Personal Injury Protection
Posted December 28, 2011
PIP, Insurance Law—
GEICO Indemnity Co. v. Virtual Imaging Services, Inc.,
36 FLW D2398a (Fla. 4th DCA , Nov. 2, 2011)
Third DCA Agrees With Fourth DCA's Kingsway Amigo
Decision And Finds That Where Policy Does Not Make Specific Election To Apply Statutory Payment Limitations,
Insurer Must Make Payment At 80% Of Charge
Posted November 7, 2011
PIP, Discovery, Work Product, Claims File Discovery—
State Farm Mut. Auto. Ins. Co. v. South Miami Health Center, Inc. (a/a/o Trinidad Bullen),
FLWSUPP 1901BULL, Case NO: 10-349 AP, (Circ. Ct. 11th Circ., Oct. 12, 2011)
Miami Circuit Court Grants Certiorari To Quash Discovery Order That Compelled Production Of Adjuster Notes In PIP Suit
Posted August 3, 2011
Personal Injury Protection, Attorney Fee—
Comprehensive Health Center, LLC, a/a/o Huldah Lynch v. United Automobile Insurance Company,
36 FLW D1553b (Fla. 3d DCA, July 20, 2011)
Third DCA Grants Assignee's Petition For Writ Of Certiorari Holding That The Circuit Court Appellate Division Departed From
The Essential Requirements Of Law In Failing To Award Appellate Attorney's Fees To Comprehensive For Prevailing On The Expert Witness Fee Issue
Posted July 7, 2011
Personal Injury Protection,Insurance—
Nationwide Mut. Fire Ins. Co. v. AFO Imaging, Inc.,
36 FLW D1463b (Fla. 2nd DCA July 6, 2011)
Second DCA Rules That OPPS CAP Does Not Apply To MRI Fees Under 2008 PIP Statute
Posted June 21, 2011
PIP, Insurance, Bad Faith—
Regional MRI of Orlando, Inc. v. State Farm Mut. Auto. Ins. Co.,
FLWSUPP 1807REG1, Case No: CVA1 09-38 (Fla. 9th Cir. Ct. Feb. 23, 2011
Ninth Circuit Holds That Insurer's Decision To Exhaust Benefits In Payment Of Insured's Wage Loss Claim Rather Than
Pay Earlier Received Claim From Medical Provider Was Not Bad Faith
Posted May 19, 2011
PIP - Insurance—
Kingsway Amigo Ins. Co. v. Ocean Health, Inc. (a/a/o Belizaire Gomez),
36 FLW D1062a (Fla. 4th DCA May 18, 2011)
Fourth DCA Rules That PIP Insurer May Not Elect To Use Medicare Part B Fee Schedule Set Forth In Section
627.736(5)(a)(2) When The Subject Policy Specifies That The PIP Insurer Will Pay 80% Of Medically Necessary Expenses-
Incorporation Of PIP Statute Into Policy Did Not Give Insurer The Unilateral Right To
Ignore The Only Payment Methodology Referenced In The Policy
Posted May 5, 2011
PIP - Insurance—
MRI Assoc. of America, LLC (a/a/o Ebba Register) v. State Farm Fire & Cas. Co.,
36 FLW D960b (Fla. 4th DCA May 4, 2011)
Fourth DCA Confirms That Demand Letter And Claim Forms Must Give Insurer Notice Of Exact Amount Owed For Treatment-
Affirms Judgment In Favor Of Insurer
Posted April 28, 2011
PIP - Insurance—
V&T Investment Partners v. State Farm Mut. Auto. Ins. Co.,
FLWSUPP 1805MEDI (Fla. 18th Circ. County Ct., Feb. 16, 2011), Case No: 2010-SC-001045
Seminole County Court Rules That State Farm Policy Allowed Use Of Statutory Fee Schedule And That Statute Adopted Medicare Pay System,
Excluding Only Identified Sections, And Thus OPPS Caps Applies
Posted March 16, 2011
PIP, Insurance, Statutory Interpretation—
Desaussure v. Direct General Ins. Co.,
FLWSUPP 1804DESA, Case No: 2010-100018-APCC (7th Cir. Ct. Feb. 11, 2011)
Seventh Circuit (Volusia) Reverses Summary Judgment In Favor Of Insurer Where Insured Incorrectly Advised Provider That
