Volume 14

14 Fla. L. Weekly Supp. 675a

Insurance — Personal injury protection — Evidence — Motion to take judicial notice of fee schedules applicable to Medicare and workers’ compensation coverage is denied where insurer has withdrawn Mitchell Medical/Ingenix defense that was sole basis for reduction of bills

14 Fla. L. Weekly Supp. 1010a

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable charges — Evidence — No error in admitting explanation of benefits forms from insurer and other entities that paid medical provider’s charges in full — No abuse of discretion in finding that Medicare fee schedule was irrelevant where provider does not accept Medicare patients — No abuse of discretion in finding workers’ compensation fee schedule irrelevant where, although provider accepts workers’ compensation patients, fee schedule is not only way provider receives payment for their treatment — No abuse of discretion in finding that testimony of physician who used to work for provider and who treated insured regarding his understanding of what the test he ordered would accomplish was not relevant to issue of reasonableness of charge for test — No abuse of discretion in sustaining relevancy objection to testimony of physical therapist who does not practice in same community as provider

14 Fla. L. Weekly Supp. 628a

Insurance — Personal injury protection — Coverage — Medical expenses — Failure to obtain reasonable proof within 30 days — Insurer is not barred from contesting reasonableness, relatedness or medical necessity of claim by failure to obtain peer review within 30 days

14 Fla. L. Weekly Supp. 1018a

Insurance — Personal injury protection — Coverage — Denial — Independent medical evaluation — Error to find that IME report that discusses lack of need for future medical treatment, therapy, and diagnostic testing did not terminate coverage for future medical evaluations — Court declines to distinguish, as matter of law, between medical evaluation and medical treatment, therapy, and diagnostic testing

14 Fla. L. Weekly Supp. 939a

NOT FINAL VERSION OF OPINION
Subsequent Changes at 15 Fla. L. Weekly Supp. 123a

Insurance — Personal injury protection — Coverage — Medical expenses — Failure to obtain reasonable proof within 30 days — Insurer is not barred from contesting reasonableness, relatedness or necessity of treatment merely because peer review was obtained after benefits were denied and overdue — Remand to consider legal sufficiency of peer review affidavit

14 Fla. L. Weekly Supp. 937a

Insurance — Personal injury protection — Coverage — Medical expenses — Failure to obtain proof within 30 days — Insurer that denied benefits as soon as claim was submitted was not required to obtain peer review report within 30 days of receipt of bills in order to contest claim on grounds of reasonableness, relatedness and necessity

14 Fla. L. Weekly Supp. 934a

Insurance — Personal injury protection — Coverage — Medical expenses — Failure to obtain proof within 30 days — Insurer that denied benefits as soon as claim was submitted was not required to obtain peer review report within 30 days of receipt of bills in order to contest claim on grounds of reasonableness, relatedness and necessity

14 Fla. L. Weekly Supp. 539a

Insurance — Personal injury protection — Coverage — Denial — Unreasonable, unrelated or unnecessary treatment — Failure to obtain reasonable proof within 30 days — Insurer’s failure to obtain medical or peer review report within 30 days did not preclude insurer from contesting reasonableness, relatedness or necessity of treatment — Error to grant summary judgment for medical provider because peer review report was submitted more than 30 days after claim was filed

14 Fla. L. Weekly Supp. 132a

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary expenses — Summary judgment — Opposing affidavit — Validity — No error in entering summary judgment in favor of medical provider where affidavit and peer review report filed in opposition to motion did not comport with statutory requirements that they be based upon examination of patient or factually supported by examination and treatment records and prepared by physician in active practice

14 Fla. L. Weekly Supp. 782b

Insurance — Personal injury protection — Summary judgment — Opposing affidavit — Summary judgment granted in favor of medical provider on issue of reasonableness, relatedness and necessity of MRI where provider’s motion establishes prima facie entitlement to relief, and insurer’s affidavit was untimely served — Independent medical examination and peer review reports, if admissible, do not create genuine issue of material fact where IME was performed on day insured received MRI and opines only as to reasonableness, relatedness or necessity of further treatment — Explanation of benefits — Insurer breached policy by not furnishing provider with EOB County