Volume 15

15 Fla. L. Weekly Supp. 136a

NOT FINAL VERSION OF OPINION
Subsequent Changes at 15 Fla. L. Weekly Supp. 333c

Insurance — Personal injury protection — Summary judgment — Error to fail to consider independent medical examination report which created genuine issue of material fact regarding necessity of treatment — Insurer did not waive right to assert that treatment is not reasonable, related or necessary or that charge was excessive by failing to notify medical provider of intent to dispute claim on that basis — Defects in IME report and affidavit are not sufficient to exclude evidence; insurer should have been given opportunity to correct defects

15 Fla. L. Weekly Supp. 375b

Insurance — Personal injury protection — Demand letter — Sufficiency — Demand letter was not deficient for failing to calculate exact amount to be paid after application of deductible and co-payment — Coverage — Medical expenses — Reasonable, related and necessary expenses — Affidavit of claims adjuster creates genuine issue of material fact as to reasonableness of those charges to which adjuster testified — Jury will decide reasonable charge between amount testified to by adjuster and amount billed — Insurer is estopped from denying benefits for dates prior to date IME cutoff letter was sent where insurer failed to timely furnish notice of result of independent medical examination opining that further treatment would not be reasonable

15 Fla. L. Weekly Supp. 190a

Insurance — Personal injury protection — Summary judgment — Affidavits — Notarization — Affidavits not signed in presence of notary are stricken — Failure to maintain patient logs and sign-in sheets is not fatal to medical provider’s claim where, although PIP statute requires that records be maintained, it does not make records part of claims process by requiring that provider submit records to insurer

15 Fla. L. Weekly Supp. 28b

Insurance — Personal injury protection — Coverage — Medical expenses — Needle electromyography — Section 627.736 does not cap fees for needle EMG procedures — Error to enter summary judgment in favor of medical provider where insurer was not confined to explanation of benefits which erroneously cited statutory fee cap in refuting provider’s claim that charge for needle EMG was reasonable, and affidavit of peer review doctor was sufficient to raise disputed issue of material fact as to reasonableness of charge — Error to find affidavit conclusory, irrelevant under section 627.736(7)(a), which does not apply to reduction of benefits at issue, and invalid due to failure to attach referenced peer review report

15 Fla. L. Weekly Supp. 1223a

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Allowable amount — Adjustment to Consumer Price Index — Insurer failed to apply cumulative and compounding inflation adjustments for 2001, 2002 and succeeding years such that fee schedule amount will reflect prior years’ increases through August 1 of year MRI scan was performed — Demand letter with HCFA form attached was fully compliant with statute, irrespective of fact that amount demanded for MRI exceeded amount allowed under preset fee schedule

15 Fla. L. Weekly Supp. 271a

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Allowable amount — Adjustment to Consumer Price Index for All Urban Consumers in South Region — Calculation — CPI adjustment must be made on August 1, 2001, and adjusted annually on August 1 of each subsequent year through date of treatment — No merit to argument that first CPI adjustment should be applied as of November 1, 2002 — Applicable CPI adjustment factor is number published for 12-month period ending June 30 of each year since 2001 — Where correct CPI adjustment calculation reveals insurer did not pay medical provider appropriate amount for MRI, provider is entitled to difference plus prejudgment interest

15 Fla. L. Weekly Supp. 265c

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Allowable amount — Adjustment to Consumer Price Index for All Urban Consumers in South Region — Calculation — CPI calculation must be made annually and cumulatively, reflecting combined prior years’ increases from 2001 through August 1 of year MRI was performed — Where correct CPI adjustment calculation reveals insurer did not pay medical provider appropriate amount for MRI within 30 days, provider is entitled to statutory interest and attorney’s fees

15 Fla. L. Weekly Supp. 182a

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Allowable amount — Adjustment to Consumer Price Index for All Urban Consumers in South Region — Calculation — CPI calculation must be made annually and cumulatively, reflecting combined prior years’ increases from 2001 through August 1 of year MRI was performed — Correct CPI adjustment calculation reveals insurer paid medical provider less than allowable amount for MRIs

15 Fla. L. Weekly Supp. 93a

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 his 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

15 Fla. L. Weekly Supp. 88a

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