24 Fla. L. Weekly Supp. 863a

Online Reference: FLWSUPP 2410BACAInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy providing that insurer will pay 80% of reasonable charges and also providing that in no event will insurer pay more than 80% of No-Fault Act schedule of maximum charges does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule — Approval of PIP 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

MANUEL V. FEIJOO, M.D., & MANUEL V. FEIJOO, M.D., P.A., a/a/o Josefina Bacallao, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 15-2825 SP 25 (3). November 30, 2016. Patricia Marino Pedraza, Judge. Counsel: Kenneth B. Schurr, for Plaintiff. Rachel Minetree, for Defendant.

ORDER DENYING DEFENDANT’S MOTION FORSUMMARY JUDGMENT REGARDINGTHE 9810A POLICY LANGUAGE

THIS CAUSE came before the Court on November 21, 2016 at 9:30 a.m. for hearing on the Defendant’s Motion for Summary Judgment regarding the sufficiency of its 9810A policy language, and the Court having reviewed the motion, the subject policy, the entire court file, the relevant legal authorities, and the Court having heard argument of counsel and having been sufficiently advised in the premises, this Court finds as follows:

Background: This case involves a relatively narrow issue: Whether State Farm’s insurance policy form 9810A complies with the requirements of Florida law entitling it to limit its Personal Injury Protection (PIP) medical bill reimbursements to 200% of the Medicare Part B fee schedule.

The Plaintiff, as the assignee of the insured patient’s PIP benefits, filed suit to recover unpaid PIP benefits claimed due and owing from the Defendant. Plaintiff submitted bills to State Farm totaling $1,675 for medical services arising out of an automobile accident in which the insured patient was injured. Rather than paying 80% of the claimed medical expenses (i.e. $1,340), State Farm paid just $878.79, which represents 80% of 200% of the Medicare Part B fee schedule, also known as the schedule of maximum charges set forth in Florida Statute §627.736(5)(a)(l) (2013).

The Plaintiff seeks to recover the difference between 80% of the amount it billed, and the amount that was already paid by State Farm. The Plaintiff contends that State Farm did not specifically and unambiguously elect the Medicare fee schedule methodology and as a result Defendant was required to process the Plaintiff’s bills under the “reasonable amount” methodology set forth in Florida Statute §627.736(5)(a)(2013).

The Policy: On February 6, 2012, State Farm submitted its 48-page insurance policy form 9810A to the Office of Insurance Regulation (“OIR”) for approval as required by law before any insurance policy may be sold in the State of Florida. See, Fla. Stats. 627.410, 627.411, and 627.4145. State Farm contends the OIR’s approval of its 9810A policy form is conclusive proof that State Farm correctly elected the Medicare fee schedule reimbursement methodology in its policy.

State Farm’s 9810A policy contains several provisions relevant to this inquiry. First, on page 14 of the policy, under “Insuring Agreement,” the State Farm policy states, in pertinent part:

We will pay in accordance with the No-Fault Actproperly billed and documented reasonable charges for bodily injury to an insured . . . .”

(Emphasis in original).

Then, at pages 15-16 of the 9810A policy, State Farm includes a section under the heading: “Limits” which provides, in pertinent part as follows:

1. We will not pay any charge that the No-Fault Act does not require us to pay, or the amount of any charge that exceeds the amount the No-Fault Act allows to be charged.

2. The most we will pay for each injured insured as a result of any one accident is $10,000 for all combined Medical Expenses, Income Loss, and Replacement Services Loss, described in the Insuring Agreement of this policy’s No-Fault Coverage.

* * *

Wewill limit payment of Medical Expenses described in the Insuring Agreement of this policy’s No-Fault Coverage to 80% of a properly billed and documented reasonable charge, but in no event will we pay more than 80% of the following No-Fault Act “schedule of maximum charges” including the use of Medicare coding policies and payment methodologies of the federal Centers for Medicare and Medicaid Services, including applicable modifiers:

* * *

d. For all other medical services, supplies, and care, 200 percent of the allowable amount under:

(I) The participating physicians fee schedule of Medicare Part B, . . . .

(Emphasis in original).

