Volume 21

21 Fla. L. Weekly Supp. 399d

Online Reference: FLWSUPP 2105WILLInsurance — Personal injury protection — Small claims — Summary disposition — On appeal of summary disposition of small claims case, issue is not whether trial court erred by finding absence of genuine issue of material fact, but whether trial court abused its discretion by finding there was no triable issue — No merit to argument that medical provider’s affidavit in support of reasonableness of medical bill is insufficient to support summary disposition because it fails to address every factor mentioned in section 627.736(5)(a) — Statute does not mandate that consideration be given to every factor — No error in rejecting affidavit of litigation adjuster filed in opposition to summary disposition where affidavit was conclusory and self-serving — Further, trial court did not err in determining that litigation adjuster lacked sufficient personal knowledge to render opinion on reasonableness of charges

21 Fla. L. Weekly Supp. 368a

Online Reference: FLWSUPP 2104FULTInsurance — Personal injury protection — Coverage — Medical expenses — Where PIP policy expressly states that insurer will pay 80% of all medically necessary expenses and does not incorporate language of permissive statutory fee schedule, insurer is not entitled to apply fee schedule limitations — Neither section 627.7407, which incorporates No-Fault Law into existing policies to add PIP coverage, nor policy’s reference to payment in accordance with No-Fault Law alters express promise of contract to pay 80% of all medically necessary expenses — No merit to argument that reasonable amount payable under PIP statute is now capped by permissive fee schedule — Question certified: Does section 627.736(5)(a)2 through 5 (2008) limit the insured or his assignee from claiming the reasonable amount of services in excess of that subsection’s schedule where the policy of insurance expresses no such limitation but instead, expressly promises reimbursement of all medically necessary expenses?

21 Fla. L. Weekly Supp. 200a

Online Reference: FLWSUPP 2102TELUInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Insurer failed to create genuine issue of material fact regarding reasonableness of charges where insurer’s expert, who opined that charges were unreasonable and that amount equal to 200% of Medicare Part B fee schedule was only reasonable amount, relied exclusively on undisclosed “underlying data” which insurer failed to produce or make available for inspection

21 Fla. L. Weekly Supp. 440b

Online Reference: FLWSUPP 2105CWILInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Where, in addition to fee schedules submitted by insurer to rebut medical provider’s prima facie case that charges at issue were reasonable, provider admitted that it accepted Medicare payments and that it accepted far less from other insurers for same services, jury had sufficient evidence to support finding that amount billed by provider was not reasonable — Motion for judgment notwithstanding verdict and motion for new trial are denied

21 Fla. L. Weekly Supp. 592a

Online Reference: FLWSUPP 2106JRODInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Where affidavit of insurer’s expert opining that 200% of Medicare fee schedule is reasonable charge does not take into consideration any amount except Medicare fee schedule and fails to attach underlying data, insurer has not demonstrated that opinion is based upon sufficient facts or data and has failed to rebut medical provider’s affidavit as to reasonableness of charges

21 Fla. L. Weekly Supp. 590a

Online Reference: FLWSUPP 2106DINGInsurance — Personal injury protection — Expert witness — Insurer’s actuary is not qualified to render opinion on reasonableness of x-ray charges where proposed witness has never worked for or provided billing services for x-ray providers, has no knowledge of what hospitals or other x-ray providers in county charge for x-ray examination and review and, in reaching his opinion, excludes from consideration evidence of usual and customary charges and payment accepted by medical provider and any amounts above 200% of Medicare Part B fee schedule

21 Fla. L. Weekly Supp. 707a

Online Reference: FLWSUPP 2107TRUOInsurance — Personal injury protection — Expert witness — Insurer’s actuary is not qualified to render opinion on reasonableness of medical provider’s charges

21 Fla. L. Weekly Supp. 871a

Online Reference: FLWSUPP 2109MONTInsurance — Personal injury protection — Coverage — Medical expenses — Related and necessary treatment — Directed verdict — Trial court properly granted medical provider’s motion for directed verdict on issues of relatedness and medical necessity of treatment where provider presented expert testimony that treatment was related and necessary, insurer’s expert conceded that his determination that treatment was not related or necessary was not reliable and not a just determination, and insurer did not severely impeach provider’s expert

21 Fla. L. Weekly Supp. 201b

Online Reference: FLWSUPP 2102ROBIInsurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related, and necessary treatment — Affidavit of physician was not competent evidence of relatedness and medical necessity of treatment provided to insured where affiant and treating physician were licensed under different chapters of Florida Statutes — Chiropractic treatment — Affidavit of chiropractor submitted by insurer was sufficient to raise disputed issue of material fact only with respect to “daily consecutive treatment” for certain dates, but raises no disputed issue of material fact as to any other issue — Discussion of deficiencies in affidavit

21 Fla. L. Weekly Supp. 306b

Online Reference: FLWSUPP 2104WESTInsurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related, and necessary treatment — Testimony by insurer’s expert regarding alleged deficient recordkeeping on part of treating physician was not sufficient to refute testimony by insured that treatment she received was related to injuries sustained in automobile accident — Trial court erred in denying insured’s motion for directed verdict on issue of relatedness — Remand with directions to enter directed verdict on this issue and for new trial on remaining issues of medical necessity and reasonableness of bills