Volume 8

8 Fla. L. Weekly Supp. 245b

Insurance — Personal injury protection — Complaint for PIP benefits and declaratory relief based on medical treatment provided by medical provider to insured for injuries sustained in automobile related accident — Section 627.736(5)(b) which requires medical providers to submit to insurer the bill for medical treatment rendered to insured within 30 days of providing treatment, is constitutional as written and as applied — Access to courts — Regarding argument that statute violates medical providers’ access to courts, provider has complete access to the court to recover from insured and/or insurer, assuming provider complies with notice requirements of statute — Pursuant to (5)(b), no one is denied access to court; instead, access is merely regulated by billing requirements of that section — Due process — As to due process argument that statute makes unreasonable and arbitrary distinction for emergency service providers by not requiring these providers to bill insurer within 30 days of providing services, distinction between emergency service providers and other medical service providers bears reasonable relationship to legislative concerns of stopping practice of “bulk billing” by providers and making insurer aware of commencement of treatment — Impairment on contracts — Freedom to contract is not totally denied since only medical provider’s failure to comply with notice requirements of statute will excuse payment of services rendered by medical provider

8 Fla. L. Weekly Supp. 262a

Insurance — Personal injury protection — Preferred provider rates — Section 627.736(a) provides exclusive means by which an insurance company can pay preferred provider rates on Florida personal injury protection automobile coverage — An insurance company cannot, by artifice of erecting a buffer or middleman avoid the mandate of statute — Full PIP benefits of 80% of reasonable and necessary medical expenses must be paid by insurer if insurer does not comply with all requirements of statute

8 Fla. L. Weekly Supp. 246b

Insurance — Personal injury protection — Medical bills — Reduction — Insurer had no privity of contract and no standing to reduce medical bills submitted by medical provider for treatment of insured, pursuant to contract in which insurer was not a party or “Third Party Payor” as defined by contract — Insurer could not reduce plaintiff’s medical bills as it did not have a preferred provider policy as required by statute — Section 627.736(10) allows a specific method for insurers to take Preferred Provider reductions, and insurer’s failure to follow this methodology prohibits the taking of preferred provider reductions

8 Fla. L. Weekly Supp. 735c

Insurance — Personal injury protection — Plaintiff is not entitled to recover PIP benefits for MRI provided to insured, where plaintiff does not perform necessary medical services and is not a “physician, hospital, clinic, or other person or institution lawfully rendering treatment to an injured person for a bodily injury covered by PIP insurance”

8 Fla. L. Weekly Supp. 250a

Insurance — Personal injury protection — Coverage — Denial — Reasonable and necessary expenses — Medical provider/assignee is entitled to be paid for medical bill submitted to insurer prior to exhaustion of benefits under policy if the charges were reasonable and necessary, even though all benefits under the policy were subsequently exhausted — Insurer may seek to recover against medical provider that insurer wrongfully paid

8 Fla. L. Weekly Supp. 229b

Insurance — Personal injury protection — Action against insurer by assignee of PIP benefits, claiming that insurer, who made payments on subsequently submitted bills until limits of PIP coverage had been exhausted, failed to timely pay assignee’s claim — Summary judgment improper where material issues of fact remain as to whether assignee was notified of reason for denial, whether insurer had reasonable proof of its nonresponsibility for bill, and whether the way assignee’s bill was handled is standard operating procedure used by insurer and insurance industry

8 Fla. L. Weekly Supp. 209b

Insurance — Personal injury protection — Coverage — Unreasonable charge — Reasonable proof — Insured entitled to summary judgment on claim for benefits where there remains no disputed material facts as to whether insurer had reasonable proof that amounts charged by health care provider were unreasonable, and insurer failed to obtain physician’s report required by statute, which is condition precedent to refusing payment of treating physician — Insurer, as matter of law, did not have reasonable proof that charges submitted by health care provider for medical products he dispensed to insured were unreasonable — Excess of policy limits — Insurer not entitled to summary judgment on ground that insured cannot recover because policy limits available to insured had been exhausted — Insured is an aggrieved party who is capable of receiving benefits as awarded by court for outstanding interest on payments owed on bills of health care provider which were not paid prior to benefits being exhausted — Insurer entitled to partial summary judgment regarding its liability for medical benefits in excess of policy limits — Interest — Insured entitled to 10% interest on overdue amount owed to health care provider from date insurer received bill until date benefits were exhausted

8 Fla. L. Weekly Supp. 143b

Insurance — Personal injury protection — Insurer not precluded from challenging medical bills on grounds that they were not reasonable, related or necessary simply because it did not obtain reasonable proof to support a denial within thirty days of receipt — Where jury found that bills were not related to accident, trial court erred in denying insurer’s motion for judgment in accordance with verdict on ground that insurer did not obtain independent medical examination or other reasonable proof until after thirty-day period

8 Fla. L. Weekly Supp. 204a

Insurance — Personal injury protection — Sanctions — Motion for sanctions based on conduct of insured’s treating physician in withholding, concealing or disposing of relevant evidence that would go to possible defense that insured’s injuries and treatment were not related to accident in issue — Sanctions granted — Motion for sanctions based on conduct of insured’s counsel in denying requests for admissions and forcing insurer to file motions for partial summary judgment to eliminate issues, and in circumventing rules of civil procedure by engaging in ex parte discovery with insurer’s retained expert — Sanctions granted — A trial court has inherent authority to sanction destruction of evidence, even in absence of order determining that evidence must be preserved or produced in discovery — Courts have inherent power to assess attorney’s fees against counsel for litigating in bad faith

8 Fla. L. Weekly Supp. 203a

Insurance — Personal injury protection — Insured alleging insurer wrongfully failed to pay bills of medical provider in accordance with insurance policy and Florida No-fault Statute — Motion to strike medical provider as witness granted where medical provider engaged in pattern of withholding, concealing, or disposing of relevant evidence that would go to possible defense that insured’s injuries and treatment were not related to accident in issue — Medical provider should not be permitted to testify in support of claim that his bills were reasonable, necessary and related to subject accident — Insurer has been irreparably prejudiced by conduct of medical provider because insurer is essentially thwarted from investigating and developing defense that any necessity for insured’s treatment arose from prior medical conditions rather than subject accident