Volume 16

16 Fla. L. Weekly Supp. 773a

Online Reference: FLWSUPP 168EBNER

Insurance — Personal injury protection — Disclosure and acknowledgment form — Sufficiency — Failure to comply with requirement to submit sufficient D&A form for initial date of service is fatal to medical provider’s entire claim — Listing of CPT codes on D&A form does not satisfy requirement to describe services actually rendered — Patient’s signing of treatment records does not satisfy requirement that patient countersign D&A form attesting to fact that services described were actually rendered — D&A form signed by physician one day after treatment was rendered is deficient where statute requires that provider sign form before patient countersigns form — Motion for summary judgment granted

16 Fla. L. Weekly Supp. 355a

Online Reference: FLWSUPP 164VICTO

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — No merit to insurer’s claim that medical provider forfeited right to benefits by providing D&A form that failed to define actual services provided where D&A form with attached CMS 1500 and notes for treatment substantially complied with statute and placed insurer on notice of actual services provided; there is no prejudice to insurer, which conceded that treatment was reasonable, related and necessary; D&A form is not condition precedent to filing suit; insurer did not cite defective D&A form in explanation of benefits, and provider submitted second D&A form that described actual services provided

16 Fla. L. Weekly Supp. 1155a

Online Reference: FLWSUPP 1612PIER

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — Where medical provider submitted self-generated D&A form that transcribed D&A form adopted by Office of Insurance Regulation verbatim except for state seal and Office’s name at top of form, form substantially complied with section 627.736(5)(e) and provided notice of covered loss

16 Fla. L. Weekly Supp. 347b

Online Reference: FLWSUPP 164MONGA

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — Where it is undisputed that PIP policy had effective date well before sunset of PIP statute, D&A form requirement applies even though statute had sunset and was not in effect at time of initial date of service — No merit to argument that defects in D&A form can be overlooked where bills and records are sent contemporaneously — Further, resubmission of D&A form with changes made to description of services after form was signed does not comply with requirement that patient attest that services were actually rendered — No merit to argument that defective D&A form affects only first date of service; form is prerequisite to billing — Summary judgment entered in favor of insurer

16 Fla. L. Weekly Supp. 444a

Online Reference: FLWSUPP 165VILLA

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form requirement applies to initial date of service only

16 Fla. L. Weekly Supp. 433b

Online Reference: FLWSUPP 165SCHUL

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form — Description of service provided as “chiropractic treatment” on D&A form does not substantially comply with statutory requirement — Noncompliant D&A form only allows insurer to withhold payment for initial date of service where medical provider complied with all statutory requirements for claims for subsequent treatment

16 Fla. L. Weekly Supp. 114b

Insurance — Personal injury protection — Notice of loss — Disclosure and acknowledgment form that failed to identify services actually rendered did not provide notice of covered loss — No merit to argument that failure to provide properly completed D&A form impacts only initial date of service and not entire claim

16 Fla. L. Weekly Supp. 918a

Online Reference: FLWSUPP 1610GAIT

Insurance — Personal injury protection — Independent medical examination — Failure to attend — Trial court erred in entering summary judgment in favor of insurer based on insured’s failure to attend second, chiropractic IME after insurer terminated benefits based on earlier IME performed by medical doctor — Whether request to attend chiropractic IME was reasonable is at best question of fact precluding summary judgment where IME could have no effect on benefits because benefits were already terminated and insured received no chiropractic benefits

16 Fla. L. Weekly Supp. 338a

Online Reference: FLWSUPP 164MADRI

Insurance — Personal injury protection — Independent medical examination — Failure to appear — Where insured provided excuse for nonappearance at IMEs and cooperated with insurer by attending examination under oath, factual issue exists as to whether insured unreasonably refused to submit to IME — Defendant’s motion for partial summary judgment denied

16 Fla. L. Weekly Supp. 199b

Online Reference: FLWSUPP 162FIGEU

Insurance — Personal injury protection — Independent medical examination — Failure to attend — Notice — Where insurer that received representation letter from insured’s attorney specifically requesting notice of IME failed to send notice of IME to attorney, insured had no obligation to attend IME — No merit to argument that insurer was not required to provide notice to attorney where representation letter and IME notice sent to insured crossed in mail; insurer was required to provide notice to attorney once it received representation letter