Volume 20

20 Fla. L. Weekly Supp. 120a

Online Reference: FLWSUPP 2002PINOInsurance — Personal injury protection — Denial of claim — Valid medical report — No abuse of discretion in declining to consider peer review report that contains mere conclusions as to reasonableness, relatedness and necessity of treatment and does not create factual issue precluding summary judgment — Affirmative defenses — Amendment — No merit to claim that trial court exceeded appellate mandate requiring reconsideration of motion for summary judgment on issues of reasonableness, relatedness and necessity of treatment by allowing insurer to amend its affirmative defenses to assert claim that medical provider submitted false or misleading disclosure and acknowledgment form where court ruled on motion for summary judgment prior to considering motion to amend — No abuse of discretion in allowing insurer to amend affirmative defenses where provider that did not require extensive preparation to prevail on affirmative defense was not prejudiced by amendment — Trial court correctly found that D&A form defense was legally insufficient where insurer failed to bring deficiencies in form to provider’s attention, and insurer chose not to raise defense of fraud under insurance fraud statute

20 Fla. L. Weekly Supp. 286a

Online Reference: FLWSUPP 2003ALAYInsurance — Personal injury protection — Insurer was not required by terms of policy to reimburse insured for mileage expenses or lost wages associated with attending independent medical examination

20 Fla. L. Weekly Supp. 442a

Online Reference: FLWSUPP 2004ESTRInsurance — Personal injury protection — Exhaustion of policy limits — Insurer entitled to summary judgment in action brought by provider challenging insurer’s payment of reduced amounts based on state fee scheduling guidelines where it is undisputed that benefits payable under policy were exhausted before suit was filed — Absent any allegation or finding of bad faith on insurer’s part when it exhausted benefits, insurer is not required to set aside a reserve fund with which to supplement reduced payments to a provider in the event those payments are subsequently challenged

20 Fla. L. Weekly Supp. 441a

Online Reference: FLWSUPP 2004MACHInsurance — Personal injury protection — Exhaustion of policy limits — Insurer entitled to summary judgment in action brought by provider challenging insurer’s payment of reduced amounts based on state fee scheduling guidelines where it is undisputed that benefits payable under policy were exhausted before suit was filed — Absent any allegation or finding of bad faith on insurer’s part when it exhausted benefits, insurer is not required to set aside a reserve fund with which to supplement reduced payments to a provider in the event those payments are subsequently challenged

20 Fla. L. Weekly Supp. 862a

Online Reference: FLWSUPP 2009LAUZInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where insurer wrongly paid medical bills in accordance with permissive reimbursement limitation of section 627.736(5)(a)2.f despite fact that policy obligated it to pay 80% of reasonable medical expenses, insurer’s exhaustion of benefits will not shield insurer from having to pay in excess of policy limits

20 Fla. L. Weekly Supp. 934a

Online Reference: FLWSUPP 2009FLYNInsurance — Personal injury protection — Coverage — Exhaustion of policy limits — Insurer is entitled to summary judgment in action brought by medical provider challenging insurer’s payment of reduced amounts based on PPO agreement where benefits payable under policy were exhausted before suit was filed

20 Fla. L. Weekly Supp. 323a

Online Reference: FLWSUPP 2004HERNInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of benefits — Trial court abused its discretion in denying insurer’s second motion to amend its affirmative defenses to include that of exhaustion of benefits where motion was filed before trial date was set and before court ruled on motion for summary judgment — Trial court not precluded from imposing costs incurred by insurer’s belated discovery that it had exhausted available benefits should plaintiff sustain its burden of demonstrating those costs after remand

20 Fla. L. Weekly Supp. 678a

Online Reference: FLWSUPP 2007FLINInsurance — Personal injury protection — Affirmative defenses — Amendment — Motion to amend affirmative defenses is denied where insurer was aware of defense two years before filing original answer and medical provider would be prejudiced by allowing amendment

20 Fla. L. Weekly Supp. 936b

Online Reference: FLWSUPP 2009MOSEInsurance — Personal injury protection — Affirmative defenses — Amendment — Second motion to amend answer and affirmative defenses to assert defenses of deficient demand letter and exhaustion of benefits is denied where insurer filed motion seven months after exhaustion occurred and medical provider would be substantially prejudiced by amendment

20 Fla. L. Weekly Supp. 829b

Online Reference: FLWSUPP 2008HUBBInsurance — Personal injury protection — Complaint — Amendment — Substitution of insurer — Motion to amend complaint to substitute insurer that is entirely separate and distinct legal entity from, but closely affiliated to, insurer against whom action had been pending is denied