Volume 15

15 Fla. L. Weekly Supp. 611a

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — Failure to submit — Where medical provider failed to submit D&A form to insurer prior to insured filing suit, insurer was never placed on notice of covered loss, and claim was never overdue and is legal nullity — No prejudice to insured because, where provider fails to comply with legal requirement to submit bill, neither insurer nor insured is responsible for payment — No merit to argument that failure to provide D&A form impacts only initial date of service, not entire claim

15 Fla. L. Weekly Supp. 1007b

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form requirement applies to initial date of service only — On insurer’s motion for summary judgment, it is insurer’s burden to present evidence that patient logs for subsequent dates of service were not maintained, not medical provider’s burden to prove logs were maintained — Where insurer sent generic explanation of benefits that did not indicate that D&A form is defective, insurer is estopped from asserting D&A form defense

15 Fla. L. Weekly Supp. 393a

Insurance — Personal injury protection — Notice of loss — Disclosure and Acknowledgment form — Fact question as to whether insurer waived D&A form requirement by processing claim without raising objection or sending explanation of benefits concerning lack of form precludes summary judgment on D&A form issue as to initial date of service — Summary judgment is denied as to subsequent dates of service because D&A form requirement applies only to initial date of service

15 Fla. L. Weekly Supp. 389a

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — D&A form that did not list services rendered and was not signed by medical provider was insufficient — Insurer did not waive D&A form defense by failing to furnish explanation of benefits denying claim based on insufficient form where insurer asserted defense in all pleadings, and EOB did state that insurer might raise defense of failure to comply with section 627.736(5) — Because D&A form requirement is applicable to first date of service only, failure to properly complete form is not fatal to entire claim

15 Fla. L. Weekly Supp. 922b

Insurance — Personal injury protection — Medical treatment — Reasonable, related and necessary expenses — Evidence — Peer review — Affidavit of peer review physician was sufficient to create question of fact as to reasonableness, relatedness and medical necessity of treatment although peer review was not conducted until after litigation had commenced

15 Fla. L. Weekly Supp. 279b

Insurance — Personal injury protection — Mediation — Failure to appear — Sanctions — Default — Where insurer willfully failed to comply with order to appear at mediation and pay mediation fee prior to mediation and failed to respond to order to show cause why default should not be entered, insurer’s pleadings are stricken and default is entered as to liability

15 Fla. L. Weekly Supp. 84b

Insurance — Personal injury protection — Interest due on overdue claim is not subject to 10% statutory penalty

15 Fla. L. Weekly Supp. 950a

Insurance — Personal injury protection — Independent medical examination — Location — Where insurer did not have IME conducted in limited areas required by PIP statute, IME report was invalid, and suspension of benefits based solely on IME violated statute prohibiting withdrawal of payment without first obtaining valid report stating treatment was not reasonable, related or necessary — Request by insured’s mother that IME take place in certain area does not constitute valid waiver of statutory requirement regarding IME locations

15 Fla. L. Weekly Supp. 1115b

Insurance — Personal injury protection — Fraud — Insurer’s motion for summary judgment on claim that provider committed fraud by charging patient 20% of the amount actually collected from insurer is denied

15 Fla. L. Weekly Supp. 499c

Insurance — Personal injury protection — Filing fees — Waiver — County court has no discretion to waive case reopen fee