Volume 27

27 Fla. L. Weekly Supp. 237a

Online Reference: FLWSUPP 2703EASTInsurance — Personal injury protection — Coverage — Medical expenses — Relatedness and medical necessity of treatment — Summary judgment — Trial court abused discretion in denying insurer’s request for continuance of summary judgment hearing on issues of relatedness and medical necessity of treatment to allow insurer to secure deposition of insured where insured’s deposition was critical to resolving inconsistencies between physician’s handwritten notes and typed reports on diagnosis and treatment, and insurer has made diligent efforts to secure insured’s deposition

27 Fla. L. Weekly Supp. 137a

Online Reference: FLWSUPP 2702FORTInsurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related, and necessary treatment — Insurer did not concede medical necessity and relatedness of provider’s services by paying reduced reimbursement amount prior to suit

27 Fla. L. Weekly Supp. 127a

Online Reference: FLWSUPP 2702ENCAInsurance — Personal injury protection — Coverage — Medical expenses — Trial court erred in finding that insurer could not contest relatedness and necessity of claim because it had partially paid claim — Trial court also erred in rejecting affidavit regarding reasonableness of charges as conclusory

27 Fla. L. Weekly Supp. 123a

Online Reference: FLWSUPP 2702STORInsurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Trial court erred in entering summary judgment in favor of medical provider on issues of relatedness and necessity of second interpretation of x-rays that occurred after physical therapy had already been started and reasonableness of charges for second interpretation where opposing affidavits filed by insurer were sufficient to create genuine issues of material fact

27 Fla. L. Weekly Supp. 236a

Online Reference: FLWSUPP 2703JOHNInsurance — Personal injury protection — Coverage — Medical expenses — Medical necessity of treatment — Summary judgment — Trial court erred in entering summary judgment in favor of medical provider on issue of necessity of treatment — Fact that insurer paid charges did not bar insurer from contesting necessity in suit — Deposition of insurer’s claims representative not basis for granting summary judgment in favor of provider on issue of medical necessity

27 Fla. L. Weekly Supp. 235a

Online Reference: FLWSUPP 2703WATKInsurance — Personal injury protection — Coverage — Medical expenses — Relatedness and medical necessity of treatment — Summary judgment — Trial court erred in concluding that insurer had waived right to contest relatedness and medical necessity of treatment by paying claim — Insurer is entitled to contest relatedness and necessity at any time, claims representative’s deposition testimony that insurer was not contesting relatedness and necessity “at this time” could not be construed as concession of those issues, and affidavit of insurer’s expert raises disputed issues of fact on those issues — Abuse of discretion to preclude insurer from deposing treating physician and insured based on holding that insurer had waived issues of relatedness and necessity

27 Fla. L. Weekly Supp. 234a

Online Reference: FLWSUPP 2703JEANInsurance — Personal injury protection — Coverage — Medical expenses — Relatedness and medical necessity of treatment — Summary judgment — Trial court erred in concluding that insurer had waived right to contest relatedness and medical necessity of treatment by paying claim — Insurer is entitled to contest relatedness and necessity at any time, claims representative’s deposition testimony that insurer was not contesting relatedness and necessity “at this time” could not be construed as concession of those issues, and affidavit of insurer’s expert raised disputed issues of fact on those issues — Abuse of discretion to preclude insurer from deposing treating physician and insured based on holding that insurer had waived issues of relatedness and necessity

27 Fla. L. Weekly Supp. 129c

Online Reference: FLWSUPP 2702HEALInsurance — Personal injury protection — Coverage — Medical expenses — Summary judgment — Trial court erred in entering summary judgment where insurer raised genuine issue of material fact as to reasonableness of charges and relatedness and necessity of services — Insurer may challenge reasonableness, relatedness and necessity at any time

Online Reference: FLWSUPP 2711CROCInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that limits reimbursement to 80% of 200% of allowable amount under Medicare Part B fee schedule clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule — Policy does not create unlawful hybrid payment methodology — Insurer properly reimbursed medical provider using participating physicians fee schedule specified in policy rather than non-facility limiting charge

27 Fla. L. Weekly Supp. 726b

Online Reference: FLWSUPP 2708DRESInsurance — Personal injury protection — Coverage — Medical expenses — Insurer properly reimbursed provider at 80% of 200% of participating physician’s fee schedule for Medicare for Part B for 2007 rather than utilizing Medicare Limiting Charge — Based on language of statute and terms of policy, when read as a whole, medical providers like plaintiff are to be reimbursed based on higher of the participating physician’s fee schedule for Medicare Part B for the year in which the services, supplies, or care is rendered or the participating physician’s fee schedule for 2007, whichever results in a higher reimbursement