Volume 15

15 Fla. L. Weekly Supp. 1094a

Insurance — Personal injury protection — Coverage — Medical expenses — Lawfully rendered services — Nonperformance of medical director — Where medical provider appointed doctor to be medical director as required by clinic registration/licensing statutes, but doctor failed to perform duties of medical director, provider’s services were not lawfully rendered, and bills are noncompensable and unenforceable

15 Fla. L. Weekly Supp. 964a

Insurance — Personal injury protection — Judgment on pleadings — Trial court erred in considering matters outside pleadings when granting judgment on pleadings in favor of insurer — Tipsy coachman doctrine cannot be applied to affirm decision as summary judgment where medical provider was not given notice that summary judgment would be considered or opportunity to present evidence establishing existence of genuine issue of material fact

15 Fla. L. Weekly Supp. 1016a

Insurance — Personal injury protection — Coverage — Medical expenses — Where insurer failed to request additional documentation within 30 days of receipt of bill for functional capacity test and supplies, request was untimely — Partial summary judgment is entered in favor of medical provider as to test and supplies

15 Fla. L. Weekly Supp. 1213b

Insurance — Personal injury protection — Insurer cannot use its investigative rights to extend 30-day period without reasonable proof that it is not responsible for claim — Insurer owes statutory interest and penalty on bills which were paid late

15 Fla. L. Weekly Supp. 821a

Insurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Motion for summary judgment is granted where benefits were exhausted before suit was filed — Motion to amend complaint is denied

15 Fla. L. Weekly Supp. 907b

NOT FINAL VERSION OF OPINION
Subsequent changes at 16 Fla. L. Weekly Supp. 92a

Insurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — If amount of benefits claimed by medical provider/assignee was available at time of claim, provider is allowed to challenge reasonableness of reduction in payment regardless of whether benefits were subsequently exhausted and is entitled to damages if insurer did not pay claim in manner prescribed by statute — Insurer’s motion for summary judgment is denied

15 Fla. L. Weekly Supp. 1005a

Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — In absence of bad faith, medical provider cannot maintain cause of action for unpaid portion of reduced medical bills where policy limits have been exhausted, even where exhaustion occurred after suit was filed — Insurer is not required to reserve funds for disputed claims

15 Fla. L. Weekly Supp. 682b

Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — Priority of payments — Hospital lien — Trial court did not err in finding that insurer improperly exhausted benefits in favor of hospital where provider’s bill was received by insurer long before hospital lien was properly recorded and became entitled to priority — Demand letter — Sufficiency — Where demand letter erroneously requested reimbursement of full amount of single medical bill that has been partially paid by Medicare, but insurer was able to easily verify partial payment from attached patient account information sheet and note balance due, insurer should not be permitted to escape liability due to form of demand letter

15 Fla. L. Weekly Supp. 936b

Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — In absence of bad faith, manipulation, or other improper conduct, medical provider cannot sustain action for PIP benefits once benefits have been exhausted in payment of other claims while coverage investigation regarding provider’s claim was pending — Prior order denying motion to amend complaint is withdrawn as to amendment to allege bad faith and improper conduct, but reaffirmed as to requested substantive amendment by interlineation and untimely request to amend complaint to allege that insurer has adopted improper reimbursement method — If exhaustion of benefits eliminates recovery of PIP benefits, it also eliminates recovery of interest, penalties, and attorney’s fees to which provider would otherwise be entitled due to wrongful denial of claim

15 Fla. L. Weekly Supp. 615a

Insurance — Personal injury protection — Coverage — Medical expenses — Nerve conduction velocity test and electromyography procedure — Denial of motion for reconsideration of order holding that, where statute allows charges for NCV testing done in conjunction with EMG procedure to be billed at rate not exceeding 200% of fee schedule of Medicare Part B when both procedures are performed and billed solely by appropriately licensed physician and for payment under lower workers’ compensation rates when NCV does not meet those requirements, medical provider’s use of medical and physician assistants to perform physical portions of NCV and EMG did not require that provider be paid only under lower rates — Insurer that did not pay consumer price adjustment for year 2002 for either MRI or EMG/NCV charges did not pay amount due