Volume 16

16 Fla. L. Weekly Supp. 953a

Online Reference: FLWSUPP 1610TUCK

Insurance — Personal injury protection — Independent dental examination — Refusal to submit to exam — Provision of PIP statute governing location of independent medical examinations did not apply where insured’s PIP benefits had been exhausted at time insurer requested IME, and only med pay coverage was available to pay dental bills — Where policy does not restrict IME location, insurer did not act unreasonably in requiring insured to attend IME in location other than city and county of residence — Where it is undisputed that insured traveled to IME location but then refused to submit to exam, and insured previously appeared for IME and then refused to allow IME to be performed, refusal was unreasonable

16 Fla. L. Weekly Supp. 271a

Online Reference: FLWSUPP 163MALAV

Insurance — Personal injury protection — Explanation of benefits — Compliance with insurer’s request in EOB for legible, identifiable office notes was condition precedent to suit for PIP benefits — Insurer was entitled to ask for and obtain documents even if medical provider contends that documents had already been submitted

16 Fla. L. Weekly Supp. 682a

Online Reference: FLWSUPP 167SALGA

Insurance — Personal injury protection — Explanation of benefits — Letter which suspended benefits due to independent medical examination and stated that some or all charges were not reasonable, but which did not identify which specific charges were not reasonable and did not itemize each charge received and identify why it was not paid, was not legally compliant EOB

16 Fla. L. Weekly Supp. 595a

Online Reference: FLWSUPP 166KEEN

Insurance — Personal injury protection — Explanation of benefits — Where it is undisputed that insurer wrongfully failed to provide EOB to medical provider, provider is entitled to nominal damages and reasonable attorney’s fees and costs

16 Fla. L. Weekly Supp. 576b

Online Reference: FLWSUPP 166PLANT

Insurance — Personal injury protection — Explanation of benefits — Where insurer breached contract by failing to provide EOB within thirty days of receipt of bills, medical provider is awarded nominal damages of $1.00, attorney’s fees and costs

16 Fla. L. Weekly Supp. 663a

Online Reference: FLWSUPP 167PAUL

Insurance — Personal injury protection — Explanation of benefits — Failure to provide — Letter stating that claim is under investigation is not rejection triggering duty to provide EOB — No merit to argument that bills were automatically rejected 30 days after receipt — Insurer’s response to demand letter rejecting entire claim is clear rejection that triggered duty to provide EOB — There is no requirement that EOB provide detail as to why items are rejected, although EOB at issue does specify reason for rejection

16 Fla. L. Weekly Supp. 439a

Online Reference: FLWSUPP 165JOSEP

Insurance — Personal injury protection — Explanation of benefits — Failure to provide — Neither insurer’s letter advising that claim is under investigation nor failure to remit payment within 30 days of receipt of claim were rejections of claim triggering requirement to provide EOB — Rather, insurer’s response to demand letter is clear rejection that triggered EOB requirement — Where response to demand letter stated that entire claim was denied, no further detail was required to satisfy EOB requirement of providing itemized specification

16 Fla. L. Weekly Supp. 103b

Insurance — Personal injury protection — Explanation of benefits — Duty to provide — Question certified: When an insurer does not pay a portion of a claim or reject a claim within 30 days, does it, pursuant to Florida Statute §627.736(4)(b), have to provide an itemized specification of each item that the insurer had reduced, omitted, or declined to pay and any information that the insurer desires the claimant to consider related to the medical necessity of the denied treatment or explain the reasonableness of the related charge?

16 Fla. L. Weekly Supp. 871a

Online Reference: FLWSUPP 169NUTEC

Insurance — Personal injury protection — Examination under oath — Where claimant voluntarily appeared at EUO, made admissions regarding fraud by treating physicians, and thereafter terminated EUO, claimant’s actions constitute refusal to cooperate — Claimant’s refusal to cooperate is not excused by fact that he had no duty to submit to EUO which was scheduled more than 30 days after insurer’s receipt of notice of claim where claimant voluntarily appeared for EUO

16 Fla. L. Weekly Supp. 106b

Insurance — Personal injury protection — Examination under oath — Failure to attend — Insurer did not waive EUO no-show defense by failing to state defense on explanation of benefits where failure to attend EUO could not have been cured even if insurer had given notice