24 Fla. L. Weekly Supp. 823a
Online Reference: FLWSUPP 2410FOSTInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that provides that insurer will pay 80% of all reasonable medical expenses, considering any and all limitations authorized by section 627.736, and further states that applicable fee schedule or payment limitation shall be under the permissive payment methodology clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule
CHIROPRACTIC & REHABILITATION, P.A., a/a/o Harry Foster, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 2015-SC-1723, Division N. October 28, 2016. Gary P. Flower, Judge.
ORDER ON CROSS-MOTIONS FORSUMMARY JUDGMENT
The sole issue before the Court on the Parties’ cross-motions for Summary Judgment in this PIP case is whether Defendant, in its insurance policy, gave proper notice of its election to limit payments for medical services based on Medicare fee schedules.
Interpreting a prior version of the statute, the Supreme Court held that PIP insurers must “clearly and unambiguously elect the permissive [i.e., Medicare-based] payment methodology in order to rely on it.” Geico Gen. Ins. Co. v. Virtual Imaging Servs., Inc., 141 So. 3d 147, 158 (Fla. 2013) [38 Fla. L. Weekly S517a]. After that decision, however, the legislature amended the PIP statute to modify the notice required by an insurer. Under the current version of Section 627.736(5)(a)5, Fla. Stat., an insurer is only required to provide notice that it may utilize the Medicare fee schedules to reduce payments.
In Allstate Fire & Casualty Ins. Co. v. Stand-Up MRI of Tallahassee, P.A., 188 So. 3d 1, (Fla. 1st DCA 2015) [40 Fla. L. Weekly D693b], the First District was called upon to construe the following language:
In accordance with the Florida Vehicle No-Fault Law, [the Insurer] will pay to or on behalf of the injured person the following benefits. . . [E]ighty percent of reasonable expenses for medically necessary . . . services . . . Any amounts payable under this coverage shall be subject to any and all limitations, authorized by section 627.736, or any other provisions of the Florida Motor Vehicle No-Fault Law, as enacted, amended or otherwise continued in the law, including but not limited to, all fee schedules.
The First District held that this language gave sufficient notice of the insurer’s election to limit payments for medical services based on Medicare fee schedules.
The policy at hand provides that the Defendant will pay 80% of all reasonable medical expenses, considering any and all limitations authorized by Section 627.736, Fla.Stat. and further says that applicable fee schedule or payment limitation under shall be under the permissive payment methodology. This language is not distinguishable from that approved in Stand-Up MRI of Tallahassee, supra. Defendant made and gave sufficient notice to limit payments for medical services based on the permissive methodology. Thus, using the operative notice standard contained in the 2012 amendment to Fla. Stat. Section 627.736(5)(a)2-5, this Court finds the policy at issue gave satisfactory notice of electing to utilize the Medicare fee schedules for repayment purposes.
Therefore, Defendant’s Motion for Summary Judgment is GRANTED. Plaintiff’s Cross Motion for Summary Judgment is DENIED.
