2010

35 Fla. L. Weekly D613b
31 So. 3d 234

Insurance — Personal injury protection — Medical expenses — Notice of loss — An independent diagnostic corporate supplier of MRI services does not have to include the professional license number of either the interpreting radiologist or its medical director in block 31 of its CMS 1500 claim form to have furnished notice of the amount of covered loss or medical bills under section 627.736(5)(d) — Statute requires that claim form be “properly completed,” and claim form submitted in this case complied with statute where it provided substantially accurate responses to all relevant information and material elements

35 Fla. L. Weekly D2448a
47 So. 3d 354

Insurance — Personal injury protection — 2008 amendment to statute which limits amount insurers reimburse providers for nonemergency, nonhospital services does not apply retroactively to policies that were in effect and that expired before statute’s effective date of January 1, 2008

35 Fla. L. Weekly D1850a

NOT FINAL VERSION OF OPINION
Subsequent Changes at 35 Fla. L. Weekly D2448a

Insurance — Personal injury protection — 2008 amendment to statute which limits amount insurers reimburse providers for nonemergency, nonhospital services does not apply retroactively to policies that were in effect and that expired before statute’s effective date of January 1, 2008

35 Fla. L. Weekly D1934a
43 So. 3d 127

Insurance — Personal injury protection — Where insurer raised, as an affirmative defense in medical provider’s action for PIP benefits, the insured’s failure to attend a duly scheduled independent medical examination, plaintiff moved for summary judgment on the affirmative defense, and defendant filed, in opposition, the affidavit of the records custodian for the vendor responsible for scheduling IME appointments, attaching a notice letter which was sent by certified mail to the claimant, together with the signature confirmation receipt signed by claimant, and the fax transmittal cover page which contained the date, time, and location for the IME, together with the transmittal verification report and an indication that the fax was sent to the office of claimant’s attorney, it was error for the trial court to strike the affidavit on the basis that it was hearsay because the person who sent the fax was the only person who had personal knowledge of whether the fax was sent — In order to lay a foundation for business records exception to hearsay rule, it is not necessary to call the person who actually prepared the document — To the extent the records custodian failed to lay a sufficient foundation for the admission of the fax as a business record in her affidavit, trial court was required to afford insurer at least one opportunity to amend the affidavit to correct this technical defect before entering summary judgment — Circuit court appellate division departed from essential requirements of law in affirming trial court’s denial of insurer’s request to amend affidavit to correct technical deficiencies

35 Fla. L. Weekly D501a
28 So. 3d 246

Insurance — Personal injury protection — Portion of circuit court order affirming county court’s directed verdict and final judgment in favor of provider on claim for breach of contract for failing to provide explanation of benefits quashed

35 Fla. L. Weekly D215b
29 So. 3d 329

Insurance — Personal injury protection — Disclosure and Acknowledgment Form to be completed and furnished to insurer upon initial treatment — Submission of incomplete form is not the equivalent of no written notice of claim — Failure to correctly complete and deliver initial form does not preclude further claims — Complete form is not a condition precedent to payment of all medical bills — There is no merit to insurer’s contention that it does not waive its right to raise incomplete form as a defense, even if it pays the claim, because it can raise the incomplete form as a defense at any time — Submission of flawless form is not a condition precedent to right of provider to access courts to recover a claim unpaid by the insurer

35 Fla. L. Weekly D334a
27 So. 3d 743

Insurance — Personal injury protection — Circuit court acting in its appellate capacity departed from essential requirements of law when it affirmed county court ruling that peer review report insurer furnished to defend summary judgment motion was not valid because it did not state that doctor either physically examined insured or that his opinion was based on an independent medical examination — “Valid report” under section 627.736(7)(a) does not require an insurer to order an IME before denying claim for PIP benefits

35 Fla. L. Weekly D2280b
45 So. 3d 940

Insurance — Personal injury protection — Withdrawal of benefits — Pursuant to section 627.736(7)(a), Florida Statutes (2009), a “valid report” may be based on a physical examination conducted by the treating physician and does not require a physical examination by the reporting physician or an examination conducted on the insurer’s behalf

35 Fla. L. Weekly D2107a
44 So. 3d 1189

Insurance — Personal injury protection — Pursuant to section 627.736(7)(a), Florida Statutes (2009), a “valid report” may be based on a physical examination conducted by the treating physician and does not require a physical examination by the reporting physician or an examination conducted on the insurer’s behalf

35 Fla. L. Weekly D51b
26 So. 3d 49

Insurance — Personal injury protection — Physician’s report, whether used to support denial of a claim that a bill or claim is not reasonable, related, or necessary, or used to support withdrawal or termination of payments being made to a treating physician, is not required to be based on a physical examination conducted by either the reporting physician or by another physician on the insurance company’s behalf