Volume 19

19 Fla. L. Weekly Supp. 979a

Online Reference: FLWSUPP 1912ANTEInsurance — Personal injury protection — Denial of claim — Valid medical report — There was no requirement that peer review report offered to support denial of medical provider’s claim comply with statutory requirements for valid report in support of withdrawal of benefits or that report be obtained by insurer before denial, and trial court erred in rejecting report filed in opposition to summary judgment for failure to meet those requirements — Trial court also erred in rejecting peer review physician’s affidavit as technically or legally insufficient where affidavit and attached report, which opined that treatment was not reasonable, related, and necessary because it was duplicative or unsubstantiated and which detailed the bases for this opinion, raised doubt as to existence of issues of fact — Abuse of discretion to fail to grant insurer’s motion for relief from technical admissions where motion was timely, answer and other filings contradict technical admissions, and provider did not establish prejudice

19 Fla. L. Weekly Supp. 323a

Online Reference: FLWSUPP 1905GARRInsurance — Personal injury protection — Denial of benefits — Insurer was not required to obtain valid report prior to denial of benefits — Examination under oath — Notice — No abuse of discretion in refusing to admit affidavit of corporate representative that conflicted with prior deposition testimony of litigation adjuster with regard to EUO notice sent to insured

19 Fla. L. Weekly Supp. 159a

Online Reference: FLWSUPP 1903PIERInsurance — Personal injury protection — Denial of benefits — Necessity of valid medical report

19 Fla. L. Weekly Supp. 129a

Online Reference: FLWSUPP 1902FRANInsurance — Personal injury protection — Delay in payment — Request for information or documentation — Medical provider’s response to request for complete medical file, asserting that medical file had been previously provided to insurer, was insufficient where not all documents in file had been previously provided — Further, provider’s partial response to request for documentation was insufficient for failing to include sworn statement required by statute — Due to incomplete response to request for documentation, medical bills were not overdue at time suit was filed and claim is premature

19 Fla. L. Weekly Supp. 174a

Online Reference: FLWSUPP 1903GONZInsurance — Personal injury protection — Answer — Amendment — Abuse of discretion to deny insurer leave to file amended answer to assert statutory defense of late billing where amendment would not be futile, insurer had not previously amended answer, medical provider was not prejudiced by fact that motion to amend was not calendared prior to summary judgment hearing, and amendment will not cause delay because case must be set for trial due to reversal and remand on another issue

19 Fla. L. Weekly Supp. 14b

Online Reference: FLWSUPP 1901LIMAInsurance — Personal injury protection — Coverage — By including language in PIP policy that provides for both payment of 80% of reasonable expenses and limitation of reimbursement to 80% of 200% of Medicare fee schedule, insurer has created ambiguity that must be resolved in favor of insured

19 Fla. L. Weekly Supp. 1023b

Online Reference: FLWSUPP 1912HOLLInsurance — Personal injury protection — Affirmative defenses — Motion to strike affirmative defenses is denied where defenses are consistent with amended admissions

19 Fla. L. Weekly Supp. 653b

Online Reference: FLWSUPP 1908HORNInsurance — Personal injury protection — Coverage — Summary judgment — Factual issues — Where there exist disputed issues of material fact as to whether insurer paid medical provider correct amount under Medicare Part B fee schedule as required by PIP statute, it would be inappropriate to grant insurer’s motion for summary judgment

19 Fla. L. Weekly Supp. 841b

Online Reference: FLWSUPP 1910CURAInsurance — Personal injury protection — Damages — Insured’s action against insurer to recover for bills for treatment which was necessitated by automobile accident and which was provided by now-deceased physician whose estate has never laid claim to medical bills — Summary judgment entered in favor of insurer in absence of competent evidence that plaintiff continued to be liable for medical bills — In absence of proof of damages, breach of contract action against insurer cannot stand

19 Fla. L. Weekly Supp. 423a

Online Reference: FLWSUPP 1906JOSEInsurance — Personal injury protection — Coverage — Summary judgment — Factual issues — Error to grant summary judgment in favor of insurer where there was conflicting deposition testimony as to whether claimant resided with insured on date of accident