Volume 26

26 Fla. L. Weekly Supp. 998a

Online Reference: FLWSUPP 2612RAMOInsurance — Personal injury protection — Coverage — Medical expenses — Where PIP policy provides that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges

26 Fla. L. Weekly Supp. 915a

Online Reference: FLWSUPP 2611MEGAInsurance — Personal injury protection — Coverage — Medical expenses — Where PIP policy provides that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges

26 Fla. L. Weekly Supp. 257a

Online Reference: FLWSUPP 2604ROIGInsurance — Personal injury protection — Coverage — Trial court erred in denying provider’s motion for directed verdict on insurer’s affirmative defense that provider submitted false or misleading statement relating to PIP claim where sole evidentiary support for insurer’s defense consisted of trial testimony by insurer’s corporate representative that she had “information” that there was a “possibility” of false billing by the provider

26 Fla. L. Weekly Supp. 257b

Online Reference: FLWSUPP 2604ALVAInsurance — Personal injury protection — Trial court abused its discretion in denying insurer’s motion for leave to amend its answer to plead exhaustion of benefits as an affirmative defense where there was no indication in the record that amendment was subject to any of the exceptions for liberal pleading requirements — Although motion for leave to amend was filed the day before hearing on plaintiff’s motion for summary judgment, the case had not yet been set for trial when the motion for summary judgment was filed and, consequently, there is no prejudice

26 Fla. L. Weekly Supp. 853a

Online Reference: FLWSUPP 2610CROCInsurance — Personal injury protection — Coverage — Medical expenses — Where PIP policy provides that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges — Affirmative defenses — Amendment — Motion to amend affirmative defenses to allege failure to strictly comply with presuit demand letter requirement is granted — Demand letter is not defective for failing to specify exact amount insurer will ultimately owe

26 Fla. L. Weekly Supp. 852a

Online Reference: FLWSUPP 2610STAFInsurance — Personal injury protection — Coverage — Medical expenses — Where PIP policy provides that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges — Affirmative defenses — Amendment — Motion to amend affirmative defenses to allege failure to strictly comply with presuit demand letter requirement is denied — Action for declaratory relief is not “action for benefits” to which demand letter condition precedent applies, and attempt to inject new defense at summary disposition hearing is untimely and inequitably prejudicial

26 Fla. L. Weekly Supp. 672a

Online Reference: FLWSUPP 2608STEEInsurance — Personal injury protection — Med pay — Coverage — Medical expenses — Exhaustion of policy limits — Where insurer exhausted PIP and med pay benefits in payments of claims, and medical provider failed to prove bad faith on part of insurer in adjusting claims, insurer is not liable for balance of provider’s reduced bill — Insurer was not required to reserve benefits for disputed portion of provider’s claim

26 Fla. L. Weekly Supp. 979b

Online Reference: FLWSUPP 2612PERIInsurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — Insurer is precluded from asserting exhaustion of benefits defense where insurer initially denied claim on basis that claimant was not covered under daughter’s PIP policy, but failed to inform medical provider for four years that claimant was covered under policy on another of its insureds and did not notify court of exhaustion of benefits under that other policy until four years after exhaustion

26 Fla. L. Weekly Supp. 995a

Online Reference: FLWSUPP 2612GUERInsurance — Personal injury protection — Coverage — Examination under oath — Failure to appear — Insurer is not liable for PIP benefits where insured failed to appear at two EUOs of which insured and his attorney had notice, and insured offered no explanation for failure to appear

26 Fla. L. Weekly Supp. 981a

Online Reference: FLWSUPP 2612COR1Insurance — Personal injury protection — Coverage — Examination under oath — Failure to appear — Where insured failed to comply with EUO provision of PIP policy, insurer is relieved of liability for payment of PIP benefits to medical provider — Provider’s request to abate action to allow compliance with EUO requirement is denied — Permitting EUO two years after suit was filed would defeat purpose of EUO provision