Volume 27

27 Fla. L. Weekly Supp. 311a

Online Reference: FLWSUPP 2703RTInsurance — Health maintenance organizations — Out-of-network or non-participating provider — Reimbursement rate — Reduction of claim to “allowed amount” — Because there was no contractual relationship between provider and HMO, rate of reimbursement was to be determined by section 641.513(5), which provides that reimbursement rate is lesser of provider’s charges, the usual and customary provider charges in the community, or a charge mutually agreed upon by HMO and provider within 60 days of submittal of claim — Because HMO failed to prove that “allowed amount” reduction of claim was agreed to by parties or the usual and customary charge in community, HMO was required to reimburse full amount of medical provider’s charge — HMO is also required to pay interest on overdue claim — Provider entitled to attorney’s fees and costs pursuant to section 641.28

27 Fla. L. Weekly Supp. 480a

Online Reference: FLWSUPP 2705GRAttorney’s fees — Insurance — Expert witness fees — Expert witness on reasonableness of attorney’s fees is entitled to witness fee to be taxed as costs

27 Fla. L. Weekly Supp. 549a

Online Reference: FLWSUPP 2706DIAZInsurance — Personal injury protection — Attorney’s fees — Confession of judgment — Where insurer paid benefits and interest in check that was sent to medical provider rather than payee identified in demand letter and was cashed in error by separate entity unaffiliated with provider, and payment did not include statutorily required postage and penalty, payment does not relieve insurer of its obligation to pay provider pursuant to notice of confession of judgment, and provider is entitled to award of attorney’s fees — Motion to enforce confession of judgment is granted

27 Fla. L. Weekly Supp. 785a

Online Reference: FLWSUPP 2709GOMEInsurance — Personal injury protection — Attorney’s fees — Charging lien — Medical provider appeals final judgment determining that discharged attorney that formerly represented provider in action for PIP benefits that eventually ended in settlement was entitled to attorney’s fees beyond amount of global settlement — No merit to argument that attorney has statutory right, under section 627.428, to proceed against provider for attorney’s fees rather than having fees capped by terms of settlement — Statute is inapplicable to claim for fees pursuant to charging lien — Remand for evidentiary hearing to determine apportionment of settlement between discharged attorney and successor attorney — Trial court further erred by awarding expert witness fee and other costs incurred in prosecuting charging lien

27 Fla. L. Weekly Supp. 129a

Online Reference: FLWSUPP 2702MARQInsurance — Attorney’s fees — Appellate attorney’s fees granted contingent on finding that insurer filed valid proposal for settlement and satisfied requirements of proposal for settlement statute

27 Fla. L. Weekly Supp. 735b

Online Reference: FLWSUPP 2708DELOAttorney’s fees — Insurance — Personal injury protection — Amount

27 Fla. L. Weekly Supp. 734b

Online Reference: FLWSUPP 2708FERNAttorney’s fees — Insurance — Amount

27 Fla. L. Weekly Supp. 270a

Online Reference: FLWSUPP 2703CITIInsurance — Homeowners — Appraisal — Specific performance — Jurisdiction — Amount in controversy below $15,000 — Circuit court has jurisdiction over insurer’s action seeking specific performance of appraisal clause where, although amount in controversy does not exceed $15,000, section 26.012(2)(c) grants circuit courts subject matter jurisdiction in all cases in equity and contains no amount in controversy threshold — Circuit court may not abdicate its jurisdiction by transferring case to county court — Court rejects argument that a dispute over reasonableness of amount charged for completed mitigation services is not a “disagreement regarding the amount of covered loss” for purposes of appraisal provision — Dispute is clearly over the amount of loss and within scope of appraisal provision regardless of whether loss had already been mitigated and “invoiced,” or was to be repaired in future and “estimated” — Appraisal provision is not ambiguous — Waiver — Insurer’s right to appraisal was not waived by filing lawsuit seeking appraisal as the filing of the lawsuit was obviously not inconsistent with the right of appraisal itself — Insurer did not waive right to appraisal by failing to comply with section 627.7015(2) where insurer advised policyholder of the right to participate in mediation program — Current version of section 627.7015(2) imposes no requirement that insurer notify an assignee — Appraisal provision is not unconscionable merely because, given the costs of appraisal, assignee would allegedly recover far less for its services than it could have reasonably anticipated when it entered into contract with insureds

27 Fla. L. Weekly Supp. 88a

Online Reference: FLWSUPP 2701ESCAInsurance — Attorney’s fees — Contingency risk multiplier of 1.5 awarded — Expert witness fees — Taxable costs — Case involving denial of insurance coverage based on alleged material misrepresentation in application for insurance

27 Fla. L. Weekly Supp. 758a

Online Reference: FLWSUPP 2708PEREInsurance — Personal injury protection — Coverage — Medical expenses — Condition precedent — Provision of claimant’s social security number to insurer — Where insurer did not make specific denial of complaint’s allegation that all conditions precedent had been met or file affirmative defense claiming failure to comply with condition precedent, trial court will not consider defense of failure to comply with condition precedent on motion for summary judgment — Non-cooperation — Claimants’ failure to provide their social security numbers to insurer did not violate cooperation clause of PIP policy where clause does not require provision of social security numbers — Speculative chance that insurer may be required to provide social security numbers to federal government if government seeks to recoup Medicare benefits paid on behalf of claimants does not support non-cooperation defense where there is no basis to assume that claimants are Medicare-eligible, and federal law does not require claimants to provide or even have social security numbers