Volume 7

7 Fla. L. Weekly Supp. 292a

Insurance — Personal injury protection — When insurer fails to pay expenses of insured’s treating physicians within 30 days of their submission and without reasonable proof establishing that insurer is not responsible for payment, insurer is not precluded from disputing propriety of charges — Insured’s motion for partial summary judgment asserting that, by failing to timely pay expenses without adequate justification, insurer was precluded from contesting charges denied

7 Fla. L. Weekly Supp. 760a

Insurance — Personal injury protection — Insurer complied with statutory and contractual obligations when it timely paid medical provider eighty percent of charges for all reasonable and necessary medical services and agreed to defend and indemnify insured if provider pursued insured for any unpaid balance — Record showed that insured did not suffer damages from insurer’s reduction of payments to medical provider, and there was no evidence that insurer had breached its promise to defend and indemnify insured in the event provider attempted to collect unpaid balance — Insured not denied right to access to court in connection with breach of contract claims where insured did not suffer any damages, an essential element of a breach of contract claim — Insured cannot maintain cause of action for breach of contract for potential damages — Insurer’s company policy of not paying for unreasonable or unnecessary expenses and its provision to defend and indemnify insured if insured is sued for unpaid charges is not contrary to statutory or case law

Certiorari denied for failure to establish threshold requirements for certiorari relief at 27 Fla. L. Weekly D88b
District Court opinion quashed at 28 Fla. L. Weekly S287a

7 Fla. L. Weekly Supp. 552a

Insurance — Personal injury protection — Insurer failed to present any evidence to refute reasonableness of medical bills of chiropractor and of neurologist and orthopedic surgeon to whom insured was referred by chiropractor — Plaintiff entitled to directed verdict as to each bill — Argument — Expressions of personal opinion as to credibility of witness or personal knowledge of facts is fundamentally improper — Defense counsel’s improper character attacks, expression of personal views and opinions which were not supported by evidence, and improper appeals to jury’s emotion, bias and prejudices had cumulative effect of denying plaintiff a fair trial — New trial required as to medical expenses not encompassed by plaintiff’s motion for directed verdict

7 Fla. L. Weekly Supp. 424b

Insurance — Personal injury protection — Release

7 Fla. L. Weekly Supp. 63a

Insurance — Personal injury protection — Insurer may not reduce bills submitted on behalf of insured on ground that treatment was not medically necessary unless it obtains reasonable proof that it does not owe benefits within thirty days of receipt of bills — Court disagrees with insured’s contention that section 627.736(7)(a), providing that insurer, before withdrawing payment of benefits, must obtain a report from a physician licensed under the same chapter as the treating physician, whose report states that treatment is not reasonable, necessary or related, should be interpreted to include reduction of bills by an insurance company — Question certified: Must an insurance company, who seeks to reduce bills for medical treatment, pursuant to Section 627.736(1)(a), first obtain a report from a physician licensed under the same licensing chapter as the treating physician stating that the bills for treatment are not reasonable, pursuant to Section 627.736(7)(a), Florida Statues?

7 Fla. L. Weekly Supp. 713a

Insurance — Personal injury protection — Error to enter summary judgment in favor of insurer on ground that insured unreasonably refused to attend two independent medical examinations — There was genuine issue of material fact regarding whether failure to attend IMEs amounted to unreasonable refusal given evidence that insurer sent notice of scheduled IMEs to insured’s counsel, but that insured had recently moved and could not be contacted by counsel

7 Fla. L. Weekly Supp. 654b

Insurance — Personal injury protection — Error to grant summary judgment in favor of insurer based upon insured’s failure to attend two scheduled independent medical examinations where genuine issues of material fact remain as to whether insured unreasonably refused to attend IMEs of which she claimed she had no notice

7 Fla. L. Weekly Supp. 596a

Insurance — Personal injury protection — Medical pay benefits — Error to enter summary judgment in favor of insurer, which terminated coverage based on insured’s refusal during independent medical examination to answer questions posed physician, where there was factual issue concerning whether insured unreasonably refused to participate in IME

7 Fla. L. Weekly Supp. 438b

Insurance — Personal injury protection — Error to grant summary judgment in favor of insurer based on insured’s unreasonable refusal to submit to independent medical examination where record demonstrates existence of material facts in dispute regarding circumstances surrounding insured’s failure to attend IME

7 Fla. L. Weekly Supp. 151a

Insurance — Personal injury protection — Appeal from summary judgment for insurer holding that insured’s refusal to submit to independent medical examination unless insurer provided written assurances that insured’s right of privacy would be maintained by insurer was unreasonable based upon finding that insured does not have right of privacy regarding IME, pursuant to Section 455.667, Florida Statutes, and that, pursuant to Klipper v. Government Employees Ins. Co., insured did not have right to set additional conditions for IME — Reversible error to rely on Klipper to determine that, because insured did not have right to set additional conditions on IME, insured’s refusal to submit to IME was unreasonable — Although county court relied upon Section 455.667, Florida Statutes (1997), instead of Section 455.241, Florida Statutes, (1996), which was in effect at time PIP contract was executed, error harmless because relevant provision regarding confidentiality of patient records when examination is procured by third party are identical — Where insured gave insurer written authorization to obtain her medical records when she submitted her PIP application, but did not give authorization to obtain or discuss her medical condition or records to independent vendor that arranged and scheduled IME on behalf of insurer, summary judgment was based upon improper application of law because neither statute nor terms of insured’s policy gave insurer right to allow independent vendor to obtain insured’s medical records — Because summary judgment was based upon improper application of law, summary judgment for insurer must be reversed