Volume 16

16 Fla. L. Weekly Supp. 396a

Online Reference: FLWSUPP 165LEADB

Insurance — Personal injury protection — Coverage — Medical expenses — CPT coding — No merit to argument that trial court erred in considering deposition of insurer’s coding expert in opposition to motion for summary judgment because insurer violated rule 1.510(c) by failing to specifically designate deposition transcript as evidence to oppose motion for summary judgment where notice of filing transcript 19 days prior to summary judgment hearing was appropriate and sufficient notice satisfying intent of rule — Further, even if transcript was not properly before court, where provider’s motion for summary judgment did not negate allegation that CPT codes at issue had been unbundled, denial of summary judgment was proper — Where insurer denied payment for CPT codes for unbundled services and paid benefits for simultaneously billed bundled service code that included those other services, statutory obligation to contact provider to discuss change in coding was not triggered

16 Fla. L. Weekly Supp. 1161d

Online Reference: FLWSUPP 1612VILS

Insurance — Personal injury protection — Coverage — Medicare Part A fee schedule — Where Medicare fee schedule entirely excludes payment for medically necessary service, insurer is nonetheless obligated to pay for that service by use of other fee determinations provided by PIP law, such as usual and customary charges or workers’ compensation fee schedule

16 Fla. L. Weekly Supp. 1160c

Online Reference: FLWSUPP 1612FEIJ

Insurance — Personal injury protection — Limitation of actions — Where action for breach of PIP contract was filed more than five years after breach occurred when benefits claimed by last set of medical bills submitted to insurer became overdue, action is barred by statute of limitations — Demand letter did not toll running of statute of limitations where letter was untimely served after expiration of limitations period

16 Fla. L. Weekly Supp. 1036b

Online Reference: FLWSUPP 1611ZAYA

Insurance — Personal injury protection — Appeals — Timeliness — Where trial court entered final order dismissing amended complaint pursuant to plaintiff’s notice of voluntary dismissal and denying plaintiff’s motion to vacate final judgment that had been subject of prior appeal, plaintiff did not file a motion for rehearing or appeal of that order but reasserted motion to vacate during hearing on defendant’s entitlement to attorney’s fees, and trial court entered second order denying motion to vacate that did not meaningfully alter or amend prior order, appeal filed within thirty days of second order denying motion to vacate but five months after first order denying motion was not timely filed — No merit to argument that first order denying motion was legal nullity that court lacked jurisdiction to issue because plaintiff had taken voluntary dismissal before order was issued

16 Fla. L. Weekly Supp. 1067b

Online Reference: FLWSUPP 1611FRAN

Insurance — Personal injury protection — Striking of affirmative defense

16 Fla. L. Weekly Supp. 956a

Online Reference: FLWSUPP 1610VASQ

Insurance — Personal injury protection — Answer and affirmative defenses — More definite statement is ordered as to which bills or services insurer alleges fail to follow CPT codes, which services it alleges were upcoded, and which bills it alleges were not timely submitted — Affirmative defenses alleging that medical provider has charged unreasonable and excessive fee and billed for services not rendered are denials of allegations of complaint, not affirmative defenses, and are stricken

16 Fla. L. Weekly Supp. 472a

Online Reference: FLWSUPP 165ADRIE

Insurance — Personal injury protection — Examination under oath — Failure to attend — Where insurer failed to schedule EUOs within 30 days of receiving notice of claim and did not have reasonable proof that it was not responsible for payment of claim, insured’s failure to attend EUOs did not give insurer right to deny benefits — Insured had no duty to attend second set of EUOs scheduled after insurer cut off benefits based on failure to attend independent medical examinations — Insured’s failure to attend IMEs did not give insurer right to deny benefits where all dates of service predate missed IMEs — Notice of loss — Where insurer received bills 32 days after start of treatment but 41 days after accident, question of whether provider failed to properly notify insurer of existence of claim or withheld notice of loss is question of fact for jury — Affidavit of peer review physician swearing to “best of his knowledge” is defective, but may be corrected — Hearing on motion for summary judgment on issue of reasonableness, relatedness and necessity of treatment is continued to address whether peer review affidavit that is not based on all medical records should be stricken where insurer claims that records allegedly omitted from review were not furnished by provider

16 Fla. L. Weekly Supp. 456a

Online Reference: FLWSUPP 165RODRI

Insurance — Personal injury protection — Accord and satisfaction — Where in response to demand letter insurer sent explanation of benefits listing reduced amounts it was allowing for charges and check for reduced amounts which conspicuously contained language indicating that payment was in full and final payment of PIP benefits, and medical provider negotiated check and had no further contact with insurer about reduced amounts paid, accord and satisfaction of charges at issue occurred

16 Fla. L. Weekly Supp. 781a

Online Reference: FLWSUPP 168BAPTI

Insurance — Personal injury protection — Accord and satisfaction — Conspicuous statement — Where full and final payment language in insurance draft for reduced amount of claim was located in the “pay to order” section of draft, not at heading of draft, and was in the same size font as surrounding text, and full and fair language in accompanying explanation of benefits was also in same size font as surrounding text, neither draft nor EOB contained conspicuous statement that draft was tendered as full satisfaction of claim — Medical provider’s endorsement and cashing of draft did not give rise to accord and satisfaction precluding action for unpaid portion of bills

16 Fla. L. Weekly Supp. 97b

Insurance — Personal injury protection — Accord and satisfaction — Where medical provider cashed draft tendered by insurer that contained conspicuous notation that draft was for “full/final PIP payment,” insured’s claim was unliquidated and subject to bona fide dispute, and amount was tendered in good faith, final judgment is rendered in favor of insurer