Volume 21

21 Fla. L. Weekly Supp. 586b

Online Reference: FLWSUPP 2106HAMInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Deposition of insurer’s expert opining that 80% of 200% of Medicare fee schedule is reasonable charge for MRIs is not competent evidence where deponent relied only on case law and PIP statute in making that determination, and his interpretation of PIP statute was not based on sufficient facts, data or experience — Affidavit of adjuster who has no experience in MRI industry cannot create factual issue

21 Fla. L. Weekly Supp. 239a

Online Reference: FLWSUPP 2103DESHInsurance — Personal injury protection — Coverage — Medical benefits — MRI — Medical necessity — Affidavit and deposition of insurer’s expert asserting that provider’s documentation was deficient, indicating that necessity for MRI so late in treatment of insured was questionable, and averring to fact that, in expert’s opinion, the MRI was not medically necessary, was sufficient to create genuine issue of material fact regarding necessity of MRI — Trial court erred in entering final summary judgment in favor of provider — Precedent standing for proposition that MRIs can be determined to be medically reasonable and necessary as matter of law when adverse party presents no evidence to the contrary does not apply in this case in which there were disputed issues of material fact on the issue

21 Fla. L. Weekly Supp. 273a

Online Reference: FLWSUPP 2103BARRNOT FINAL VERSION OF OPINION
Subsequent Changes at 22 Fla. L. Weekly Supp. 835bInsurance — Personal injury protection — Coverage — Medical expenses — Mobile x-rays — Summary judgment is entered for insurer regarding medical necessity of mobile x-rays where insurer presented evidence of absence of documentation that insured was not ambulatory or could not be transferred to stationary x-ray equipment, and medical provider did not present any evidence on medical necessity of mobile x-rays

21 Fla. L. Weekly Supp. 489a

Online Reference: FLWSUPP 2106SEOTInsurance — Personal injury protection — Affirmative defenses — Failure of medical provider to comply with chiropractic record keeping requirements set by administrative rule is valid basis for affirmative defense that medical treatment was not lawfully rendered — Error to fail to allow insurer to prove that provider failed to lawfully comply with record keeping requirements

21 Fla. L. Weekly Supp. 578a

Online Reference: FLWSUPP 2106PEREInsurance — 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

21 Fla. L. Weekly Supp. 443a

Online Reference: FLWSUPP 2105AGARInsurance — 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

21 Fla. L. Weekly Supp. 428b

Online Reference: FLWSUPP 2105RODRInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — In absence of any evidence of bad faith, where benefits were exhausted through payment of other medical providers before plaintiff -provider filed suit, insurer is entitled to summary judgment — Insurer was not required to reserve funds for claim which had been reduced through erroneous application of permissive statutory fee schedule and is not liable for balance of reduced claim after exhaustion of benefits where insurer relied upon then-existing law in reducing claim

21 Fla. L. Weekly Supp. 362a

Online Reference: FLWSUPP 2104BORDInsurance — 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

21 Fla. L. Weekly Supp. 274a

Online Reference: FLWSUPP 2103WELCInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where benefits were exhausted prior to medical provider filing suit, and there is no evidence of bad faith, insurer’s motion for summary judgment is granted

21 Fla. L. Weekly Supp. 445a

Online Reference: FLWSUPP 2105GOMEInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where insurer wrongly paid medical bills out of order by skipping over medical provider’s bill and exhausting benefits on payment of bills received after provider’s bill, insurer is prohibited from asserting that insufficient benefits remained for payment of plaintiff’s bill or that benefits were properly exhausted on claim