Volume 14

14 Fla. L. Weekly Supp. 699a

Insurance — Personal injury protection — Trial court properly directed verdict in favor of medical provider in actions for PIP benefits where insurer based denial of benefits solely on paper peer review report without medical report from physician who actually examined insureds — Denial of payment is withdrawal of payment to which report requirement of section 627.736(7) applies

QUASHED at 33 Fla. L. Weekly D839a

14 Fla. L. Weekly Supp. 1019a

Insurance — Personal injury protection — Summary judgment — Opposing affidavit — Sufficiency — Trial court’s reasoning as to insufficiency of affidavit filed in opposition to motion for summary judgment is unclear — Case is remanded for reconsideration and more specific ruling — Insurer is not barred from contesting medical bill solely by fact that peer review affidavit was obtained and filed after initial denial of benefits

14 Fla. L. Weekly Supp. 84a

Insurance — Personal injury protection — Coverage — Summary judgment is entered in favor of insurer where insured denied that he was involved in accident on alleged date of loss or that he was treated by medical provider — Examination under oath attached to motion for summary judgment was sufficient to support motion without necessity of affidavit from insured

14 Fla. L. Weekly Supp. 339a

Insurance — Personal injury protection — Summary judgment — Error to enter summary judgment in favor of medical provider prior to filing of answer — Fact that motion to dismiss was pending, that provider made claims for conflicting dates of service and that significant amount of time had passed between accident and treatment demonstrate existence of material issues of fact — Failure to pay or investigate within 30 days — Insurer is entitled to rely on peer review report indicating that claimed medical expenses are not reasonable, related, and necessary despite fact that medical report was not obtained within 30-day period to investigate and authenticate claim

14 Fla. L. Weekly Supp. 184b

Insurance — Personal injury protection — Affirmative defenses — Affirmative defenses that services rendered by medical provider were not reasonable, related and/or necessary are not legally cognizable defenses and are stricken, as it is provider’s burden to prove that services were reasonable, related and/or necessary — Fraud — Affirmative defense contending that insured’s failure to disclose ultrasound and reeducation of movement services during examination under oath constituted fraud was not pled with sufficient specificity and is stricken with leave to amend — Demand letter — Sufficiency — Affirmative defense alleging demand letter was improper because only HCFA forms were attached is stricken — Submission of either itemized statement or HCFA forms satisfies demand letter requirement when demanding full amount of claims submitted — Further, insurer failed to furnish explanation of benefits notifying provider that insurer considered demand letter insufficient and benefits would not be provided

14 Fla. L. Weekly Supp. 1089a

Insurance — Personal injury protection — Error to enter summary judgment in favor of insurer based on insurer’s affirmative defense of fraud where discrepancies between insured’s examination under oath, claim forms, insured’s medical record, and depositions of insured and treating physician raised issue of fact as to what services were rendered, an issue which is material to fraud defense — Burden never shifted to medical provider to file anything in opposition to insurer’s motion for summary judgment where insurer failed to demonstrate absence of genuine issue of material fact

14 Fla. L. Weekly Supp. 184a

Insurance — Personal injury protection — Affirmative defenses — Striking — Affirmative defense claiming insured failed to fulfill all conditions precedent by not attending sworn statement is not pled with sufficient specificity and is stricken without prejudice — Affirmative defense alleging that medical provider’s fee for MRI was not reasonable and is in excess of allowable amount under Medicare Part B fee schedule is stricken with prejudice because assertion that MRI fee is unreasonable does not excuse payment in entirety

14 Fla. L. Weekly Supp. 671a

Insurance — Personal injury protection — Coverage — Defenses — Affirmative defenses regarding validity of assignment, failure to comply with conditions precedent and policy, failure to comply with standard disclosure and acknowledgment form requirement, and failure to provide discovery of facts about injured person are not pled with required specificity and are stricken — Fraud defense is stricken because county court does not have jurisdiction to determine criminal fraud — Insurer does not have standing to assert defense that medical provider is attempting to exploit insured for financial gain

14 Fla. L. Weekly Supp. 384a

Insurance — Personal injury protection — Coverage — Medical expenses — Where plaintiff received medically necessary and reasonable treatment for injuries related to automobile accident, and fees charged for treatment were reasonable in amount, partial final summary judgment on issue of medical fees is entered in favor of plaintiff

14 Fla. L. Weekly Supp. 305a

Insurance — Personal injury protection — Hospital lien — Timeliness — Medical provider is entitled to full payment of bill where hospital lien was untimely