Volume 26

26 Fla. L. Weekly Supp. 400a

Online Reference: FLWSUPP 2605CRUZInsurance — Personal injury protection — Coverage — Emergency medical condition — Only licensed medical professionals listed in section 627.736(1)(a)3 are capable of making determination that insured had emergency medical condition; neither court nor insurer are authorized to make that determination — Where medical provider failed to provide determination of emergency medical condition requested by insurer, PIP benefits were not overdue, and demand letter was premature — Insurer did not waive requirement to provide emergency medical condition determination by paying benefits in excess of $2,500 limit for claimants who had not suffered an emergency medical condition

26 Fla. L. Weekly Supp. 1001a

Online Reference: FLWSUPP 2612CLARInsurance — Personal injury protection — Coverage — Medical expenses — Electrodes — PIP insurer is not required to pay separate additional charge for electrodes used in conjunction with electrical muscle stimulation treatment where electrodes are not compensable under Medicare Part B fee schedule or workers’ compensation fee schedule

26 Fla. L. Weekly Supp. 994a

Online Reference: FLWSUPP 2612HENRInsurance — Personal injury protection — Coverage — Medical benefits — CPT coding — Unbundling — Insurer properly denied payment for electrodes where payment for electrodes was already included with calculation for payment of electrical stimulation procedure performed during the same encounter, and additional payment would have been considered unbundling and result in duplicative payment

26 Fla. L. Weekly Supp. 903a

Online Reference: FLWSUPP 2611ALANInsurance — Personal injury protection — Coverage — Medical expenses — Electrodes — PIP insurer is not required to pay separate additional charge for electrodes used in conjunction with electrical muscle stimulation treatment where electrodes are not compensable under Medicare Part B fee schedule or workers’ compensation fee schedule — No merit to arguments that electrodes are compensable as supply/durable medical equipment or because superior electrodes were medically necessary

26 Fla. L. Weekly Supp. 898a

Online Reference: FLWSUPP 2611ESPIInsurance — Personal injury protection — Coverage — Medical expenses — Electrodes — PIP insurer is not required to pay separate additional charge for electrodes used in conjunction with electrical muscle stimulation treatment where electrodes are not compensable under Medicare Part B fee schedule or workers’ compensation fee schedule — No merit to arguments that electrodes are compensable as supply/durable medical equipment or because superior electrodes were medically necessary

26 Fla. L. Weekly Supp. 553a

Online Reference: FLWSUPP 2607SANTInsurance — Personal injury protection — Coverage — Medical expenses — Diagnostic testing — Trial court erred by entering summary judgment in favor of provider who filed suit after insurer paid invoice at reduced rate set in Medicare Part B fee schedule where affidavit submitted by insurer raised genuine issue of material fact as to whether x-rays which were subject of claim were medically necessary and whether payment was reasonable

26 Fla. L. Weekly Supp. 413b

Online Reference: FLWSUPP 2605ORTIInsurance — Personal injury protection — Examination under oath — Failure to attend — Where insurer’s request for EUO was made more than 30 days after it received notice of loss and medical bills, request was untimely

26 Fla. L. Weekly Supp. 613a

Online Reference: FLWSUPP 2608CHERInsurance — Personal injury protection — Post-loss obligations — Examination under oath — Failure to attend — Timeliness of request — Insured was not obligated to attend EUO scheduled to take place after thirty-day statutory period for payment of PIP claims had expired where insurer breached contract by failing to pay PIP claim within thirty days and failing to extend the payment period pursuant to section 627.736(4)(i)

26 Fla. L. Weekly Supp. 404b

Online Reference: FLWSUPP 2605ELOPInsurance — Personal injury protection — Coverage — Conditions precedent — Examination under oath — Failure to attend — Where language of PIP policy, adopted from PIP statute, requires compliance with insurer’s request for EUO as condition precedent to receiving PIP benefits and does not provide for any reasonable excuse for non-attendance, insured’s failure to attend two properly scheduled and noticed EUOs constituted failure to satisfy condition precedent, and medical provider, as assignee of insured, is not entitled to PIP benefits

26 Fla. L. Weekly Supp. 225a

Online Reference: FLWSUPP 2603NCASInsurance — Personal injury protection — Coverage — Conditions precedent — Examination under oath — Failure to attend — Where insurer was already in breach of policy by failing to pay PIP claim within 30 days before EUO was scheduled to take place, insured was not obligated to submit to EUO