Volume 23

23 Fla. L. Weekly Supp. 219b

Online Reference: FLWSUPP 2303WARNInsurance — Personal injury protection — Small claims — Doctrine of de minimis non curat lex does not preclude small claims action seeking less than $100 in PIP benefits — Error to base dismissal in part on affirmative defense that medical provider did not bring action in good faith because it did not attempt to mitigate damages by reaching out to insurer before initiating litigation — PIP statute only requires that claimant submit presuit demand letter, which provider did

23 Fla. L. Weekly Supp. 654a

Online Reference: FLWSUPP 2306BERNInsurance — Personal injury protection — Coverage — Emergency medical condition — Where no qualified medical provider has determined that claimant suffered emergency medical condition, insurer properly limited benefits to $2,500

23 Fla. L. Weekly Supp. 820a

Online Reference: FLWSUPP 2308TATAInsurance — Personal injury protection — Reimbursement by insurer of commercial vehicle — Sedan is private passenger vehicle within meaning of PIP statute, notwithstanding that it was used as taxicab

23 Fla. L. Weekly Supp. 587a

Online Reference: FLWSUPP 2306JFRAInsurance — Personal injury protection — Answer — Amendment — Timeliness — Motion to amend answer and affirmative defenses is denied — PIP action has been pending for four years, insured has incurred deposition costs and has filed motion for summary judgment, trial date is set, and insurer was unable to advise court of legitimate reason for significant delay in case

23 Fla. L. Weekly Supp. 343a

Online Reference: FLWSUPP 2304CWILInsurance — Personal injury protection — Coverage — Timeliness of claim — Claim originally submitted to wrong carrier — Medical provider’s actions and submittals fell within exception to 30-day billing requirement applicable when providers have been furnished incorrect insurance information by a patient where provider/assignee of uninsured passenger injured in rental car originally submitted claims to two PIP insurers, who denied coverage; provider instituted declaratory action to determine coverage and added rental car company as co-defendant in action when it also denied coverage; during litigation rental car company became aware of reasons why provider had not previously sent statement of charges to company and eventually admitted coverage; and provider sent claim forms to rental car company within 35 days of its admission of coverage

23 Fla. L. Weekly Supp. 570a

Online Reference: FLWSUPP 2306PEREInsurance — Personal injury protection — Coverage — Lawfully rendered services — Medical provider’s submission of claim that included bills with rendering provider identification number of individual who had been barred from practicing medicine over one year prior to dates of treatment amounts to unlawful treatment or false and misleading statement, thus invalidating entire claim

23 Fla. L. Weekly Supp. 1a

Online Reference: FLWSUPP 2301THOMInsurance — Personal injury protection — Coverage — Medical expenses — Video fluoroscopy — Trial court entering summary judgment in favor of medical provider seeking balance of reduced claims for video fluoroscopies erred in relying on holdings in Kingsway, Virtual Imaging, and DCI MRI to determine that insurer improperly applied permissive statutory fee schedule where those cases involve applicability of permissive fee schedule of 2008 PIP statute and present cases are controlled by 2002 and 2003 versions of PIP statute that contain mandatory cap limiting payment for video fluoroscopy charges to maximum reimbursement allowed by workers’ compensation fee schedule

23 Fla. L. Weekly Supp. 98a

Online Reference: FLWSUPP 2302MARQInsurance — Personal injury protection — Coverage — Medical expenses — CPT coding — Unbundling — Affidavit of insurer’s expert regarding unbundling defense did not create genuine issue of material fact precluding summary judgment where affidavit merely offered different legal conclusion as to unbundling defense based on undisputed facts — Medical provider inappropriately unbundled and billed separately for x-ray readings that were performed as part of comprehensive evaluation component of evaluation and management CPT code that was billed for same day of service

23 Fla. L. Weekly Supp. 121a

Online Reference: FLWSUPP 2203STATInsurance — Personal injury protection — Coverage — Medical expenses — Notice of claim — Claim form — CPT Code — Video fluoroscopy — No-Fault Law requires that provider comply with AMA CPT coding in submission of bills for payment of insureds’ PIP benefits — Insurer is not required to pay claim or charges with respect to bill that does not meet requirements of statute — Court must turn to AMA CPT coding requirements and statutorily-referenced AMA promulgated guides when interpreting appropriate CPT code — Since 2003, proper CPT code to be used when billing for video fluoroscopic procedures is 76120 — AMA has specifically referenced that video fluoroscopic procedures performed under trade name Digital Motion X-Ray or by the procedural technology being described or utilized in the performance of a digital motion x-ray should be billed under 76120 — By failing to use appropriate AMA CPT Code, provider failed to place insurer on notice of a covered loss — Judgment granted in favor of insurer on its declaratory requests — Provider’s counterclaim seeking declaration that insurer acted improperly in its reimbursement determinations is denied — Under policies at issue, insurer elected to reimburse 80% of reasonable expenses and provided that insurer could consider various federal and state medical fee schedules in determining reimbursement amount — Evidence established that insurer was not limiting its reimbursement to an amount set by fee schedule, but rather considered fee schedule in determining reasonableness — Provider failed to prove by greater and more persuasive standard that its $900 charge was reasonable — Court declines to declare that insurer engaged in practice of downcoding provider’s bills, and provider failed to prove by greater and more persuasive standard any bad faith on part of insurer — Provider’s counterclaim for declaration that insurer was required to contact provider prior to correcting what it believed to be a misrepresentative CPT code each time a bill was submitted by provider for Digital Motion X-ray, beginning in October 2003, is denied

23 Fla. L. Weekly Supp. 522e

Online Reference: FLWSUPP 2306FAHIInsurance — Personal injury protection — Partial payment — Penalties — PIP insurer that partially paid claim upon receipt of pre-suit demand letter is obligated to also pay statutory penalty and postage costs