Volume 26

26 Fla. L. Weekly Supp. 125a

Online Reference: FLWSUPP 2602VELAInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that states that insurer will determine to be unreasonable any charges that exceed maximum charges set forth in PIP statute and will pay no more than 80% of schedule of maximum charges clearly and unambiguously elects to limit payment pursuant to statutory fee schedules — Inclusion in policy of statement that insurer may use fact-based method to determine reasonableness of charges does not render policy language ambiguous — Multiple Procedure Payment Reduction is payment methodology whose use is allowed by section 627.736(5)(a)3, not utilization limit prohibited by that statute

26 Fla. L. Weekly Supp. 521a

Online Reference: FLWSUPP 2606COACInsurance — Personal injury protection — Coverage — Medical expenses — Multiple Procedure Payment Reduction — Clear and unambiguous election by insurer

26 Fla. L. Weekly Supp. 146a

Online Reference: FLWSUPP 2602CANNInsurance — Personal injury protection — Coverage — Medical expenses — Multiple Procedure Payment Reduction is payment methodology whose use is allowed by section 627.736(5)(a)3, not utilization limit prohibited by that statute — PIP policy that provides that insurer will apply MPPR when determining amount payable under Medicare fee schedule clearly and unambiguously provided notice of insurer’s intent to rely upon MPPR in calculating reimbursement

26 Fla. L. Weekly Supp. 129a

Online Reference: FLWSUPP 2602TRINInsurance — Personal injury protection — Coverage — Medical expenses — Multiple Procedure Payment Reduction is payment methodology whose use is allowed by section 627.736(5)(a)3, not utilization limit prohibited by that statute — PIP policy that provides that insurer will apply MPPR when determining amount payable under Medicare fee schedule clearly and unambiguously provided notice of insurer’s intent to rely upon MPPR in calculating reimbursement

26 Fla. L. Weekly Supp. 871a

Online Reference: FLWSUPP 2611SANCInsurance — Personal injury protection — Coverage — Medical expenses — Policy clearly and unambiguously elected use of Medicare coding policies and payment methodologies, including applicable modifiers such as Multiple Procedure Payment Reduction methodology, even without specific mention of “MPPR” — Policy properly complied with statutory notice provision — MPPR is permissible payment methodology, not improper utilization limit — Trial court erred in granting summary judgment in favor of provider

26 Fla. L. Weekly Supp. 331a

Online Reference: FLWSUPP 2604ALONInsurance — Personal injury protection — Coverage — Medical expenses — Application of Multiple Procedure Payment Reduction — Insurer’s motion for final summary judgment determining that it paid proper amount in benefits by paying 200% of Medicare fee schedule with application of MPPR is denied — MPPR is form of utilization limit, insurer does not apply MPPR consistently and does not apply other Medicare payment modifiers that would result in higher benefit payments, and PIP statute supports medical provider’s argument that insurer may be sued up to ceiling of full 200% of Medicare fee schedule

26 Fla. L. Weekly Supp. 233c

Online Reference: FLWSUPP 2603ALEXInsurance — Personal injury protection — Coverage — Medical expenses — Relatedness and necessity of treatment — Summary judgment — Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issues of relatedness and necessity of treatment where affidavit relies on hearsay report of independent medical examination and is conclusory

26 Fla. L. Weekly Supp. 865b

Online Reference: FLWSUPP 2611ROJANOT FINAL VERSION OF OPINION
Subsequent Changes at 27 Fla. L. Weekly Supp. 349bInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Affidavit in opposition to motion for summary judgment filed by insurer was legally sufficient where it was premised upon personal knowledge and reflected admissible evidence that insurer based its payment on Medicare fee schedule — Trial court abused its discretion in striking the affidavit and granting summary judgment in favor of provider

26 Fla. L. Weekly Supp. 521c

Online Reference: FLWSUPP 2606LANNInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Opposing affidavit and deposition filed by insurer do not preclude summary judgment in favor of medical provider on issue of reasonableness of charges where affiant, whose statement that he always attempted to charge near or at 200% of Medicare fee schedule is rebutted by own charges, is not qualified to render opinion on reasonableness of charges

26 Fla. L. Weekly Supp. 521c

Online Reference: FLWSUPP 2606LANNInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Opposing affidavit and deposition filed by insurer do not preclude summary judgment in favor of medical provider on issue of reasonableness of charges where affiant, whose statement that he always attempted to charge near or at 200% of Medicare fee schedule is rebutted by own charges, is not qualified to render opinion on reasonableness of charges

26 Fla. L. Weekly Supp. 978a

Online Reference: FLWSUPP 2612WPERInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Opposing affidavit filed by insurer precludes summary judgment in favor of medical provider on issue of reasonableness of charges where affidavit does not consist solely of unsupported speculation or mere subjective belief and demonstrates genuine issue of material fact on reasonableness issue — Pure opinion testimony is permitted under Frye standard reaffirmed in Delisle