Volume 21

21 Fla. L. Weekly Supp. 195b

Online Reference: FLWSUPP 2102MARPInsurance — Personal injury protection — Coverage — Medical expenses — Policy which provides that insurer will pay 80% of reasonable expenses but limits payment to lesser of amount provided by any fee schedule whether mandatory or permissive as contained in Florida Motor Vehicle No-Fault Law and also provides that insurer may use independent sources of information to determine if medical expenses are reasonable does not unambiguously elect to pay benefits pursuant to section 627.736(5)(a)2-5

21 Fla. L. Weekly Supp. 182a

Online Reference: FLWSUPP 2102GHERInsurance — Personal injury protection — Coverage — Medical expenses — Motion for summary judgment and judicial determination that insurer is obligated to pay 80% of entire medical bill because insurer is barred by stipulation from contesting reasonableness of charges, insurer did not expressly elect permissive statutory fee schedule as reimbursement method in policy, and policy is ambiguous as to whether insurer will pay unreasonable charges is denied — Insurer did not stipulate that it would not challenge reasonableness of charges, and reasonableness was always at issue — Insurer is not required to expressly elect permissive fee schedule as its reimbursement method in policy in order to dispute reasonableness of expenses in excess of that fee schedule — PIP policy is not ambiguous as to insurer’s duty to pay only reasonable charges where one part of policy states that insurer will pay 80% of all medically necessary expenses without mentioning a reasonableness requirement, but another part of policy unambiguously permits insurer to reduce or reject unreasonable charges — Even if policy were ambiguous, PIP statute allows medical providers to recover only reasonable charges

21 Fla. L. Weekly Supp. 285b

Online Reference: FLWSUPP 2103KHVOInsurance — Personal injury protection — Coverage — Medical expenses — Where PIP policy specifically advises insured that any amounts payable shall be subject to any and all limitations authorized by PIP statute, including all fee schedules, policy provided sufficient notice of election to use statutory fee schedule as basis for calculating reimbursement

21 Fla. L. Weekly Supp. 350b

Online Reference: FLWSUPP 21041STInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that clearly subjects payments to any limitations in PIP statute, including all fee schedules, unambiguously elects to limit reimbursement to permissive statutory fee schedule — No merit to argument that insurer is required to incorporate statutory language or specific fee schedules into policy to effectuate election to apply fee schedule limitations

21 Fla. L. Weekly Supp. 336a

Online Reference: FLWSUPP 2104NEWLInsurance — Personal injury protection — Coverage — Medical expenses — Reference in policy to amounts payable being subject to any and all limitations authorized by section 627.736 or any other provisions of No-Fault Law, including fee schedules, does not clearly and unambiguously elect to limit reimbursement pursuant to Medicare Part B fee schedule — No merit to argument that policy may be construed to pay lesser coverage because doing so would benefit insured — Policies are construed according to plain meaning with ambiguities construed against insurer

21 Fla. L. Weekly Supp. 1083a

Online Reference: FLWSUPP 2110BOONInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy providing that insurer will pay 80% of reasonable expenses but also providing that amount payable “shall be subject to any and all limitation” authorized by PIP statute does not provide clear and unambiguous notice of intent to limit reimbursement to Medicare Part B fee schedule

21 Fla. L. Weekly Supp. 1070a

Online Reference: FLWSUPP 2110ALUMInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy providing that insurer will pay 80% of reasonable expenses but also providing that amount payable “shall be subject to any and all limitation” authorized by PIP statute does not provide clear and unambiguous notice of intent to limit reimbursement to Medicare Part B fee schedule

21 Fla. L. Weekly Supp. 1066a

Online Reference: FLWSUPP 2110PALAInsurance — Personal injury protection — Coverage — Medical expenses — Policy that clearly subjects all payments to any limitations of PIP statute, including all fee schedules, unambiguously elects to limit reimbursement to permissive statutory fee schedule — Failure to reference Medicare and inclusion of language regarding payment of reasonable charges does not render policy ambiguous

21 Fla. L. Weekly Supp. 1062a

Online Reference: FLWSUPP 2110RIVEInsurance — Personal injury protection — Coverage — Medical expenses — Divergent judicial opinions from county and circuit courts as to whether policy provision at issue clearly elects to limit reimbursement to permissive statutory fee schedule render policy provision ambiguous per se — Florida Supreme Court’s opinion in Virtual Imaging does not compel finding that policy provision at issue unambiguously elects use of statutory fee schedule — Sufficiency of policy language was never considered in Virtual Imaging opinion, and policy provision at issue here is much broader and open to wider construction than policy language in Virtual Imaging — Policy provision that makes vague references to “any and all limitations…including, but not limited to, all fee schedules” does not unambiguously elect to limit reimbursement to permissive statutory fee schedule

21 Fla. L. Weekly Supp. 1059a

Online Reference: FLWSUPP 2110COLOInsurance — Personal injury protection — Coverage — Medical expenses — Divergent judicial opinions from county and circuit courts as to whether policy provision at issue clearly elects to limit reimbursement to permissive statutory fee schedule render policy provision ambiguous per se — Florida Supreme Court’s opinion in Virtual Imaging does not compel finding that policy provision at issue unambiguously elects use of statutory fee schedule — Sufficiency of policy language was never considered in Virtual Imaging opinion, and policy provision at issue here is much broader and open to wider construction than policy language in Virtual Imaging — Policy provision that makes vague references to “any and all limitations…including, but not limited to, all fee schedules” does not unambiguously elect to limit reimbursement to permissive statutory fee schedule