Volume 17

17 Fla. L. Weekly Supp. 1178b

Online Reference: FLWSUPP 1712BARC

Insurance — Personal injury protection — Summary judgment — Opposing affidavit — Sufficiency — Error to exclude peer review affidavit filed in opposition to medical provider’s motion for summary judgment where no physical examination was required, and challenge to reasonableness, relatedness and medical necessity of treatment does not require valid medical report under section 627.736(4)(b)

17 Fla. L. Weekly Supp. 984b

Online Reference: FLWSUPP 1710MART

Insurance — Personal injury protection — Coverage — Medical expenses — Denial of benefits — Valid medical report — Trial court erred in failing to consider peer review report/affidavit because it was acquired after PIP lawsuit had been filed by provider where case involved denial of benefits rather than withdrawal of benefits — Fact that insurer chose to pay only one bill and then, after further investigation, decided to reject payment of others as unreasonable, unrelated, and not medically necessary, does not require that case be classified as one involving withdrawal — Error to find that peer review report/affidavit was not valid because it was based on review of treating physician’s examination, diagnosis, and treatment records rather than on independent medical examination

17 Fla. L. Weekly Supp. 980b

Online Reference: FLWSUPP 1710PORR

Insurance — Personal injury protection — Coverage — Medical expenses — Denial — Valid medical report — Error to strike peer review report on ground that it was untimely and was based on treating physician’s records rather than on independent medical examination — Florida law does not require insurer to file peer review within thirty days from date of notice of loss to establish or contest reasonable, related, and necessity of PIP claim; instead thirty-day period is provision for insurer to avoid interest and attorney’s fees

17 Fla. L. Weekly Supp. 162b

Online Reference: FLWSUPP 1703ROMO

Insurance — Personal injury protection — Denial of benefits — Peer review — To deny payment of PIP benefits, insurer is not required to provide valid report mandated by section 627.736(7)(a)

17 Fla. L. Weekly Supp. 980a

Online Reference: FLWSUPP 1710APOL

Insurance — Personal injury protection — Coverage — Medical expenses — Denial — Valid medical report — Error to exclude peer review testimony because peer review was generated after denial of benefits — Statute relied upon by trial court applies when insurer withdraws already-commenced payments for treatments made by provider, not when payment is denied

17 Fla. L. Weekly Supp. 416a

Online Reference: FLWSUPP 1706MART

Insurance — Personal injury protection — Denial of benefits — Valid medical report — Error to determine that medical report contesting reasonableness, relatedness and necessity of treatment must be obtained within thirty days and before insured filed suit — Trial court further erred in determining that claim not paid before suit is filed was automatically denied

17 Fla. L. Weekly Supp. 379b

Online Reference: FLWSUPP 1705PAUL

Insurance — Personal injury protection — Neither medical provider nor insured knowingly submitted false or misleading statements — Examination under oath — Where insurer rescheduled EUO after insured’s failure to appear at first EUO, operative date of alleged breach of duty to attend EUO is date insured failed to appear at rescheduled EUO — Duty to submit to EUO is condition precedent to suit, but does not fall under purview of duty to cooperate under policy — Insured did not have duty to cooperate after insurer denied claim — Insurer was provided with written notice of covered loss

17 Fla. L. Weekly Supp. 617b

Online Reference: FLWSUPP 1708BERG

NOT FINAL VERSION OF OPINIONSubsequent changes at 17 Fla. L. Weekly 997aInsurance — Personal injury protection — Coverage — Medical expenses — Overdue bills — Request for documentation — Where insurer’s notice requesting documentation to verify that medical provider was eligible to receive payments for PIP benefits was not request for information within scope of section 627.736(6)(b), provider was not required to respond to request and time for payment of benefits was not tolled — Where services were lawfully provided, supervised and presecribed by licensed physician, provider is entitled to benefits

17 Fla. L. Weekly Supp. 382b

Online Reference: FLWSUPP 1705FORG

Insurance — Personal injury protection — Delay in payment — Request for information or documentation — Sufficiency — Non-specific statement printed on each explanation of benefits inviting medical provider to submit whatever documentation or information provider would guess is necessary in response to insurer’s rejection of claim was insufficient to demand additional documentation needed to process claim and toll time for payment of claim

17 Fla. L. Weekly Supp. 1269a

Online Reference: FLWSUPP 1712CILL

Insurance — Personal injury protection — Coverage — Medical expenses — CPT coding — National Correct Coding Initiative is incorporated in Florida PIP law as part of Medicare pay system — Where medical provider improperly unbundled services when billing, neither insured nor insurer was obligated to pay provider for unbundled amounts