He Had No Insurance And Provider Submitted Bills Within 35 Days After Learning Of Correct Insurance Information
Posted January 26, 2011
Personal Injury Protection—
Ann K. Medical Office Inc. (a/a/o Rosa Delgado), v. United Auto,
18 Fla L. Weekly Supp. 116a (11th Cir. County Court, Nov. 10, 2010)
Eleventh Circuit-Miami-Dade County Fails To Follow Long Standing Law On Accord And Satisfaction,
Holds That A Provider's Acceptance And Cashing Of Insruer's Check,
Which Stated "Final/Final P.I.P. Benefits Payment" On the Check,
Did Not Amount to Accord And Satisfaction Without A Showing Of Mutual Intent
Posted January 26, 2011
Personal Injury Protection, Insurance—
United Automobile Ins. Co., v. Perez,
18 Fla. L. Weekly Supp. 31a (Fla. 11th Cir. Ct. Nov. 8, 2010)
Dade County Circuit Court Holds That Insurer Waived Issue Of Defective Pre-Suit Demand Letter,
Which Failed To Include Assignment Or Indicate Whether Payment Should Be Made To Provider Or Insured,
By Failing To Raise The Issue Until After Suit Was Filed By Insured
Posted January 25, 2011
Personal Injury Protection, Insurance—
State Farm Mut. Auto. Ins. Co. v. Henry,
18 Fla. L. Weekly Supp. 3a (5th Cir. Ct. Oct. 4, 2010)
Lake County Appellate Court Affirms Insured's Right To Reallocation Of PIP And Med Pay Benefits,
Even After PIP Exhausts But Dissent Offers Key Argument To Contrary And Also Rules That
Insufficient Pre-Suit Demand Letter Not Fatal To Insured's Claim Where Demand Would Have Been Futile Given That
Insurer Refused To Pay Further Benefits
Posted January 25, 2011
Personal Injury Protection, Insurance—
Senpri Medical Center Inc. (a/a/o Benjamin Almeida) v. State Farm Mut. Auto. Ins. Co.,
18 Fla. L. Weekly Supp. 96a (13th Cir. County Court, Aug. 11, 2010)
Judge Steinberg Of The Hillsborough County Court Affirms Application Of NCCI Edits To PIP Bills;
Disallows Use Of 97124 And 97140 On Same Dates Of Service
Posted December 29, 2010
Personal Injury Protection—
Richard Sheldon, DC (a/a/o Travis Baliel) v. United Services Auto. Ass'n,
36 FLW D23a (Fla. 1st DCA Dec. 28, 2010)
First DCA Rules That Summary Judgment In Favor Of Insurer Is Proper Where Benefits Are Exhausted Before
Insurer Is Served With Lawsuit— Provider Cannot Maintain Suit For Sole Purpose Of Pursuing Claim For Penalties,
Interest And Attorney's Fees On Benefits Reduced Or Denied Prior To Exhaustion Of Benefits
Posted December 28, 2010
PIP, Insurance, Certiorari, Appellate Issues—
United Auto. Ins. Co. v. Palm Chiropractic Center, Inc.(a/a/o Joyce Thomas),
35 FLW D2686 (Fla. 4th DCA Dec. 8, 2010)
Fourth DCA Denies Certiorari Review Despite Expressly Finding That County And Circuit Courts Committed Clear Legal Error,
Holds That Something More Than The Obligation To Pay A Money Judgment That Should Not Otherwise Be Owed Was Required To
Justify The Narrow Second Tier Review Requested In This Case
Posted November 24, 2010
PIP, Insurance, Statutory Interpretation—
GEICO Indemnity Co. v. Physicians Group, LLC, (a/a/o Paul Androski),
35 FLW D2449 (Fla. 2nd DCA, Nov. 3, 2010)
Second DCA Revises Opinion Addressing Applicability Of Amended PIP Statute To Policies Issued Prior To
January 1, 2008 And Clarifies That Opinion Is Limited To Facts Of Case Which Involve A Policy That Was Not In Effect On January 1, 2008—
All Other Holdings Withdrawn
Posted November 16, 2010
PIP, IME, Certiorari Jurisdiction—
Custer v. United Auto Ins. Co.,
