Volume 17

17 Fla. L. Weekly Supp. 1235a

Online Reference: FLWSUPP 1712DWFI

Insurance — Personal injury protection — Coverage — Medical expenses — CPT coding — National Correct Coding Initiative — PIP statute does not permit insurer to rely on NCCI edits to bar claim — Insurer may, nonetheless, raise affirmative defense of unbundling of CPT codes as this raises issue of medical necessity — Where there exists genuine issue of material fact as to whether treatment involved circumstances in which unbundling is appropriate, summary judgment on unbundling issue is precluded

17 Fla. L. Weekly Supp. 1116b

Online Reference: FLWSUPP 1711LLAN

Insurance — Personal injury protection — Coverage — Medical expenses — CPT coding — Where medical provider improperly filed claim for CPT code for unbundled service, insurer properly paid benefits for simultaneously billed bundled service code that included denied unbundled service

17 Fla. L. Weekly Supp. 990b

Online Reference: FLWSUPP 1710BELL

Insurance — Personal injury protection — Coverage — Medical expenses — Notice of loss — Errors and omissions — Name and address of facility where services were rendered, if different from that of entity submitting form — Even if failure to complete box 32 on HCFA form can be deemed a material omission, it was cured by amended and properly completed form subsequently submitted by provider, which was received by insurer well before initiation of litigation

17 Fla. L. Weekly Supp. 886a

Online Reference: FLWSUPP 1710BARR

Insurance — Personal injury protection — Coverage — Medical expenses — Notice of loss — Insured failed to put insurer on notice of claim for services rendered by emergency room physician where bills were not properly submitted to insurer and where no demand letter was sent for payment of emergency room physician’s bills — Error to enter directed verdict for plaintiff on this issue — Disclosure and acknowledgment form must be executed at time of initial medical services upon which claim for PIP benefits is based — Entity which only provided reading and interpretations of diagnostic services is not exempt from D&A requirement — Error to enter directed verdict in favor of plaintiff on issue of D&A form — Reasonable, related, and necessary treatment — Error to enter directed verdict on issue of whether bills were reasonable, related, and necessary where evidence was conflicting

17 Fla. L. Weekly Supp. 1126a

Online Reference: FLWSUPP 1711HENR

Insurance — Personal injury protection — Coverage — Version of PIP statute in effect at time PIP policy was executed rather than version in effect at time of treatment, which provides for payment of 200% of Medicare and/or workers’ compensation fee schedule, is applicable where statutory change affects substantive rights

17 Fla. L. Weekly Supp. 33b

Online Reference: FLWSUPP 1701AMAD

Insurance — Personal injury protection — Coverage — Medical expenses — Because amendment to PIP statute giving insurer option to pay charges at 200% of applicable Medicare Part B or Workers’ Compensation fee schedules with effective date of January 1, 2008, does not affect insured’s substantive contract rights, amendment applies to policy that went into effect before January 1, 2008, where assignment of benefits and medical services occurred after January 1, 2008 — Question certified

17 Fla. L. Weekly Supp. 1113a

Online Reference: FLWSUPP 1711PINE

Insurance — Personal injury protection — Coverage — Medical expenses — CPT coding — Reduced fee schedule in 2008 PIP statute providing for payment of 200% of Medicare Part B fee schedule cannot be applied to payment of benefits under policy issued in 2007, prior to effective date of statute — Even if 2008 statute were applicable, insurer cannot deny payment for CPT code recognizable under Medicare Part B fee schedule on grounds that Medicare’s National Correct Coding Initiative provides that code cannot be billed on same date as another code billed by medical provider where PIP statute forbids insurer from applying utilization limits — No merit to argument that NCCI is payment limitation rather than utilization limitation

17 Fla. L. Weekly Supp. 1112b

Online Reference: FLWSUPP 1711DOMI

Insurance — Personal injury protection — Coverage — Reduced fee schedule in 2008 PIP statute cannot be applied to payment of benefits under policy issued in 2007, prior to effective date of statute — Even if 2008 statute were applicable, insurer is required to pay 80% of medical expenses in accordance with plain language of policy rather than limiting payment in accordance with permissive language of 2008 statute

17 Fla. L. Weekly Supp. 1111a

Online Reference: FLWSUPP 1711HERRInsurance — Personal injury protection — Coverage — Fee schedule in 2008 version of PIP statute is inapplicable where policy was issued prior to effective date of 2008 PIP statute, and plain language of policy required defendant to pay 80% of reasonable expenses rather than limiting payment in accordance with permissive language of 2008 PIP statute

17 Fla. L. Weekly Supp. 592b

Online Reference: FLWSUPP 1707SAN2

Insurance — Personal injury protection — Coverage — Version of PIP statute in effect at time PIP policy was executed, which provided for payment of 80% of reasonable charges, rather than version in effect at time of treatment, which provides for payment of 80% of 200% of Medicare Part B fee schedule, is applicable where statutory change is substantive, and statement in policy that insurer “will pay in accordance with Florida Motor Vehicle No-Fault Law, as amended” does not clearly and unambiguously provide that insured has expressly consented to future statutory changes — Question certified