Volume 25

25 Fla. L. Weekly Supp. 816a

Online Reference: FLWSUPP 2509ALFOInsurance — Personal injury protection — Coverage — Medical expenses — Provider established prima facie case that services provided were reasonable, related, and medically necessary, and defendant failed to establish existence of material fact on this issue — Summary judgment granted

25 Fla. L. Weekly Supp. 123a

Online Reference: FLWSUPP 2501BESTInsurance — Personal injury protection — Coverage — Medical expenses — Summary judgment entered in favor of provider on issues of medical necessity of treatment and reasonableness of charge

25 Fla. L. Weekly Supp. 122a

Online Reference: FLWSUPP 2501COLIInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Related and necessary treatment — Summary judgment granted in favor of provider

25 Fla. L. Weekly Supp. 828a

Online Reference: FLWSUPP 2509DINGInsurance — Personal injury protection — Coverage — Medical expenses — Nurse practitioner adjustment is Medicare payment methodology, 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 nurse practitioner adjustment to reimburse for service that was provided by nurse practitioner rather than physician

25 Fla. L. Weekly Supp. 988a

Online Reference: FLWSUPP 2511NOZIInsurance — Personal injury protection — Coverage — Medical expenses — Non-massage therapies, performed by licensed massage therapist on behalf of non-LMT owned and duly licensed healthcare clinic, are reimbursable under statute’s plain meaning where the therapies were medically necessary and related to underlying accident

25 Fla. L. Weekly Supp. 93a

Online Reference: FLWSUPP 2501MANEInsurance — Personal injury protection — Exhaustion of benefits — By introducing some evidence that there may have been improperly paid claims and showing evidence of potential unlicensed and fraudulent activity by other providers whose claims were paid by insurer, plaintiff demonstrated genuine issues of fact as to whether benefits were exhausted by payment of invalid claims — Plaintiff was not required to prove that insurer acted intentionally or with knowledge of any impropriety in its payments — Insurer’s motion for summary judgment on ground that benefits were exhausted is denied

25 Fla. L. Weekly Supp. 984a

Online Reference: FLWSUPP 2511CAMPInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where claims for PIP benefits were paid to insured’s other medical providers in order in which compensability was established, thereby exhausting policy limits before plaintiff medical provider’s claims were deemed compensable, final summary judgment is entered in favor of insurer — Assignment of benefits does not provide plaintiff with standing to challenge insurer’s determination that other providers’ bills were reasonable, related and necessary

25 Fla. L. Weekly Supp. 832a

Online Reference: FLWSUPP 2509SAUVInsurance — Personal injury protection — Exhaustion of benefits — Gratuitous payments — Insurer’s payments based on 200% of 2007 Non-Facility Limiting Charge of Medicare Fee Schedule were in good faith and appropriate based upon language of statute and, accordingly, were not gratuitous

25 Fla. L. Weekly Supp. 902a

Online Reference: FLWSUPP 2510KEITInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where insurer made payment to medical provider other than plaintiff that exhausted remainder of insured’s PIP benefits, insurer had no further liability on unresolved pending claims irrespective of fact that medical provider that received final payment then returned portion of payment to insurer with expressed intent to preserve benefits for other medical providers — What receiving medical provider does with insurer’s payment is immaterial to insurer’s liability under policy

25 Fla. L. Weekly Supp. 11a

Online Reference: FLWSUPP 2402LPERInsurance — Personal injury protection — Exhaustion of policy limits — Trial court erred in finding that insurer that initially improperly reduced provider’s charge by using Medicare Part B fee schedule could not later assert exhaustion of benefits as an affirmative defense in provider’s action against it — Absent bad faith, insurer’s liability ended at policy limits — Court rejects provider’s argument that it can recover nominal damages when underlying claim has been obviated by exhaustion of benefits