35 FLW S640a (Fla., Nov. 4, 2010)
Florida Supreme Court Concludes That Whether Refusal To Attend IME Is Unreasonable Is A Question Of Fact On For Which
Insurer Bears The Burden Of Proof And Even An Unreasonable Refusal To Attend Only Eliminates Obligation To
Pay For Treatment Subsequent To IME, Not Treatment Provided Before The IME Was Noticed
Posted October 12, 2009
Personal Injury Protection—
United Automobile Insurance Company v. Santa Fe Medical Center,
34 Fla. L. Weekly D2051b (Fla. 3rd DCA Oct. 7, 2009)
Third DCA Allows First Party Bad Faith To Proceed Following Appraisal And Confirmation Of
Third DCA Issues En Banc Opinion Clarifying Requirements For Denying Benefits
Posted August 23, 2010
Personal Injury Protection—
United Auto. Ins. Co. v. Miami Neurology Rehab Specialist
(a/a/o Yoan Diaz Alfonso),
FLWSUPP 1709ALFO, Case No: 08-488, (11th Cir. Ct., Mar. 23, 2010)
Miami Dade Appellate Court Concludes That Omnibus Insured Not Obligated To Submit To EUO And That Insurer
Could Not Deny Coverage For Failure To Attend EUO
Posted August 16, 2010
Personal Injury Protection—
GEICO Indemnity Co. v. Physicians Group, LLC (a/a/o Paul Androski),
35 FLW D1850 (Fla. 2nd DCA Aug. 13, 2010)
Second DCA Finds That 2008 PIP Statute Was Not Retroactive And Cannot Be Applied To Policies That Were Not
In Effect On Or After January 1, 2008, Even Though Medical Treatment In Issue Was Performed After January 1, 2008
Posted August 13, 2010
Personal Injury Protection—
Mercury Ins. Co. of Fla. v. Med Manage Group, Inc. (a/a/o Michael Bergey),
17 FLW Supp. 617b (15th Circ. Apr. 8, 2010)
Fifteenth Judicial Circuit Affirms Final Judgment Finding That Insurer’s Request For Clinic Verification To
Establish That Provider Was Eligible To Receive Payments For PIP Benefits Was Not A Request For Information
Within Scope of 627.736(6)(b) And Did Not Toll Time For Insurer To Pay Bills
Posted August 12, 2010
Personal Injury Protection—
United Auto. Ins. Co. v. NDNC Neurological Treatment Center (a/a/o Cheyene Duncan),
17 FLW Supp. 622a (17th Cir. Mar. 31, 2010)
Broward Circuit court Reverses Order Striking Expert Witness Who Failed To Produce IME Reports For Non-Parties And
Failing To consider Expert's Deposition Testimony In Addressing Summary Judgment - Also Affirmed No Cause Of
Action Exists for Insurer's Failure To Provide EOB
Posted August 3, 2010
Personal Injury Protection—
United Automobile Insurance Company v. Otero,
35 FLW D1683b (Fla. 3d DCA, July 28, 2010)
Third DCA Grants Insurer's Petition For Certiorari Review And Quashed The Decision Of The
Circuit Court Holding The Insured Who Had Made An Unqualified Assignment Of Benefits Had No Standing To Sue The Insurer
Posted May 4, 2010
Personal Injury Protection—
AFO Imaging, Inc. v. Peak Property & Cas. Ins. Corp.,,
17 FLW Supp. 368a (Jan. 25, 2010)
Hillsborough Circuit Court Rules That Insurers Cannot Apply Opps Cap To Limit Reimbursement For Non-Hospital,
Non-Emergency MRI Services Under 2008 PIP Statute
Posted April 26, 2010
Personal Injury Protection—
Bosem v. Commerce & Industry Ins. Co.,
35 Fla. L. Weekly D892a (Fla. 3rd DCA Apr. 21, 2010)
Third DCA Rules That Fraud Related To Claim For Lost Wages Voided All Coverage, Including Claim For Medical Expenses And
Affirmed Summary Judgment Where Evidence Of Fraud Was Clear In The Record
Posted March 18, 2010
