Volume 24

24 Fla. L. Weekly Supp. 131a

Online Reference: FLWSUPP 2402IMPERInsurance — Personal injury protection — Coverage — Medical expenses — Lawfully rendered services — Medical clinic that is wholly owned by licensed massage therapist does not qualify for exemptions from licensure delineated in PIP statute and, therefore, was required to obtain health care clinic license as condition precedent to receiving reimbursement of PIP benefits — Services provided to insureds by unlicensed clinic are unlawful and noncompensable

24 Fla. L. Weekly Supp. 206a

Online Reference: FLWSUPP 2403PROGInsurance — Personal injury protection — Coverage — Medical expenses — Lawfully rendered services — Where plaintiff clinic failed to register with Department of Health after divorce of clinic owners disqualified it from exemption from registration requirement for clinics wholly owned by health care practitioner and spouse, services provided after date of divorce were not lawfully rendered, and PIP insurer is not required to pay for those services — Trial court erred in finding that date of divorce was date of rendition of amended final judgment vacating and superceding earlier final dissolution judgment, rather than date of that earlier dissolution judgment, where amended judgment related only to asset distribution

24 Fla. L. Weekly Supp. 889b

Online Reference: FLWSUPP 2410MOREInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy does not clearly and unambiguously elect permissive statutory fee schedule — Exhaustion of policy limits — Where insurer did not plead exhaustion of benefits as affirmative defense and raised issue for first time in motion for summary judgment, insurer cannot prevail on that basis — Additionally, affidavit in support of insurer’s motion for summary judgment is legally insufficient where affidavit does not lay foundation to authenticate attached business records and, therefore, does not establish exhaustion of benefits

24 Fla. L. Weekly Supp. 691cO

nline Reference: FLWSUPP 2409HAMMInsurance — Personal injury protection — Coverage — Exhaustion of policy limits — In absence of any evidence of bad faith, where benefits were exhausted through payment of valid claims, insurer has no liability for medical provider’s claim — Provider lacks standing to argue that benefits would be available if insurer had not paid untimely submitted prescription claim — Moreover, although PIP statute provides that insurer is not required to pay untimely submitted claim, insurer can elect to do so

24 Fla. L. Weekly Supp. 697b

Online Reference: FLWSUPP 2409HAMEInsurance — Personal injury protection — Coverage — Exhaustion of policy limits — Motion to sanction insurer for providing medical provider with PIP log indicating incorrect total loss paid and failing to provide presuit notice that benefits had been exhausted is denied — PIP statute does not require insurer to maintain or provide PIP log or to provide presuit notice of exhaustion of benefits — Insurer’s motion to sanction provider for filing motion for sanctions that it knew or should have known was not supported by necessary material facts or application of existing law is denied — Provider had good faith belief that it was entitled to notice of exhaustion of benefits in response to demand letter and to accurate PIP log

24 Fla. L. Weekly Supp. 972c

Online Reference: FLWSUPP 2411RICKInsurance — Personal injury protection — Coverage — Medical benefits — Notice of claim — CMS 1500 form or medical bill submitted within 21 days of service does not qualify as “a notice of initiation of treatment” for purposes of statute stating that statement of charges may not include charges for treatment or services rendered more than 35 days before postmark date or electronic transmission date of the statement unless provider submits to the insurer a notice of initiation of treatment within 21 days of first examination or treatment of claimant, in which case the statement may include charges for treatment or services rendered up to 75 days before postmark date of statement — Payments made by insurer in response to untimely statement were gratuitous and did not count as benefits paid under PIP policy when determining whether policy limits were exhausted

24 Fla. L. Weekly Supp. 891a

Online Reference: FLWSUPP 2410TYNAInsurance — Personal injury protection — Coverage — Exhaustion of policy limits — Insurer’s payment of bill submitted more than 35 days after date of service was gratuitous payment that does not count toward limit of benefits payable under policy — Medical provider’s motion for summary judgment regarding exhaustion of benefits is granted

24 Fla. L. Weekly Supp. 101a

Online Reference: FLWSUPP 2402MAYEInsurance — Personal injury protection — Coverage — Exhaustion of policy limits — Trial court’s finding that benefits were not exhausted is affirmed — Case remanded for recalculation of amount of remaining benefits after deduction of gratuitous payments

24 Fla. L. Weekly Supp. 305a

Online Reference: FLWSUPP 2404HERNInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where insurer acted in good faith in exhausting policy limits by allocating portion of global settlement reached with another of insured’s assignees to PIP benefits in amount equal to that assignee’s original demand, benefits are exhausted notwithstanding unilateral actions of counsel representing both plaintiff medical provider and other assignee that allocated lesser amount of settlement to PIP benefits so as to not exhaust policy limits

24 Fla. L. Weekly Supp. 530a

Online Reference: FLWSUPP 2407TLCInsurance — Personal injury protection — Coverage — Medical expenses — Where ledger indicates that insured made payment to medical provider that resulted in zero balance due, provider no longer has claim against insurer for PIP benefits — Provider’s arguments that it intended to return monies to insured if it prevailed in suit against insurer and that insured’s payment was intended only to reduce outstanding balance, not to be payment in full, are not supported by admissible evidence