2003

28 Fla. L. Weekly D1464a

Insurance — Personal injury protection — Claimant who was injured in a collision when operating a vehicle rented by the insured while the insured’s car was being repaired was not entitled to benefits under the insured’s PIP policy — Claimant was not an “injured person” as defined in PIP section definitions because she was not riding in an “insured motor vehicle” as that phrase was specifically defined in PIP section of policy — PIP section of policy clearly defined “insured motor vehicle” to mean a motor vehicle owned by the insured — Where definition of insured vehicle in PIP section of policy was unambiguous, trial court erred in borrowing definitions of “insured auto” from liability and uninsured motorist sections of policy, which defined that term to include a substitute auto being temporarily used while an insured auto was being serviced or repaired

28 Fla. L. Weekly D484a

Insurance — Personal injury protection — Circuit court acting in appellate capacity applied wrong law in affirming decision of county court, which entered summary judgment in favor of insurer based on conclusion that insurer had no duty to act on insured’s claims for medical bills within thirty days because insurer raised a coverage issue — Certain claim which was not paid by insurer within thirty days was mature, and insured was entitled to seek judicial determination of his rights — There was no arguable breach of contract by insured that appellate court can identify that would excuse payment of this claim and statutory penalties if coverage is established — Circuit court and county court were wrong in concluding that insured’s subsequent refusals to attend examinations under oath, as required by policy, justified insurer’s refusal to pay earlier claims which were more than thirty days old — With regard to insured’s refusal to attend examination under oath, which county court found to be material breach of policy, this would bar recovery for any claim that was not thirty days old when policy was breached

28 Fla. L. Weekly D796a

Insurance — Personal injury protection — Action against insurer by insured after insurer had suspended benefits — Appellate division of circuit court departed from essential requirements of law in affirming county court’s directed verdict for insurer on ground that insured was required to prove, as part of his prima facie case, that his medical providers were licensed to perform the services that they rendered — Fact that a provider is not licensed is more appropriately raised as an affirmative defense by the insurer

28 Fla. L. Weekly D1661a

Insurance — Personal injury protection — Insured’s assignment of PIP benefits to a third party who is not a medical provider is not prohibited by statute — Corporation that is not a physician, hospital, clinic or other person or institution lawfully rendering treatment to an insured person for bodily injury covered by personal injury protection benefits is entitled to recover PIP benefits services provided by a healthcare provider pursuant to a valid assignment of benefits from the insured — Possible conflict noted — Insured’s assignment of PIP benefits to a billing company is not contrary to public policy

28 Fla. L. Weekly S57a

Insurance — Personal injury protection

28 Fla. L. Weekly D935a

Administrative law — Nursing homes — Medicaid reimbursement — Interim rate increase — Agency for Health Care Administration erred in rejecting hearing officer’s findings and conclusions and in denying nursing homes’ request for interim rate increase due to increase in liability insurance premiums — Because Federal Medicare Program’s Health Insurance Manual (HIM-15) makes it clear that a prudent Medicaid provider is expected to carry liability insurance or to self insure, AHCA erred in denying request for interim rate increase on ground that there was no specific requirement in Florida Title XIX Long-Term Care Reimbursement Plan or in state or federal law requiring that liability insurance be carried by a nursing home — AHCA erred in rejecting as erroneous the ALJ’s conclusion that the requirements of HIM-15 are Medicaid standards — Because competent substantial evidence demonstrated that nursing homes were effectively required, under the HIM-15 guidelines, to maintain liability insurance, ALJ’s determination that the preponderance of the evidence proved that an unanticipated large increase in liability insurance premiums justified the approval of interim rate increase was proper and should not have been rejected by agency

28 Fla. L. Weekly D1042d

Insurance — Liability — Coverage — Insured’s failure to secure workers’ compensation coverage was not an “occurrence” under liability policy

28 Fla. L. Weekly D2220a

Insurance — Liability — Coverage — Where policy limited coverage to “bodily injury arising out of the ownership, maintenance or use of the premises shown in the schedule and operations necessary or incidental to those premises,” there was no coverage for a shooting death by a member of the crowd at a street rally sponsored by the insured a mile away from the insured’s insured premises — In concluding that there was coverage under the policy on the basis of a finding that the event at which the shooting occurred was an operation necessary or incidental to the business of the insured, the trial court erroneously substituted “business” for the policy word “premises”

NOT FINAL VERSION OF OPINION
Subsequent Changes at 29 Fla. L. Weekly D388b

28 Fla. L. Weekly D1059a

Torts — Automobile accident — Action by plaintiff individually and on behalf of his minor son arising out of accident in which vehicle owned and occupied by plaintiff’s former wife, who was at time two months pregnant with son, was struck, causing serious injury to former wife and unborn child — Insurance — Plaintiff was not entitled to uninsured motorist coverage under insurance policy that covered a vehicle which was owned by plaintiff but sold two weeks prior to accident — Plaintiff did not maintain an insurable interest for 30 days after sale of his car because he did not meet conditions necessary to trigger policy’s 30-day grace period, which were that he become owner of another car within policy period and request coverage, in writing, within 30 days of date of ownership — Because insurable interest expired when plaintiff sold car, and plaintiff did not create new insurable interest by acquiring new vehicle and requesting coverage within 30 days, plaintiff had no insurable interest in policy at time of accident, and trial court should have granted insurer’s motion for summary judgment — Damages — Loss of parental consortium — Unborn, non-viable fetus can be considered an “unmarried dependent” for purposes of statute permitting recovery of damages for loss of parent’s services, comfort, companionship, and society, although court notes that fetus does not have this claim until after it is born alive — Damages for loss of filial consortium are limited to period of child’s minority by common law, and award of these damages must be remitted to reflect this — Damages recoverable by child for loss of parental consortium are not limited to period of child’s minority

28 Fla. L. Weekly D287c

Insurance — Insolvent insurers — Uniform Insurers Liquidation Act — Where Florida action against insurer for declaratory relief and breach of contract had been stayed indefinitely by foreign state court in delinquency proceeding finding insurer to be insolvent, Florida court departed from essential requirements of law in lifting stay after it had been in effect for six months