payment of claim does not amount to waiver of any defects in claim — Where insurer filed affidavits averring that it was not aware of incorrect taxpayer identification number at time it partially paid claim and would not have paid claim if it had known, and medical provider filed no opposing affidavits or sworn evidence, insurer has established for summary judgment purposes that it did not waive defect in claim — Due to defect in HCFA, insurer was not provided with notice of covered loss and summary judgment is granted in favor of insurer

13 Fla. L. Weekly Supp. 610b

Insurance — Personal injury protection — Claims — HCFA form — Defects — Waiver — Medical provider has failed to prove that insurer waived defect in HCFA form which did not have professional license number in Box 31 by making partial payment of claim — Waiver cannot be inferred from deposition of litigation adjuster which did not indicate that insurer knew of defect in form at time it made partial payment, and statute mandating inclusion of license number provides that deficiency may be asserted even after payment — Insurer has not been provided with notice of covered loss