Personal Injury Protection—
USAA Cas. Ins. Co. v. Pembroke Pines MRI, Inc.,
___ So.3d ___, 35 FLW D613 (Fla. 4th DCA, Mar. 17, 2010)
Fourth DCA Aligns Itself With Third DCA And Rules That Substantially Accurate CMS-1500 Is Sufficient;
MRI Facility Not Required To Include License Number In Block 31
Posted February 9, 2010
Personal Injury Protection—
United Auto. Ins. Co. v. Dade Injury Rehab Center, Inc. (a/a/o Denis Diaz-Matamoro),
17 FLW Supp.82 (Fla. 11th Cir. Ct., Dec. 23, 2009)
Dade Circuit Court Rules No Expert Witness Fee For Treating Provider And Rejects
Lack Of Cooperation/Late Notice Defense Due To Lack Of Prejudice To Insurer;
Awards Fees To Provider For Prevailing On Substantive Issues
Posted February 8, 2010
Personal Injury Protection—
Menendez v. Progressive Express Insurance Co., Inc.,
35 Fla. L. Weekly S81a, (Fla. 3rd DCA Feb. 4, 2010)
Florida Supreme Court Finds That Pre-Suit Notice Requirement Was Substantive Amendment To PIP Statute And Could Not Be
Applied Retroactively Despite Legislative Intent
Posted January 29, 2010
Personal Injury Protection—
State Farm Mut. Auto. Ins. Co. v. Pressley,
28 So.3d 105 (Fla. 1st DCA Jan 12, 2010)
First DCA Finds That PIP Statute Requires Medical Provider To Submit Bills for Payment And that Bills Submitted By
Insured Directly Are Not Properly Submitted To Trigger Payment Requirement
Posted January 27, 2010
Personal Injury Protection—
United Auto. Ins. Co. v. County Line Chiropractic Center (a/a/o Anasa Dexter),
Case No: 08-14841, 08-29172 (Broward Cir. Ct., Dec. 11, 2009)
Online Reference: FLWSUPP 1702DEXT
Broward Circuit Court Finds Provider Does Not Have Standing To
Recover Statutory Fines For Insurer's Alleged Violations Of Various PIP Provisions
Posted December 21, 2009
Personal Injury Protection - Benefits—
Walsh v. GEICO General Ins. Co., 34 Fla. L. Weekly D2482a (Fla. 4th DCA, December 2, 2009)
Insured Not Entitled To PIP Benefits Where Date Of Accident Occurred During GAP Period And
Policy In Effect Did Not Provide PIP Coverage
Posted December 4, 2009
Personal Injury Protection—
United Auto. Ins. Co. v. Professional Med. Group, Inc. (a/a/o Gaston Botta), 34 Fla. L. Weekly D2500a (Fla. 3rd DCA Dec. 2, 2009)
Third DCA Clarifies That Statute Requires Substantial Compliance With Claim Form Requirements And That
Omissions And Defects Can Be Cured By Later Submissions
Posted December 2, 2009
Personal Injury Protection—
Central Magnetic Imaging Open MRI of Plantation, Ltd. (a/a/o Evelyn Deshommes) v. State Farm Fire & Cas. Ins. Co.,
34 FLW D2396 (Fla. 4th DCA Nov. 18, 2009)
Fourth DCA Holds That PIP Insurer Is Not Required To Obtain IME Before Denying Claim For Medical Benefits
Posted November 18, 2009
Personal Injury Protection—
Espaillat v. Permanent Gen. Assurance Corp., Case No: CVA1 08-38, (9th Circ. Ct. Oct. 8, 2009)
(no FLW Supp citation available at this time)
Circuit Court For Orange County Affirms Denial Of Fee Award For Motion To Enforce Settlement Of A PIP Suit
Posted November 16, 2009
Personal Injury Protection - Benefits—
United Automobile Insurance Company v. A 1st Choice Healthcare Systems, 34 Fla. L. Weekly D2268a (3rd DCA Nov. 4, 2009)
(no FLW Supp citation available at this time)
Third DCA Rules That EOB Is Not Required Until Payment Is Made And That An Insured Has No Private Right Of
Action Against Insurer For Failure To Provide EOB