Volume 28

28 Fla. L. Weekly Supp. 375a

Online Reference: FLWSUPP 2805MGONInsurance — Personal injury protection — Coverage — Medical expenses — Accord and satisfaction — Reasonableness of charges — Trial court correctly rejected insurer’s accord and satisfaction defense, ruling that insurer’s partial payment did not meet the elements of accord and satisfaction under either common law or the Uniform Commercial Code — Trial court abused its discretion by excluding insurer’s conflicting affidavit on whether medical bills at issue were reasonable in price — Taking excluded affidavit into account, it was error to grant summary judgment on issue of reasonableness

28 Fla. L. Weekly Supp. 465a

Online Reference: FLWSUPP 2806VDELInsurance — Personal injury protection — Summary judgment — Error to reject affidavit of expert on reasonableness of charges and relatedness and medical necessity of treatment

28 Fla. L. Weekly Supp. 465b

Online Reference: FLWSUPP 2806GHENInsurance — Personal injury protection — Summary judgment — Error to reject affidavit of expert on reasonableness of charges

28 Fla. L. Weekly Supp. 299a

Online Reference: FLWSUPP 2804BERMInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Expert testimony — Where Frye standard was the law when insurer filed its initial brief arguing that trial court erred in discrediting its expert’s affidavit, and Daubert standard was the law when medical provider’s answer brief was filed, insurer did not waive right to argue that court erred in discounting affidavit under Daubert standard — Abuse of discretion to exclude expert’s affidavit on ground that her testimony is based on hearsay where expert relied on own extensive experience and did not become conduit for hearsay — Trial court further abused its discretion by rejecting affidavit within summary judgment order without Daubert motion or hearing on affidavit’s admissibility that would have afforded insurer the opportunity to amend affidavit

28 Fla. L. Weekly Supp. 433b

Online Reference: FLWSUPP 2806EVANInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — Policy clearly and unambiguously elected to limit reimbursement payments to the schedule of maximum payments by stating that “we will limit reimbursement to, and pay no more than, 80 percent of … schedule of maximum charges” — No merit to medical provider’s contention that insurer must elect either the reasonable charge method of calculation or the schedule of maximum charges method of calculation and that, because its policy includes both, insurer relied on an unlawful hybrid method of reimbursement calculation — Trial court erred in entering summary judgment in favor of provider

28 Fla. L. Weekly Supp. 435a

Online Reference: FLWSUPP 2806VOSInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — “Clear and unambiguous election” standard set by Virtual Imaging was superceded by 2012 amendment to PIP statute — In order to utilize statutory fee schedules, insurer was required only to give notice that it may limit reimbursement based on fee schedules — Policy at issue gave legally sufficient notice that it may limit reimbursements based on applicable Medicare fee schedules

28 Fla. L. Weekly Supp. 165a

Online Reference: FLWSUPP 2802GOODInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Use of workers’ compensation fee schedule to cap payment — Motion for summary judgment on plaintiff’s claim of underpayment denied — Question certified: When a PIP insurer has elected the Medicare fee schedule limitation permitted by Florida Statute §627.736(5)(a)1, which provides that the insurer may limit reimbursement to “200 percent of the allowable amount under [t]he participating physicians fee schedule of Medicare Part B,” and the “allowable amount” under the fee schedule is not specified in a general amount but instead must be determined on an individualized basis, is the PIP insurer entitled to limit the reimbursement to 80 percent of the workers’ compensation fee schedule?

28 Fla. L. Weekly Supp. 477a

Online Reference: FLWSUPP 2806CHARInsurance — Personal injury protection — Coverage — PIP policy that is silent as to whether policy benefits are stackable is ambiguous and must be construed in favor of coverage and against insurer — Trial court erred in relying on extrinsic evidence of PIP statute to give meaning to policy terms and conclude that policy is not ambiguous

28 Fla. L. Weekly Supp. 520a

Online Reference: FLWSUPP 2806HUGHInsurance — Personal injury protection — Demand letter — Letter reflecting an amount claimed to be due that exceeded $2500 policy limits applicable where an insured has not been determined to have emergency medical condition was not invalid

28 Fla. L. Weekly Supp. 418a

Online Reference: FLWSUPP 2805DRAGInsurance — Personal injury protection — Demand letter that did not account for application of fee schedules elected in policy and included services for which payment was not yet due is invalid — Case abated to allow medical provider to submit compliant demand letter