Volume 19

19 Fla. L. Weekly Supp. 595b

Online Reference: FLWSUPP 1907GARNInsurance — Personal injury protection — Coverage — Medical expenses — Summary judgment — Opposing affidavit — Affidavit of actuary filed in opposition to provider’s motion for partial summary judgment is insufficient to create issue of fact as to reasonableness of medical provider’s charges where actuary merely compiled data to conclude that insurer’s reimbursement at 200% of Medicare fee schedule or 100% of workers’ compensation fee schedule was reasonable

19 Fla. L. Weekly Supp. 730b

Online Reference: FLWSUPP 1909MARRInsurance — Personal injury protection — Summary judgment — Where insurer did not file affidavit or present any evidence to contradict medical provider’s evidence that services provided to insured were reasonable, necessary and related to accident and that bill for services was reasonable in amount, provider is entitled to judgment as matter of law

19 Fla. L. Weekly Supp. 975a

Online Reference: FLWSUPP 1912CHAVInsurance — Personal injury protection — Summary judgment — Trial court erred treating independent medical examination and peer review report as sworn statements for purposes of rule set forth by supreme court in Ellison v. Anderson that a party in summary judgment proceedings may not repudiate a prior sworn affidavit, deposition, or prior sworn testimony by using a subsequent sworn statement, and in refusing to consider IME and peer review report under Ellison rule based upon finding that there were contradictions between IME and report — IME finding that insured needs no further treatment is not “bald repudiation” of peer review report opining that some prior treatment was not reasonable, related and necessary — Error to enter summary judgment where affidavit of physician and attached peer review report and IME created genuine issue of material fact as to reasonableness, relatedness and necessity of treatment — Trial court erred in ruling that insurer that rejected some of provider’s bills was required to have valid medical report before denying payment

19 Fla. L. Weekly Supp. 882a

Online Reference: FLWSUPP 1910EVANInsurance — Personal injury protection — Insurer may not challenge medical necessity and relatedness of services for which it has already paid benefits

19 Fla. L. Weekly Supp. 487b

Online Reference: FLWSUPP 1906CAMBInsurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary expenses — Summary judgment — Medical provider’s motion for final summary judgment is granted where affidavit of treating physician is sufficient to demonstrate absence of any genuine issue of material fact as to reasonableness, relatedness and medical necessity of treatment and reasonableness of charges, and opposing affidavit of peer review physician does not render opinion as to reasonableness, relatedness or necessity of treatment or reasonableness of charges for dates of service at issue — Peer review affidavit is technically deficient where affidavit is not made on personal knowledge, affiant would not be able to set forth information in manner admissible in evidence, and affiant cannot show that he would be competent to testify on issue of reasonableness, relatedness and necessity of treatment

19 Fla. L. Weekly Supp. 215b

Online Reference: FLWSUPP 1903MORRInsurance — Personal injury protection — Coverage — Reasonable charges — Evidence that insurer paid more than amount medical provider accepts from Medicare for like services by paying 200% of Medicare fee schedule as provided for in PIP statute is not sufficient to prove that amount charged by provider was unreasonable — Insurer improperly elected permissive fee schedule of PIP statute despite policy language requiring payment of 80% of reasonable charges and further reduced payments below even permissive fee schedule’s minimum reimbursement by improperly applying outpatient prospective payment system cap

19 Fla. L. Weekly Supp. 202b

Online Reference: FLWSUPP 1903MAYEInsurance — Personal injury protection — Coverage — Insurer is not permitted to apply permissive reimbursement limitations of PIP statute where policy requires payment of 80% of reasonable expenses

19 Fla. L. Weekly Supp. 202a

Online Reference: FLWSUPP 1903SYLVInsurance — Personal injury protection — Coverage — Medical expenses — Medical provider’s payment schedule is contrary to provision of PIP statute

19 Fla. L. Weekly Supp. 166e

Online Reference: FLWSUPP 1903PALMInsurance — Personal injury protection — Coverage — Confession of error regarding use of Medicare fee schedule in 2008 PIP statute where policy specifies that insurer will pay 80% of necessary expenses

19 Fla. L. Weekly Supp. 136b

Online Reference: FLWSUPP 1902MILOInsurance — Personal injury protection — Coverage — Where legislature expressed intent that 2008 PIP statute apply retroactively, but application of 2008 statute to calculate benefits adds new legal consequences to terms agreed upon at time of issuance of policy, which provided that payment of benefits would be in accordance with PIP statute “as amended,” retroactive application of statute is not constitutional — Policy reference to PIP statute “as amended” refers to past amendments to PIP statute and does not incorporate future amendments to PIP statute into policy — Even if “as amended” language was intended to incorporate future changes to PIP statute into policy, changes would be applicable only to extent that they do not conflict with specific method of calculating benefits provided in policy