As further evidence to prospective employers of how I tried to use my time wisely this summer, here are some of my notes from Florida Motor Vehicle No-Fault Law: Personal Injury Protection (P.I.P.) 2009-2010 edition by Russel Lazega. Like in my previous entry, most of the notes that I selected to type are questions to which I do not know the answer.
This book in large part outlines the Florida No-Fault Statute: 627.736. The Table of Contents at the beginning of each chapter provided a good outline of the statute. As this book says, I will have to read this statute again and again to gain competency in dealing with it.
Chapter 1 Introduction to No-Fault and Definitions pgs.1-25.
-p.4 I do not understand the statement that a person is allowed one free accident before being compelled to buy liability coverage.
-p.11 $10,000 coverage for property damage- Is this for your own property or for the 3rd party's that you damaged? Answer p.62. It is liability coverage.
-p.20 PIP is primary coverage in an auto accident. But other health insurance may cover the deductible. Submit claims to both carriers. See p.88.
-p.24 What is the financial responsibility law?
Chapter 2 The No-Fault Act: Required Coverages and Deductibles 627.736(2) & 627.734 pgs.27-64
-p.30 How do you divide the $10K worth of coverage? Answer p.61 and p.103-104.
-p.45 I need to become familiar with Medicare Parts A & B. See p.309.
-p.48 The statute refers to forms of notice approved by the office. What is "the office?" Answer, bottom of p.115? Centers for Medicare and Medicaid Services?
-p.63 "Nolle prossed" means "will no further prosecute."
Chapter 3 Limitation of Insured's Right to Recover Special Damages in Tort Claims: Collateral Sources and Property Damage 627.736(3) pgs.65-85
-p.69 Be aware of the use of post trial discovery.
-p.75 I need to research what the 2 year proof of insurance period and the 3 year proof of financial responsibility means.
-p.82 Does a right of subrogation exist against a non-owner of a commercial vehicle?
-p.84 Can you bring up the existence of insurance in a non-medical malpractice negligence case? I think not. It is not relevant. See Sawaya's treatise.
Chapter 4 The No-Fault Act Benefits; When Due, Interest; and Required Coverages 627.736(4) pgs.87-110.
-p.89 Who covers when the insurance company pays under the wrong priority? Arguably, the insurer should pay. See p.316.
-p.91 How do you charge attorney's fees for failure to pay PIP when you work on a contingency basis? Answer is the one-way street provision?
-p.99 What does a PIP log look like?
-p.105 I do not understand the case note. Interest payments are not counted as part of the $10,000 in PIP payments.
-p.108 What is "contempt jurisdiction?"
Chapter 5 Charges for Treatment of Injured Persons 627.736(5) pgs.111-166
-p.120 See www.cms.hhs.gov for the Medicare fee schedule.
-p.121 What is the HCFA form?
-p.137 What is a CMS 1500? Or a UB92 form? See p.162 for some help with form names.
-p.142 Are charges different for medical services after the gap period at the end of 2007? See p.143 and consult Chapt. 440 Fla. Stat.
-p.152 Who provides notice of the insured's rights? The insurer to the provider? When is this done?
-p.155 Policy on why hospital ERs have different billing requirements from medical providers.
-p.161-162 Arbitration is useful for the defense. Non-binding arbitration can have serious consequences once judgment is entered.
-p.162 "One way attorney's fees provision." See p.211. In a judgement against an insurer, the trial court should enter a ruling for attorney's fees.
Chapter 6 Discovery of Facts About an Injured Person; Disputes 627.736(6) pgs.167-188.
-p.169 The statute makes mention of a form approved by the department. What is "the department?"
-p.175 This book does not discuss federal law about physician/patient privilege.
-p.179-180 Is there a difference between a PIP log and a PIP payout log? Answer, probably not. See bottom of p.180.
Chapter 7 Examination of Persons- Independent Medical Examinations and Examinations Under Oath 627.736(7) p.189-208
-p.193 When a policy is renewed, that should change the effective date of the policy, correct? Answer, p.392. Yes. The renewal is like forming a new contract.
-p.205 What is the insurance code? What are the remedies for violating it? See pgs.251-252 for help.
-p.206 The examination under oath requirement is not statutory, so look at the policy provisions carefully.
Chapter 8 Attorney's Fees 627.736(8) pgs.209-229
-p.213 What is an attorney's fees multiplier? See p.217 for details. The trial court decides what the witness fees should be. Make this clear in the contract with your expert witness.
