Volume 25

25 Fla. L. Weekly Supp. 49a

Online Reference: FLWSUPP 2501KRUIInsurance — Personal injury protection — Demand letter — Medical provider was not required to submit demand letter as condition precedent to filing amended complaint to include charges for dates of service not mentioned in original complaint — No merit to argument that demand letter is required where amendment alleges additional charges that were denied by insurer for reasons other than those given for denying charges that were subject of original complaint

25 Fla. L. Weekly Supp. 974a

Online Reference: FLWSUPP 2511PAPHInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — Neither approval of PIP policy by Office of Insurance Regulation nor incorporation of OIR sample form in policy is dispositive as to whether policy makes proper election for payment under permissive statutory fee schedule — Where definition of “reasonable charge” in PIP policy is hybrid of factors found in reasonable amount method of reimbursement and provisions from fee schedule method of reimbursement, policy is ambiguous as to reimbursement method and did not clearly and unambiguously elect fee schedule method of reimbursement

25 Fla. L. Weekly Supp. 915a

Online Reference: FLWSUPP 2510DPERInsurance — Personal injury protection — Coverage — Medical expenses — Summary judgment is entered in favor of medical provider on issues of relatedness of treatment and medical necessity of certain treatments that are undisputed — Issues of improper CPT coding and defective medical record keeping that were raised in affidavit of insurer’s expert but were not pled as affirmative defenses are deemed waived — Reasonableness of charges — Opposing affidavit filed by insurer does not preclude summary judgment in favor of 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. 229c

Online Reference: FLWSUPP 2503BRADInsurance — Personal injury protection — Trial court erred in denying insurer’s timely-filed motion to amend affirmative defenses to add plaintiff’s lack of standing to sue on bills incurred by another entity where there was no showing that plaintiff would be prejudiced, that insurer abused privilege to amend, or that amendments would be futile

25 Fla. L. Weekly Supp. 549a

Online Reference: FLWSUPP 2506SANCInsurance — Personal injury protection — Coverage — Medical benefits — Massage therapy — Treatment provided by licensed massage therapist and billed under CPT code 97124 is not compensable under statutory changes that came into effect in 2013 — Neither demand letter nor bill contained false and misleading statements by provider, as provider sought payment for specific codes that were rendered and that provider believed to be payable

25 Fla. L. Weekly Supp. 1039a

Online Reference: FLWSUPP 2512INTEInsurance — Personal injury protection — Coverage — Conditions precedent — Examination under oath — Where both PIP statute and policy provide that EUO is condition precedent to receipt of benefits, neither insured who failed to appear at two scheduled EUOs nor medical provider/assignee is entitled to benefits irrespective of whether EUOs were set to occur within thirty days of insurer’s receipt of bills

25 Fla. L. Weekly Supp. 897a

Online Reference: FLWSUPP 2510GIAMInsurance — Personal injury protection — Coverage — Failure to attend examination under oath — Provider/assignee not entitled to receive benefits where insured failed to attend EUO that PIP policy establishes as condition precedent to receipt of benefits

25 Fla. L. Weekly Supp. 980a

Online Reference: FLWSUPP 2511TURKInsurance — Personal injury protection — Coverage — Lost wages — Bodily injury “arising out of” ownership, maintenance or use of vehicle — Plaintiff who was shot by police while he was occupying and using his car, which was parked in his driveway with the motor running, sustained bodily injury arising out of ownership, maintenance or use of vehicle is entitled to lost wage benefits

25 Fla. L. Weekly Supp. 308a

Online Reference: FLWSUPP 2504NELSInsurance — Personal injury protection — Affirmative defenses — Amendment — Abuse of discretion to deny insurer’s motion to amend affirmative defenses to allege defense of fraud where discovery revealed that medical provider had submitted claims for services that were not performed — Amendment one week before hearing would not have prejudiced provider, insurer had not previously sought leave to amend, and amendment would not be futile since fraud would invalidate provider’s claim

25 Fla. L. Weekly Supp. 826a

Online Reference: FLWSUPP 2509WHITInsurance — Personal injury protection — Where provider filed complaint seeking damages in amount of $99, exclusive of interest, costs, and attorney’s fees, and insurer thereafter tendered amount sought, with interest, and filed confession of judgment, insurer made valid confession of judgment, and court lacked jurisdiction to consider amended complaint seeking additional damages — Defendant’s motion for entry of final judgment granted — Jurisdiction reserved on issue of attorney’s fees