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Volume 24

Case Search

MOHAMMED MOSTAFA, Plaintiff, vs. TOWER HILL PRIME INSURANCE COMPANY, Defendant.

24 Fla. L. Weekly Supp. 156a

Online Reference: FLWSUPP 2402MOSTInsurance — Breach of contract claim filed against insurer after insurer paid claim submitted by insured in 2009 — Insurer’s motion for summary judgment based on prior payment is denied where genuine issues of material fact exist as to whether insurer’s conduct in response to claim constituted performance of its obligation under policy

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CENTER FOR BONE & JOINT SURGERY OF THE PALM BEACHES (a/a/o Goerdeen Harripersaud), Plaintiff, vs. THE FIRST LIBERTY INSURANCE CORPORATION, Defendant.

24 Fla. L. Weekly Supp. 748a

Online Reference: FLWSUPP 2409HARRInsurance — Small claims — Default — Excusable neglect — Insurer has failed to establish excusable neglect warranting vacation of default entered when it failed to appear at pretrial conference in small claims case where, although parties had agreement to invoke rules of civil procedure and avoid appearance at pretrial conference, court had denied motion to invoke rules and waive appearance, and insurer failed to submit fully compliant waiver of appearance at pretrial conference under rule 7.090(e)

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RIVER CITY MEDICAL ASSOCIATES, INC., a/a/o John Wesley Fudge, Jr., Plaintiff, v. HARTFORD CASUALTY INSURANCE COMPANY, Defendant.

24 Fla. L. Weekly Supp. 758a

Online Reference: FLWSUPP 2409FUDGCivil procedure — Default — Insurance — Personal injury protection — Default entered after insurer failed to appear for pretrial conference vacated based upon finding that there was excusable neglect, insurer acted in timely manner to address default, and vacation of default would not result in prejudice to plaintiff

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EMERGENCY PHYSICIANS, Inc. d/b/a EMERGENCY RESOURCES GROUP, as assignee of Florence Freeman, Plaintiff, v. USAA CASUALTY INSURANCE COMPANY, Defendant.

24 Fla. L. Weekly Supp. 546a

Online Reference: FLWSUPP 2407FREEInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Insurer improperly processed medical bills out of order by applying deductible to bill from emergency medical provider, which was sixth bill received, instead of applying deductible to first bill received — Standing — Assignment — Insurer has waived any right to contest provider’s standing based on provider’s failure to attach assignment to demand letter where insurer did not apprise provider of deficiency when it received bill and subsequent demand letter, but instead applied bill to deductible and made reduced payment on remaining balance — Provider has standing as real party in interest where provider was required by law to treat insured, insured has not made claim for provider’s services, and insurer issued reduced payment directly to provider — As member of class of persons that legislature intended to protect by enacting section 627.736(4)(c) requirement that PIP insurers reserve benefits for emergency service providers, provider has standing to enforce that statute

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EMERGENCY PHYSICIANS, Inc. d/b/a EMERGENCY RESOURCES GROUP, as assignee of Judith Rainwater, Plaintiff, v. USAA CASUALTY INSURANCE COMPANY, Defendant.

24 Fla. L. Weekly Supp. 64a

Online Reference: FLWSUPP 2401RAINInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Insurer improperly processed medical bills out of order by applying deductible to bill from emergency service provider, which was second bill received, instead of applying deductible to first bill received — Standing — Assignment — Insurer has waived any right to contest provider’s standing based on provider’s failure to attach written assignment to demand letter where insurer did not apprise provider of deficiency when it received bill and subsequent demand letter, but instead applied bill to deductible and made reduced payment on remaining balance — Provider has standing as real party in interest where provider was required by law to treat insured, insured has not made claim for provider’s services, and insurer issued reduced payment directly to provider — As member of class of persons that legislature intended to protect by enacting section 627.736(4)(c) requirement that PIP insurers reserve benefits for emergency service providers, provider has standing to enforce that statute

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EMERGENCY MEDICAL ASSOCIATES OF TAMPA BAY, L.L.C., as assignee of Kayla High, Plaintiff, v. GARRISON PROPERTY AND CASUALTY INSURANCE COMPANY, Defendant.

24 Fla. L. Weekly Supp. 58a

Online Reference: FLWSUPP 2401HIGHInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Where insurer received bills from other medical providers prior to bill from plaintiff emergency service provider, insurer should have applied deductible to other providers’ bills, thereby extinguishing deductible before payment of plaintiff’s bill — No merit to argument that because insurer is mandated by statute to reserve $5,000 for emergency service providers deductible was properly applied to plaintiff’s bill as “first compensable bill” even though plaintiff’s bill was third bill received — Insurer cannot dispute reasonableness of charge or relatedness and medical necessity of services after it allowed full amount of charge when applying charge to deductible and conceded reasonableness, relatedness and necessity at deposition of its corporate representative — Standing — Assignment — Document assigning insured’s rights, benefits and causes of action to plaintiff provider conferred standing on plaintiff

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