Volume 17

17 Fla. L. Weekly Supp. 1259b

Online Reference: FLWSUPP 1712PLOP

Insurance — Personal injury protection — Coverage — Medical expenses — Because provision of PIP statute providing that insurer may limit reimbursement to 80% of Medicare Part B fee schedule is permissive and not mandatory, where contract provides that insurer will pay in accordance with No-Fault Act 80% of reasonable charges for necessary medical services and does not indicate that insurer was going to limit payments as permitted by statute, insurer is required to pay 80% of reasonable expenses

17 Fla. L. Weekly Supp. 1228a

Online Reference: FLWSUPP 1712COMP

Insurance — Personal injury protection — Coverage — Medical expenses — Policy language requiring that insurer pay claim at 80% of reasonable expenses for medically necessary care controls over permissive language of PIP statute allowing reduced reimbursement rates

17 Fla. L. Weekly Supp. 470a

Online Reference: FLWSUPP 1706MONT

Insurance — Personal injury protection — Coverage — Medical expenses — Because provisions of PIP statute providing that insurer may limit reimbursement to 80% of Medicare Part B fee schedule is permissive and not mandatory, where contract provides that insurer shall pay 80% of reasonable expenses of medically necessary treatments and does not indicate that insurer was going to limit payments as permitted by statute, insurer is required to pay 80% of reasonable expenses

17 Fla. L. Weekly Supp. 10b

Online Reference: FLWSUPP 1701GONZ

Insurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Trial court correctly entered summary judgment in favor of insurer where PIP coverage was exhausted prior to medical provider sending demand letter, and there is no allegation or evidentiary showing of bad faith — Explanation of benefits — Requirement to send EOB was not triggered where benefits had been exhausted

17 Fla. L. Weekly Supp. 55b

Online Reference: FLWSUPP 1701TRUJ

Insurance — Personal injury protection — Coverage — Priority — Hospital lien — Hospital that failed to comply with requirement to file verified claim of lien within ten days after patient was discharged was unsecured creditor until it perfected lien by filing claim, at which time it became secured creditor subject to priority payment — Medical provider/assignee has no standing to challenge hospital’s failure to perfect lien and insurer’s payments to hospital — Further, provider/assignee is bound by insured’s request that insurer pay hospital bill prior to paying provider — Insurer was not required to reserve benefits for disputed claim

17 Fla. L. Weekly Supp. 479a

Online Reference: FLWSUPP 1706SCHO

Insurance — Personal injury protection — Coverage — Exhaustion of policy limits — Bad faith — Insurer’s reliance on controlling case law, subsequently overruled on appeal, to deny claim based on failure to provide disclosure and acknowledgment form cannot be deemed bad faith that would permit insurer to be held responsible for claim despite exhaustion of benefits — Insurer’s destruction of original claim documents after scanning, including any D&A form that medical provider submitted, does not demonstrate bad faith or establish spoliation of evidence where medical provider retained duplicate D&A form that it could have provided to insurer to resolve matter before benefits were exhausted and could use in prosecution of case — Even if documents revealed that insurer had received D&A form, subsequent exhaustion of benefits vitiates any liability of insurer for mistakenly not paying claim

17 Fla. L. Weekly Supp. 1121b

Online Reference: FLWSUPP 1711HARV

Insurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where insurer did not act in bad faith in down-coding CPT codes and applying negotiated PPO adjustment, and payment sent after receipt of demand letter seeking balance of reduced claims exhausted benefits, there can be nothing further due and owing from insurer — No merit to argument that medical provider’s failure to deposit check sent in response to demand letter means benefits have not been exhausted

17 Fla. L. Weekly Supp. 1115c

Online Reference: FLWSUPP 1711SILV

Insurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where PIP benefits were exhausted by payment of medical bills, including untimely bill of medical equipment provider, and there is no allegation that insurer acted in bad faith, insurer is not liable for payment of additional charges

17 Fla. L. Weekly Supp. 386a

Online Reference: FLWSUPP 1705HARKInsurance — Personal injury protection — Coverage — Exhaustion of policy limits — Partial summary judgment is entered in favor of insurer where no benefits or damages are or will be due and owing as benefits are exhausted and medical provider has withdrawn or dismissed claims

17 Fla. L. Weekly Supp. 9c

Online Reference: FLWSUPP 1701MART

Insurance — Personal injury protection — Trial court erred in withholding from jury evidence that insured was pregnant at time of accident where pregnancy materially affected how medical provider was able to treat insured’s condition, and failure to fully understand reasons for provider’s initial limited treatment of insured may have caused jury to conclude treatment was not reasonable — Error to grant insurer’s motion for directed verdict as to reasonableness of provider’s bills where insured had submitted evidence that bills were reasonable