Volume 17

17 Fla. L. Weekly Supp. 468a

Online Reference: FLWSUPP 1706ALEN

Insurance — Personal injury protection — Examination under oath is condition precedent to maintenance of action to recover PIP benefits

17 Fla. L. Weekly Supp. 387a

Online Reference: FLWSUPP 1705LANG

Insurance — Personal injury protection — Complaint — Amendment — Where defendant insurer knew at all times whether or not insured who had paid premiums to an entity under insurer’s brand was its customer but failed to disclose that medical provider was addressing wrong corporate entity until answer to complaint, and neither insurance card nor explanation of benefits lists entity that insurer now argues is true insurer, motion for leave to amend complaint to name correct insurer is granted

17 Fla. L. Weekly Supp. 386c

Online Reference: FLWSUPP 1705MONT

Insurance — Personal injury protection — Complaint — Amendment — Where defendant insurer knew at all times whether or not insured who had paid premiums to an entity under insurer’s brand was its customer, but failed to disclose that medical provider was addressing wrong corporate entity, and neither insurance card nor explanation of benefits lists entity that insurer now argues is true insurer, motion for leave to amend complaint to name correct insurer is granted

17 Fla. L. Weekly Supp. 997a

Online Reference: FLWSUPP 1710BERG

Original opinion a 17 Fla. L. Weekly Supp. 617b

Insurance — Personal injury protection — Coverage — Medical expenses — Notice of loss — Provider who submitted properly completed HCFA claim form to insurer was not required to respond to insurer’s “Notice to Produce Records Under F.S. 627.736(6),” which requested production of “documentation, including a completed Office of Insurance Regulation approved form (OIR-B1-1809), to verify that [provider] was in compliance with section 627.736(1)(a)” where notice did not request information which was within the scope of section 627.736(6)(b) — Moreover, physician, an osteopathic physician licensed under chapter 459, was not an entity which was required to complete the OIR form requested by insurer

17 Fla. L. Weekly Supp. 874a

Online Reference: FLWSUPP 1710ROUS

Insurance — Personal injury protection — Notice of loss — Bills not submitted on standard claim form — Substantial compliance exception to statutory requirements for submitting PIP claims only applies once insured has met threshold requirement to submit claim on approved standardized form — Waiver — Where insured did not submit claim on standard form, requirement to issue explanation of benefits was not triggered, and failure to issue EOB did not waive insurer’s right to raise affirmative defense of failure to provide notice of covered loss — However, where complaint alleges performance of all conditions precedent, insurer’s failure to deny allegation specifically and with particularity waived affirmative defense

17 Fla. L. Weekly Supp. 122b

Online Reference: FLWSUPP 1702FLOR

Insurance — Personal injury protection — Fraud — Medical provider that submitted bill to insurer for x-ray that it did not perform as well as bills for treatment that it did provide is barred from any recovery of PIP benefits

17 Fla. L. Weekly Supp. 855b

Online Reference: FLWSUPP 1709HARR

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Insurer’s motion for summary judgment on ground that provider failed to render services/engaged in illegal patient broker and/or fee splitting and billed in excess of amounts permitted by statute denied

17 Fla. L. Weekly Supp. 855a

Online Reference: FLWSUPP 1709HAR2

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Notice of loss — Claim form which included name of facility and health care clinic number was sufficient — MRI facility is not required to have professional license number and, accordingly, failure to include that number in Box 31 of claim form not basis for finding lack of notice

17 Fla. L. Weekly Supp. 477a

Online Reference: FLWSUPP 1706GALEInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where insurer denied payment of MRI facility’s bill based on legal position that facility’s failure to provide professional license number on bill failed to provide notice of loss, but only court to address issue has found that statutory requirement to place license number on bill does not apply to MRI facilities, insurer did not have reasonable proof that it was not responsible for payment so as to trigger tolling provision of PIP statute, and insurer is not relieved of liability for MRI facility’s bill by exhaustion of benefits in payment of later-received bills of other providers

17 Fla. L. Weekly Supp. 718a

Online Reference: FLWSUPP 1708FUME

Insurance — Personal injury protection — Claim form — Name and professional license number — Omission of medical provider’s name and professional license number from claim form constitutes failure to provide notice of covered loss