Volume 8

8 Fla. L. Weekly Supp. 169a

Insurance — Personal injury protection — Civil procedure — In ruling on motion to dismiss, trial court is confined to allegations found within four corners of complaint — Trial court erred in conducting evidentiary hearing and treating matter as motion for summary judgment

8 Fla. L. Weekly Supp. 571b

Insurance — Personal injury protection — Discovery — Insurer is ordered to produce certain documents, photographs, and surveillance films and to respond to interrogatories

8 Fla. L. Weekly Supp. 350a

Insurance — Personal injury protection — Trial court correctly held that insured had standing to sue insurer for failure to timely pay medical bills submitted by health care provider for treatment of injuries sustained in covered accident where there was no evidence of assignment of medical benefits to health care provider, and insured had not even signed claim form through which assignment was allegedly made — Where insurance policy allows amendments to policy only by endorsement signed by an executive officer or by revision to policy form to give broader coverage without extra charge, trial court erred in concluding that letter sent to insured by insurer after accident, promising to indemnify insured if sued by his health care provider for unpaid bills, amounted to amendment to policy since letter was signed by claims representative, was addressed only to insured and did not amend policy form, and does not afford greater coverage — Insurer could not modify policy to remove insured’s standing to sue where insured’s right to PIP benefits resulting from covered accident had vested

8 Fla. L. Weekly Supp. 503b

Insurance — Personal injury protection — Insurer’s failure to investigate medical claims is not excused by fact that it did not have a medical authorization from claimant since insurer had alternative means of obtaining needed information through section 627.736(6)(b), Florida Statutes — Whether notice of claim is deemed the insurer’s receipt of Accord Automobile Loss Notice and health insurance claims forms or when insurer received at least six claims from or on behalf of claimant, it was sufficient as a matter of law — Notice having been given, thirty days having passed, there being no provision for tolling the 30-day period, payment not having been made nor denial of coverage having occurred within the 30 days, partial summary judgment is granted and affirmative defense that complaint is barred by failure to provide adequate and timely notice which prejudiced insurer is stricken

8 Fla. L. Weekly Supp. 608b

Insurance — Personal injury protection — Insurer was not required to have report authored by a physician in order to reduce payments to a medical provider — Remand for new trial

8 Fla. L. Weekly Supp. 411b

Insurance — Personal injury protection — No error in granting summary judgment in favor of insurer in action by insured for payment of PIP benefits for charges which insurer had denied as not reasonable or necessary where insurer had advised insured that it would defend and indemnify insured should any legal action be brought to recover the unpaid charges — Insurer complied with its contractual obligation when it denied payment of benefits it deemed unreasonable or unnecessary — Record contained no evidence of damage to insured, who has not been pursued for unpaid charges or suffered related adverse consequences, and there was no evidence that insurer has breached promise to defend and indemnify insured

8 Fla. L. Weekly Supp. 398a

Insurance — Personal injury protection — Summary judgment motion based on medical provider’s lack of standing to bring action for PIP benefits granted where insured executed document purporting to be assignment of benefits to medical provider and on same date executed another document stating that his benefits were not being assigned to medical provider — Legal effect of two documents was that documents canceled each other out making both a nullity — Insurer not entitled to summary judgment on ground that charges for performing an MRI were not medically necessary as matter of law and therefore no benefits are payable where affidavit of treating doctor stating that, based upon his care and treatment of insured, MRI was reasonable and necessary created genuine issues of material fact as to necessity of MRI

8 Fla. L. Weekly Supp. 160a

Insurance — Personal injury protection — Action against insurer by plaintiffs who, while rollerblading, were struck by a vehicle operated by insured — Assignments given by plaintiffs to medical provider did not deprive plaintiffs of right to sue insurer where plaintiffs remained liable to provider for any amounts not covered by the assignments, any amounts insurer might refuse to pay, and attorney’s fees and costs — Where plaintiff stated in her application for benefits that vehicle owned by her was inoperable and swore in her interrogatory answers that car was “not operable and not insured,” fact that insurer learned that car was registered in the two years preceding the accident, although with an expired decal on it, did not rise to level of reasonable proof that plaintiff was not entitled to PIP benefits — With regard to second plaintiff, there was no factual basis to believe that she was related to first plaintiff — On remand, court to enter judgment in favor of plaintiffs upon proper motion

8 Fla. L. Weekly Supp. 505a

Insurance — Personal injury protection — Weight training through personal trainer was necessary palliative treatment for claimant who suffered permanent nerve damage as a result of a motor vehicle accident — No merit to argument that a service must lead to a cure to be compensable under No-Fault Act — Palliative care is available under No-Fault Act upon a showing of permanency — Evidence — Expert testimony is not needed to establish the reasonableness of charges and necessity of medical treatment — Necessity is determined from the claimant’s perspective

Additional ruling in this case at 8 Fla. L. Weekly Supp. 649c

8 Fla. L. Weekly Supp. 868a

Insurance — Personal injury protection — Dispute between medical provider and insurer — Notice of initiation of treatment creates an additional thirty days for medical provider to submit bills to insurer for initial examination and treatment only, not all bills for services rendered