2001

26 Fla. L. Weekly D8c

Insurance — Personal injury protection — Insurer was not required to obtain report from physician licensed under same licensing chapter as treating physician stating that bill was not reasonable before reducing payment on certain bills based upon determination that bills exceeded reasonable and customary charge for same service in the geographic area — No error in denying insured’s motion for summary judgment on claim for balance of partially paid bills — Failure of insurer to obtain reasonable proof that it was not responsible for payment within thirty days of receipt of bill did not preclude insurer from contesting payment on ground that treatment was medically unnecessary — Error to grant summary judgment in favor of insured on claim for unpaid bill

26 Fla. L. Weekly D2408a

Insurance — Personal injury protection — Where insured’s physician submitted bills to insurer for treatment allegedly relating to injuries sustained in automobile accident, insurer did not pay or deny bills within thirty days, insurer sought an independent medical examination, and insurer discontinued payments based on IME, insurer was not precluded from contesting payment by its failure to obtain negative IME within thirty days of receipt of bills — Conflict certified — No error in circuit court’s reversal of trial court’s final judgment in favor of insured for the medical bills received by insurer thirty days or more prior to date of IME where jury found none of insured’s medical bills were related to injuries sustained as result of the automobile accident

26 Fla. L. Weekly D1658cNOT FINAL VERSION OF OPINION
Subsequent Changes at 26 Fla. L. Weekly D2408a

Insurance — Personal injury protection — Where insured’s physician submitted bills to insurer for treatment allegedly relating to injuries sustained in automobile accident, insurer did not pay or deny bills within thirty days, insurer sought an independent medical examination, and insurer discontinued payments based on IME, insurer was not precluded from contesting payment by its failure to obtain negative IME within thirty days of receipt of bills — No error in circuit court’s reversal of trial court’s final judgment in favor of insured for the medical bills received by insurer thirty days or more prior to date of IME where jury found none of insured’s medical bills were related to injuries sustained as result of the automobile accident

26 Fla. L. Weekly D1793a

Insurance — Personal injury protection — Medical payments — Circuit court acting in its appellate capacity applied incorrect law when it affirmed final judgment entered by county court in favor of insurer in action brought by insured for PIP and medpay benefits on ground that insured could not sue insurer without first paying medical provider — Insured who incurs reasonable and necessary medical expenses on account of an automobile accident sustains losses and incurs liability for PIP and medpay purposes, whether or not the medical bills have been paid — A right of action arises thirty days after notice to insurer that reasonable and necessary medical treatment against which it has insured has resulted in a debt — Circuit court directed to reverse county court’s summary judgment and remand to county court for further proceedings

26 Fla. L. Weekly D608a

Dissolution of marriage — Child support — Life insurance — Constructive trust — Where judgment of dissolution required father to maintain life insurance policy for benefit of child, father thereafter remarried, and upon father’s death estate contained only policy naming widow as beneficiary, trial court erred in granting summary judgment finding that widow was entitled to policy proceeds — Where mother showed that father failed to provide life insurance for child’s benefit as required by final judgment of dissolution, mother sufficiently showed either abuse of confidence or clear mistake to establish constructive trust — Trial court improperly determined that there was no basis to find that widow has been unjustly enriched — Requirement that father maintain life insurance policy for benefit of child was not invalid court-ordered insurance estate for child but, rather, established collateral for child support obligation — Constructive trust of life insurance proceeds did not depend on showing that widow against whom it would be imposed engaged in fraudulent conduct, undue influence, abuse of confidence, or mistake, but on showing of abuse of confidence or mistake by father — Reversed and remanded for reconsideration of equity of case in light of fact that child is receiving more in Social Security benefits than he had been receiving in child support

26 Fla. L. Weekly D2906aNOT FINAL VERSION OF OPINION
Subsequent Changes at 27 Fla. L. Weekly D467a

Administrative law — Department of Insurance properly suspended license to operate as a viatical settlement provider of company which failed to report to Division of Insurance Fraud that life insurance policies sold by viators had been fraudulently obtained by denying on insurance applications the existence of specific known and diagnosed medical conditions — Statute requiring that licensee report to Division of Insurance Fraud a fraudulent insurance act of which licensee has knowledge is not unconstitutionally vague

26 Fla. L. Weekly D2093d

Torts — Order adding insurance company as party defendant and judgment debtor to a judgment against school based upon finding in related insurance coverage declaratory judgment case that insurance company was school’s insurer at time of accident summarily reversed in view of fact that appellate court reversed the final judgment stemming from the declaratory action and remanded for entry of judgment in insurance company’s favor

26 Fla. L. Weekly D1237b

Insurance — Personal injury protection — Interest — Error to enter summary judgment in putative class action, finding that interest insurer was required to pay on overdue PIP benefits was to be calculated from date insurer received written notice of the fact of a covered loss and its amount — Statutory interest on overdue PIP payments accrues 30 days after insurance company receives written notice of claim

26 Fla. L. Weekly D664a

Insurance — Homeowners — Replacement cost — Liability of insurance company toward purchase of a home different from the home damaged or destroyed is limited to cost of repairing or replacing insured home

26 Fla. L. Weekly D2344a

Insurance — Homeowners — Coverage — Claim for injuries caused to pedestrian by insured’s son driving golf cart owned by third party on a sidewalk — Error to enter summary judgment in favor of insurer on coverage issue — Where it was not clear whether a golf cart qualified as a recreational vehicle under terms of policy, and provisions of liability section of policy provided coverage for injury and damage resulting from a golf cart while golfing and for operating a non-owned recreational motor vehicle created an ambiguity as to whether there was coverage for a golf cart when it was not being used for golfing, policy must be construed in favor of insured — Application of the dangerous instrumentality doctrine inapposite where the issue is narrowly one of interpreting the language in homeowners’ policy