Volume 18

18 Fla. L. Weekly Supp. 900a

Online Reference: FLWSUPP 1809RHOD Insurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Summary judgment is granted in favor of insurer in action brought by medical provider/assignee for unpaid portion of reduced medical bills where benefits were exhausted in payment of other providers’ bills, and provider does not allege that insurer acted in bad faith or processed bills inappropriately

18 Fla. L. Weekly Supp. 613a

Online Reference: FLWSUPP 1807PARIInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Following confession of judgment and payments by insurer exhausting remaining PIP benefits available under policy, medical provider is not entitled to any further benefits or interest for unpaid balance of medical bills

18 Fla. L. Weekly Supp. 29a

Online Reference: FLWSUPP 1801SANC Insurance — Personal injury protection — Directed verdict — Error to direct verdict for medical provider where there was ample evidence to support jury’s verdict in favor of insurer concluding that provider’s services were related, but not medically necessary

18 Fla. L. Weekly Supp. 1067a

Online Reference: FLWSUPP 1811CUNI Insurance — Personal injury protection — Denial of benefits — Valid medical report — Where some but not all claims from medical provider were rejected by insurer as unreasonable, unrelated or unnecessary, and case involves denial of payment rather than withdrawal of payment, there was no requirement that insurer obtain medical report prior to denying payment or that medical report relied upon be created by physician in active practice — Trial court erred in refusing to consider peer review and independent medical examination filed in opposition to summary judgment and in entering summary judgment in favor of provider

18 Fla. L. Weekly Supp. 28a

Online Reference: FLWSUPP 1801RGON Insurance — Personal injury protection — Coverage — Medical expenses — Denial of benefits — Valid medical report — Where insurer paid some medical bills after medical provider completed treatment on insured, trial court erred in excluding peer review report on reasonableness, relatedness and necessity of treatment on ground that it was obtained after treatment was rendered — Where some but not all claims from provider are rejected or reduced as unreasonable, unrelated or unnecessary, section 627.736(4)(b) applies and insurer is not required to obtain report or proof before denying claim

18 Fla. L. Weekly Supp. 157a

Online Reference: FLWSUPP 1801SALA Insurance — Personal injury protection — Denial of benefits — Valid medical report — Requirement of valid medical report applies only prior to withdrawal or termination of authorization for further treatment, not prior to outright denial of benefits — Where insurer denied claim, it was not barred from submitting affidavit of peer review doctor in opposition to summary judgment by fact that affidavit was not prepared within 30 days of submission of bills — Error to enter summary judgment in favor of insured on issue of reasonableness, relatedness and necessity of past treatment based on peer review doctor’s affidavit stating that insured had reached maximum medical improvement, that no “further” treatment was necessary, and that symptoms were causally related

18 Fla. L. Weekly Supp. 1198a

Online Reference: FLWSUPP 1811MOOR Insurance — Personal injury protection — Delay in payment — Request for information or documentation — Where medical provider made no response to insurer’s request for information and documentation, insurer had no option but to consider claim tolled — Issue of whether insurer has regular practice of requesting additional information is not ripe in absence of finding of breach of contract — Court will not abate action for unpaid bills to allow provider to attempt belatedly to satisfy request for information and documentation to avoid entry of summary judgment — Insurer’s motion for summary judgment is granted

18 Fla. L. Weekly Supp. 1178a

Online Reference: FLWSUPP 1811BYOU Insurance — Personal injury protection — Coverage — Non-prescription drugs — Medical provider is “dispensing practitioner” of non-prescription drugs as contemplated by workers’ compensation statute and is entitled to be compensated for dispensing drugs if he follows billing requirements of statute — However, where there is no record evidence to establish that drugs were dispensed by provider on date at issue, insurer correctly denied payment for related CPT code

18 Fla. L. Weekly Supp. 1195a

Online Reference: FLWSUPP 1811SANT Insurance — Personal injury protection — Coverage — Medical expenses — CPT coding — Unbundling

18 Fla. L. Weekly Supp. 1050a

Online Reference: FLWSUPP 1810BONH Insurance — Personal injury protection — Coverage — Medical expenses — CPT coding — Unbundling — Medical provider inappropriately unbundled and billed separately for re-reading of diagnostic scans performed as part of medical decision making and counseling components of evaluation and management CPT code which was billed for same day of service