Volume 7

7 Fla. L. Weekly Supp. 301a

Insurance — Personal injury protection — Error to grant summary judgment on action to collect medical bills after medical benefits under policy were exhausted, because claim for statutory damages, including attorney’s fees, was still available to insured — Although insured cannot recover any more benefits, she may be able to prove that at time suit was filed insurer was in violation of statute and therefore would be entitled to statutory damages, including attorney’s fees

7 Fla. L. Weekly Supp. 688a

Insurance — Personal injury protection — Insurer’s motion for summary judgment on claim for payment of MRIs performed on insured by agent of corporate person denied — Assertion that first sentence of Section 627.736(5) establishes standing requirement for presentation of valid PIP claims misapplies effect of words in that sentence — Nothing in Florida law requires licensure of corporate person to provide medical services through use of agent, nor is there any evidence in record that indicates that services performed by corporate person or its agent were unlawful or unlawfully rendered

7 Fla. L. Weekly Supp. 694a

Insurance — Personal injury protection — Role of insured’s treating physician in dispute between insured and insurer relating to bills submitted by treating physician was that of fact witness, not expert witness, and accordingly, treating physician is not entitled to payment of expert witness fee — Motion to compel deposition of treating physician without expert witness fee granted

7 Fla. L. Weekly Supp. 541a

Insurance — Personal injury protection — Insurer, who denied claim for medical expense pursuant to provision of insurance policy which permits insurer to decide unilaterally what treatment is reasonable and medically necessary and to deny payment, not entitled summary judgment on claim for payment of PIP benefits — Policy provision directly contravenes purpose of PIP statute to provide swift and virtually automatic payment of benefits and to discourage companies from contesting valid claims — Policy provision leaves insureds powerless to challenge insurer’s decision as to what medical care is medically necessary, exposing insureds to lawsuits, judgments and subsequent harmful credit consequences — Enforcing policy provision would create adversarial relationship between medical care providers and patients and inevitably will have chilling effect on willingness of medical providers to treat persons injured in motor vehicle accidents — Policy provision violates no-fault act as insurance companies cannot impose requirements that are more onerous than those specified in PIP statute — Argument that plaintiff will sustain no damages as result of wrongful non-payment fails because provision to indemnify insured by providing legal representation in lawsuits filed against them by medical care providers ignores harmful consequences to an insured’s credit history and financial future caused by mere filing of credit driven lawsuit — Notwithstanding insurer’s payment of any judgment obtained by medical care provider, insured’s credit history will reflect untimely payment and subsequent judgment — Court rejects argument that insurer’s promise to defend insured should his medical care provider sue him for non-payment is sufficient as matter of law to establish insured cannot be damaged and therefore has no cause of action

7 Fla. L. Weekly Supp. 613a

Insurance — Personal injury protection — Insurer refusing to pay medical bill based on determination that charges were not reasonable, necessary and related to subject accident — Only way an insurer may legally make unilateral decision as to whether medical expense is reasonable, necessary or related is for it to provide indemnification for medical expenses up to policy limits, and /or provide unqualified defense to insured if sued, even if such defense exceeds policy limits — Defense promised by defendant is anything but unqualified where contract provision purports to protect insured from any claim or law suit filed by medical provider, but explanation of that protection indicates that such protection is subject to limits of insured’s coverage — Further, there is no insurance regulation providing protection for insured and no evidence that insurer secured releases from medical providers

7 Fla. L. Weekly Supp. 542b

Insurance — Insurer’s motion for summary judgment granted as to health care provider who submitted $1,500 bill for services which were performed in his office by third party without his supervision, direction or control and for which third party billed provider $100

7 Fla. L. Weekly Supp. 466a

Insurance — Personal injury protection — PIP insurer is not prevented from defending claim for benefits on merits because it obtained written report from a reviewing physician 40 days after receiving notice of medical provider’s claim, rather than 30 days after — 30-day provision in Section 627.736(4) determines when interest accrues, not when an insurer loses any right to deny payment for unnecessary and unrelated testing — Medical provider’s motions for summary judgment denied — PIP insurer entitled to attorney’s fees and costs

7 Fla. L. Weekly Supp. 414a

Insurance — Personal injury protection — Insurer is precluded from defending claim for PIP benefits on basis that medical bill in question was not reasonable, related or medically necessary because insurer failed to obtain, within 30 days after receipt of application for benefits, medical report providing reasonable proof that insurer is not responsible for payment — There is no issue to be tried on reasonableness and necessity of medical bill at issue — Insured entitled to partial summary judgment

7 Fla. L. Weekly Supp. 389a

Insurance — Personal injury protection — No error in awarding insured’s medical provider the balance of a bill after finding that insurer did not obtain physician’s report, as required by statute, prior to reducing payment to medical provider — When basis for nonpayment to medical provider is that treatment was not reasonable, related or necessary, physician’s report is required prior to insurer reducing, withdrawing, or denying benefits — There is no practical difference between reducing rather than withdrawing or denying benefits

7 Fla. L. Weekly Supp. 324b

Insurance — Personal injury protection — PIP insurer refusing to pay insured’s medical bills on ground that medical treatment was not related, reasonable, or necessary must obtain reasonable proof that it is not responsible within thirty days of receiving written notice of the fact of a covered loss and the amount of the loss — Issue of reasonableness of insured’s medical bills should not have been presented to jury where insurer obtained report that bills were not reasonable or necessary more than thirty days after bills were submitted to insured’s adjuster