Volume 25

25 Fla. L. Weekly Supp. 201a

Online Reference: FLWSUPP 2502CORRCivil procedure — Insurance — Summary judgment — Supporting affidavit — Insured’s examination under oath may be used to support insurer’s motion for summary judgment — Plaintiff’s motion to strike EUO is denied

25 Fla. L. Weekly Supp. 816b

Online Reference: FLWSUPP 2509WALFInsurance — Personal injury protection — Civil procedure — Filings submitted in opposition to plaintiff’s motion for summary judgment on issue of reasonableness, relatedness, and necessity of services provided were untimely — Further, affidavit submitted by insurer failed to place plaintiff on notice of its intended use in support of insurer’s opposition to plaintiff’s motion for summary judgment on fee schedule limitations

25 Fla. L. Weekly Supp. 309a

Online Reference: FLWSUPP 2504CAMBInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Policy at issue clearly and unambiguously provided sufficient notice to insured and provider of insurer’s election of permissive method of reimbursement where amendatory endorsement clearly provided that insurer would reimburse either 80% of actual charge or 80% of Medicare fee schedules, whichever was lesser — Policy language does not state that insurer has ability to reimburse based on a reasonable amount, but instead describes insurer’s method of determining whether treatment itself is reasonable

25 Fla. L. Weekly Supp. 910a

Online Reference: FLWSUPP 2510SZABInsurance — Personal injury protection — Coverage — Medical benefits — Statutory fee schedule — Notice provided by insurer at time policy was renewed was sufficient to limit reimbursement to schedule of maximum charges — Insurer complied with express directives of statute

25 Fla. L. Weekly Supp. 943c

Online Reference: FLWSUPP 2511LUGOInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules

25 Fla. L. Weekly Supp. 754b

Online Reference: FLWSUPP 2508OTERInsurance — Personal injury protection — Declaratory action — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that provides for hybrid method of calculating reimbursement utilizing elements from both reasonable amount method and statutory fee schedule method of reimbursement and other elements not authorized by PIP statute does not clearly and unambiguously elect use of statutory fee schedules — Insurer must calculate benefits pursuant to reasonable amount method of reimbursement

25 Fla. L. Weekly Supp. 108a

Online Reference: FLWSUPP 2501PWILNOT FINAL VERSION OF OPINION
Subsequent Changes at 25 Fla. L. Weekly Supp. 376aInsurance — Personal injury protection — Coverage — Medical expenses — 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 specifically elect fee schedule method of reimbursement

25 Fla. L. Weekly Supp. 107d

Online Reference: FLWSUPP 2501PICAInsurance — Personal injury protection — Coverage — Medical expenses — 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 specifically elect fee schedule method of reimbursement — Approval of PIP policy form by Office of Insurance Regulation does not override requirement that policy provide insured with notice of election of one of two payment methodologies

25 Fla. L. Weekly Supp. 1047a

Online Reference: FLWSUPP 2512VILCInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — Insurer’s motion for summary judgment based on exhaustion of PIP benefits is denied where insurer has not presented sufficient evidence to demonstrate as matter of law that benefits were exhausted and were not exhausted in bad faith, and medical provider seeks declaration as to whether policy properly elected statutory fee schedule, not PIP benefits — Where PIP policy does not clearly and unambiguously elect statutory fee schedule method of reimbursement, insurer is not lawfully authorized to pay claims using hybrid method described in policy and must use fact dependent method of section 627.736(5)(a)

25 Fla. L. Weekly Supp. 1038a

Online Reference: FLWSUPP 2512SEIJInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — Declaratory action — Motion to dismiss declaratory action seeking determination as to whether PIP policy clearly and unambiguously elects payment methodology is denied — Fact that insured has available remedy through breach of contract action does not preclude declaratory relief