Volume 9

9 Fla. L. Weekly Supp. 51b

Insurance — Dispute between medical provider and insurer — Standing — Assignment — Document is insufficient to constitute valid assignment, but instead is a direction to pay — Motion for summary judgment granted

9 Fla. L. Weekly Supp. 250b

Insurance — Personal injury protection — Medical bills — Where medical bills are not countersigned by insured, insurer may not pay the assignee medical provider directly — Insurer cannot in good faith pay insured who has assigned claim — Where medical provider failed to follow guidelines of HCFA form 1500 which require patient’s signature in addition to that of physician or medical supplier, insurer has not been provided with notice of a covered loss and has not breached its duties under statutes and policy — Form reflecting words “Signature on file” does not attest to treatment rendered — Line of HCFA form which authorizes insurer to issue payment to medical provider does not comply with statutory requirement that insured attest that medical charges have actually been rendered to best knowledge of insured — Even if medical provider were now to resubmit HCFA form countersigned, medical provider would be barred from recovery because both 30-day and 60-day periods for claims will have expired — Insurer’s motion for summary judgment granted

9 Fla. L. Weekly Supp. 553b

Insurance — Personal injury protection — Standing — Assignment — Where both insured and medical provider affirm that “Direct Payment Authorization Without Assignment of Benefits” was not an assignment of benefits, and insurer has not shown that arrangement is illegal, contrary to public policy or prohibited by insurer’s contract with insured, document is not assignment — Insurer’s motion for summary judgment denied

9 Fla. L. Weekly Supp. 707a

Insurance — Personal injury protection — Standing — Assignment — Where document directs payment to medical provider and states that it is a direct assignment of insured’s rights and benefits under policy, there remains a question of fact regarding intent of insured and medical provider which makes insurer’s motion for summary judgment premature

9 Fla. L. Weekly Supp. 748a

Insurance — Personal injury protection — Standing — Assignment — Absence of formal assignment — Equitable assignment — Provider does not have standing to sue under theory of equitable assignment based solely on HCFA forms allowing direct payment to health care provider by insurer

9 Fla. L. Weekly Supp. 92b

Insurance — Dispute between medical provider and insurer — Standing — Assignment — Error to enter summary judgment in favor of insurer where both language of alleged assignment and insured’s deposition testimony are ambiguous, such that a genuine issue of material fact remains as to what insured intended to transfer — Medical provider’s motion for attorney’s fees pursuant to section 627.428 is denied since provider has not yet been determined to be insured’s assignee

9 Fla. L. Weekly Supp. 127a

Insurance — Dispute between medical provider and insurer — Motion for summary judgment denied where insurer failed to plead affirmative defenses covering grounds for motion — Insured who executed assignment of benefits had no standing to settle benefits owed by insurer to provider

9 Fla. L. Weekly Supp. 362a

Torts — Insurance — Jury instructions — No error in not giving concurrent cause instruction where plaintiff did not plead or prove that pre-existing condition of his dental bridge led to damages he suffered but, rather, maintained that his bridge was in good condition prior to the accident — It was within purview of trial court to determine whether insurer’s violation of pre-trial order by making comments concerning settlement offers warranted a mistrial — Trial court correctly denied request for directed verdict where there were issues of fact for the jury to consider due to conflicting testimony

9 Fla. L. Weekly Supp. 535a

Insurance — Windstorm — Rates — Arbitration — Constitutionality — Delegation of insurance rate determinations to arbitration panels is not unconstitutional — Separation of powers — Where arbitrators are not members of judicial or executive branches, their activities do not constitute an encroachment on legislative powers by another branch — Due process — Challenged statutes do not deprive plaintiffs of due process of law where the procedures for premium rate determinations, including provision for arbitration as an alternative to Chapter 120 proceedings, are rationally related to assisting the economic viability of property insurers, and plaintiffs have not shown that they have a constitutionally protected right which overrides compelling state interest in maintaining viable and orderly private sector market for property insurance in state — No merit to claim that statute provides statutory due process by requiring a hearing if a rate filing based on computer data exceeds 25% where Florida Windstorm Underwriting Association held hearings during development of the filing, meetings of the actuarial committee were publicly noticed, and arbitration hearing was open to public — Fact that Association’s plan of operation provides that association’s rates shall be those approved by the Department of Insurance does not render statute providing for arbitration invalid where section 627.062(6)(a) states that department and insurer must treat arbitrator’s decision as final and, therefore, arbitration resulted in department approval as matter of law — Summary judgment granted in favor of defendants

9 Fla. L. Weekly Supp. 217a

Insurance — Personal injury protection — Arbitration — Attorney’s fees — Appeals — Issue of whether a medical provider as the PIP insured’s assignee may receive attorney’s fees when the insurer pays the full amount of the outstanding bill after receiving a demand for arbitration but before suit is filed involves pure legal determination of entitlement to fees that is subject to de novo standard of review — Error to award attorney’s fees to medical providers where demands for arbitration were made after section 627.736(5) was declared unconstitutional by Fifth District Court of Appeal, and insurer paid full amount of claim plus interest before suit was filed — Appellate fees awarded to insurer as prevailing party