Volume 25

25 Fla. L. Weekly Supp. 751b

Online Reference: FLWSUPP 2508BOESInsurance — Personal injury protection — Coverage — Medical expenses — Physician assistant reduction is Medicare payment limitation, not utilization limit prohibited by section 627.736(5)(a)3 — Where PIP policy clearly and unambiguously states that insurer may utilize Medicare coding policies and payment methodologies to determine appropriate amount of reimbursement, insurer properly applied physician assistant reduction to reimburse for service that was provided by assistant rather than physician

25 Fla. L. Weekly Supp. 753a

Online Reference: FLWSUPP 2508PUENInsurance — Personal injury protection — Expert witnesses — Insurer’s expert is qualified to testify as expert on issue of reasonableness of MRI charge where expert relies on other charges and reimbursements to insurer for same service that are less than what medical provider charges, and expert has experience as radiologist and experience regarding medical charges

25 Fla. L. Weekly Supp. 5a

Online Reference: FLWSUPP 2501BARRInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Error to enter final summary judgment in favor of provider of issue of reasonableness of charges where affidavits in support of motion were conclusory and contradictory — Insurer’s motion for appellate attorney’s fees granted, pending favorable outcome at trial on remand

25 Fla. L. Weekly Supp. 492a

Online Reference: FLWSUPP 2505CHRIInsurance — 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 opinion that nothing above 200% of Medicare fee schedule would ever be reasonable is not based upon sufficient facts or data and is not product of reliable principles and methods

25 Fla. L. Weekly Supp. 698b

Online Reference: FLWSUPP 2508HALLInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Opposing affidavit filed by insurer did not preclude summary judgment in favor of medical provider on issue of reasonableness of charges where affidavit asserts that reimbursement payment was reasonable because it met reimbursement level prescribed by Medicare Part B fee schedule, despite fact that fee schedule is not elected in PIP policy, and does not raise genuine issue of material fact as to reasonableness of charges

25 Fla. L. Weekly Supp. 559a

Online Reference: FLWSUPP 2506TULIInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Medical provider made prima facie showing of reasonableness of MRI charge by presenting affidavit testifying that it regularly received payment of its charge as reasonable and incorporating data from industry source placing its charge between 50th and 75th percentile of charges for service at issue in community — Affidavit submitted by insurer in opposition to provider’s motion for summary judgment did not meet Daubert standard where expert relied primarily on personal experience, offered opinion rooted in circular logic and conclusory statements, and included only Medicare reimbursement rates in his analysis

25 Fla. L. Weekly Supp. 551a

Online Reference: FLWSUPP 2506DUGAInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Medical provider made prima facie showing of reasonableness of charges by presenting affidavit testifying that charges were in line with prevailing charges of other providers in community and within range of usual and customary charges and reimbursement rates in community — Affidavit submitted by insurer in opposition to provider’s motion for summary judgment did not meet Daubert standard where expert relied primarily on personal experience, offered opinion rooted in conclusory statements, and included only Medicare reimbursement rates in his analysis

25 Fla. L. Weekly Supp. 912a

Online Reference: FLWSUPP 2510RESTInsurance — Personal injury protection — Coverage — Medical expenses — Summary judgment — Reasonableness of charges — Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of charges — Affidavit opining that nothing in excess of 80% of 200% of Medicare fee schedules can ever be reasonable is inadmissible “pure opinion” based on nothing but expert’s own experience

25 Fla. L. Weekly Supp. 554b

Online Reference: FLWSUPP 2506CHACInsurance — 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 charges where affiant has not established nexus to county in which services were provided and based opinion solely on reimbursements at his own facilities — Fact that Medicare and health insurance reimburse less than amount billed by provider does not, by itself, create factual issue as to reasonableness of charges

25 Fla. L. Weekly Supp. 130a

Online Reference: FLWSUPP 2501MORAInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Medical provider met burden of proving that charges for MRI scans were reasonable by introducing bill, assignment of benefits, and affidavit of its owner/corporate representative — Owner’s affidavit is not insufficient for failing to address every reasonableness factor mentioned in PIP statute — Opposing affidavit of non-expert that presents inadmissible lay opinion testimony and relies on inadmissible unauthenticated documents and settlement documents is insufficient to create genuine issue of material fact and avoid summary judgment — Even if affiant were offered as expert, she is not competent to be expert witness where her opinions are not based on sufficient facts or data — Fact that Medicare and health insurance pay less than amount billed by provider does not, by itself, create factual issue as to reasonableness of charges