Volume 24

24 Fla. L. Weekly Supp. 456a

Online Reference: FLWSUPP 2406WARDInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that includes fact-dependent factors and permissive statutory fee schedules in definition of reasonable charge impermissibly commingles payment methodologies and does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule — Neither approval of policy language by Office of Insurance Regulation nor incorporation of OIR sample language in policy rises to level of per se compliance with notice requirements

24 Fla. L. Weekly Supp. 177a

Online Reference: FLWSUPP 2402DORInsurance — Personal injury protection — Affirmative defenses — Medical provider’s agreement to waive right to be paid by claimant for unpaid balance of medical bills did not waive its right to be paid by, or to sue, insurer that was not party to agreement or effect accord and satisfaction of dispute between provider and insurer

24 Fla. L. Weekly Supp. 433b

Online Reference: FLWSUPP 2406HOPKInsurance — Personal injury protection — Settlement agreement — Where assignment of benefits provides that insured is responsible for all services received and promises to pay regardless of insurance payments or lawsuit settlements, settlement agreement between medical provider and insured in which provider accepted payment from insured as full and final satisfaction of outstanding balance settled any claim by provider against PIP insurer — No merit to argument that term “outstanding balance” is ambiguous and, therefore, parol evidence should be admissible to prove that intent of parties was to settle only 20% of bills not covered by PIP benefits

24 Fla. L. Weekly Supp. 297c

Online Reference: FLWSUPP 2404NBROInsurance — Personal injury protection — Standing — Assignment — No merit to argument that medical billing company that sent demand letter on behalf of plaintiff medical provider is consumer collection agency to whom provider’s assignment from insured was transferred by operation of Florida Consumer Collection Practices Act — Insurer’s motion for summary judgment on issue of provider’s standing is denied — Insurer’s motion for sanctions under section 57.105 is denied

24 Fla. L. Weekly Supp. 998a

Online Reference: FLWSUPP 2411MASIInsurance — Personal injury protection — Standing — Assignee — Document attached to assignee’s complaint against insurer was a valid assignment of benefits and was sufficient to confer standing upon plaintiff

24 Fla. L. Weekly Supp. 23c

Online Reference: FLWSUPP 2401ACEVInsurance — Personal injury protection — Standing — Error to dismiss PIP suit on ground that plaintiff is not medical provider that actually provided services at issue where deposition testimony supporting that finding is contradicted by documentary evidence — Director of plaintiff that is dissolved corporation was entitled to appoint agent to bring PIP suit in plaintiff’s name

24 Fla. L. Weekly Supp. 461a

Online Reference: FLWSUPP 2406RIERInsurance — Personal injury protection — Coverage — Medical expenses — “Special Report” is not service reimbursable under policy or No Fault Law — Further, insurer is not liable for payment for conclusory report not signed by health care provider

24 Fla. L. Weekly Supp. 347a

Online Reference: FLWSUPP 2405MARSInsurance — Personal injury protection — Settlement agreement — Enforcement — Where medical provider brought suit for single date of service and voluntarily dismissed suit with prejudice as result of settlement, provider’s subsequent suit for additional dates of service related to same accident is dismissed with prejudice

24 Fla. L. Weekly Supp. 466a

Online Reference: FLWSUPP 2406ADLEInsurance — Personal injury protection — Coverage — Medical expenses — Where medical provider could have billed service as HCPCS code that is reimbursable under Medicare fee schedule but instead chose to bill service as CPT code that is not reimbursable under Medicare fee schedule, insurer correctly reimbursed code as billed pursuant to workers’ compensation fee schedule

24 Fla. L. Weekly Supp. 894a

Online Reference: FLWSUPP 2410BRYAInsurance — Personal injury protection — Coverage — Medical expenses — Multiple Procedure Payment Reduction is payment methodology whose use is allowed by Section 627.736(5)(a)3, not utilization limit prohibited by that statute — Policy that provides that insurer will apply MPPR when determining amount payable under Medicare fee schedule clearly and unambiguously provided notice of insurer’s intent to rely upon MPPR in calculating reimbursement