Volume 24

24 Fla. L. Weekly Supp. 832b

Online Reference: FLWSUPP 2410LOSOInsurance — Personal injury protection — Coverage — Emergency services — Exhaustion of policy limits — Insurer waived right to argue that medical provider sued wrong entity by arguing at same time that it has properly exhausted all benefits under policy — Where insurer had no knowledge of basis/data to support reduction of provider’s bill, but instead relied on third-party vendor to process bill through utilization of undisclosed database supplied by another third-party vendor, insurer reduced payment without having reasonable basis for doing so and acted in bad faith when it subsequently exhausted benefits in payments to other providers — Once insurer reduced bill without reasonable proof, bill became overdue, provider obtained priority rights to benefits, and insurer’s payment of benefits to other providers violated plaintiff provider’s right to priority payment — Insurer also acted in bad faith by failing to reserve disputed portion of emergency service provider’s bill under section 627.736(4)(c) until statute of limitations period expired or suit was filed and concluded

24 Fla. L. Weekly Supp. 877c

Online Reference: FLWSUPP 2410DOCInsurance — Personal injury protection — Coverage — Emergency medical condition — Under amendments to PIP statute requiring PIP insurer to pay benefits up to $10,000 if qualified medical provider has determined that claimant had emergency medical condition and limiting reimbursement to $2,500 if qualified provider has determined that claimant did not have emergency medical condition, insurer was required to extend benefits to $10,000 where qualified provider determined that insured suffered emergency medical condition — There is no statutory basis for insurer to challenge qualified provider’s determination that emergency medical condition exists with opinion from defense expert who performed peer review or compulsory medical examination; statute limits class of medical professionals who may determine that emergency medical conditions does not exist to those who provided initial treatment or follow-up care to insured

24 Fla. L. Weekly Supp. 558a

Online Reference: FLWSUPP 2407GUTIInsurance — Personal injury protection — Coverage — Emergency medical condition — Under amendments to PIP statute requiring PIP insurer to pay benefits up to $10,000 if qualified medical provider has determined that claimant had emergency medical condition and limiting reimbursement to $2,500 if qualified provider has determined that claimant did not have emergency medical condition, insurer had right to limit benefits to $2,500 where qualified provider had not determined that insured suffered emergency medical condition — Insurer’s payment of benefits in excess of $2,500 cap was gratuitous payment and does not constitute waiver which would obligate insurer to pay up to $10,000

24 Fla. L. Weekly Supp. 41a

Online Reference: FLWSUPP 2401DAVIInsurance — Personal injury protection — Coverage — Emergency medical condition — Declaratory action — Insurer’s right to challenge EMC determination — Section 627.736(7) permits insurer to review and challenge physicians’ diagnosis of EMC by conducting independent medical examination and, by extension, peer review

24 Fla. L. Weekly Supp. 373a

Online Reference: FLWSUPP 2405CEREInsurance — Personal injury protection — Coverage — Emergency medical condition — Under amendments to PIP statute requiring PIP insurer to pay benefits up to $10,000 if qualified medical provider has determined that claimant had emergency medical condition and limiting reimbursement to $2,500 if qualified provider has determined that claimant did not have emergency medical condition, insurer properly limited benefits to $2,500 where qualified provider had not determined that insured suffered emergency medical condition — No merit to argument that insurer was required to pay benefits up to $10,000 unless there was determination of absence of emergency medical condition — Where medical provider first provided insurer with documentation potentially establishing existence of emergency medical condition after provider had filed suit for benefits above $2,500 limitation, documentation was legally insufficient to establish emergency medical condition — Insurer did not have duty to investigate whether insured had emergency medical condition or to request additional information from provider prior to limiting benefits to $2,500

24 Fla. L. Weekly Supp. 487a

Online Reference: FLWSUPP 2407SIMMInsurance — Personal injury protection — Coverage — Medical expenses — Emergency medical condition — Where at time of payment insured had not been diagnosed with emergency medical condition, insurer did not wrongfully withhold payments by limiting benefits to $2500 and explaining to provider that benefits were exhausted — Post-suit payment of remaining balance after provider obtained a positive EMC diagnosis did not amount to confession of judgment — Insurer was not required to propound discovery request under §627.736(6)(b) to toll 30-day time-to-pay period and protect itself from liability for fees

24 Fla. L. Weekly Supp. 366a

Online Reference: FLWSUPP 2405MCDOInsurance — Personal injury protection — Coverage — Emergency medical condition — Under amendments to PIP statute requiring PIP insurer to pay benefits up to $10,000 if qualified medical provider has determined that claimant had emergency medical condition and limiting reimbursement to $2,500 if qualified provider has determined that claimant did not have emergency medical condition, insurer properly limited benefits to $2,500 where qualified provider has not determined that insured suffered emergency medical condition at time suit was filed — Where provider ignored insurer’s requests for information regarding whether emergency medical condition existed, claims never became overdue and demand letter was premature — Confession of judgment — Insurer’s payment of benefits above $2,500 upon receipt of determination of emergency medical condition during litigation is not confession of judgment where insurer did not wrongfully withhold payment and premature suit was not catalyst for payment

24 Fla. L. Weekly Supp. 999a

Online Reference: FLWSUPP 2411APHIInsurance — Personal injury protection — Coverage — Medical expenses — Emergency medical condition — Insurer entitled to limit reimbursement to $2500 in absence of determination by qualified physician that insured had emergency medical condition — Provider seeking $1000 in benefits had obligation to establish legal entitlement to those benefits prior to initiating litigation

24 Fla. L. Weekly Supp. 764a

Online Reference: FLWSUPP 2409JBELInsurance — Personal injury protection — Coverage — Emergency medical condition — Where insured had emergency medical condition, medical provider is entitled to seek up to $10,000 in PIP benefits

24 Fla. L. Weekly Supp. 163a

Online Reference: FLWSUPP 2402GILBInsurance — Personal injury protection — Coverage — Conditions precedent — Examination under oath — Notice — Insurer properly notified insured of EUO by providing notice to insured’s attorney — Where insured’s attorney only requested that insurer reschedule EUO, insured could not later challenge location of EUO — Summary judgment is entered in favor of insurer