Volume 13

Case Search

ESSEX INSURANCE COMPANY, Appellant, vs. DANIELLE AUTO CENTER, INC., d/b/a SHANI MANAGEMENT, Appellee.

13 Fla. L. Weekly Supp. 33a

Insurance — Commercial property — Default — Where insurer filed motion to dismiss and/or compel appraisal, trial court denied motion to dismiss and granted insured’s motion to enforce settlement agreement, and thirteen days later trial court entered final judgment for insured without insurer having filed an answer or affirmative defenses, lack of responsive pleading by insurer makes final judgment a default final judgment, and trial court erred in entering judgment without providing insurer with notice of any application for default and opportunity to respond — Remand with instructions to allow insurer to file answer and affirmative defenses

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DENNIS J. D’ERAMO, D.C., P.A., as assignee of PAUL STRAM, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant.

13 Fla. L. Weekly Supp. 840a

Insurance — Personal injury protection — Medical payments — Coverage — Exhaustion of policy limits — Where medical provider submitted bills to insurer after exhaustion of PIP benefits but while medpay benefits still remained, claim is for medpay benefits only and is governed by contract principles rather than No-Fault law — Priority of payments — Assignment given to provider by insured conferred on provider right to priority of payment of bills from medpay benefits over later-submitted claims from other providers or insured — While it is prerogative of insurer to pay, reduce or deny claims without reserving disputed benefits, insurer reduces or denies claims at own peril, and if it is subsequently shown that claim should have been paid, insurer will be required to pay claim despite exhaustion of medpay benefits — Further if provider establishes that claims should have been paid, insurer will be obligated to pay prejudgment interest

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ST. GERMAIN CHIROPRACTIC, P.A., as assignee of SUSAN O’BERRY, Plaintiff, vs. PROGRESSIVE CONSUMERS INSURANCE COMPANY, Defendant.

13 Fla. L. Weekly Supp. 200b

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary services — Summary judgment — Opposing affidavit — Medical provider’s motion to strike physician’s affidavit filed in opposition to motion for partial summary judgment, based on argument that it is not competent evidence because it is only acknowledged and not made under oath, is denied — Where affidavit of treating physician establishes that amounts charged are usual, customary and reasonable and that services rendered were reasonable, necessary and related to accident and opposing affidavit does not address whether services rendered were reasonable, related and necessary but disputes the reasonableness of only some of charges claimed, provider is entitled to partial summary judgment regarding bills for which opposing affidavit does not create question of fact — Where PIP benefits have been exhausted since filing of suit, provider is only entitled to recover interest on past due amounts, from date insurer received bills to date of exhaustion, and statutory penalties

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BRENCE STEWARD, Plaintiff, vs. PROGRESSIVE AUTO PRO INSURANCE COMPANY, Defendant/Third-Party Plaintiff, vs. ALL FAMILY CLINICS OF DAYTONA BEACH, INC., d/b/a FLORIDA MEDICAL ASSOCIATES, Third-Party Defendant.

13 Fla. L. Weekly Supp. 888a

Insurance — Personal injury protection — Indemnification — Motion to dismiss insurer’s action against medical provider as third party defendant under theory of common law indemnity is granted — Party seeking indemnification must be without fault, and its liability must be vicarious and solely for the wrong of another; indemnification can only come from party who was at fault; and Florida courts require special relationship between parties in order for common law indemnification to exist — Insurer has failed to demonstrate that provider’s charges were unlawful due to failure to appoint medical director where, although person appointed as director testified that he was unaware of appointment, insurer did not allege that director failed to perform statutory duties — Further, insurer failed to prove wrongdoing on part of provider where there was no allegation that services were not reasonable and necessary — Insurer could not satisfy requirement that its liability be vicarious and solely from wrong of another where insurer’s liability arose from insurance policy insurer sold to plaintiff/insured — Special relationship — Insurer cannot satisfy requirement of showing special relationship between parties based solely on submission of bills to insurer and receipt of payments pursuant to now-revoked assignment — Further, decision to dismiss satisfies legislative intent of clinic responsibilities statute where there is no evidence of injury to consumers or that provider was in violation of basic care standards or other applicable provisions of statute

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SPIRELLI HEALTHCARE OF BROWARD, INC., as assignee of John Coulanges, Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant.

13 Fla. L. Weekly Supp. 186a

Insurance — Personal injury protection — Expert witnesses — Striking — Expert is stricken as trial witness where insurer was ordered to produce all underlying data for CPT codes at issue from HMO database relied upon by expert witness to opine on reasonableness of charges as well as all Medicare documents used by expert; insurer did not produce any Medicare or HMO data, but produced only summary of data received by database proprietor without data from which summary was compiled; and provider will be prejudiced because there will be no way to effectively cross-examine expert on summary or confirm summary’s accuracy

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JOHN ECHTERLING, Plaintiff, v. MERCURY INSURANCE COMPANY OF FLORIDA, a Florida corporation, Defendant.

13 Fla. L. Weekly Supp. 889a

Insurance — Automobile — Coverage — Rental car used in business — Where policy unambiguously excluded coverage of any vehicle rented and used in insured’s employment or business, rental vehicle used by insured in door-to-door sales and delivery of educational books was excluded — Further, loss itself was excluded where policy provided that, unless rated for business use, insurance would not apply to claims arising from accidents occurring while insured vehicle was used in course of business, and policy was not rated for business use

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