Volume 16

16 Fla. L. Weekly Supp. 867a

Online Reference: FLWSUPP 169LOPEZ

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form that listed “initial visit” as services rendered on first date of treatment substantially complied with statutory D&A form requirement where CMS-1500 form and medical records fully listing specific therapies rendered were submitted with D&A form

16 Fla. L. Weekly Supp. 772a

Online Reference: FLWSUPP 168LYNAM

Insurance — Personal injury protection — Notice of loss — Acknowledgment and disclosure form — Sufficiency — D&A form describing services as “evaluation new patient & therapy” was sufficient to describe services that included physical therapy evaluation, manual therapy, ultrasound and E-Stim — Medical provider was not required to list all four therapy services individually on form

16 Fla. L. Weekly Supp. 347a

Online Reference: FLWSUPP 164BISTL

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form on which medical provider wrote “Consult/Procedure” and to which provider attached bills did not set forth services actually rendered and, therefore, did not provide insurer with notice of loss

16 Fla. L. Weekly Supp. 754a

Online Reference: FLWSUPP 168BLACK

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — Where medical provider was given notice that D&A form, which lacked list of services actually rendered, was so deficient as to not put insurer on notice of covered loss, provider was required to correct deficiency before statements sent to insurer for subsequent dates of treatment could legally put insurer on notice of loss — Provider’s concern that insurer would refuse to pay any bills regardless of resubmission of properly completed D&A form was premature and unwarranted

16 Fla. L. Weekly Supp. 857a

Online Reference: FLWSUPP 169ELLER

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — Medical provider’s submission of D&A form that did not contain description of medical services rendered did not permanently forfeit provider’s right to be paid for medical services — Provider’s resubmission of properly completed D&A form constitutes substantial compliance with statutory D&A form requirement — No merit to argument that insurer is only required to pay for services rendered within 35 days of receipt of resubmitted D&A form where at time resubmission was received insured had completed all treatment and all statements of charges had been submitted to insurer on timely basis

16 Fla. L. Weekly Supp. 755a

Online Reference: FLWSUPP 168YOUN2

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — PIP statute does not allow insurer to raise deficiency of D&A form as defense after payment of claim — No merit to argument that even if insurer can raise deficient D&A form as defense, payment of claim waived defense as to incompleteness of form — Both waiver and estoppel would prevent insurer from raising defense that form was deficient because fax copy rather than original was sent to insurer where insurer gave permission for fax and paid claim — Question certified: Does section 627.736(4)(b) allow an insurer to assert at any time, including after payment of the claim or after the 30-day time period for payment set forth in subsection (4)(b), that a claim violates any of the requirements set forth in subsection (5)

16 Fla. L. Weekly Supp. 1155b

Online Reference: FLWSUPP 1612ROO2

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form that described services as “consult, exam, x-rays, therapy, biofreeze, hot pk” was not deficient for failing to specifically list all services performed or for listing consult service not reflected in medical notes — Even if D&A form did not list services provided, insurer would continue to be liable for services rendered after initial date of service

16 Fla. L. Weekly Supp. 175c

Online Reference: FLWSUPP 162LAHOD

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — Medical provider that provided insurer with self-generated D&A form that lacked physician’s affirmations, failed to identify services provided and was not standard form promulgated by Department of Financial Services did not provide insurer with notice of covered loss — Insurer did not waive defective D&A form defense by asserting in explanation of benefits that denial of claim was based on peer review/independent medical examination

16 Fla. L. Weekly Supp. 1081d

Online Reference: FLWSUPP 1611LAZA

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — Use of self-generated D&A form that fails to contain required language of standard form promulgated by Department of Financial Services failed to place insurer on notice of covered loss — No merit to argument that defective D&A form only invalidates claim for initial date of service

16 Fla. L. Weekly Supp. 683a

Online Reference: FLWSUPP 167OSHEA

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form requirement applies only to first date of service and failure to submit form is not fatal to entire claim