-p.221 What is an "out of the box" PIP suit?
-p.225 What is the effect of a second offer on the ramifications of rejecting the first offer?
-p.226 What is the difference between an offer of judgment and an offer of settlement? What are the pros and cons of utilizing each?
Chapter 9 Preferred Provider Agreements 627.736(9) pgs.231-235
-p.231 I do not understand why an insurer would choose to pay more than required by the statute, or why an insurer would waive or reduce the deductible.
-p.232 I do not understand the 2nd paragraph. PPO plan users can treat wherever they wish, too. And if a PIP claimant uses the network, then the reduced rate will mean more of the 10k to go around, right?
Chapter 10 Pre-Suit Demand Letter 627.736(10) pgs.237-249
-See the chapter outline.
Chapter 11 Insurer's Failure to Pay Claims pgs.251-252.
-Are these provisions part of the insurance code?
Chapter 12 Civil Actions for Insurance Fraud 627.736(12) pgs.253-297.
-p.254 I need more detail on the differences between compensatory and consequential damages. Does compensatory automatically include consequential damages?
-p.255 Are chiropractic and dental services reimbursable under PIP? Answer, p.302. Yes.
-p.255 What is a grand jury report?
-See pgs. 257,258,268 It is only a crime to solicit PIP cases with the intent to defraud. It still may be an ethics violation to solicit legitimate claims.
Chapter 13 Looking to the Future; Possible Increase of the PIP Coverage and Effect of the Repeal and then Re-Adoption of PIP pgs.299-310.
-p.300 How can you choose not to carry PIP coverage?
-p.306 Insurers may reimburse at an amount less than billed. So what happens to the remainder of the bill? Answer, p.308(5). Providers may not attempt to collect from the insured except for amounts not covered due to coinsurance amount or to maximum policy limits.
-p.310 Agreements regarding secure electronic data transfer. This does not apply to submission of documents to the court, right?
Chapter 14 Assignment of Benefits pgs.311-324.
-p.313 Why cannot one assign benefits after suit has been filed for arbitration? See p.314. Re-assignment is a litigation strategy as to who would be the better plaintiff.
-p.322 What is the difference between a written assignment and an equitable assignment?
Chapter 15 Litigation Procedure, Settlement and Appeals p.325-353
-p.331. See p. 338. Ask for attorney's fees in the complaint.
-p.332 Insurers cannot contract to shorten the statute of limitations because Florida statutes are considered part of the insurance contract, right?
-p.337 What does it mean to be issued a 20-day summons? p.339 The summons does not apply to small claims cases.
-p.341 Who is "the department?" The Department of Insurance?
-p.347 Who pays for copies of the IME physicians records? Is it as simple as whomever the requesting party is?
-p.348 What are these terms in the Practitioner's Note?
-p.352 How do you find unpublished circuit court appeals decisions?
Chapter 16 Cancellation of Coverage 627.736(9) pgs.355-378.
-p.361 Class actions have a whole different set of rules.
-p.371 What happens to the replacement policy when the department sides with the insured and orders a reinstatement of the old policy? Just a refund of the premium from the new insurer?
-p.377 What is "the commission?" How is the commission different from "the office" and "the department" mentioned throughout the statute and this book. What are their separate roles and responsibilities?
Chapter 17 Policy Construction and Interpretation pgs.379-395
-p.380 Bad faith actions are not subject to declaratory judgments, right? They are separate COAs and are the fact finder, right?
-p.393 I need more information on Florida's borrowing statute.
Chapter 18 Rehabilitation, Liquidation, and the Florida Insurance Guaranty Association pgs.397-412.
-See the Table of Contents at the beginning of the chapter.
Chapter 19 Crime Victim Compensation pgs.413-417
-p.414 Must there be a conviction before a "crime" has occurred? The form on p.429 does not ask for conviction information that I see.
-p.414 It appears from Chapter 20 that an application for the Crime Victims Compensation Act must be submitted to the Office of the Attorney General, yet the statute says "the department." Who needs to see this application?
Chapter 20 Forms pgs.419-448.
-p.448 What is compounding the consumer price index, as opposed to adjusting it annually?
For this entire book, it is good to go back and read the Practitioner's Notes.
Hopefully, my next entry will be more interesting.
Nathan Marshburn
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