However, the inquiry does not end there. The State Farm 9810A policy at pages 14-16 repeatedly refers to the phrase “Reasonable Charges,” which is a term of art defined by the policy at page 5 as follows:

Reasonable Charge,which includes reasonable expense, means an amount determined by us to be reasonable in accordance with the No-Fault Act, considering one or more of the following:

1. usual and customary charges;

2. payments accepted by the provider;

3. reimbursement levels in the community;

4. various federal and state medical fee schedules applicable to motor vehicle and other insurance coverages;

5. the schedule of maximum charges in the No-Fault Act;

6. other information relevant to the reasonableness of the charge for the service, treatment, or supply; or

7. Medicare coding policies and payment methodologies of the federal Centers for Medicare and Medicaid Services, including applicable modifiers, if the coding policy or payment methodology does not constitute a utilization limit.

(Emphasis in original).

Five of the foregoing seven “reasonable charge” factors track the factors to be considered by an insurance carrier when opting to pay PIP medical bills pursuant to the default payment methodology found in Fla. Stat. 627.736(5)(a)(2013), commonly known as the “reasonableness” methodology. By opting to include these fact-dependent factors in its definition of a “reasonable charge”, while also attempting to reimburse pursuant to the “permissive” Medicare fee schedule payment methodology, the Defendant impermissibly commingled the mandatory payment method set forth in Fla. Stat. 627.736(5)(a)(2013) with the permissive payment method found in Fla. Stat. 627.736(5)(a)(1)(2013). Such commingling runs afoul of the mandates set forth by the Florida Supreme Court in Geico v. Virtual Imaging, 141 So. 3d 147 (Fla. 2013) [38 Fla. L. Weekly S517a]. However, when an insurance company properly amends its policy to reimburse pursuant to the “permissive” Medicare payment methodology, the fact-dependent factors set forth in Fla. Stat. 627.736(5)(a) are irrelevant because the “reasonableness” of a submitted charge is no longer a factor and the reimbursement amount is defined exclusively by the Medicare fee schedule method, and not via the seven ‘reasonableness’ factors listed above, and on page 5 of the subject policy.

Defendant argued that it included the seven “reasonableness” factors in its definition section of the 9810A policy (at page 5) because it wanted to provide a reimbursement method for medical services and care which were not recognized by, nor payable under, the Medicare fee schedule method.¹ This suggests to the Court that State Farm is attempting use both payment methodologies. If the “reasonable charge” is less than 200% of the Medicare fee schedule, then State Farm will pay only the lesser amount. If, however, the charge exceeds 200% of Medicare fee schedule, then State Farm will cap its payment by using the 200% of Medicare fee schedule calculation method. Otherwise, the language found at page 5 of the policy would be mere surplusage, which is discouraged when construing policies of insurance. See Price v. Home Ins. Co. of the Carolinas, 100 Fla. 338, 344-459, 129 So. 748, 751 (1930). In construing insurance policies, the courts should read the policy as a whole, endeavoring to give every provision its full meaning and operative effect. See Auto-Owners Ins. Co. v. Anderson, 756 So. 2d 29 (Fla. 2000) [25 Fla. L. Weekly S211a]. The question then becomes whether a PIP insurer is entitled to include in its policy both payment methodologies, to wit: Fla. Stat. 627.736(5)(a) and (5)(a)(1).

The Florida Supreme Court’s ruling in Virtual Imaging Service, Inc. is controlling on this issue. In Virtual Imaging, the Court concluded that an insurer was required to give notice to its insured by making a specific and unambiguous election in its policy that it has chosen one payment method to the exclusion of the other payment method before it can take advantage of the Medicare fee schedule payment methodology to limit reimbursements. Specifically, the Florida Supreme Court found that there are two reimbursement methods permitted under the PIP statute, and that the PIP statute “offered insurers a choice in dealing with their insureds as to whether to limit reimbursements based on the Medicare fee schedules, or whether to continue to determine the reasonableness of provider charges for necessary medical services rendered to a PIP insured based on the “reasonableness” factors enumerated in section 627.736(5)(a)(l)” (now known as 627.736(5)(a)(2013)) ² . Consistent with Kingsway Amigo Ins. Co. v. Ocean Health, Inc., 63 So.3d 63, 67 (Fla. 4th DCA 2011) [36 Fla. L. Weekly D1062a], a PIP insurer must give notice and elect the Medicare fee schedule methodology in its policy if it wants to avail itself of it. The Florida Supreme Court further held that “a PIP insurer cannot take advantage of the Medicare fee schedules to limit reimbursements without notifying its insured by electing the fee schedule in its policy.” This election must be done in a “clear and unambiguous” manner. Virtual Imaging, supra. In this Court’s opinion, the question is whether State Farm has left its choice in “limbo.” See Orthopedic Specialists (Serridge) v. Allstate Ins. Co., 177 So. 3d 19, 25-26 (Fla. 4th DCA 2015) [40 Fla. L. Weekly D1918a].

