Volume 24

24 Fla. L. Weekly Supp. 174b

Online Reference: FLWSUPP 2402NFIGInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Where Medicare Part B fee schedule was not incorporated into PIP policy, and insurer presented no evidence to oppose motion for summary disposition on issue, medical provider is entitled to summary disposition — Relatedness and medical necessity — Insurer that paid claim at reduced amount without disputing relatedness or necessity of service and failed to raise relatedness or necessity as affirmative defense cannot challenge relatedness or necessity in opposing motion for summary disposition

24 Fla. L. Weekly Supp. 463b

Online Reference: FLWSUPP 2406IRVIInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Medical provider established prima facie showing of reasonableness of MRI charges through affidavit of provider’s owner, publications, and geozip report — Reasonableness of charges is undisputed where insurer withdrew affidavit of its expert and offered no other evidence on issue — 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

24 Fla. L. Weekly Supp. 472a

Online Reference: FLWSUPP 2407BURGInsurance — Personal injury protection — Demand letter — Trial court did not err in finding that substantial compliance with demand letter requirement satisfied PIP statute — Coverage — Medical expenses — Error to enter summary judgment in favor of medical provider where there are genuine issues of material fact regarding reasonableness of charges — Trial court erred in concluding that insurer waived right to contest relatedness and medical necessity of services by failing to plead lack of relatedness and necessity as affirmative defense or contest those issues in handling of claim — Small claims rules do not require filing of answer or affirmative defenses, and section 627.736(4)(b) allows insurer to contest reasonableness, relatedness or necessity at any time

24 Fla. L. Weekly Supp. 378a

Online Reference: FLWSUPP 2405VINCInsurance — 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 of physician presented as fact witness rather than expert is not admissible and does not create triable issue as to reasonableness of charge — Affidavit would not preclude summary judgment if offered as expert opinion where affidavit is conclusory and lacks foundation, and affiant is not qualified to render opinion on reasonableness of charge — 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

24 Fla. L. Weekly Supp. 374a

Online Reference: FLWSUPP 2405CADEInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charge — 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 of physician presented as fact witness rather than expert is not admissible and does not create triable issue as to reasonableness of charge — Affidavit would not preclude summary judgment if offered as expert opinion where affidavit is conclusory and lacks foundation, and affiant is not qualified to render opinion on reasonableness of charge — Insurer’s technical admissions admit medical necessity and relatedness of charge — Even if admissions were disregarded, 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 — Even if insurer had timely contested relatedness and necessity of services, affidavit filed by insurer on issue was untimely and was legally and factually insufficient to raise disputed issue of material fact

24 Fla. L. Weekly Supp. 704a

Online Reference: FLWSUPP 2409GARCInsurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Summary judgment is granted in favor of medical provider on issues of relatedness and medical necessity of x-rays where opposing affidavits fail to create genuine issue of material fact — Affidavit of provider’s owner and records custodian that establishes that charges were usual and customary for provider’s facility but fails to provide information on payments accepted by provider and reimbursement levels in community is insufficient to establish prima facie showing of reasonableness of charges — Provider’s motion for summary judgment as to reasonableness of charges is denied

24 Fla. L. Weekly Supp. 559a

Online Reference: FLWSUPP 2407LSANInsurance — Personal injury protection — Coverage — Medical expenses — Timeliness of claim — Insurer that issued payment in response to bill that it now claims was untimely submitted more than 35 days after date of treatment waived untimely billing defense — Reasonableness of charges — Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of charges where affiant’s opinion is not based on sufficient facts, lacks data analysis, and erroneously relies on fee schedules and payments by HMOs and PPOs — Relatedness and medical necessity of treatment — Affidavit alleging deficiencies in medical provider’s record-keeping does not create genuine issue of material fact regarding relatedness or necessity of treatment

24 Fla. L. Weekly Supp. 444a

Online Reference: FLWSUPP 2406GSANInsurance — Personal injury protection — Coverage — Medical expenses — Summary judgment — Relatedness and medical necessity of services — Insurer’s pre-suit decision to pay for medical services, albeit at reduced rate, is confession that services are medically necessary, related to accident, and otherwise payable — Reasonableness of charges — Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of charges where affiant considered only Medicare and workers’ compensation fee schedules

24 Fla. L. Weekly Supp. 161a

Online Reference: FLWSUPP 2402PIERInsurance — Personal injury protection — Coverage — Medical expenses — Medical provider’s motion for summary judgment on issue of relatedness of treatment is denied where affidavit of insurer’s expert, stating that insured was injured in previous motor vehicle accident and only suffered minor sprains in subject accident that were not ameliorated by provider’s passive treatment, demonstrates existence of genuine disputed issue of material fact regarding relatedness of treatment

24 Fla. L. Weekly Supp. 191b

Online Reference: FLWSUPP 2402MIRAInsurance — Personal injury protection — Coverage — Medical expenses — Medical provider’s motion for summary judgment regarding relatedness, reasonableness and medical necessity of charge for electrodes is granted where provider met prima facie burden of proof, and opposing affidavits raise issue of improper billing and coding that was not preserved in affirmative defenses