Volume 25

25 Fla. L. Weekly Supp. 897c

Online Reference: FLWSUPP 2510SCUTInsurance — Personal injury protection — Coverage — Medical expenses — National Correct Coding Initiative edits are utilization limits — Insurer’s use of NCCI utilization edits to deny payment of PIP benefits amounted to bad faith claims adjusting — Insurer may not use exhaustion of benefits as shield where claim was adjusted in bad faith

25 Fla. L. Weekly Supp. 1025a

Online Reference: FLWSUPP 2512DIZAInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Bad faith — Application of National Correct Coding Initiative edits — Where at time PIP insurer denied reimbursement of billed CPT codes based upon NCCI edits there was binding authority holding that NCCI edits are utilization limits prohibited by PIP statute, insurer’s application of NCCI edits was bad faith claims adjusting that exposes it to liability beyond policy limits

25 Fla. L. Weekly Supp. 103b

Online Reference: FLWSUPP 2501RPERNOT FINAL VERSION OF OPINION
Subsequent Changes at 25 Fla. L. Weekly Supp. 647bInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where PIP benefits were exhausted in payments to medical providers, and there is no evidence that gratuitous payments were made or that insurer acted in bad faith, no further benefits are due and owing

25 Fla. L. Weekly Supp. 366a

Online Reference: FLWSUPP 2504LYNCInsurance — Personal injury protection — Discovery — Examination under oath — Plaintiff’s motion to exclude insured’s examination under oath is granted, and insurer is excluded from using EUO at trial for any purpose based on insurer’s having refused for over three years to produce EUO to plaintiff, although it is undisputed that insurer relied on EUO in support of its affirmative defense and ultimate denial of PIP claim

25 Fla. L. Weekly Supp. 365a

Online Reference: FLWSUPP 2504THEOInsurance — Personal injury protection — Coverage — Emergency medical condition — Insurer properly limited benefits to $2,500 where qualified provider had not determined that insured suffered emergency medical condition — Fact that insurer paid additional benefits beyond $2,500 cap when it determined during litigation that it had utilized incorrect fee schedule in calculating reimbursement did not waive insurer’s right to claim exhaustion of benefits

25 Fla. L. Weekly Supp. 226a

Online Reference: FLWSUPP 2503CORAInsurance — Personal injury protection — Coverage — Emergency medical condition — Confession of judgment — Where medical provider failed to provide determination that insured had EMC at time it filed claim for PIP benefits, provider was not forced into litigation by insurer’s failure to pay more than $2,500 in benefits, and trial court erred in finding that insurer’s payment of additional benefits after provider supplied post-suit determination that insured had EMC constituted confession of judgment

25 Fla. L. Weekly Supp. 494a

Online Reference: FLWSUPP 2505FAITInsurance — Personal injury protection — Coverage — Emergency medical condition — In suit seeking PIP benefits is excess of $2,500, proof of determination of emergency medical condition is essential element of plaintiff medical provider’s case — Where no qualified medical provider has made determination that insured had emergency medical condition, and insurer had paid $2,500 in benefits on behalf of insured prior to filing of suit, insurer has no additional liability to provider — Where provider ignored insurer’s requests for information on whether emergency medical condition existed, claims never became overdue and demand letter was premature — Insurer’s motion for summary disposition is granted

25 Fla. L. Weekly Supp. 470a

Online Reference: FLWSUPP 2505AETIInsurance — Personal injury protection — Coverage — Emergency medical condition — Under amendments to PIP statute requiring PIP insurer to pay benefits up to $10,000 if qualified medical provider has determined that claimant had emergency medical condition and limiting reimbursement to $2,500 if qualified provider has determined that claimant did not have emergency medical condition, insurer properly limited benefits to $2,500 where qualified provider had not determined that insured suffered emergency medical condition — No merit to argument that insurer was required to pay benefits up to $10,000 unless there was determination of absence of emergency medical condition — Determination of emergency medical condition made and submitted to insurer after suit was filed was not sufficient to place insurer on notice of covered loss for benefits over $2,500 prior to suit being filed

25 Fla. L. Weekly Supp. 489a

Online Reference: FLWSUPP 2505CHARInsurance — Personal injury protection — Coverage — Medical expenses — Declaratory action — PIP policy, when read in conjunction with PIP statute limiting benefits to $2,500 in absence of determination of emergency medical condition and extending benefits to $10,000 when emergency medical condition has been determined to exist, is deemed to provide $2,500 in benefits that are subsumed in total aggregate of $10,000 in benefits when emergency medical condition is determined to exist, not total aggregate of $12,500 in benefits

25 Fla. L. Weekly Supp. 79a

Online Reference: FLWSUPP 2501PAULInsurance — Personal injury protection — Coverage — Medical expenses — Emergency medical condition — Insurer did not unreasonably limit reimbursement to $2500 in absence of determination by qualified provider that claimant had emergency medical condition — Post-suit payment of additional benefits did not amount to confession of judgment