Volume 23

23 Fla. L. Weekly Supp. 783a

Online Reference: FLWSUPP 2307ADAMInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy stating that benefits shall be payable at lesser of 80% of actual charge or 80% of schedule of maximum charges contained in PIP statute, including 200% of Medicare Part B fee schedule, clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule — Policy language stating that insurer may use various sources of information to decide if medical expense is reasonable and necessary and caused by accident is nullity based on clear and unambiguous election of statutory fee schedule as method of reimbursement

23 Fla. L. Weekly Supp. 759b

Online Reference: FLWSUPP 2307ALEXInsurance — Personal injury protection — Coverage — Medical expenses — Insurer that breached contract by utilizing statutory fee schedule which was not incorporated in policy when processing medical provider’s bill is not entitled to challenge reasonableness of charges

23 Fla. L. Weekly Supp. 473a

Online Reference: FLWSUPP 2305MCCOInsurance — Personal injury protection — Coverage — Medical expenses — Insurer that breached contract by utilizing statutory fee schedule not incorporated in policy when processing medical provider’s bill is not entitled to challenge reasonableness of charges

23 Fla. L. Weekly Supp. 622a

Online Reference: FLWSUPP 2306MCCAInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Where Medicare Part B fee schedule was not incorporated into PIP policy, insurer is not entitled to use that fee schedule as sole basis to limit reimbursement or as sole factor when determining reasonableness of MRI charge — Where insurer elected to automatically reduce medical provider’s charge to predetermined reasonable rate by applying Medicare fee schedule, insurer cannot retroactively change its position and claim that payment methodology was based on factors set forth in section 627.736(5)(a)1 — Summary disposition in favor of provider

23 Fla. L. Weekly Supp. 63a

Online Reference: FLWSUPP 2301APPLInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of charge for orthopedic consultation where affidavit fails to refute provider’s evidence of its usual and customary charges accepted during year at issue, reimbursement levels in community, and routine approval of same charge as reasonable by defendant insurer and five other insurers

23 Fla. L. Weekly Supp. 212a

Online Reference: FLWSUPP 2303WEINInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Fact that policy is silent as to reasonableness requirement does not preclude insurer from challenging charges as unreasonable — PIP statute, which is incorporated in all PIP policies, requires only that reasonable expenses be paid

23 Fla. L. Weekly Supp. 362a

Online Reference: FLWSUPP 2304YARTInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Medical provider failed to meet its burden of proof for summary judgment on reasonableness of charges where provider’s expert stated no opinion as to reasonableness of charges, and provider failed to file authenticated copy of medical bill in record — Where PIP policy provides that insurer may consider “various federal and state medical fee schedules” to determine whether charge is reasonable, insurer and its experts may consider Medicare reimbursement rates in determining reasonableness of charges

23 Fla. L. Weekly Supp. 874a

Online Reference: FLWSUPP 2308MASTInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of MRI charge where affidavit is self-serving, conclusory, devoid of sufficient facts or data and based on inadmissible hearsay and lacks foundation for opinion that charge is unreasonable — Insurer that did not unambiguously elect in policy to limit reimbursement to permissive statutory fee schedule cannot rely on fee schedule to suggest that it reimbursed reasonable amount by making payment in accord with fee schedule — Fact that Medicare and private health insurance pay less than amount billed by provider does not, by itself, create factual issue as to reasonableness of charge

23 Fla. L. Weekly Supp. 871a

Online Reference: FLWSUPP 2308GONZInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of MRI charge where affidavit states that amount is excessive charge unless scan was performed at licensed facility, and provider is fully licensed facility — Fact that provider accepts lower payments from cash paying patients on rare occasions does not create factual issue as to reasonableness of charge — Insurer that did not unambiguously elect in policy to limit reimbursement to permissive statutory fee schedule cannot limit payment to fee schedule

23 Fla. L. Weekly Supp. 560a

Online Reference: FLWSUPP 2306ABREInsurance — Personal injury protection — Expert witness — Insurer’s actuary is not qualified to render opinion on reasonableness of medical charges where proposed witness has no experience in pricing of medical services and his opinion is based on data that includes factors, such as Medicare and workers’ compensation fee schedules, that are irrelevant to determining whether PIP charges are reasonable