2010

35 Fla. L. Weekly D34a
128 So. 3d 1

Insurance — Personal injury protection — Coverage — Medical expenses — Insurer’s obligation to obtain “valid medical report” applies to withdrawal, not denial, of PIP benefits — Portion of circuit court’s appellate decision concluding that peer review report which was not obtained before denial of benefits was not a valid medical report quashed

35 Fla. L. Weekly D150b
28 So. 3d 105

Insurance — Personal injury protection — Action by insured against PIP insurer seeking reimbursement for health insurance lien asserted by insured’s health insurance carrier on proceeds of settlement of insured’s claim against tortfeasor — Trial court erred in denying insurer’s motion for summary judgment where none of medical bills claimed to be at issue were submitted to insurer by medical providers in accordance with section 627.736(5)(c)1 or on proper forms as required by section 627.736(5)(d) — Insured cannot circumvent payment procedures outlined in section 627.736(5)(c)1 after her health insurer places a lien on her settlement proceeds by seeking reimbursement from her PIP insurer three years after the motor vehicle accident

35 Fla. L. Weekly D620a
32 So. 3d 159

Insurance — Personal injury protection — Where county court erroneously entered summary judgment in favor of provider on ground that affidavit of peer review physician submitted in opposition to motion was not valid because physician did not physically examine insured, and circuit court, sitting in its appellate capacity, applied “tipsy coachman” doctrine to affirm summary judgment on grounds that insurer’s opposing affidavit was technically deficient, circuit court departed from essential requirements of law, resulting in miscarriage of justice, by failing to provide insurer an opportunity to amend, which insurer specifically requested

35 Fla. L. Weekly D2832a
52 So. 3d 48

Class actions — Certification — Insurance — Personal injury protection — Coverage — Medical expenses — Radiological services associated with reading MRI — Plaintiff seeking to represent class of all health care providers who had submitted claims to insurer for MRI services rendered between specified dates — Provider was not required to send proper statutory notice of intent to litigate as condition precedent to suit against insurer where complaint was one for declaratory judgment which did not seek any damages, but sought declaration of correct calculation to be applied for reimbursement of the MRI services at issue — No error in certifying class

35 Fla. L. Weekly D1240d
41 So. 3d 268

Insurance — Personal injury protection — County court erred in entering summary judgment for insurer in insured’s action for breach of contract on ground that insured’s failure to attend a chiropractic medical examination, although insured had not been treated by a chiropractor, was unreasonable as a matter of law — Circuit court, sitting in its appellate capacity, did not depart from essential requirements of law by reversing summary judgment and remanding for county court to determine whether insured’s refusal to attend chiropractic examination was reasonable

35 Fla. L. Weekly D1438a
41 So. 3d 293

Insurance — Personal injury protection — Attorney’s fees — Paralegal fees — Multiplier — Circuit court did not depart from essential requirements of law in affirming county court orders awarding attorney’s fees and costs to parties prevailing in PIP cases — There is no clearly established law prohibiting application of multiplier to paralegal fees that are included as part of attorney’s fee award — Section 57.104 clearly supports inclusion of paralegal fees as attorney’s fees

35 Fla. L. Weekly D1020a
37 So. 3d 329

Insurance — Personal injury protection — Provider’s action against insurer — Conditions precedent — Examination under oath — Clause in policy providing 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,” is not binding on an assignee of the right to payment of no-fault benefits — The assignment of a contract right does not entail the transfer of any duty to the assignee, unless the assignee assents to assume the duty — The medical provider, as assignee of the right of the insured to payment under the insurance contract, had no duty to perform any covenant under the contract because the assignee never agreed to do so — Provider did not undertake any duty of performance, and insurer cannot unilaterally impose an obligation on provider by putting it in the policy — Question certified: Whether a health care provider who accepts an assignment of no-fault insurance proceeds in payment of services provided to an insured can be required by a provision in the policy to submit to an examination under oath as a condition to the right of payment?

35 Fla. L. Weekly D1481b
40 So. 3d 68

Insurance — Personal injury protection

35 Fla. L. Weekly D1276a
38 So. 3d 200

Administrative law — Office of Insurance Regulation — Rules — Administrative law judge properly found that documents, policies, and procedures used by Office of Insurance Regulation in its examination of Florida-licensed viatical settlement providers do not constitute unpromulgated rules — Statute gives Office of Insurance Regulation authority to review books and records of viatical settlement providers licensed in state, and statute does not differentiate between in-state and out-of-state records of licensees — Letters which OIR sends to licensees requesting production of records for examination, including records of out-of-state viatical settlement agreements, are not unpromulgated rules

35 Fla. L. Weekly D814b
31 So. 3d 953

Administrative law — Office of Insurance Regulation — Rules regulating viatical settlements — Administrative law judge erred in finding to be invalid a portion of proposed rule which requires viatical settlement providers to document changes to the provider’s method of operation in an annual report