WHEN THE INSURER FAILS TO PAY ANY OR SOME OF AN INSURED’S MEDICAL BILLS, §627.736(4)(b) APPLIES

United Automobile Insurance Co. v. Perez, 34 Fla. L. Weekly D2267 (Fla. 3^rd DCA November 4, 2009):

When the insurer fails to pay any or some of an insured’s medical bills under PIP, §627.736(4)(b) requires only that it have reasonable proof that it rejected payment of bills because they are unreasonable, unrelated or unnecessary.  That proof may be supplied by a report prepared in accordance with §627.736(7)(a) or otherwise, and may be provided at any time.  In this case, the appellate division erred in concluding that the report was untimely (it was prepared a year after the PIP suit was filed) and in concluding the report was untimely and could not be used.

INSURED HAS NO PRIVATE CAUSE OF ACTION AGAINST A PIP INSURER WHO FAILS TO PROVIDE AN ITEMIZED SPECIFICATION OF EACH ITEM THE INSURER HAS REDUCED, OMITTED OR DECLINED TO PAY WITHIN 30 DAYS AFTER BEING FURNISHED WITH WRITTEN NOTICE OF LOSS

United Automobile Insurance Co. v. A 1st Choice Healthcare Systems, 34 Fla. L. Weekly D2268 (Fla. 3^rd DCA November 4, 2009):

There is no requirement or deadline for a personal injury protection insurer to respond to a request for payment.  An insurer may deny a PIP claim in whole or in part either before or after the claim becomes overdue, provided that it has reasonable proof it is not responsible for the payment. 

The statute does not afford a private right of action against an insurer for its failure to meet the 30 day deadline for submission of an EOB.  The only cause of action authorized by the statute is one for PIP benefits.

NO ERROR IN GRANTING SUMMARY JUDGMENT IN FAVOR OF DEFENDANT WHERE PLAINTIFF SPLIT HER CAUSE OF ACTION BY FIRST OBTAINING JUDGMENT FOR PROPERTY DAMAGE TO HER MOTOR VEHICLE, AND THEN FILING SUIT FOR PERSONAL INJURIES FROM SAME ACCIDENT

Bryant v. Tarman, 34 Fla. L. Weekly D2276 (Fla. 5^th DCA November 6, 2009):

All damages claimed as a result of a single wrongful act must be sought in one lawsuit, even when it involves a motor vehicle accident.  The law does not permit the owner of a single cause of action to divide or split that cause of action so as to make it the subject of several lawsuits.

THE PARTIES’ ARBITRATION AGREEMENT IN A NURSING HOME CASE WAS NOT RENDERED INVALID OR UNENFORCEABLE SIMPLY BECAUSE THE AAA BECAME UNAVAILABLE TO CONDUCT THE ARBITRATION – INSTEAD CIRCUIT COURT MUST APPOINT ANOTHER ARBITRATOR OR ARBITRATORS

Perez v. Life Care Centers, 34 Fla. L. Weekly D2277 (Fla. 5^th DCA November 6, 2009):

Plaintiff did not present any evidence in the circuit court that the choice of the AAA as the forum for the arbitration proceedings was an integral part of the agreement to arbitrate.  Thus, when the AAA changed its rules and procedures to no longer handle healthcare cases, that was not fatal to the agreement to arbitrate itself; it simply required the appointment of another arbitrator. 

*Available to handle appellate and trial support matters for attorneys throughout the state.

This entry was posted on Wednesday, November 25th, 2009 at 9:43 am and is filed under The Week in Torts. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.