Volume 27

27 Fla. L. Weekly Supp. 972a

Online Reference: FLWSUPP 2711POLLInsurance — 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 — Pursuant to terms of policy and section 627.736(5)(a) 1-3, insurer is permitted to utilize Medicare Multiple Procedure Payment Reduction to calculate reimbursement amounts so long as application does not result in utilization limit

27 Fla. L. Weekly Supp. 755a

Online Reference: FLWSUPP 2708ADAVInsurance — Personal injury protection — Coverage — Medical expenses — Multiple Procedure Payment Reduction — PIP statute establishes that allowable amount under 2007 Medicare fee schedule must be used to calculate reimbursement when it is higher than allowable amount under applicable year’s Medicare fee schedule, but statute also permits that allowable amount to then be reduced by application of Medicare’s MPPR

nline Reference: FLWSUPP 2701SIMMInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Trial court erred in concluding that insurer that improperly utilized statutory fee schedule which was not elected in policy when reimbursing PIP claim was precluded from litigating reasonableness of charges — Further, trial court abused its discretion by granting summary judgment in favor of medical provider with relevant discovery pending

27 Fla. L. Weekly Supp. 433a

Online Reference: FLWSUPP 2705BELLInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Trial court did not err in applying Daubert standard to determine whether affidavit filed by insurer in opposition to summary judgment is admissible as expert testimony — Insurer’s affidavit regarding reasonableness of charges complied with section 627.736(5)(a) and rule 1.510(e) and was not conclusory — Trial court erred in entering summary judgment in favor of medical provider

27 Fla. L. Weekly Supp. 934a

Online Reference: FLWSUPP 2711MUNOInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Trial court erred in rejecting affidavit of insurer filed in opposition to medical provider’s motion for summary judgment on issue of reasonableness of charges on basis that affidavit referred to Medicare and workers’ compensation fee schedules and HMO and PPO rates — Affidavit that was not conclusory, indicated source of affiant’s knowledge, contained evidence pertinent to statutory reasonableness factors, and was supported by exhibits was legally sufficient — Motion for summary judgment should have been denied

27 Fla. L. Weekly Supp. 7a

Online Reference: FLWSUPP 2701BARRInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Error to enter summary judgment in favor of medical provider on issue of reasonableness of MRI charge where opposing affidavit filed by insurer created disputed issue of material fact — Trial court erred in rejecting opinion of insurer’s expert on basis that he referenced Medicare fee schedules in his affidavit when fee schedule method of reimbursement was not elected in policy

27 Fla. L. Weekly Supp. 677a

Online Reference: FLWSUPP 2708PAGAInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Trial court improperly rejected affidavit of insurer’s adjuster for referring to Medicare fee schedules and negotiated contract rates — Medicare and other fee schedules and negotiated contract rates are relevant to consideration of reasonableness of charges submitted for PIP benefits — Affidavit that complied with requirements of rule 1.510(e) and was not conclusory was legally sufficient — Reversed and remanded for further proceedings

27 Fla. L. Weekly Supp. 348a

Online Reference: FLWSUPP 2704TULIInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Trial court did not err in finding that affidavit of medical provider’s owner met summary judgment burden on issue of reasonableness of MRI charge — Trial court abused discretion by rejecting affidavit of insurer’s expert where affiant explained how his experience led to his opinion on reasonableness of charge, why his experience provided sufficient basis for his opinion and how his experience is reliably applied to facts — Error to enter summary judgment in favor of provider on reasonableness issue

27 Fla. L. Weekly Supp. 15a

Online Reference: FLWSUPP 2701ANGUInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Trial court did not abuse discretion in striking opposing affidavit of insurer’s expert and did not err in entering summary judgment in favor of medical provider on issue of reasonableness of charges where affidavit of insurer’s expert sets forth no specific elements that he considered in determining whether charges were reasonable and did not provide opinion on reasonableness of provider’s charges, and affidavit of claims adjuster impermissibly offered opinion testimony from lay witness

27 Fla. L. Weekly Supp. 208a

Online Reference: FLWSUPP 2702LEONInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of charges where affidavit is based on affiant’s opinion that 200% of Medicare fee schedule is per se reasonable, not whether provider’s charges are reasonable, and opinion is not based on sufficient facts or data and is not demonstrated to be product of reliable principles and methods — Medicare fee schedule should not be used to determine reasonableness of charges where insurer has not elected use of fee schedules in policy