Volume 26

26 Fla. L. Weekly Supp. 974a

Online Reference: FLWSUPP 2612KENNInsurance — Personal injury protection — Coverage — Conditions precedent — Examination under oath — Failure to attend — Where letter scheduling EUO did not mention that insurer was investigating claim for suspicion of insurance fraud, insurer was not entitled to additional 60 days to investigate claim under section 627.736(4)(i) — Amendment to PIP statute stating that submission to EUO is condition precedent to receipt of benefits does not affect requirement that insurer comply with investigative timeline imposed by section 627.736(4)(b) — Insurer waived right to deny benefits based on insured’s failure to appear at first EUO where insurer continued to process claim thereafter and scheduled second EUO — Insurer is precluded from denying benefits based on failure to attend second EUO where investigation had already exceeded 30-day time limit and claim was overdue by date of second EUO

26 Fla. L. Weekly Supp. 413a

Online Reference: FLWSUPP 2605HANSInsurance — Personal injury protection — Independent medical examination — Physician who did not have own medical practice in years preceding IME but who performed temporary office coverage for other chiropractors for 20 days during that time was in “active practice” within meaning of statute requiring that IME physician be in active practice — Statute requires only that physician devote professional time to evaluation, diagnosis or treatment of patients, not that physician regularly or continuously treat patients — Motion to disqualify physician and strike IME is denied

26 Fla. L. Weekly Supp. 996a

Online Reference: FLWSUPP 2612DUYOInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Insurer that elected use of statutory fee schedule reimbursement methodology in PIP policy is entitled to use fee schedule amounts that reflect 2% reduction applied by Centers for Medicaid and Medicare Services for CPT codes for chiropractic manipulation when reimbursing for chiropractic services — Question certified

26 Fla. L. Weekly Supp. 416a

Online Reference: FLWSUPP 2605ESTEInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Because 2% reduction applied by Centers for Medicaid and Medicare Services to physician fee schedule payment amounts for CPT codes for chiropractic manipulation is explicit part of formula for calculating fee schedule payment amounts for those CPT codes, PIP insurer is entitled to use fee schedule amounts that reflect 2% reduction when reimbursing for chiropractic services under PIP policy that adopts statutory fee schedules and is not required to calculate reimbursement using formula that would add 2% back into fee schedule payment amounts

26 Fla. L. Weekly Supp. 1003a

Online Reference: FLWSUPP 2612SAGMInsurance — Personal injury protection — Coverage — Medical expenses — CPT coding — Claim for re-examination conducted on same date of service as chiropractic manipulation was not payable where medical provider failed to include modifier required by CPT coding guidelines

26 Fla. L. Weekly Supp. 1004a

Online Reference: FLWSUPP 2612GRIMInsurance — Personal injury protection — Coverage — Medical expenses — Material misrepresentation regarding claim — Where claimant who was passenger in covered vehicle at time of accident made material misrepresentation to insurer regarding his residence on date of loss, insurer is not required to pay claim

26 Fla. L. Weekly Supp. 298a

Online Reference: FLWSUPP 2604WARNInsurance — Personal injury protection — Med pay — Standing — Injured insured has standing to bring action against insurer for PIP and med pay benefits for full amount of services billed by medical provider and denied by insurer, irrespective of whether insured has paid bills

26 Fla. L. Weekly Supp. 38a

Online Reference: FLWSUPP 2601AMInsurance — Personal injury protection — Venue — Forum selection clause — Provision requiring any legal action against insurer to be brought in county and state where covered person lived at time of accident, unless insurer agreed otherwise, was mandatory and enforceable absent showing that it is unreasonable or unjust — Motion to transfer venue to county in which assignor/insured resided at time of accident granted

26 Fla. L. Weekly Supp. 521b

Online Reference: FLWSUPP 2606CARAInsurance — Personal injury protection — Defendant’s rule 1.140 motion for judgment on pleadings was not proper in small claims proceeding where rules of civil procedure were not invoked and it had been made clear that case would proceed under small claims rules — Plaintiff’s motion for relief from judgment is granted — Judgment on pleadings pursuant to small claims rule not proper due to posture of the case

26 Fla. L. Weekly Supp. 620a

Online Reference: FLWSUPP 2608WHITInsurance — Small claims — Confession of judgment — No error in entering judgment after insurer filed confession of judgment — Responsive pleading to a complaint is not required under small claims rules, and there was no issue of fact left to resolve