PUBLISHED OPINIONS

A published case is a narrow ruling on a specific issue and binding upon the immediate court that had issued the opinion. The opinions also may be persuasive upon other courts statewide.

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Summary judgment — Independent medical examination is rejected as opposing affidavit where IME report was untimely served and is unsworn — Insured’s statement acknowledging that he suffered knee injury more than twenty years ago does not create a disputed issue of material fact as to the reasonableness, relatedness or necessity of treatment where the statement is consistent with medical provider’s position that treatment did not arise because of a prior knee injury but because of new injury — Even if insured believed that current injury was related to a prior injury, PIP statute requires the insurer to obtain physician’s statement, not layman’s statement, to avoid liability for payment of PIP benefits — Provider’s motion for final summary judgment granted.

Insurance — Personal injury protection — Coverage — Medical expenses — Reasonable, related and necessary treatment — Summary judgment — Independent medical examination is rejected as opposing affidavit where IME report was untimely served and is unsworn — Insured’s statement acknowledging that he suffered knee injury more than twenty years ago does not create disputed issue of material fact as to reasonableness, relatedness or necessity of treatment where statement is consistent with medical provider’s position that treatment did not arise because of prior knee injury but because of new injury — Even if insured believed that current injury was related to prior injury, PIP statute requires insurer to obtain physician’s statement, not layman’s statement, to avoid liability for payment of PIP benefits — Provider’s motion for final summary judgment granted

Insurance — Personal injury protection — Arbitration — Where parties did not request trial de novo within deadline for such request, trial court must enter judgment in accordance with arbitrator’s decision — No merit to argument that joint motion for stay submitted prior to deadline for requesting trial de novo should have been retroactively granted.

Insurance — Personal injury protection — Arbitration — Where parties did not request trial de novo within deadline for such request, trial court must enter judgment in accordance with arbitrator’s decision despite insurer’s claim that its failure to timely request trial de novo was result of mistake or inadvertence.

Insurance — Personal injury protection — Accord and satisfaction — Insurer not entitled to summary judgment on affirmative defense of accord and satisfaction — Provider’s negotiation of checks which were marked for full and final payment of PIP benefits and for full and final payment of PIP interest did not, as matter of law, result in accord and satisfaction — Record did not reveal the existence of a preexisting dispute between the parties, and there was nothing in the language of the checks, the explanation of benefits sent to provider, or the explanation of review which reasonably implied that provider, by accepting checks, would be deemed to have agreed with insurer’s position — Conflicting affidavits submitted by parties create genuine issue of material fact as to parties’ intent — Statutory accord and satisfaction — Language “FOR FULL AND FINAL PAYMENT,” placed within body of “Pay to the Order” line of checks, did not meet statutory definition of conspicuous.

Insurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Insurer did not clearly and unambiguously elect to limit reimbursement to statutory fee schedules where policy as a whole indicated that insurer could calculate reimbursement through either a fact dependent inquiry or through Medicare fee schedules — Safe harbor — Approval of policy by Office of Insurance Regulation does not satisfy requirement that policy provide unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule.

Insurance — Personal injury protection — Attorney’s fees — Claim or defense not supported by material facts or applicable law — Where insurer has provided no evidence that complaint in voluntarily dismissed action for PIP benefits was frivolous other than self-serving statement that benefits were correctly paid in accordance with policy endorsement and statutory fee schedules, insurer is not entitled to award of attorney’s fees under section 57.105

Insurance — Personal injury protection — Coverage — Medical expenses — PIP policy does not provide unambiguous notice of intent to limit reimbursement to Medicare fee schedule.

Insurance — Personal injury protection — Coverage — Medical provider’s motion for partial summary judgment as to applicability of Medicare fee schedule is granted where Medicare fee schedule language was not included in policy, and prior explanation of benefits did not put medical provider on proper notice of intent to pay pursuant to that fee schedule

Insurance — Personal injury protection — Complaint — Premature — Request for mediation — Statute which provides that filing demand for mediation tolls requirements for filing suit for 60 days does not apply to action for PIP benefits.