2008

33 Fla. L. Weekly D1846b

Insurance — Personal injury protection — Untimely bills — Decision of circuit court appellate division, concluding that insurer waived right to assert that medical bills submitted for payment by medical provider were untimely, amounted to violation of clearly established principle of law resulting in miscarriage of justice — Insurer has no obligation to pay late-filed bills — Neither submitting of untimely bills along with timely bills to an independent medical examiner for determination of medical necessity, nor failing to check “late billing” as reason for denying payment of untimely bills on explanation of benefits form, constitutes waiver

33 Fla. L. Weekly D1746a
990 So. 2d 3

Insurance — Personal injury protection — PIP insurer is not required to set aside a reserve fund for claims that are reduced or denied when other valid health care provider claims continue to be submitted — In absence of a showing of bad faith, PIP insurer is not liable for benefits once benefits have been exhausted — Where insurer denied health care provider’s claim based on results of independent peer review, health care provider mailed insurer a 15-day demand letter demanding that its bills be paid and requesting that insurer hold monies in trust until disputed amount is settled, but insurer continued paying or denying claims from health care providers as they were submitted until insurance benefits had been exhausted, circuit court acting in its appellate capacity departed from essential requirements of law in finding that insurer violated health care provider’s right to priority payment and therefore may be liable for claim plus statutory interest and penalties

33 Fla. L. Weekly D2543a

Insurance — Personal injury protection — Breach by insurer — Failure to pay benefits — Summary judgment properly granted in favor of insurer on claim that insurer failed to pay personal injury protection benefits mandated by Florida’s PIP statute and the automobile insurance policy when insurer paid $8,000 of basic PIP benefits and $2,000 of additional PIP benefits, where unambiguous terms of policy did not provide for payment of any more than $10,000 of PIP or APIP payments, and insurer paid that amount

33 Fla. L. Weekly D1819b

Administrative law — Office of Insurance Regulation — Appeal of final order dismissing with prejudice insurance company’s amended petition seeking formal administrative hearing of agency’s requirement that company cease selling its long-term care insurance policies because of company’s failure to submit annual rate certification filing — OIR abused its discretion in not granting company leave to amend its amended petition where it was not apparent from face of amended petition that pleading defects could not be cured — Fact that company submitted its rate filing untimely does not constitute defect in petition — Moreover, amended petition raised new issues which arose after the filing of the original petition, and company has represented that it can allege specific disputed facts to support an amended petition for a formal hearing

33 Fla. L. Weekly D1947a

Torts — Negligence — Dismissal — Nonjoinder of insurers — Trial court erred in dismissing negligence complaint against insurer based on section 627.4136, Florida Statutes, ruling that insurer was not a first-party insurer, where language in unauthenticated document that formed basis for trial court’s dismissal contained language that could be construed as directly indemnifying plaintiff for any losses sustained

33 Fla. L. Weekly D1343b

Insurance — Homeowners — Valued Policy Law — Total loss resulting from covered and excluded perils

33 Fla. L. Weekly S224a

Insurance — Homeowners — Valued Policy Law — Total loss resulting from covered and excluded perils

33 Fla. L. Weekly S223b

Insurance — Homeowners — Valued Policy Law — Total loss resulting from covered and excluded perils

33 Fla. L. Weekly S223a

Insurance — Homeowners — Valued Policy Law — Total loss resulting from covered and excluded perils

33 Fla. L. Weekly D2852a
2 So. 3d 360

Torts — Insurance — Subrogation — Where homeowners policy provided for right of subrogation, insurer paid insured for fire loss to home, and insurer assigned its right of subrogation to insured, insured could properly maintain action against manufacturer of defective surge protector which allegedly caused fire