Volume 16

16 Fla. L. Weekly Supp. 389a

Online Reference: FLWSUPP 165VALIE

Insurance — Personal injury protection — Withdrawal of benefits — Notice — Insurer is not required to provide insured with notice that it will not pay for medical expenses after physician who conducted independent medical examination determines that further treatment would not to be reasonable, related or necessary — Error to find that cutoff of benefits following IME was effective on date insurer sent notice of cutoff rather than date IME physician determined and notified insurer that further treatment would not be reasonable, related or necessary

16 Fla. L. Weekly Supp. 194b

Online Reference: FLWSUPP 162BERGE

Insurance — Personal injury protection — Provider who is licensed orthopedic doctor under chapter 459 is not required to provide additional sworn statement or affidavit verifying credentials — Accordingly, provider’s failure to comply with insurer’s request for verification form does not relieve insurer of liability for claim

16 Fla. L. Weekly Supp. 1158b

Online Reference: FLWSUPP 1612ORTH

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — Where insured who was unaware of PIP coverage on initial date of treatment advised medical provider that there was no PIP coverage, provider could not and did not provide services upon which PIP claim could be based and was under no duty to have insured execute D&A form on initial date of treatment — Further, provider’s failure to submit bills to insurer within 35 days of treatment is not fatal to claim where insured gave provider wrong insurance information — Provider’s acts of having insured sign and return D&A form when PIP coverage was discovered, signing of returned form, and immediate submission of form and medical bills to insurer create issue of fact that precludes summary judgment

16 Fla. L. Weekly Supp. 100a

Insurance — Personal injury protection — Coverage — Summary judgment — Insurer disclaiming reliance on peer review and independent medical examination obtained prior to denial of claim and opposing motion for summary judgment based on peer review obtained only days before summary judgment hearing — Affidavit and peer review prepared solely for purpose of litigation, to defeat motion for summary judgment, is untrustworthy and inadmissible — Alternatively, affidavit and peer review are stricken because peer review was not obtained before denying PIP claim — While insurer may obtain valid report in support of denial of benefits more than thirty days after receipt of claim, insurer may not wait until after it has denied claim to obtain report — Summary judgment granted in favor of medical provider

16 Fla. L. Weekly Supp. 317a

Online Reference: FLWSUPP 164EXPLO

Insurance — Personal injury protection — Declaratory judgment — Although legislature intended that new fee schedule that allows PIP insurers to limit reimbursement to 80% of 200% of Medicare Part B fee schedule rather than paying 80% of reasonable expenses would apply retroactively, application of new fee schedule to medical services under PIP contract that was in effect prior to effective date of amended PIP statute would be unconstitutional — Medical provider that has assignment of rights and benefits under policies has standing to raise constitutional issue

16 Fla. L. Weekly Supp. 763a

Online Reference: FLWSUPP 168FERNA

Insurance — Personal injury protection — Coverage — Medical expenses — Because amendment to PIP statute giving insurer option to pay charges at 200% of applicable Medicare Part B Fee Schedule is procedural in nature, amendment operates prospectively and applies to all policies in effect on or after January 1, 2008

16 Fla. L. Weekly Supp. 332a

Online Reference: FLWSUPP 164TUOME

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable charges — Treating physician’s affidavit that charge at issue has been largely unchanged in eight years of practice and that other insurance companies have paid the charge when submitted was sufficient to shift to defendant the burden of showing that genuine issue of fact exists — Evidence that insurer determined allowable charge based on Medicare Part B fee schedule is not sufficient to raise disputed issue of fact as to reasonableness of fees charged by medical provider in non-Medicare context — Provider’s motion for summary judgment is granted

16 Fla. L. Weekly Supp. 632a

Online Reference: FLWSUPP 167PETER

Insurance — Personal injury protection — Summary judgment — Opposing affidavit — Sufficiency — Peer review physician’s affidavit is insufficient where affidavit failed to make any showing of affiant’s competency to act as PIP medical expert by complying with record-keeping requirement, failed to specify which medical records and insurance forms physician reviewed, identified the records reviewed as those of a person other than insured, and offered little if any explanation for affiant’s opinions — Conclusory statements that peer review physician saw no justification for use of heating pad or for “other bills” were insufficient to support finding that material fact regarding reasonableness or necessity of treatment is at issue — Order granting summary judgment in favor of medical provider is affirmed

16 Fla. L. Weekly Supp. 232a

Online Reference: FLWSUPP 163UNITE

Insurance — Personal injury protection — Denial of benefits — Where insurer obtained independent medical examination report opining that further treatment of insured was not reasonable, related or medically necessary and subsequently obtained peer review report opining that none of medical care received by insured was reasonable, related or necessary, trial court correctly granted summary judgment in favor of insured for treatment prior to IME since peer review report was not obtained prior to denial of benefits

16 Fla. L. Weekly Supp. 882a

Online Reference: FLWSUPP 169POWEL

Insurance — Personal injury protection — Coverage — Medical expenses — Necessity — Summary judgment — Severe impeachment — Where insurer has not shown how facts brought out on impeachment of medical expert mean treatment was not necessary, and has only offered speculation that facts might mean treatment was not necessary, insurer has failed to establish severe impeachment of expert sufficient to defeat motion for summary judgment on issue of medical necessity