Volume 14

14 Fla. L. Weekly Supp. 1137b

Insurance — Personal injury protection — Coverage — Medical expenses — Lawfully rendered treatment — Medical provider’s failure to maintain massage establishment license at time massage treatments were performed renders treatments unlawful and noncompensable — Where provider was never certified to supervise certified chiropractic physician’s assistants who examined insured and made recommendations for her treatment, and CCPAs were never authorized to work under supervision of provider, treatments were unlawful and noncompensable — Treatments were not rendered unlawful by failure to obtain county occupational license

14 Fla. L. Weekly Supp. 1144c

Insurance — Personal injury protection — Coverage — Medical expenses — Lawfully rendered treatment — Medical provider’s failure to maintain massage establishment license at time massage treatments were performed renders treatments unlawful and noncompensable — Where provider was never certified to supervise certified chiropractic physician’s assistants who examined insured and made recommendations for her treatment, and CCPAs were never authorized to work under supervision of provider, treatments were unlawful and noncompensable — Treatments were not rendered unlawful by failure to obtain county occupational license

14 Fla. L. Weekly Supp. 45a

Insurance — Personal injury protection — Coverage — Medical expenses — Lawfully rendered services — Licensure — Medical provider was precluded from seeking or obtaining payment of PIP or medical payment benefits from insurer or patients for care rendered when provider was not registered clinic or exempt from registration requirement — Insurer is entitled to reimbursement for all expenses paid for services rendered while provider was unregistered, even if investigation of charges did not commence within 30 days from submission of bill to insurer — Where insurer’s common law cause of action is founded on fact that provider was not licensed, reimbursement is required even after repeal of statute providing that insurer may assert claim that treatment was not reasonable, related or necessary after payment of claim

14 Fla. L. Weekly Supp. 786a

Insurance — Personal injury protection — Coverage — Lawfully rendered services — Medical provider that lacks massage therapy establishment license cannot recover from insurer or insured for massage therapy treatment — Possession of county occupational license does not obviate need for massage establishment license

14 Fla. L. Weekly Supp. 1062c

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable charges — Insurer’s policy of uniformly paying certain procedure codes at 200% of workers’ compensation statute or Medicare Part B fee schedule does not violate PIP statute — If medical provider disagrees with payment, it may sue and bears burden of proving charges are reasonable

14 Fla. L. Weekly Supp. 299a

Insurance — Personal injury protection — Coverage — Medical expenses — Failure to pay or investigate within 30 days — Tolling of period — Where insurer timely requested that medical provider submit invoice from supplier of electrical stimulation pads to determine proper payment, and provider did not submit invoice prior to filing suit, request for invoice tolled time for payment of charge for pads, and charge was not overdue at time provider filed suit

14 Fla. L. Weekly Supp. 1149b

Insurance — Personal injury protection — Explanation of benefits — Failure to provide — Sufficiency of petition for declaratory judgment/complaint for breach of contract

14 Fla. L. Weekly Supp. 534a

Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — Error to enter summary judgment in favor of medical provider where benefits were exhausted before provider filed suit and before insurer received notice that reduced claims were contested — Insurer is not liable for statutory interest since it is not liable for reduced claims — Appeals — Absence of transcript of summary judgment hearing does not preclude appellate review

14 Fla. L. Weekly Supp. 520a

Insurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where insurer had no reason for reduction of medical bills and was on notice prior to exhaustion of benefits that medical provider disputed reductions, trial court correctly denied insurer’s motion for summary judgment based on exhaustion of benefits — Benefits paid to other providers, which should have been paid to plaintiff provider first and which resulted in exhaustion of benefits, should be considered gratuitous payments

14 Fla. L. Weekly Supp. 1087a

Insurance — Personal injury protection — Summary judgment — Trial court correctly entered partial summary judgment in medical provider’s favor where provider submitted affidavit attesting that treatment of insured was reasonable, related to accident, and medically necessary and that charges were reasonable, and insurer failed to file affidavit to counter provider’s affidavit or provide medical opinion to support claim that treatment was not reasonable, related or necessary — No abuse of discretion in striking transcript of examination under oath where insurer withheld transcript based on assertion of privilege and/or claim that transcript did not exist until it amended answer to assert fraud based on EUO long after discovery had been completed