Volume 14

14 Fla. L. Weekly Supp. 1027a

Insurance — Personal injury protection — Coverage — Medical bills — CPT coding — No error in finding as matter of law that CPT provision does not require that medical provider’s interpretation of diagnostic test results ordered by another provider be bundled with office consultation CPT code, but allows for separate CPT code for reading test — Physician’s affidavit stating that medical provider’s billing practices were unreasonable and constituted impermissible unbundling did not create fact issue precluding summary judgment because meaning of terms was question of law, not issue for expert testimony, and there was no evidence that affiant was expert on interpretation of CPT — Further, insurer’s interpretation of CPT code provision was contrary to past practice and cost-saving policy — Reasonable charges — Peer review and affidavit filed one year after bills were submitted to insurer was not time-barred by statute — Peer review affidavit was not excludable for taking position inconsistent with claims adjuster’s deposition testimony that basis for reducing provider’s bills was Mitchell medical billing system where deposition and affidavit both stand for proposition that provider’s charges are not reasonable — Peer review affidavit is not required to be supported by examination of insured because insurer’s reduction of provider’s claims does not constitute withdrawal of benefits — Error to exclude peer review affidavit

14 Fla. L. Weekly Supp. 977a

Insurance — Personal injury protection — Claim form — Disclosure and acknowledgment form — Where the only services rendered by provider for insured consisted of interpretation of diagnostic testing, which was not performed in presence of insured, provider is exempt from disclosure and acknowledgment form requirement

14 Fla. L. Weekly Supp. 982a

Insurance — Personal injury protection — Explanation of benefits — Failure to provide — Insurer that failed to provide EOB upon denial of medical provider’s bill waived right to assert that bill was defective for lack of disclosure and acknowledgment form

14 Fla. L. Weekly Supp. 687b

Insurance — Personal injury protection — On rehearing, motion to dismiss is denied

14 Fla. L. Weekly Supp. 687a

Insurance — Personal injury protection — Summary judgment granted in favor of insurer where unambiguous policy language provides no benefits

14 Fla. L. Weekly Supp. 50a

Insurance — Personal injury protection — Declaratory judgment — Coverage — Misrepresentations — Where insured failed to cooperate with insurer’s investigation of accident allegedly caused by phantom vehicle by providing documents requested by insurer to corroborate insured’s testimony in examination under oath, insured and other vehicle occupants gave conflicting statements and made material misrepresentations in EUOs, and insurer’s accident reconstructionist found that accident could not have occurred in manner claimed by insured, no insurance coverage exists

14 Fla. L. Weekly Supp. 978c

Insurance — Personal injury protection — Interest on overdue PIP payments is calculated from date insurer was furnished with written notice of amount of covered loss

14 Fla. L. Weekly Supp. 174b

Insurance — Homeowners — Where homeowner’s insurance policy was issued before effective date of section 627.7011, which requires insurer to offer law and ordinance and replacement value coverage when issuing or renewing policy, homeowner is not entitled to declaration that statute applies to policy, as constitution bars retroactive application of statute to change rights that vested before statute went into effect

14 Fla. L. Weekly Supp. 1118c

Insurance — Homeowners — Appraisal process — Waiver — Insurer that failed to notify insured of right to participate in mediation of dispute regarding claim for hurricane damage waived right to invoke appraisal clause of homeowners insurance policy

14 Fla. L. Weekly Supp. 1118b

Insurance — Homeowners — Motion to dismiss complaint for failure to state cause of action or to abate to appraisal denied