Volume 21

21 Fla. L. Weekly Supp. 699a

Online Reference: FLWSUPP 2107MAMOInsurance — Personal injury protection — Complaint — Amendment — Substitution of insurer — Motion to amend complaint to substitute insurer that is entirely separate and distinct corporate entity from insurer against whom action has been pending is denied

21 Fla. L. Weekly Supp. 676b

Online Reference: FLWSUPP 2107NEWCInsurance — Personal injury protection — Plaintiff not required to submit demand letter as condition precedent to filing amended complaint — Motion to amend to include additional charges for unpaid benefits for dates of service not mentioned in original complaint and which could not have been known to plaintiff at time of original complaint is granted

21 Fla. L. Weekly Supp. 133a

Online Reference: FLWSUPP 2102MORAInsurance — Personal injury protection — Claims — Failure to submit — Anticipatory breach — Although there may have been question of fact as to whether PIP policy was cancelled at time of accident in view of insurer’s previous rescission of cancellations when late premium payments were made, anticipatory breach of policy did not excuse insured from obligation to timely submit medical bills to insurer — Insurer cannot be liable for medical bills that were not timely and properly submitted

21 Fla. L. Weekly Supp. 181a

Online Reference: FLWSUPP 2102ALVAInsurance — Personal injury protection — Coverage — Medical expenses — Inadequacy of record keeping is not lawful basis for nonpayment of PIP benefits — Affirmative defenses — Insurer waived defense of inadequate demand letter by failing to complain of defective demand letter until after suit was filed — Where policy does not unambiguously indicate that insurer will utilize statutory fee schedule, insurer must pay 80% of reasonable expenses — CPT codes — National Correct Coding Initiative edits, which bar physicians from administering certain services to patients on same day, are utilization limitations prohibited by PIP statute — Unbundling — No merit to unbundling defense based on impermissible NCCI edits

21 Fla. L. Weekly Supp. 373a

Online Reference: FLWSUPP 2104WALKInsurance — Personal injury protection — Affirmative defenses — Amendment — Insurer’s motion to amend affirmative defenses is denied where motion is untimely as to defenses which were known to insurer six months prior to filing answer, insurer waived right to assert defenses not raised in answer, and medical provider would be prejudiced by allowing amendment

21 Fla. L. Weekly Supp. 146a

Online Reference: FLWSUPP 2102GRIMInsurance — Personal injury protection

21 Fla. L. Weekly Supp. 82c

Online Reference: FLWSUPP 2101FRANInsurance — Personal injury protection — Late payment penalty — Where medical provider submitted two demand letters to insurer, each relating to different dates of treatment provided to insured, insurer was required to pay provider two separate $250 late payment penalties

21 Fla. L. Weekly Supp. 1069b

Online Reference: FLWSUPP 2110LCOHInsurance — Personal injury protection — Penalty and postage — Insurer that paid medical expenses and interest after receipt of demand letter cannot defend against action for penalty and postage by claiming that services for which it paid were not related or medically necessary — No merit to argument that insurer is obligated to pay penalty only if full amount is paid after receipt of demand letter

21 Fla. L. Weekly Supp. 339a

Online Reference: FLWSUPP 2104SETAInsurance — Personal injury protection — Coverage — Medical expenses — Insurer that elected to reimburse medical provider pursuant to permissive statutory fee schedule erred in adjusting charges downward by applying coding policies and payment methodologies used on Medicare claims — No merit to argument that exhaustion of PIP benefits renders insured’s motion for summary judgment for balance of unpaid bills moot where insured seeks to recover 20% not paid by PIP benefits under Medpay coverage — Where insurer paid 80% of charges because it determined charges were reasonable, it cannot argue remaining 20% of charges is not reasonable — No merit to argument that fact that insurer did not pay 80% of full 200% of Medicare Part B fee schedule indicates that reasonableness of charges is at issue where reduction was not based on reasonableness of charges, but on insurer’s improper application of Medicare payment methodologies

21 Fla. L. Weekly Supp. 430a

Online Reference: FLWSUPP 2105VEGAInsurance — Post-judgment interest — Checks for full amount of final judgment on motion for attorney’s fees and costs, which checks contained notation that checks were full and final payment of fees, costs, and interest, per judgment, and were unaccompanied by letter or conditions, were effective to stop accrual of interest on judgment — Checks did not constitute conditional tender