Volume 21

21 Fla. L. Weekly Supp. 878a

Online Reference: FLWSUPP 2109EUGEInsurance — Personal injury protection — Coverage — Medical expenses — Verdict finding that none of services provided to insured were medically necessary was contrary to manifest weight of evidence where insurer failed to present any evidence to contradict provider’s testimony that treatment provided to insured was medically necessary — Testimony of insurer’s expert that all services rendered were not “reimbursable” does not address issue of medical necessity — Error to deny motion for directed verdict

21 Fla. L. Weekly Supp. 370a

Online Reference: FLWSUPP 2104OROZInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Insurer failed to create genuine issue of material fact regarding reasonableness of medical provider’s charges where insurer’s expert, who opined as to recommended amounts for charges, relied exclusively on several undisclosed databases and failed to state that provider’s charges were unreasonable — Insurer failed to create genuine issue of material fact as to relatedness and medical necessity of charges where opinion of insurer’s expert that charges were not related or necessary was based on alleged insufficient record keeping by provider, which was not raised as affirmative defense, and where expert’s affidavit was self-serving and conclusory

21 Fla. L. Weekly Supp. 432a

Online Reference: FLWSUPP 2105CADEInsurance — Personal injury protection — Expert witnesses — Witness’s thirty years of experience working in insurance industry consulting with numerous medical providers and familiarity with reimbursement levels qualifies witness as expert on issue of reasonableness of charges under Daubert standard — Motion to strike affidavit is denied

21 Fla. L. Weekly Supp. 115a

Online Reference: FLWSUPP 2102GLOBInsurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Trial court did not err in declining to exclude adjuster’s deposition testimony as to amount insurer calculated for possible negotiation of bills as evidence of offer to compromise claim — Trial court erred, however, in deeming insurer’s establishment of reasonable settlement sum to be admission of amount of reasonable benefits owed

21 Fla. L. Weekly Supp. 625a

Online Reference: FLWSUPP 2107NGARInsurance — Personal injury protection — Where nothing in record indicates that jury did not follow instructions to determine amount of reasonable medically necessary expenses in reaching $1,000 verdict and instead took into consideration $1,000 deductible that was mentioned at trial notwithstanding motions in limine and applied deductible to expenses before reaching verdict, trial court abused discretion by granting new trial

21 Fla. L. Weekly Supp. 432b

Online Reference: FLWSUPP 2105DCADInsurance — Personal injury protection — Expert witness — Insurer’s actuary is qualified to render opinion on reasonableness of charges where proposed witness has worked in insurance industry consulting with numerous medical providers and is familiar with reimbursement levels in area where medical provider is located — Insurer may challenge medical necessity of treatment at any time, including after payment of claim — Affidavit citing errors and deficiencies in documentation of claimed services creates questions of fact as to necessity of treatment

21 Fla. L. Weekly Supp. 712a

Online Reference: FLWSUPP 2107RAMIInsurance — Personal injury protection — Summary disposition — Reasonableness of charges — Medical provider met burden of proving its charges were within range of what is reasonable for CPT codes at issue — Opposing affidavit of claims representative who was not expert and excluded consideration of any amount above 200% of Medicare or 100% of workers’ compensation fee schedules was insufficient to create triable issue — Summary disposition is granted in favor of provider

21 Fla. L. Weekly Supp. 979a

Online Reference: FLWSUPP 2110IMAGInsurance — Personal injury protection — Coverage — Medical expenses — Insurer could use Medicare fee schedules to determine reasonable amount to be paid in PIP benefits notwithstanding failure to elect use of fee schedules in policy, but fee schedules cannot be sole basis for determination of reasonable amount — No error in striking affidavit of expert who used fee schedules as sole basis to determine reasonable amount that should be paid and entering summary disposition in favor of medical provider

21 Fla. L. Weekly Supp. 837a

Online Reference: FLWSUPP 2108AYERInsurance — Personal injury protection — Summary disposition — Reasonableness of charges — Medical provider met burden of proving its charge for MRI was reasonable — Opposing affidavit of non-expert which was self-serving, conclusory and lacked foundation for affiant’s opinion is insufficient to create genuine issue of material fact — Summary judgment is granted in favor of provider

21 Fla. L. Weekly Supp. 836a

Online Reference: FLWSUPP 2108DESIInsurance — Personal injury protection — Summary judgment — Reasonableness of charges — Medical provider met burden of proving its charge for MRI is reasonable — Opposing affidavit of non-expert PIP adjuster which was based on hearsay and was conclusory and self-serving was insufficient to create genuine issue of material fact — Summary judgment is granted in favor of provider