Volume 20

20 Fla. L. Weekly Supp. 174a

Online Reference: FLWSUPP 2002ARANInsurance — Personal injury protection — Coverage — Exhaustion of policy limits — Affirmative defenses — Exhaustion of benefits is not affirmative defense that is waived if not affirmatively pled by insurer — Absent evidence of bad faith or gratuitous payment of bills, insurer is not liable for benefits once policy limits have been exhausted — Questions certified: 1) Did Simon v. Progressive Insurance Company abrogate the English rule of priorities as announced by the Florida Supreme Court in Boulevard National Bank of Miami v. Air Metal Industries, Inc., and applied to PIP cases in State Farm Casualty Company v. Ray? and 2) In an action by an assignor for No Fault Insurance benefits founded on a claim for breach of contract, does a post-suit exhaustion of benefits absolve the insurer from any responsibility to pay an otherwise valid claim where the exhaustion occurred after the insured: (a) paid an amount that the provider claims is less than required by contact; (b) was served with a filed complaint; (c) had no basis to reduce or otherwise underpay the bills when it first received them; and (d) withdrew all of its defenses for underpayment or failed to present any defense for the underpayment (other than exhaustion)?

20 Fla. L. Weekly Supp. 1073a

Online Reference: FLWSUPP 2011WILLInsurance — Personal injury protection — Coverage — Emergency services — Exhaustion of policy limits — Statute that requires insurer to reserve $5,000 for emergency medical service providers does not require insurer that paid bill of provider within that classification at reduced amount to reserve benefits for payment of disputed portion of bill

20 Fla. L. Weekly Supp. 697a

Online Reference: FLWSUPP 2007RODRInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Because insurer is mandated by statute to reserve $5,000 for emergency medical service providers, insurer should not have applied claim filed by medical provider within that classification to deductible — However, emergency medical provider’s bill would be paid only when deductible has been satisfied from claims of non-protected providers — If no claims from non-protected providers are received, protected provider’s bill would be applied to deductible

20 Fla. L. Weekly Supp. 689a

Online Reference: FLWSUPP 2007KARAInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Although insurer correctly applied deductible to full amount of plaintiff medical provider’s bill, provider has standing to bring suit challenging calculation of deductible where insurer’s application of deductible to allowable amount of bill submitted earlier by another provider resulted in more of deductible being applied to plaintiff provider’s bill — Insurer’s incorrect reduction of other provider’s bill by 25% before applying deductible resulted in underpayment to plaintiff provider — Because insurer is mandated by statute to reserve $5,000 for emergency medical service providers, insurer should not have applied claim filed by plaintiff provider within that classification to deductible

20 Fla. L. Weekly Supp. 186a

Online Reference: FLWSUPP 2002COCHInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Fact that insurer is mandated by statute to reserve $5,000 for emergency medical service providers does not preclude insurer from applying claim filed by provider within that classification to deductible

20 Fla. L. Weekly Supp. 362a

Online Reference: FLWSUPP 2004GAVIInsurance — Personal injury protection — Coverage — Medical expenses — Trial court correctly denied provider’s motion for directed verdict where the only issue at trial was whether treatment provided to claimant was related to accident, and there was conflicting evidence that indicated someone other than claimant occupied vehicle at time of accident

20 Fla. L. Weekly Supp. 428a

Online Reference: FLWSUPP 2004KPENInsurance — Personal injury protection — Coverage — Medical expenses — Denial — Misrepresentations — Evidence does not support insurer’s denial of coverage based on material misrepresentations by insured in connection with wage loss claim or insurer’s assertion that insured failed to provide information necessary to verify insured’s wage loss claim — Ambiguity created by inclusion of two different employer names on wage-loss claim form was inadvertent and quickly corrected by insured and was not a material misrepresentation that justified voiding coverage

20 Fla. L. Weekly Supp. 425b

Online Reference: FLWSUPP 2004MELKInsurance — Personal injury protection — Coverage — Medical expenses — Denial — Misrepresentations — Insured’s material misrepresentations in examination under oath with respect to his claim for lost wages deprived him of entitlement to coverage for medical expenses, despite insured’s contention that lost wages claim and medical expenses claim were separate claims and insured’s withdrawal of claim for lost wages

20 Fla. L. Weekly Supp. 701a

Online Reference: FLWSUPP 2007PELAInsurance — Personal injury protection — Coverage — Conditions precedent — Examination under oath is not valid condition precedent to coverage under PIP policy

20 Fla. L. Weekly Supp. 1226a

Online Reference: FLWSUPP 2012MONTInsurance — Personal injury protection — Affirmative defenses — Purported affirmative defense that merely denies allegations of complaint already denied in answer and affirmative defense that reserves right to amend defenses pending further discovery are stricken as legally insufficient