Volume 23

23 Fla. L. Weekly Supp. 776b

Online Reference: FLWSUPP 2307HOUSInsurance — Personal injury protection — Evidence — Expert witnesses — Proffered testimony of insurer’s expert on reasonableness of charges is inadmissible where expert’s opinions, which rely on application of Medicare Part B fee schedule and amounts expert accepts from HMOs and PPOs, are not based on sufficient facts or data and are not product of sufficient principles and methods — Proposed expert is stricken

23 Fla. L. Weekly Supp. 785a

Online Reference: FLWSUPP 2307MOREInsurance — Personal injury protection — Evidence — Expert witnesses — Proffered testimony of insurer’s expert on reasonableness of charges is inadmissible where expert’s opinions, which are not based on factors set forth in section 627.736(5)(a)1, are not based on sufficient facts or data and are not product of sufficient principles and methods — Proposed expert is stricken

23 Fla. L. Weekly Supp. 488a

Online Reference: FLWSUPP 2305LONGInsurance — Personal injury protection — Evidence — Expert witnesses — Where insurer’s proposed expert regarding reasonableness of charges considered only what he personally accepts from insurer that pays him pursuant to Medicare and health insurance fee schedules in forming his opinion, expert’s opinion is not based on sufficient facts or data and not product of reliable principles and methods — Proposed expert is precluded from testifying

23 Fla. L. Weekly Supp. 60a

Online Reference: FLWSUPP 2301PANInsurance — Personal injury protection — Expert witness — Insurer’s actuary is not qualified to render opinion on reasonableness of MRI charge where actuary has no experience and knowledge concerning operation of medical provider and his opinions will not assist trier of fact, are not relevant to ultimate resolution of issues in case, are not based on sufficient facts or data, and are not product of reliable principles and methods

23 Fla. L. Weekly Supp. 1058a

Online Reference: FLWSUPP 2310IGNAInsurance — Personal injury protection — Coverage — Medical expenses — Insurer that breached PIP policy by utilizing statutory fee schedule that was not clearly and unambiguously elected in policy when processing medical provider’s bill is not entitled to challenge reasonableness of charges — No merit to argument that relatedness and medical necessity of services remain at issue where relatedness and necessity were admitted by insurer’s action of making partial payment on claim

23 Fla. L. Weekly Supp. 890a Online Reference: FLWSUPP 2309BURGNOT FINAL VERSION OF OPINIONSubsequent Changes at 24 Fla. L. Weekly Supp. 197bInsurance — Personal injury protection —

23 Fla. L. Weekly Supp. 615b

Online Reference: FLWSUPP 2306NATIInsurance — Personal injury protection — Coverage — Medical expenses — Inadequate record keeping by medical provider is not lawful basis for nonpayment of PIP benefits — Affidavit attacking adequacy of provider’s record keeping is not sufficient to preclude partial summary judgment on issues of relatedness and necessity of treatment

23 Fla. L. Weekly Supp. 977a

Online Reference: FLWSUPP 2309CASSInsurance — Personal injury protection — Coverage — Medical expenses — Summary judgment — Medical provider is entitled to summary judgment as to reasonableness of MRI charge based on insurer’s technical admissions — Opposing affidavits filed by insurer do not preclude summary judgment in favor of provider on reasonableness of charge where affidavits are conclusory and lack foundation for opinions — Insurer cannot challenge medical necessity and relatedness of services where insurer made partial payment for services and did not assert lack of relatedness and necessity as affirmative defense — Section 627.736(4)(b), which provides that insurer may assert that claim was unrelated or not medically necessary at any time, does not allow insurer to challenge relatedness and necessity where there is no record evidence of insurer having made any such assertion in case

23 Fla. L. Weekly Supp. 966a

Online Reference: FLWSUPP 2309SHAWInsurance — Personal injury protection — Coverage — Medical expenses — Relatedness and medical necessity of services — Summary disposition — Opposing affidavit filed by insurer does not preclude summary disposition in favor of medical provider on issue of relatedness of MRI where insurer’s expert relied on photographs of vehicle not associated with insured’s accident, and affidavit is self-serving and conclusory — Insurer cannot rely on documents shielded from discovery as work-product to dispute relatedness and necessity of MRI — MRI used to determine whether accident was cause of injury and rule out rotator cuff injury is compensable

23 Fla. L. Weekly Supp. 484a

Online Reference: FLWSUPP 2305SHOLInsurance — Personal injury protection — Coverage — Medical expenses — Insurer that has already made reduced payment on claim and is sued for balance of claim may raise relatedness and medical necessity of services as defense