2009

34 Fla. L. Weekly D2396a
22 So. 3d 782

Insurance — Personal injury protection — Insurer is not required to obtain an independent medical examination before denying a PIP claim — Valid report may be based on physician’s review of treatment records of insured

34 Fla. L. Weekly D2174a
22 So. 3d 120

Insurance — Personal injury protection — It was improper to bar the admission of opinion of insurer’s reviewing physician that some of treatment provided to insured was not medically necessary or related to automobile accident on ground that physician did not perform an independent medical examination of the insured

34 Fla. L. Weekly D2305a
22 So. 3d 699

Insurance — Personal injury protection — Circuit court appellate division departed from essential requirement of law in upholding county court judgment for insured in insured’s action against insurer which had denied benefits on ground that insurer’s physician’s affidavit was not factually supported by examination and treatment records — Statutory requirement that physician’s report be factually supported by examination and treatment records is inapplicable in case where insurer has denied benefits rather than withdrawn benefits

34 Fla. L. Weekly D2267a
21 So. 3d 886

Insurance — Personal injury protection — Denial of benefits — Circuit court appellate division erred in adopting county court ruling striking as untimely a report of insurer’s expert on reasonableness, relatedness, and necessity and prohibiting expert from testifying — Where an insurer fails to pay any or some of insured’s medical bills, section 627.736(4)(b), Florida Statutes, applies — Statute requires only that insurer have reasonable proof that a rejected claim or claims are unreasonable, unrelated, or unnecessary — Such proof may be supplied by a report prepared in accordance with section 627.736(7)(a) or otherwise, and such proof may be provided at any time

34 Fla. L. Weekly D2218b
21 So. 3d 112

Insurance — Personal injury protection — In an action for PIP benefits, section 627.736(7)(a), Florida Statutes, does not prohibit the admission of expert testimony that is based on a physician’s report not first obtained before PIP benefits were denied

34 Fla. L. Weekly D2216a
21 So. 3d 871

Insurance — Personal injury protection — Insurer is not required to obtain a valid medical report in order to deny a medical provider’s claim — Even when a valid report is required, such report need not be predicated on either a physical examination conducted by the reporting physician or on a physical examination conducted on behalf of the insurer

34 Fla. L. Weekly D2177a
21 So. 3d 858

Insurance — Personal injury protection — An insurer’s denial of all or some benefits is governed by section 627.736(4), Florida Statutes — Where insurer has paid benefits and then seeks to withdraw or terminate further payments, section 627.736(7) is applicable — A claim may be rejected more than thirty days after submission to insurer notwithstanding being “overdue” — Section 627.736(4)(b) requires only that an insurer have reasonable proof that rejected claims or bills are unreasonable, unrelated, or unnecessary — While a section 627.736(7)(a) report may be utilized for this purpose, such a report is not required — Where an insurer withdraws payments being made to a treating physician or withdraws or terminates authorization for further treatment by a treating physician, a section 627.736(7)(a) report must first be obtained — Such a section 627.736(7)(a) report does not have to be predicated on either a physical examination by the reporting physician or on a physical examination conducted on behalf of the insurer, but may be premised on review of the records of the insured’s treating physician

34 Fla. L. Weekly D1833b
16 So. 3d 1028

Insurance — Automobile — Medical expenses — Insurer’s denial of claim by named insured’s son for medical expenses coverage on ground that claimant was not a resident relative of the named insured at time of accident — Trial court erred in finding that policy definition of “relative” was ambiguous and that claimant was entitled to medical expenses coverage as matter of law — Policy definition of “relative” as “a relative of any degree by blood or marriage who usually makes his home in the same family unit, whether or not temporarily living elsewhere,” is not ambiguous — Where claimant lives in his own mobile home, and not in his parents’ residence, but has close ties of kinship with his parents and is financially supported by them to a significant degree, there is a factual issue as to whether claimant may qualify as a relative for purposes of medical expenses coverage

34 Fla. L. Weekly D58a
997 So. 2d 1243

Insurance — Personal injury protection — Insurer’s denial or partial payment of claim — Physician report requirement

34 Fla. L. Weekly D1110a
12 So. 3d 850

Insurance — Personal injury protection — Class actions — Action based on alleged failure of insurer to correctly compute consumer price index adjustments to reimbursements due to providers of magnetic resonance imaging services — Trial court properly entered consent judgment certifying class, approving settlement agreement, and awarding fees to class representative and its attorneys — Intervening MRI provider was provided adequate notice of terms and effect of proposed class certification and settlement — Trial court properly declined to postpone fairness hearing to permit intervenor’s last-minute discovery to proceed — Predominant feature of settlement is uniform interpretation of CPI adjustment as directed by legislature — Settlement is fair where base amount is adjusted annually, but without compounding, and CPI figures published by Bureau of Labor Statistics are rounded up to the nearest one-tenth of one percent — Trial court properly approved award of attorney’s fees and costs paid by settling insurer — Provision for opt-out allowed class member claimants to recover their CPI adjustments as computed in a fair interpretation of the controlling statute and to seek any other penalties, fees, or other amounts available by law