Clearly, State Farm is attempting to have its cake and eat it too. State Farm is attempting to leave itself the option of choosing a “reasonableness” option when it is to its advantage, and choosing the Medicare “permissive” methodology if this option would result in a lower reimbursement. In its 9810A policy form, State Farm did not choose one payment method to the exclusion of the other payment method. Instead, State Farm gave itself both options to use whenever it chose to do so, in violation of Virtual Imaging.

Pursuant to the decisional law interpreting the two alternate payment methodology provisions of the PIP statute, an insurer cannot do what State Farm is attempting to do. An insurer must elect one of the two options in a clear and unambiguous manner in its policy. See, Ortho Specialists (Serridge). In policy form 9810A, State Farm failed to make a specific and unambiguous Medicare Part B fee schedule election in its policy to the exclusion of the alternate payment methodology (i.e. the “reasonableness” methodology). In fact, a specific and unambiguous Medicare Part B fee schedule election contained in a policy would provide clarity to the provider regarding balance billing because a provider is prohibited from balance billing the insured patient if the policy contains a Medicare fee schedule election. If there is no Medicare fee schedule election, then the provider is free to balance bill the patient. Additionally, there are countless medical services and modalities that are payable under the fact-dependent “reasonableness” methodology of Fla. Stat. 627.736(5)(a), but which would not be compensable if the policy contained a clear and unambiguous Medicare Part B fee schedule election pursuant to Fla. Stat. 627.736(5)(a)(1). State Farm may avail itself of various other CMS coding policies and payment methodologies if it properly elected the Medicare fee schedule method, but it may not do so if it elected the reasonable amount method³. For State Farm to be allowed, after the fact, to pick and choose which “limitation” amongst “any and all limitations” would render the Supreme Court’s ruling in Virtual Imaging meaningless. See, Ortho Specialist (Serridge).

In this regard, the Court agrees with the well-reasoned decisions in the cases of Pain and Injury Relief of Lake Worth (a/a/o Evener Deronvil) v. State Farm Fire and Casualty Company, Case No.: 2015-2819 COCE (53) (Broward County Court, March 30, 2016) [23 Fla. L. Weekly Supp. 1087a], Lee, J. (State Farm’s 9810A policy form fails to make a specific and unambiguous Medicare Part B fee schedule election limiting its PIP reimbursements) as well as the decision in Rembrandt Mobile a/a/o Cepero v. State Farm Mut. Auto. Ins. Co. Case No.: 15-1657 SP 24 (Miami-Dade County Court, April 20, 2016), Cannava, J. (same). This Court also reviewed and relied on the dozens of other decisions reaching the same conclusions on similar analysis.⁴

Furthermore, in assessing State Farm’s 9810A policy language at issue, this court also referred to the Black’s Law Dictionary definition of “unambiguous” which is defined as “susceptible of but one meaning.” By way of example, if the question is: ‘Does State Farm’s policy elect Option A or Option B?’, this court opines that an unambiguous answer (which is susceptible to just one meaning) would be “Option A” or, “Option B”. An answer such as ‘Option AB” or “Option A and Option B” would be ambiguous because it is susceptible to two or more reasonable interpretations.

State Farm next argues that the deficiencies caused by its hybrid method are cured by the Office of Insurance Regulation’s (“OIR”) “approval” of its 9810A policy pursuant to Fla. Stat. § 627.736(5)(a)5. However, This Court rejects State Farm’s argument that the OIR’s approval of its 9810A policy entitles it to claim the safe harbor provided in Florida Statute §627.736(5)(a)(5).

