2012

37 Fla. L. Weekly D1777a
96 So. 3d 949

Insurance — Property — Hurricane damage — Conditions precedent to suit — Trial court properly found that policy provisions requiring insureds to give immediate notice of loss and submit sworn proof of loss within 60 days of the loss were conditions precedent to suit, and not cooperation clauses — Insureds’ untimely pre-suit notice of loss and untimely pre-suit submission of sworn proof of loss created presumption of prejudice to insurer, which insureds failed to rebut, thereby precluding insureds from recovery under policy — Trial court properly entered summary judgment in favor of insurer

37 Fla. L. Weekly D1699a
95 So. 3d 303

Insurance — Property — Hurricane damage — Conditions precedent to suit — Trial court properly found that policy provisions requiring insureds to give immediate notice of loss and submit sworn proof of loss within 60 days of the loss were conditions precedent to suit, and not cooperation clauses — Insureds’ untimely pre-suit notice of loss and untimely pre-suit submission of sworn proof of loss created presumption of prejudice to insurer, which insureds failed to rebut, thereby precluding insureds from recovery under policy — Trial court properly entered summary judgment in favor of insurer

37 Fla. L. Weekly S395a
94 So. 3d 541

NOT FINAL VERSION OF OPINION
Subsequent Changes at 37 Fla. L. Weekly S407a

Insurance — Property — Hurricane damage — Florida law does not recognize a claim for breach of the implied warranty of good faith and fair dealing by an insured against its insurer based on the insurer’s failure to investigate and assess the insured’s claim within a reasonable period of time — Such first-party claims are actually statutory bad-faith claims that must be brought under section 624.155, Florida Statutes — An insured cannot bring a claim against an insurer for failure to comply with the language and type-size requirements of the hurricane deductible notice requirements established by section 627.701(4)(a), Florida Statutes — Insurer’s failure to comply with the language and type-size requirements of section 627.701(4)(a) does not render a noncompliant hurricane deductible provision in an insurance policy void and unenforceable — Language in a policy mandating payment of benefits upon “entry of final judgment” does not waive the insurer’s procedural right to post a bond and stay execution of a money judgment pending resolution of appeal

37 Fla. L. Weekly D1188a
90 So. 3d 841

Insurance — Property — Conditions precedent — Examination under oath — Error to enter summary judgment in favor of Florida Insurance Guaranty Association, as successor in interest for insurer, based on failure of insured and, subsequently, its assignee to submit to examination under oath where FIGA failed to plead and prove prejudice — Moreover, record indicates that FIGA was not prejudiced

37 Fla. L. Weekly D2186a
103 So. 3d 866

Insurance — Personal injury protection — Relief from judgment — Appeals — Where insurer appealed to circuit court contending that county court abused its discretion in finding that provider’s motion for attorney’s fees was timely and in finding excusable neglect sufficient to support granting provider’s rule 1.540(b) motion to vacate an order of dismissal, circuit court departed from essential requirements of law, resulting in denial of due process, when it reversed based on evidentiary deficiencies which were neither preserved in county court nor raised in insurer’s appeal brief — Court notes that circuit court could not have reversed based upon tipsy coachman doctrine, as that doctrine permits appellate court to affirm a trial court’s decision on a ground other than that raised below, and argued on appeal, where there is support for the alternative theory or principle of law in record before trial court — Tipsy coachman doctrine does not permit reviewing court to reverse on an unpreserved and unargued basis — Remand for reinstatement of county court orders

37 Fla. L. Weekly D1027a
86 So. 3d 585

Insurance — Personal injury protection — Medical treatment provider’s claim form submitted to insurer was substantially complete and properly put insurer on notice of covered claim although form did not contain provider’s professional license number — Circuit court applied correct law in reversing county court’s summary judgment for insurer in action seeking payment of claims on ground that claims were noncompensable because of omission of professional license number

37 Fla. L. Weekly D170e
79 So. 3d 840

Insurance — Personal injury protection — When insurance policy provides greater coverage than the amount required by statute, terms of policy control — Fact that amended statute would allow insurer to opt for another lesser amount does not permit insurer to do so when policy specifically provides for payment of 80% of reasonable expenses incurred — Simply indicating that insurer would pay in accordance with the law “as amended” is insufficient to place insured on notice of insurer’s intent to pay less than 80% of reasonable expenses as stated in policy

37 Fla. L. Weekly D985b
90 So. 3d 321

Insurance — Personal injury protection — Reimbursement for medically necessary services — Insurer may not limit provider reimbursement to 80 percent of 200 percent allowable amount under Medicare Part B fee schedules where policy does not make specific election to do so — Question certified to Florida Supreme Court as question of great public importance: With respect to PIP policies issued after January 1, 2008, may the insurer compute provider reimbursements based on the fee schedules identified in section 627.736(5)(a), Florida Statutes, even if the policy does not contain a provision specifically electing those schedules rather than “reasonable medical expenses” coverage based on section 627.736(1)(a)?

RESULT APPROVED. 38 Fla. L. Weekly S517a

37 Fla. L. Weekly D1663a
95 So. 3d 903

Insurance — Personal injury protection — Trial court erred in determining that PIP insurer was not required to pay for two different treatments by medical provider on the same day on ground that under the National Correct Coding Initiative (NCCI) edits Medicare Rules do not allow the billing of both treatments on the same day — NCCI edits are not incorporated into Florida PIP statute, and medical provider was owed for both treatments, even though Medicare Rules would not allow payment for those services rendered on the same day

37 Fla. L. Weekly D1107a
93 So. 3d 345

Insurance — Personal injury protection — Attorney’s fees — Contingency fee multiplier — In awarding attorney’s fees to medical care provider in its action against insurer, trial court abused discretion in applying contingency fee multiplier where there was no competent, substantial evidence that market required a multiplier for provider to obtain competent counsel