Volume 16

16 Fla. L. Weekly Supp. 374a

Online Reference: FLWSUPP 165HARPE

Insurance — Personal injury protection — Error to enter summary judgment in favor of medical provider where provider’s affidavit asserting that all bills were reasonable and affidavit of insurer’s medical expert asserting that charge was above usual and reasonable fee charged for service created genuine issue of material fact — Discovery — Depositions — Expert witness fee — Order granting expert witness fee to treating physician for deposition testimony is affirmed where insurer failed to provide appellate court with transcript of hearing on motion for expert witness fee — Attorney’s fees — Appellate fees awarded to insurer

16 Fla. L. Weekly Supp. 392b

Online Reference: FLWSUPP 165CRUZ

Insurance — Personal injury protection — Evidence — Peer review report — Error to strike report where relevant records had already been filed by medical provider

16 Fla. L. Weekly Supp. 296a

Online Reference: FLWSUPP 164PERE2

Insurance — Personal injury protection — Denial of benefits — Where insurer denied benefits for treatment subsequent to independent medical examination, and three years after denial of claim and two years after commencement of litigation, the insurer obtained peer review report opining that none of treatment rendered by medical provider was reasonable, related or necessary, trial court did not err in striking peer review report

16 Fla. L. Weekly Supp. 258a

Online Reference: FLWSUPP 163ALARC

Insurance — Personal injury protection — Withdrawal of benefits — Where insurer notified insured that it was refusing to pay benefits for any care after date of independent medical examination, but insured continued treatment nonetheless and submitted last set of bills after discharge from treatment; insurer, upon receipt of last bills, failed to make any payments, including payment for care that occurred prior to IME; and, on date suit was filed, insurer did not possess peer review report opining that some of treatment was not medically necessary or related, denial of benefits could not have occurred later than date insured filed suit — Peer review report obtained after denial of benefits is inadmissible — Question certified whether expert testimony based on a physician’s report that was not first obtained by the insurer before PIP benefits were withdrawn or denied in violation of the statutory predicate under § 627.736(7)(a), Fla. Stat. (2003) is admissible to support an insurer’s legal defense on medical necessity and relatedness in an action for PIP benefits? — Demand letter — Where no payments were made, demand letter that failed to specify amount due at 80% and take deducible into account but to which bills were attached substantially complied with statute

16 Fla. L. Weekly Supp. 199c

Online Reference: FLWSUPP 162SOTEL

Insurance — Personal injury protection — Withdrawal of benefits — Peer review report based upon review of treating physician’s records and independent medical examination conducted by doctor not licensed under same chapter as treating physician does not constitute valid report for purposes of denying or withdrawing PIP benefits

16 Fla. L. Weekly Supp. 199a

Online Reference: FLWSUPP 162HODGE

Insurance — Personal injury protection — Coverage — Medical expenses — Summary judgment — Physician’s report is legally insufficient to defeat medical provider’s motion for summary judgment on issue of whether medical bills are reasonable, related and medically necessary where report is based solely on review of records of treating physician and is not supported by independent medical examination

16 Fla. L. Weekly Supp. 22a

Insurance — Personal injury protection — Withdrawal of benefits — Reasonable proof — Physician’s report is not valid report for purposes of denying or withdrawing PIP benefits where report is based solely on review of records of treating physician and is not supported by independent medical examination — Order granting summary judgment in favor of medical provider is affirmed

16 Fla. L. Weekly Supp. 179b

Online Reference: FLWSUPP 162FERNA

Insurance — Personal injury protection — Coverage — Medical expenses — Summary judgment is granted in favor of medical provider where affidavit of physician is sufficient to establish that fees charged were reasonable and necessary, and insurer did not file any opposing affidavit

16 Fla. L. Weekly Supp. 959a

Online Reference: FLWSUPP 1610SARA

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Affidavit of peer review physician opining that treatment was not reasonable, related or necessary is not sufficient to defeat motion for partial summary judgment where opinion is conclusory and not based on full review of treatment records — Partial summary judgment granted in favor of medical provider

16 Fla. L. Weekly Supp. 352a

Online Reference: FLWSUPP 164JOHNS

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Where medical provider has filed affidavit of physician opining that MRI was related and necessary to diagnose insured’s injuries, insurer has not filed any opposing evidence, and insurer’s adjuster testified in deposition that insurer was not disputing that MRI was related and necessary, there is no genuine issue of material fact, and provider’s motion for summary judgment as to reasonableness, relatedness and necessity of treatment is granted