Volume 24

24 Fla. L. Weekly Supp. 370a

Online Reference: FLWSUPP 2405BAJOInsurance — 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 medical charges where affidavit is conclusory and does not provide opinion that is derived by scientific method

24 Fla. L. Weekly Supp. 563a

Online Reference: FLWSUPP 2407KEITNOT FINAL VERSION OF OPINION
Subsequent Changes at 24 Fla. L. Weekly Supp. 644aInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Affidavits of medical provider’s operations and billing manager stating that charges billed to insurer were charged to all patients and insurance carriers and explaining how charges were set through phone calls to various medical providers who render similar services in community and consultation with provider’s medical director are not sufficient to establish non-existence of disputed issue of material fact regarding reasonableness of charges where affidavits fail to establish which providers were called, when they were called, what charges they reported, and content of medical director’s recommendation

24 Fla. L. Weekly Supp. 644a

Online Reference: FLWSUPP 2408KEITInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Affidavit billing clerk filed in support of provider’s motion for summary judgment on issue of reasonableness of charge was sufficient to shift burden to defendant to come forward with evidence sufficient to establish existence of factual dispute — Opposing affidavit of insurer’s litigation adjuster was not supported by sufficient facts — Mere existence of Medicare, HMO, and PPO rates that are lower than actual charges in community does not create issue of fact as to reasonableness of a medical provider’s charge that exceeds such reimbursement rates — Provider’s motion for summary judgment granted

24 Fla. L. Weekly Supp. 441a

Online Reference: FLWSUPP 2406ROMEInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Opposing affidavit and transcript of expert’s testimony at Daubert hearing in another case filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of CT scan charges where expert’s opinion lacked sufficient facts or data as to charges and reimbursement in PIP industry and failed to explain how personal experience on which expert relied leads to his opinion of unreasonableness of provider’s charges, why his experience is sufficient basis for opinion, and how experience is reliably applied to facts

24 Fla. L. Weekly Supp. 705a

Online Reference: FLWSUPP 2409ALLIInsurance — Personal injury protection — Coverage — Medical expenses — Reasonable expenses — Summary judgment — Notice of summary judgment evidence on which opposing party intends to rely — Insurer did not satisfy rule 1.510(c) requirement to provide notice of evidence on which it intends to rely in opposition to motion for summary judgment by filing, before medical provider’s motion for summary judgment was filed, affidavit accompanied by notice stating insurer’s intent to rely on affidavit in support of or in opposition to any motion for summary judgment — Motion for summary judgment is granted

24 Fla. L. Weekly Supp. 72a

Online Reference: FLWSUPP 2401RHERInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Insurer that breached contract by utilizing statutory fee schedule that was not incorporated in policy when processing medical provider’s bill is not entitled to challenge reasonableness of MRI charge — Even if insurer could challenge reasonableness of charge, opposing affidavit filed by insurer does not preclude summary judgment in favor of provider on reasonableness issue where affidavit failed to establish that affiant has any experience or qualification regarding MRI charges in county where services were rendered

24 Fla. L. Weekly Supp. 106b

Online Reference: FLWSUPP 2402AYERInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Trial court did not err in entering summary judgment in favor of medical provider on issue of reasonableness of MRI charge where opposing affidavit failed to include amounts other providers charge and accept as full payment for MRI services and failed to provide facts establishing that affiant is qualified to render opinion on reasonableness of MRI charges

24 Fla. L. Weekly Supp. 989a

Online Reference: FLWSUPP 2411BARRInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Genuine issue of material facts exists as to whether amount sought by provider for CPT code at issue was reasonable — Plaintiff’s motion for summary judgment denied

24 Fla. L. Weekly Supp. 750a

Online Reference: FLWSUPP 2409PLOUInsurance — Personal injury protection — Expert witnesses — Reasonableness of charges — Where proffered expert on reasonableness of charges fails to take into consideration usual and customary charges of medical provider or community or reimbursement amounts accepted by provider and merely opines that reasonable amount is up to 135% to 145% of covered amount under Medicare Part B fee schedule, testimony constitutes prohibited pure opinion testimony — Further, expert’s opinions based on fee schedules alone are not based on sufficient facts or data and are not product of sufficient principles and methods to satisfy admissibility requirements for expert testimony

24 Fla. L. Weekly Supp. 83b

Online Reference: FLWSUPP 2401MARTInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Reasonableness of charges is jury question that can be resolved through summary judgment — Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of MRI charges where expert’s opinion is based on his experience and what his own facility charges — Affidavit of claims adjuster opining that insurer’s reimbursement was reasonable does not create factual issue as to reasonableness of charges