Volume 25

Case Search

THE CENTER FOR BONE & JOINT DISEASE, P.A., a/a/o William Wagner, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant.

25 Fla. L. Weekly Supp. 382a

Online Reference: FLWSUPP 2504WAGNInsurance — Personal injury protection — Discovery — Depositions — Motion for protective order regarding deposition of pre-litigation adjuster is granted where insurer has pending motion for summary judgment on issue of whether medical provider submitted statutorily compliant demand letter — If motion for summary judgment fails, protective order will be lifted

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ALVAREZ THERAPEUTIC CENTER INC., a/a/o Yumelkys Moreira, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant

25 Fla. L. Weekly Supp. 86b

Online Reference: FLWSUPP 2501MOREInsurance — Personal injury protection — Discovery — Depositions — Motion to compel deposition of pre-litigation adjuster who made determination to reduce or deny medical provider’s bills, rather than claims representative or litigation adjuster offered for deposition by insurer, is granted

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DR. SCOTT HEDRICK, D.C., P.A., D/B/A HEDRICK CHIROPRACTIC & NUTRITION (a/a/o Matthews, Jessica), Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant.

25 Fla. L. Weekly Supp. 837a

Online Reference: FLWSUPP 2509JMATInsurance — Personal injury protection — Default — Vacation — Due diligence — Motion to vacate default and set aside final judgment is denied where insurer was aware of default more than six weeks prior to filing motion to vacate — Further, motion to vacate was not filed under oath or with supporting affidavits and should be summarily denied

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BEACHES OPEN MRI OF THE TREASURE COAST, LLC D/B/A BEACHES MRI (a/a/o Gomez, Claudia 3), Plaintiff, v. ALLSTATE PROPERTY & CASUALTY INSURANCE COMPANY, Defendant.

25 Fla. L. Weekly Supp. 761b

Online Reference: FLWSUPP 2508CGOMInsurance — Personal injury protection — Stay of case pending Florida Supreme Court’s resolution of issue of whether policy provided sufficient notice that insurer was electing to employ Medicare fee schedules for PIP claims did not preclude litigation of issue concerning proper application of policy deductible — Amended motion for protective order from discovery relating to this issue denied

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DR. ANTHONY CARUSO, P.A. a/a/o Russell Cooper, Plaintiff, v. PROGRESSIVE SELECT INSURANCE COMPANY, Defendant.

25 Fla. L. Weekly Supp. 112a

Online Reference: FLWSUPP 2501COOPInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that states that insurer will determine to be unreasonable any charges that exceed schedule of maximum charges and will limit reimbursement to 80% of schedule of maximum charges provides notice that insurer will limit reimbursement to statutory fee schedule and allows insurer to apply Medicare payment methodologies, including Multiple Procedure Payment Reduction, to determine appropriate amount under fee schedule — Deductible — Insurer properly applied statutory fee schedule to bills before applying resulting amount to deductible

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NEW MEDICAL GROUP, INC., a/a/o Elsa Collazo, Plaintiff, v. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant.

25 Fla. L. Weekly Supp. 95a

Online Reference: FLWSUPP 2501COLLInsurance — Personal injury protection — Deductible is to be applied to 100% of reasonable and necessary medical expenses — Because reasonableness of charges was disputed, provider is not entitled to summary judgment on count alleging insurer improperly applied deductible to reduced charges rather than to 100% of provider’s bill

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EMERGENCY MEDICAL ASSOCIATES OF TAMPA BAY, L.L.C., as assignee of Shawn Chandler, Plaintiff, v. USAA GENERAL INDEMNITY COMPANY, Defendant.

25 Fla. L. Weekly Supp. 815a

Online Reference: FLWSUPP 2509CHANInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Insurer erred by applying claim from emergency service provider to deductible before earlier-received claim from hospital — Insurer was required to apply all claims, including claim from emergency service provider, to deductible in order in which they were received — Insurer waived right to challenge reasonableness of charge where corporate representative testified that insurer was not challenging reasonableness, relatedness, or medical necessity of services

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