Volume 26

26 Fla. L. Weekly Supp. 602a

Online Reference: FLWSUPP 2607BEHNInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where insurer exhausted policy limits by gratuitously overpaying another medical provider for CPT code that was not reimbursable under Medicare Part B and should have been reimbursed at 80% of maximum allowance under workers’ compensation fee schedule, PIP benefits are not exhausted, and plaintiff provider is entitled to additional benefits

26 Fla. L. Weekly Supp. 601a

Online Reference: FLWSUPP 2607PLANInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where insurer exhausted policy limits by gratuitously overpaying another medical provider for CPT code that is not reimbursable under Medicare Part B and should have been reimbursed at 80% of maximum allowance under workers’ compensation fee schedule, PIP benefits are not exhausted, and plaintiff provider is entitled to additional benefits

26 Fla. L. Weekly Supp. 592a

Online Reference: FLWSUPP 2607MIRAInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Where medical provider has shown that insurer may have exhausted policy limits by gratuitously paying for massage therapy services that were not prescribed by physician, and therefore were not lawfully rendered services, insurer’s motion for summary judgment based on exhaustion of policy limits is denied

26 Fla. L. Weekly Supp. 691a

Online Reference: FLWSUPP 2608DCHAInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Gratuitous payments — Insurer’s motion for summary judgment based on exhaustion of PIP benefits is denied where medical provider filed counter-evidence tending to show that insurer paid invalid claims to other providers, adjusted other claims improperly, and handled claims in bad faith — No merit to argument that plaintiff provider does not have standing to challenge payments to other providers

26 Fla. L. Weekly Supp. 659a

Online Reference: FLWSUPP 2608CHANInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Gratuitous payments — Insurer’s motion for summary judgment based on exhaustion of PIP benefits is denied where medical provider filed counter-evidence tending to show that insurer paid invalid claims to other providers, adjusted other claims improperly, and handled claims in bad faith — No merit to argument that plaintiff provider does not have standing to challenge payments to other providers

26 Fla. L. Weekly Supp. 323a

Online Reference: FLWSUPP 2604STEEInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Insurer’s motion for summary judgment on issue of exhaustion of benefits is granted where insured did not plead or allege bad faith exhaustion of benefits until hearing on insurer’s motion for summary judgment on exhaustion issue and did not submit any evidence of bad faith on part of insurer in adjusting hospital bill, and evidence demonstrates that insurer properly adjusted hospital bill in accordance with PIP statute

26 Fla. L. Weekly Supp. 239a

Online Reference: FLWSUPP 2603TAYLInsurance — Personal injury protection — Coverage — Medical benefits — Emergency medical condition — $2500 limit for “bodily injury” deemed to be provided by policy at issue is subsumed into total aggregate of $10,000 available when it is determined that injured person has sustained emergency medical condition

26 Fla. L. Weekly Supp. 49a

Online Reference: FLWSUPP 2601TEAMInsurance — Personal injury protection — Coverage — Emergency services — Exhaustion of policy limits — Where PIP insurer failed to maintain entire statutorily required reserve for emergency service providers after making partial payment to plaintiff provider within that classification, payments made to other non-emergency service providers that resulted in exhaustion of policy limits were improper, unauthorized and gratuitous

26 Fla. L. Weekly Supp. 255a

Online Reference: FLWSUPP 2604USAAInsurance — Personal injury protection — Coverage — Emergency medical condition — Where insurer paid full $2,500 in benefits available to insured who had not demonstrated diagnosis of emergency medical condition and requested documentation of EMC, and insurer paid additional benefits after suit had been filed and EMC documentation was provided, trial court erred in construing post-suit payment of benefits as confession of judgment — Insurer was not liable for benefits above $2,500 until EMC documentation was provided — Remand for entry of summary judgment in favor of insurer

26 Fla. L. Weekly Supp. 595a

Online Reference: FLWSUPP 2607BTInsurance — Personal injury protection — Coverage — Exhaustion of policy limits — Emergency medical condition — Where insurer properly denied medical provider’s claim in excess of $2,500 in absence of determination that insured had suffered emergency medical condition and then made payment of additional PIP benefits up to $10,000 policy limit to hospital that was first provider to submit emergency medical condition determination, payment to hospital did not constitute bad faith handling of claims — Summary judgment is entered in favor of insurer on issue of exhaustion of benefits