Volume 17

17 Fla. L. Weekly Supp. 1227b

Online Reference: FLWSUPP 1712TEP

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Where Medicare Part B participating physicians fee schedule is only fee schedule specifically identified in PIP statute, that schedule and not Medicare’s Hospital Outpatient Prospective Payment System fee schedule should be used by insurers when calculating payment for MRI services under PIP statute

17 Fla. L. Weekly Supp. 1110a

Online Reference: FLWSUPP 1711POWE

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — PIP statute does not authorize insurer to utilize Medicare’s Hospital Outpatient Prospective Payment System limitations or any other limitations not expressly described in PIP statute when determining amounts due for MRI services provided to PIP insured in non-emergency, non-hospital setting since January 1, 2008

17 Fla. L. Weekly Supp. 194b

Online Reference: FLWSUPP 1703BRAV

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Requirement that insurer pay “allowable amount” under Medicare Part B participating physicians fee schedule allows insurer to apply Outpatient Prospective Payment System cap which is expressly incorporated into “allowable amount” under fee schedule

17 Fla. L. Weekly Supp. 46a

Online Reference: FLWSUPP 1701BARA

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Requirement that insurer pay “allowable amount” under Medicare Part B participating physicians fee schedule does not require insurer to pay full or highest amount listed under fee schedule for MRI — Insurer may pay lesser amount calculated under fee schedule pursuant to Outpatient Prospective Payment System

17 Fla. L. Weekly Supp. 1039a

Online Reference: FLWSUPP 1710AQU2

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — PIP insurer cannot pay benefits in accordance with permissive fee limitations of 2008 version of PIP statute where policy language requires payment of 80% of reasonable charges — PIP statute does not authorize insurer to utilize Medicare’s Outpatient Prospective Payment System to calculate permissive limitations

17 Fla. L. Weekly Supp. 855b

Online Reference: FLWSUPP 1709HARR

Insurance — Personal injury protection — Coverage — Medical expenses — MRI — Insurer’s motion for summary judgment on ground that provider failed to render services/engaged in illegal patient broker and/or fee splitting and billed in excess of amounts permitted by statute denied

17 Fla. L. Weekly Supp. 1124b

Online Reference: FLWSUPP 1711LAMO

Insurance — Personal injury protection — Coverage — Where policy issued after enactment of 2008 version of PIP statute provides that insurer will pay 80% of reasonable expenses for medical services and does not indicate that insurer was going to limit reimbursement to 200% of allowable amount under Medicare fee schedule as permitted by 2008 statute, policy terms control reimbursement

17 Fla. L. Weekly Supp. 697a

Online Reference: FLWSUPP 1708FENN

Insurance — Personal injury protection — Coverage — Policy issued during statutory gap period — Where PIP policy was executed during statutory gap period when there was no PIP statute, policy language requiring that insurer pay 80% of medical expenses controls reimbursement — Policy language stating that insurer “will pay in accordance with No-Fault Act” is meaningless or ambiguous where at time of policy inception there was no Florida Motor Vehicle No-Fault Act in effect

17 Fla. L. Weekly Supp. 686a

Online Reference: FLWSUPP 1708VOLP

Insurance — Personal injury protection — Coverage — Where language of PIP policy which expressly states that insurer will pay 80% of reasonable expenses is not in conflict with 2008 PIP statute allowing insurer to pay in accordance with Medicare fee schedule, policy language controls reimbursement

17 Fla. L. Weekly Supp. 685a

Online Reference: FLWSUPP 1708GABL

Insurance — Personal injury protection — Coverage — Where provision of 2008 PIP statute allowing insurer to limit reimbursement to 80% of 200% of Medicare fee schedule is permissive, policy language providing that insured will pay 80% of reasonable expenses controls reimbursement