In 2012, the Legislature amended Florida Statute §627.736(5)(a)(5) to provide as follows:

Effective, July 1, 2012, an insurer may limit payment as authorized by this paragraph only if the insurance policy includes a notice at the time of issuance or renewal that the insurer may limit payment pursuant to the schedule of charges specified in this paragraph. A policy form approved by the office satisfies this requirement. If a provider submits a charge for an amount less than the amount allowed under subparagraph 1., the insurer may pay the amount of the charge submitted.

(Emphasis added).

State Farm argues it received the necessary approval to apply and pay pursuant to the “permissive” Medicare fee schedule methodology when the OIR stamped the word “APPROVED” on top of each of the 48 pages of the policy on October 5, 2012. However, there is nothing in either State Farm’s submission to the OIR, nor in the OIR’s response to State Farm, asserting that the reason for the OIR’s approval was State Farm’s proper election of the “permissive” Medicare payment methodology provided for in Fla. Stat. 627.736(5)(a)(1). In fact, a finding that a policy has clearly, unambiguously, and properly elected the permissive Medicare payment method provided for by Florida statute clearly calls for a legal conclusion, and the OIR does not make legal findings.

This Court finds that the “. . .policy form approved by the OIR. . .” as referenced in Fla. Stat. 627.736(5)(a)(5) is actually the form prepared by the OIR and attached to the OIR’s Informational Memorandum 12-02M and that form simply provided insurers with the OIR’s proposed text for an approved Medicare Part B fee schedule endorsement. The OIR’s proposed and approved Medicare Part B policy form endorsement (attached to OIR’s 12-02M Informational Memorandum) notably included a disclaimer, which stated: “Ultimately, it is the insurer’s responsibility to develop its own language after researching the law, reviewing its contract forms and conferring with its legal staff.”

Merely stating that a policy is “APPROVED,” as is the situation in the instant case, does not result in a finding that the OIR is approving a limitation on payment to the Medicare fee schedules when the policy obviously includes language pertaining to both the “reasonableness” fact-based methodology, and the separate “200% of Medicare fee schedule” methodology. Otherwise, any policy stamped “APPROVED,” without more, would result in a finding that the insurer has properly invoked the Medicare fee schedule limitations, even if an insurer decided to include the traditional “reasonableness” analysis or exclusively use the “reasonableness” method because it finds it more advantageous. As an aside, this Court notes that no insurer may sell an insurance policy in the state of Florida until it is first ‘approved’ by the OIR. See, Fla. Stat. 627.410, 627.411, and 627.4145, which mandates that all proposed insurance policies be submitted to the OIR, and they must pass the statutory readability requirements. According to State Farm’s logic, every policy that is ‘approved’ by the OIR would necessarily and automatically incorporate the Medicare fee schedules once “approved.” This is clearly not the result the Legislature intended. By way of example, the Allstate insurance policy deemed ambiguous by the 4th DCA in Ortho Specialist (Serridge), supra, was stamped “approved” as was the Geico policy at issue in Virtual Imaging, supra.

This Court finds that the OIR’s ‘approval’ of the 9810A policy was simply the OIR indicating that the subject policy satisfied Fla. Stat. 627.4145 readability requirements, and that it does not demonstrate compliance with all statutory and common law requirements regarding a specific and unambiguous Medicare Part B fee schedule election required by Virtual Imaging.

If this Court were to presume that the OIR’s “approval” of the policy authorized State Farm to utilize both the reasonableness method and the Medicare fee schedule payment methodologies, then this Court would have jurisdiction to review the policy to ensure that it “. . .does not conflict with the plain and ordinary intent of the law.” Florida Farm Bureau Casualty Ins. Co. v. State of Fla., Office of Insurance Regulation, 109 So.3d 860, 861 (Fla. 1st DCA 2013) [38 Fla. L. Weekly D597b]. (An agency’s construction of the statute receives judicial deference if it falls within the permissible range of interpretations, and does not conflict with the plain and ordinary intent of the law).

Contrary to Defendant’s assertions, even if the doctrine of “primary jurisdiction” is applicable to this matter (which it is not), the doctrine does not divest this court of jurisdiction to review the policy at issue for legal sufficiency and such an assertion may raise issues regarding the separation of powers. See, e.g., Askew v. Cross Key Waterways, 372 So. 2d 913, 924 (Fla. 1978); State. Bender, 382 So. 2d 697, 700 (Fla. 1980).

