2009

34 Fla. L. Weekly D1516a
16 So. 3d 897

Insurance — Personal injury protection — Circuit court appellate division departed from essential requirements of law in holding that a medical report, produced in accordance with section 627.736(7)(a), Florida Statutes, as a precondition to withdrawal of PIP benefits, must be based on a physical examination performed by a physician, other than the treating physician, who conducts an independent medical examination — Valid report for the withdrawal of PIP benefits may be based on a physical examination of the insured that is conducted by either the physician preparing the report or another physician’s examination — Physician preparing the report does not have to personally examine the insured

34 Fla. L. Weekly D2105a
22 So. 3d 632

Insurance — Personal injury protection — Summary judgment — Insurer was deprived of due process when county court entered summary judgment against insurer in insured’s action for breach of policy by failing to pay for medical treatment, without conducting hearing on motion for summary judgment — Circuit court appellate division departed from essential requirements of law in affirming summary judgment entered by county court without hearing

34 Fla. L. Weekly D2229c
21 So. 3d 119

Insurance — Personal injury protection — Standing to bring suit against insurer for non-payment of medical bills — Where insured had executed assignment of PIP benefits to non-existent entity under the name of which medical provider operated, and medical provider subsequently reassigned benefits to insured, insured had standing to bring suit for non-payment of medical bills — Circuit court properly found that purported assignment to non-existent entity was invalid, and the insured retained his right to claim benefits under policy

34 Fla. L. Weekly D978c
13 So. 3d 74

Jurisdiction — Amount in controversy — Insurance — Personal injury protection — Circuit court did not have jurisdiction over provider’s action against insurer for non-payment of personal injury protection benefits where amended complaint alleged it was seeking damages greater than $500, but less than $5000, and exhibits attached to amended complaint appeared to indicate the damages sought were less than $500 — County courts have exclusive jurisdiction over actions in law not exceeding $15,000 unless action is within exclusive jurisdiction of circuit court — Remand for transfer to county court

34 Fla. L. Weekly D2500a
26 So. 3d 21

Insurance — Personal injury protection — Defendant insurer’s claim that it was not required to pay medical provider’s bills because provider did not provide insurer with proper written notice of a covered loss where initial set of bills did not include a disclosure and acknowledgment form, and box 31 of CMS-1500 form did not contain physician’s license number — Where bills furnished to insurer contained physician’s name, bills were substantially complete, and provided proper notice to insurer — Even if physician’s license number were deemed a material provision of statements or bills, absence of license number was cured by later submission of number to insurer — Failure of medical provider to provide disclosure and acknowledgment form with initial set of bills was cured by submitting form prior to litigation — Circuit court appellate division did not depart from essential requirements of law in affirming county court’s entry of summary judgment for medical provider in action seeking unpaid benefits

34 Fla. L. Weekly D2189a
37 So. 3d 329

NOT FINAL VERSION OF OPINION
Subsequent Changes at 35 Fla. L. Weekly D1020a

37 So. 3d 329

WITHDRAWN 35 Fla. L. Weekly D1020a

Insurance — Personal injury protection — Provider’s action against insurer — Conditions precedent — Examination under oath clause in insurance policy was binding on an assignee of the No-Fault benefits and the cause of action to recover those benefits where clause stated that “any person or organization making claim or seeking payment . . . must, at our option, submit to an examination under oath, provide a statement under oath, or do both, as reasonably often as we require” — Trial court properly found that noncompliant assignee was prohibited from making a claim or seeking payment under the policy although the assignee had not specifically agreed to be bound by that condition — Nothing in section 627.736(6) suggests that insurers are prohibited from conducting EUO of a medical provider that is authorized by the policy, and nothing in statute provides that it is sole and exclusive means by which a No-Fault insurer may obtain pre-suit information requested in an EUO — Question certified whether the EUO provision in insurer’s policies is a condition precedent that must be complied with when a medical care provider takes an assignment of no-fault benefits and cause of action from the insured without specifically agreeing to be bound by that condition?

34 Fla. L. Weekly D2268a
21 So. 3d 124

Insurance — Personal injury protection — Explanation of benefits — Circuit court appellate division departed from essential requirements of law in affirming county court judgment finding that an insured has a private cause of action against a PIP insurer who fails to provide its insured an itemized specification of each item the insurer has reduced, omitted, or declined to pay within 30 days after the insurer is furnished written notice of the fact of a covered loss and the amount — There is neither a requirement nor a deadline for a PIP insurer to respond to a request for payment — A response is required from the insurer only when insurer either pays a portion of a claim or rejects a claim — Insured has no private right of action against insurer for insurer’s failure to provide an explanation of benefits to insured or insured’s assignee in timely manner — Appeals — Case falls within limited category of cases in which district court is authorized to exercise discretion to review a circuit court appellate division per curiam affirmance of county court order or judgment

34 Fla. L. Weekly D1819a
20 So. 3d 889

Insurance — Personal injury protection — It was improper to strike a peer review report supporting insurer’s denial of insured’s claim on the ground that the report was created more than thirty days after the insured submitted its claim — Section 627.736(4)(b) does not apply to claims for unrelated, unreasonable, or unnecessary treatment, and insurer may challenge such treatment at any time, and is permitted to rely on a report, obtained pursuant to section 627.736(7)(a), even if the report is obtained more than thirty days after the claim was submitted

34 Fla. L. Weekly D913c
12 So. 3d 242

Insurance — Personal injury protection — Benefits may be denied by insurer on ground that treatment was not reasonable, related or medically necessary based on a medical report that was obtained by the insurer more than thirty days after receiving notice of a claim based on that treatment — Thirty-day time period set forth in section 627.736(4)(b) does not apply to claims for unrelated, unreasonable or unnecessary treatment — Insurer may challenge such treatment at any time, and is permitted to rely on a report even if the report is obtained more than thirty days after the claim was submitted — Report obtained by insurer to deny benefits on ground that treatment was not reasonable, related, or necessary may be a valid report even though the reviewing physician’s report was not based on a personal physical examination of the insured, but instead was based on review of the insured’s medical records, including an IME report

34 Fla. L. Weekly D2051b
21 So. 3d 60

Insurance — Personal injury protection — Insurer is not required to obtain a valid medical report in order to deny medical provider’s claim — Where medical provider filed suit after insurer had denied payment of claim on ground that treatment was not reasonable, related, and necessary, it was error to reject physician’s affidavit submitted by insurer when ruling on motion for summary judgment on the ground that it was not based upon physician’s personal examination of the insured, and on the ground that it was generated more than thirty days after claim for PIP benefits was submitted by medical provider — Statute does not preclude insurer challenging submitted claim after thirty-day time period, or limit ability of insurer to obtain and submit proof, after the thirty-day period, that the treatment was not reasonable, necessary, or related — Statute does not require that insurer obtain a “valid report” to deny payment of a claim — Statute requires a valid report only when further benefits are withdrawn