Volume 25

25 Fla. L. Weekly Supp. 58a

Online Reference: FLWSUPP 2501SUMMInsurance — Personal injury protection — Deductible — Insurer improperly processed medical bills by applying PIP deductible out of order to otherwise compensable bills — Standing — Failure to attach written assignment to complaint — Insurer waived right to assert any defects in claim submitted by plaintiff or in presuit demand letter when it failed to give any notice to plaintiff regarding alleged deficiencies — Plaintiff emergency room physician had standing to maintain action given laws on equitable assignment, real party in interest, and as the entity that statute sought to protect — Insurer to pay balance remaining plus interest

25 Fla. L. Weekly Supp. 54b

Online Reference: FLWSUPP 2501SOLIInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Insurer improperly processed medical bills out of order by applying deductible to bill from emergency medical provider, which was third bill received, instead of applying deductible to first bill received — Standing — Assignment — Insurer has waived any right to contest provider’s standing based on provider’s failure to attach assignment to demand letter where insurer did not apprise provider of deficiency when it received bill and subsequent demand letter, but instead applied bill to deductible — Provider has standing as real party in interest where provider was required by law to treat insured, insured has not made claim for provider’s services, and insurer issued explanation of benefits directly to provider — As member of class of persons that legislature intended to protect by enacting section 627.736(4)(c) requirement that PIP insurers reserve benefits for emergency service providers, provider has standing to enforce that statute

25 Fla. L. Weekly Supp. 754a

Online Reference: FLWSUPP 2508GARCInsurance — Personal injury protection — Coverage — Medical expenses — Deductible — No merit to argument that insurer failed to produce competent, admissible evidence that insured elected deductible where adjuster’s affidavit and exhibit attests that deductible is clear term of insured’s PIP policy — Insurer improperly reduced total amount billed by medical provider to compensable expenses before applying deductible, rather than applying deductible to total amount billed

25 Fla. L. Weekly Supp. 546c

Online Reference: FLWSUPP 2506IGNAInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Insurer erred by applying bill from emergency service provider to deductible despite fact that bills from other medical providers were received before that of emergency service provider — All claims, including those of emergency service providers, are to be applied to PIP deductible in order that they are received

25 Fla. L. Weekly Supp. 114a

Online Reference: FLWSUPP 2501DENTInsurance — Personal injury protection — Deductible applies to actual amount payable by the insurer and does not apply to uncovered charges — Insurer is not required to automatically apply PIP deductible to full, face amount of provider’s bills before making any determination regarding propriety of bill amount or what billed items are allowed or covered under the insurance policy

25 Fla. L. Weekly Supp. 672a

Online Reference: FLWSUPP 2507BEAUInsurance — Personal injury protection — Coverage — Medical expenses — Deductible — Insurer that clearly and unambiguously elected statutory fee schedules in policy appropriately applied fee schedules to medical provider’s charges before applying deductible to resulting amount

25 Fla. L. Weekly Supp. 663a

Online Reference: FLWSUPP 2507AMBRInsurance — 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 maximum charges set forth in PIP statute and will pay no more than 80% of 200% of allowable amount under Medicare Part B clearly and unambiguously elects single method of calculating PIP benefits — Multiple Procedure Payment Reduction is payment modifier on which insurer is entitled to rely when reimbursing PIP claims, not utilization limit — Deductible — Insurer properly applied fee schedule reductions to medical provider’s bills before applying deductible to resulting amount

25 Fla. L. Weekly Supp. 616b

Online Reference: FLWSUPP 2507HANSInsurance — Personal injury protection — Coverage — Medical expenses — Deductible — Insurer properly reduced medical bills to allowable amounts before applying deductible to resulting amounts

25 Fla. L. Weekly Supp. 563a

Online Reference: FLWSUPP 2506KUPInsurance — Personal injury protection — Deductible — Insurer properly applied policy deductible to reasonable covered expenses calculated pursuant to fee schedules and was not required to apply deductible first against amount billed for services rendered before applying fee schedules

25 Fla. L. Weekly Supp. 372a

Online Reference: FLWSUPP 2504NEWBInsurance — Personal injury protection — Deductible — Both PIP statute and PIP policy required insurer to apply deductible to 100% of expenses and losses prior to applying fee schedule reductions