In the context of a different chronology of events than the matter before this Court, the doctrine of “primary jurisdiction” may allow a Court to postpone or suspend judicial determination regarding the legal sufficiency of the policy until after an initial decision on the policy is issued by the OIR. See Flo-Sun v. Kirk, 783 So.2d 1029 (Fla. 2001) [26 Fla. L. Weekly S189a]; Hill Top Developers v. Holiday Pines Service Corp., 478 So.2d 368 (Fla. 2d DCA 1985). In this case, the OIR has issued a decision “approving” the policy at issue as evidenced by its stamp, and this Court is empowered with the authority and jurisdiction to review the policy to ensure that it is in compliance with the law.

Finally, the argument that the OIR’s “approval” permits an insurer to utilize a policy that contains provisions which are in conflict with the statutory requirements was summarily rejected by the Third District Court of Appeal in Gonzalez v. Associates Life Insurance Company, 641 So.2d 895 (Fla. 3d DCA 1994), where the court made it clear that mere ‘approval’ by the Department of Insurance (OIR’s predecessor agency) does not automatically validate the contents of an insurance policy:

Associates Life argues that because the Department of Insurance pre-approved the form of the policy issued here, we should affirm. Regardless of what deference we should accord the Department’s determination, we find as a matter of law, its approval of the policy form in this case was clearly erroneous, and that reversal is required.

Again, in Kaufman v. Mutual of Omaha Ins. Co., 681 So.2d 747, (Fla. 3d DCA 1996) [21 Fla. L. Weekly D1716b] the Third District Court of Appeal stated that the Department of Insurance’s approval of a policy form does not override the explicit terms of a statutory requirement.

For these reasons, this Court rejects the Defendant’s argument that the OIR’s “approval” of the policy form at issue permits the insurer to utilize a policy that is in direct conflict with the law.

Accordingly, this Court finds that State Farm’s 9810A policy language is ambiguous and that it fails to make a specific and unambiguous Medicare Part B fee schedule election and instead the policy creates an improper hybrid between the two alternative payment methodologies. Accordingly, it is hereby:

ORDERED and ADJUDGED that the Defendant’s Motion for Partial Summary Judgment is DENIED and Plaintiff’s Motion is GRANTED.

__________________

¹Pursuant to Fla. Stat. 627.736(5)(a)(1)(2013), the insurer is not required to pay for services or care that is not payable by Medicare, or workers comp.

²The PIP statute that went into effect on Jan. 1, 2013 renumbered various sections that appeared in the Jan. 1, 2008 version of the statute so that 627.736(5)(a)(1)(2008) and 627.736(5)(a)(2)(2008) were renumbered and now appear as 627.736(5)(a)(2013) and 627.736(5)(a)(1)(2013).

³Fla. Stat. 627.736(5)(a)3. states that “subparagraph 1. [the Medicare fee schedule method] does not prohibit an insurer from using the Medicare coding policies and payment methodologies of the federal Centers for Medicare and Medicaid Services, including applicable modifiers, to determine the appropriate amount of reimbursement for medical services, supplies, or care if the coding policy or payment methodology does not constitute a utilization limit.” This is permissive language; a PIP insurer may therefore only take advantage of these further limitations if and only if (a) it clearly and unambiguously elected the Medicare fee schedule method to the exclusion of the reasonable amount method; (b) it clearly and unambiguously elected the specific CMS payment methods and coding policies it intends to use; (c) the allowed amount is not less than the statutory floor; and (d) the CMS payment methodologies and coding policies are not utilization limits.

