Volume 24

24 Fla. L. Weekly Supp. 71c

Online Reference: FLWSUPP 2401ROJAInsurance — Personal injury protection — Coverage — Medical expenses — Evidence — Scientific opinion — Testimony of physician cannot be considered expert testimony on reasonableness of MRI charges where physician’s opinion is based on his own experience and what his own facilities charge — Motion to strike witness is granted

24 Fla. L. Weekly Supp. 20a

Online Reference: FLWSUPP 2401VALIInsurance — Personal injury protection — Scientific evidence — Abuse of discretion to find that opinion of treating physician concerning reasonableness of charges was expert witness testimony that satisfied Daubert standard where physician relied primarily on his own experience in formulating opinion and did not explain how his experience led to his opinion, why his experience was sufficient basis for his opinion, or how his experience was reliably applied to facts

24 Fla. L. Weekly Supp. 20a

Online Reference: FLWSUPP 2401VALIInsurance — Personal injury protection — Scientific evidence — Abuse of discretion to find that opinion of treating physician concerning reasonableness of charges was expert witness testimony that satisfied Daubert standard where physician relied primarily on his own experience in formulating opinion and did not explain how his experience led to his opinion, why his experience was sufficient basis for his opinion, or how his experience was reliably applied to facts

24 Fla. L. Weekly Supp. 237b

Online Reference: FLWSUPP 2403ESQUInsurance — Personal injury protection — Reasonableness of charges — Evidence — Expert — Plaintiff’s amended motion to strike affidavit of defendant’s expert regarding reasonableness of charges denied — Discussion of factors underlying court’s decision

24 Fla. L. Weekly Supp. 851a

Online Reference: FLWSUPP 2410RRODInsurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Summary judgment — Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness, relatedness and necessity of x-ray charges where basis of affiant’s opinion is deficiencies in medical record-keeping, and affiant offers only conclusory opinion that charges were not reasonable — No merit to argument that summary judgment is precluded by provider’s failure to produce actual x-ray films where x-ray reports are in medical record, and production of actual x-ray films is not condition of coverage under PIP statute

24 Fla. L. Weekly Supp. 437c

Online Reference: FLWSUPP 2406HUYNInsurance — Personal injury protection — Coverage — Medical expenses — Provider’s motion for summary judgment with respect to reasonableness, relatedness, and necessity of treatment and charge is denied — Affidavit in support of motion failed to establish affiant’s scientific, technical, or other specialized knowledge and provided insufficient facts and data to establish basis for affiant’s ultimate opinion — Further, although affiant opined on issue of reasonableness, affidavit failed to state where affiant was employed, where he was employed in the past, or the basis for his knowledge of plaintiff’s billing process — Where expert is relying primarily on experience, expert must explain how that experience leads to expert’s opinion, why experience is sufficient basis for opinion, and how that experience is reliably applied to facts, which affiant failed to do

24 Fla. L. Weekly Supp. 103a

Online Reference: FLWSUPP 2402LEONInsurance — Personal injury protection — Summary judgment — Error to enter summary judgment in favor of medical provider on issue of reasonableness, relatedness and necessity of treatment where, even assuming provider’s conclusory affidavit is sufficient to prove non-existence of factual dispute, affidavit of insurer’s expert that court erroneously declined to consider demonstrates factual dispute — Error to refuse to consider expert’s affidavit pursuant to Ellison rule where affidavit stating that treatment was not reasonable, related and necessary as of one date did not baldly repudiate affidavit of insurer’s other expert stating that treatment was not reasonable, related and necessary as of later date

24 Fla. L. Weekly Supp. 763a

Online Reference: FLWSUPP 2409SOTOInsurance — Personal injury protection — Coverage — Medical expenses — Necessary and related expenses — Where insurer conceded medical necessity and relatedness of MRI by making partial payment for services, did not assert lack of necessity or relatedness as affirmative defense, and stated in response to interrogatories that it is not disputing necessity or relatedness, MRI is deemed necessary and related

24 Fla. L. Weekly Supp. 758b

Online Reference: FLWSUPP 2409ASANInsurance — Personal injury protection — Coverage — Medical expenses — Necessity and relatedness of services — Insurer cannot challenge medical necessity and relatedness of services where insurer paid claim, albeit at reduced amount — Section 627.736(4)(b)6, which provides that insurer may assert that claim was unrelated and not medically necessary at any time, allows insurer to challenge relatedness and necessity only when insurer has not previously determined through claim adjustment process and in consideration of terms of policy that services were related and necessary

24 Fla. L. Weekly Supp. 754a

Online Reference: FLWSUPP 2409CONNInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary disposition — Opposing affidavit filed by insurer does not preclude summary disposition in favor of medical provider on issue of reasonableness of MRI charges — Affidavit of physician presented as fact witness rather than expert is not admissible and does not create triable issue as to reasonableness of charges — Affidavit would not preclude summary disposition if offered as expert opinion where affidavit is conclusory and lacks foundation, and affiant is not qualified to render opinion on reasonableness of charges — 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 and 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