Volume 20

20 Fla. L. Weekly Supp. 151a

Online Reference: FLWSUPP 2002GRINInsurance — Personal injury protection — Plaintiff’s motion to amend complaint to correct name of defendant insurer is granted — Operative issues in this case show that the defendant named in the original complaint and defendant named in amended complaint are “sufficiently related”; that defendant knew plaintiff was making claim for unpaid PIP benefits prior to filing suit with the receipt of the pre-suit demand letter; and that plaintiff moved to amend in a timely manner and caused no prejudice to defendant

20 Fla. L. Weekly Supp. 482a

Online Reference: FLWSUPP 2005CAFIInsurance — Personal injury protection — Coverage — Medical expenses — National Correct Coding Initiative — Trial court did not err in finding that PIP insurer could not apply NCCI edits to deny payment for two different treatments by medical provider on same patient on same day — No error in failing to consider affidavit of insurer’s expert filed in support of motion for summary judgment where expert was stricken as expert witness and, therefore, was precluded from testifying at trial

20 Fla. L. Weekly Supp. 671a

Online Reference: FLWSUPP 2007HORGInsurance — Personal injury protection — Coverage — Medical expenses — Where policy provides that insurer will pay 80% of reasonable expenses, insurer cannot systematically reimburse medical expenses at 200% of Medicare Part B fee schedule without any consideration of reasonableness of amounts charged

20 Fla. L. Weekly Supp. 883a

Online Reference: FLWSUPP 2009VSOLInsurance — Personal injury protection — Coverage — Medical expenses — MRI — Accident occurring during statutory gap period — County court erred in concluding that insurer correctly applied statute limiting amount MRI providers could charge to 200% of the allowable amount under Medicare Part B fee schedule where statute had been automatically repealed under “sunset” provisions at time of accident, policy provided for payment of 80% of reasonable and necessary medical expenses, and policy stated that in determining reasonableness, insurer would consider only the actual charge, the charge negotiated with a provider, or the charge determined by a statistically valid database — Language indicating insurer would pay in accordance with No-Fault Law was not sufficient to place insured on notice that insurer intended to pay less than 80% of reasonable fee as determined by factors specified in policy — Insurer had no vested right or legitimate expectation in continuing statutory fee limitations beyond repeal date stated in law’s sunset provision

20 Fla. L. Weekly Supp. 1097a

Online Reference: FLWSUPP 2011GALDInsurance — Personal injury protection — Coverage — Medical expenses — Insurer that did not incorporate permissive statutory fee schedule in PIP policy is not entitled to limit reimbursement for MRI to 200% of Medicare fee schedule where it has not demonstrated by some alternative means that 200% of Medicare fee schedule is maximum reasonable amount — Where expert witness offered by insurer in opposition to summary judgment on issue of reasonableness of MRI charge relied upon undisclosed data to form opinion that amount equal to 200% of Medicare fee schedule is only reasonable charge for MRI, witness did not qualify as expert — Offered as fact witness, witness’s testimony is inadmissible lay opinion under guise of fact testimony — Summary judgment granted in favor of medical provider

20 Fla. L. Weekly Supp. 587a

Online Reference: FLWSUPP 2006NASSInsurance — Personal injury protection — Coverage — Medical expenses — MRI — Summary judgment is entered in favor of medical provider where affidavit submitted by provider establishes reasonableness of charge for MRI and opposing affidavit of insurer’s adjuster containing conclusory statement that charge was not reasonable is contradicted by adjuster’s admission at deposition that charge was within range of reasonable charges

20 Fla. L. Weekly Supp. 28a

Online Reference: FLWSUPP 2001DORInsurance — Personal injury protection — Coverage — Medical expenses — Lawfully rendered services — Patient Self Referral Act — Order granting summary judgment determining that medical provider who referred insured to pain management clinic of which provider is sole shareholder violated Patient Self Referral Act — Trial court erred in weighing conflicting evidence to conclude that cross-referral arrangement put in place by provider and clinic did not fall within any exclusions in Act and, therefore, disclosure did not cure violation

20 Fla. L. Weekly Supp. 1234a

Online Reference: FLWSUPP 2012IRODInsurance — Personal injury protection — Coverage — Medical expenses — Lawfully rendered services — Despite being issued clinic exemption by Agency for Health Care Administration, medical provider was not wholly owned by licensed physician where guilty plea agreement and factual proffer entered by true owners in criminal case demonstrate that owners who are not physicians handled all finances and clinic operations, including fraud scheme involving staged accidents, and retained bulk of proceeds — Because provider’s services were not lawfully rendered, they are not compensable under PIP statute

20 Fla. L. Weekly Supp. 1127b

Online Reference: FLWSUPP 2012FLOYInsurance — Personal injury protection — Affirmative defenses — Failure of medical provider to comply with chiropractic record keeping requirements is valid ground to support affirmative defense that medical treatment was unlawfully rendered — Summary judgment — Error to enter summary judgment in favor of provider on issue of reasonableness, relatedness and necessity of treatment where supporting affidavits were legally deficient and deposition excerpts incorporated in motion for summary judgment did not conclusively show absence of genuine issue of material fact

20 Fla. L. Weekly Supp. 288b

Online Reference: FLWSUPP 2003RGONInsurance — Personal injury protection — Exhaustion of policy limits — Failure to advise medical provider — Sanctions — Where there is no reasonable explanation for insurer’s failure to notify medical provider and court of exhaustion of policy limits until eight months after exhaustion occurred, insurer acted in bad faith — Motion for sanctions is granted