⁴ Quality Med. Group, Inc., a/a/o Christle Murphy v. State Farm Mut. Auto. Ins. Co., Case No.: 14-3904 SP 05 (04) (Miami-Dade County Court, October 12, 2015) [23 Fla. L. Weekly Supp. 853a], Simon, J. (State Farm’s 9810A policy form fails to make a specific and unambiguous Medicare Part B fee schedule election limiting its PIP reimbursements); Neurology Partners, P.A. d/b/a Emas Spine & Brain a/a/o Dawn Beals v. State Farm Mutual Automobile Insurance Company, 23 Fla. L. Weekly Supp. 833a (Duval County Court, December 3, 2015), Shore, J. (same); Dr. Rubin Thompson, D.C. a/a/o Soilnestes v. State Farm Mut. Auto. Ins. Co., Case No.: 14-12640 SP 05 (01) (Miami-Dade County Court, December 7, 2015), Kravitz, J. (same); Crespo and Assoc. a/a/o Rondon, State Farm Mut. Auto. Ins. Co. Case No.: 15-CC-0001357 (Hillsborough County Court, December 18, 2015) [23 Fla. L. Weekly Supp. 982b], Perrone, J. (same); First Coast Medical Center a/a/o Kevin Adams v. State Farm Mutual Automobile Insurance Company, Case No.: 2014-SC 03619 (Duval County Court, January 15, 2016) [23 Fla. L. Weekly Supp 943a], Hudson, J. Florida Emergency Physicians Kang & Associates, M.D., P.A., a/a/o Jonathan Sias v. State Farm Mutual Automobile Insurance Company, Case No.: 2014-SC-9502-O (Orange Cty Court, Feb. 10, 2016) [23 Fla. L. Weekly Supp. 1052a], Jewett, J. (same). DNA Center, LLC a/a/o Helen Roy v. State Farm Mutual Automobile Insurance Company, Case No.: 2015-021342-CONS (Volusia County Court, February 24, 2016) [23 Fla. L. Weekly Supp. 1043a], Green, J. (same); Theramed, LLC d/b/a Theramed Medical Clinics a/a/o Petrine Stanley v. State Farm Mutual Automobile Insurance Company, Case No,: 2015-SC-004069 (Duval County Court, February 25, 2016) [23 Fla. L. Weekly Supp. 1038a], Derke, J. (same); Pain and Injury Relief of Lake Worth (a/a/o Evener Deronvil) v. State Farm Fire and Casualty Company, Case No.: 2015-2819 COCE (53) (Broward County Court, March 30, 2016) [23 Fla. L. Weekly Supp. 1087a], Lee, J. (same); New Life Medical and Rehab Center, Inc., a/a/o Martinez Francisco J v. State Farm Mutual Automobile Insurance Company, Case No.: 2014-05263 SP 05 (Miami-Dade County Court, April 6, 2016), Simon, J. (same); Neurology Partners d/b/a Emas Spine & Brain Specialists a/a/o Lauren Rizzi v. State Farm Mut. Auto. Ins. Co., Case No.: 2015-SC-001816 CC-J (Duval County Court, April 12, 2016) [24 Fla. L. Weekly Supp. 618a], Derke, J. (same); Ceda Health of South Miami LLC a/a/o Lagos v. State Farm Mut. Gen. Ins. Co., Case No.: 14-1787 CC 25 (Miami-Dade County Court, April 19, 2016), Marino-Pedraza, J. (same); Argyle Chiropractic a/a/o Renella v. State Farm Mut. Auto. Ins. Co., Case No.: 16-2015-SC-157 MA (CC-M) (Duval County Court, April 20, 2016) [24 Fla. L. Weekly Supp. 619b], Floyd, J. (same); Rembrandt Mobile a/a/o Cepero v. State Farm Mut. Auto. Ins. Co. Case No.: 15-1657 SP 24 (Miami-Dade County Court, April 20, 2016), Cannava, J. (same); Pompano Spine Center a/a/o Ifautane Similien v. State Farm Mut. Auto. Ins. Co., Case No.: COCE 15-005621 (54) (Broward County Court, April 25, 2016) [24 Fla. L. Weekly Supp. 253a], DiPietro, J. (same); Ceda Health a/a/o Elio Serra v. State Farm Mut. Auto. Ins. Co., Case No.: COCE 14-005314 (Broward County Court, April 29, 2016) [24 Fla. L. Weekly Supp 81a], Zaccor, J. (same); Ceda Ortho. & Interventions Med. of FIU/Kendall, LLC a/a/o Rosa Moya v. State Farm Mut. Auto. Ins. Co., 23 Fla. L. Weekly Supp. 565a (Miami-Dade County Court, October 8, 2014), Cannava, J. (Policy failed to make a specific and unambiguous Medicare fee schedule election); Neurology Partners, P.A. D/B/A Emas Spine & Brain a/a/o Willie Brown v. State Farm Mutual Automobile Insurance Company, 23 Fla. L. Weekly Supp. 550a (Duval County Court, July 28, 2015), Mitchell, J. (Policy failed to make a specific and unambiguous Medicare fee schedule election).