Volume 25

25 Fla. L. Weekly Supp. 125b

Online Reference: FLWSUPP 2501VASSInsurance — Personal injury protection — Coverage — Medical expenses — Summary judgment — Where affidavit filed by insurer in opposition to summary judgment on issue of reasonableness of charges is conclusory and not based on sufficient facts or data, and insurer stipulated to relatedness and medical necessity of treatment in its discovery responses, final summary judgment is entered in favor of medical provider

25 Fla. L. Weekly Supp. 229a

Online Reference: FLWSUPP 2503MERIInsurance — Personal injury protection — Coverage — Medical expenses — Trial court erred in granting summary judgment on reasonableness of provider’s pricing where affidavit filed by insurer raised issues of material fact

25 Fla. L. Weekly Supp. 694a

Online Reference: FLWSUPP 2508BINGInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Trial court erred in holding that insurer was not permitted to challenge reasonableness of charges which insurer had initially paid based on Medicare Part B and Workers’ Compensation fee schedules — Although policy did not clearly and unambiguously give notice of insurer’s election to limit payment based on statutory fee schedules, insurer was not barred from litigating reasonableness of charges, but was merely precluded from availing itself of fee schedule limitation

25 Fla. L. Weekly Supp. 693a

Online Reference: FLWSUPP 2508PINEInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Insurer that failed to elect to use fee schedule method of reimbursement in PIP policy is not precluded from litigating reasonableness of medical provider’s bill under section 627.736(5)(a)1, but is merely precluded from availing itself of fee schedule limitation in section 627.736(5)(a)2 — Under these circumstances, insurer is also entitled to engage in discovery on reasonableness of charges

25 Fla. L. Weekly Supp. 579b

Online Reference: FLWSUPP 2507ALLFInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Insurer did not waive opportunity to litigate reasonableness of provider’s charge for MRI when its adjuster used computerized auto-pay process

25 Fla. L. Weekly Supp. 382c

Online Reference: FLWSUPP 2504HEREInsurance — Personal injury protection — Coverage — Medical expenses — Reasonable charges — Under PIP statute, if medical provider’s charge is reasonable, insurer must pay that amount even if its own amount of proposed reimbursement might also be deemed reasonable — Where provider’s charges fall clearly within range of MRI charges for non-hospital settings in South Florida, charges are reasonable

25 Fla. L. Weekly Supp. 117b

Online Reference: FLWSUPP 2501ROJAInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Provider made prima facie showing that amount charged for MRI was reasonable by presenting medical bill for service at issue and testimony that patient received the treatment in question and through affidavit of owner and corporate representative, who had personal knowledge of valuation of services at issue and was personally familiar with company’s billing practices, office procedures, collection practices, reimbursement trends for plaintiff’s services, and charges in the community — Affidavit of insurer’s litigation adjuster, who was offered as fact witness, was insufficient to establish disputed issue of material fact as to reasonableness of charges

25 Fla. L. Weekly Supp. 91b

Online Reference: FLWSUPP 2501PADRInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Provider made prima facie showing of reasonableness of charges by presenting medical bill for the service at issue and testimony that the patient received the treatment in question — 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 without explaining how experience led to opinion, why experience was sufficient basis for opinion, and how experience was reliably applied to facts

25 Fla. L. Weekly Supp. 89a

Online Reference: FLWSUPP 2501RIDIInsurance — 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 medical provider’s charge where affidavit is self-serving, conclusory, devoid of sufficient facts or data, is based on inadmissible hearsay and lacks reliable principles — Fact that Medicare, HMOs and PPOs pay less than amount billed by provider does not create factual issue as to reasonableness of charge

25 Fla. L. Weekly Supp. 580a

Online Reference: FLWSUPP 2507ALEXInsurance — Personal injury protection — Coverage — Medical expenses — Insurer who based its payment to provider on statutory fee schedule, although insurance policy did not give notice of insurer’s election to use fee schedule, was not precluded from litigating reasonableness of provider’s bill for MRI — Opposing affidavits submitted by provider and insurer raised genuine issue of material fact with respect to reasonableness of bill