Volume 21

21 Fla. L. Weekly Supp. 96a

Online Reference: FLWSUPP 2101AGNEInsurance — Personal injury protection — Coverage — Medical expenses — Policy language 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. 686a

Online Reference: FLWSUPP 2107HENDInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy which stated within the limitations of liability paragraphs that insurer would pay 80% of reasonable expenses and provided that amounts payable shall be subject to any and all limitations authorized by PIP statute as enacted, amended or otherwise continued in law, including, but not limited to, all fee schedules does not clearly and unambiguously elect to limit reimbursement to permissive statutory fee schedule — Plaintiff’s contention that policy is insufficient for referencing “all fee schedules” rather than citing Medicare fee schedule is rejected

21 Fla. L. Weekly Supp. 603a

Online Reference: FLWSUPP 2107NEALInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy which states that insurer will pay 80% of reasonable expenses and makes general references to section 627.736 and fee schedules does not clearly and unambiguously elect to limit reimbursement pursuant to Medicare Part B fee schedule

21 Fla. L. Weekly Supp. 75c

Online Reference: FLWSUPP 2101BROWInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that references “applicable fee schedule,” but is devoid of any reference to section 627.736(5)(a)2.f or specific limitations of which insurer intends to avail itself, does not clearly and unambiguously notify insured and medical provider of insurer’s intent to limit reimbursement to permissive statutory fee schedule

21 Fla. L. Weekly Supp. 159a

Online Reference: FLWSUPP 2102MRIInsurance — Personal injury protection — Declaratory action — Coverage — Medical expenses — Policies that provide that insurers will pay PIP claims based on “reasonable” amount and do not mention Medicare fee schedules or other statutory limitations are insufficient to allow insurers to utilize permissive fee schedule methodology of section 627.736(5)(a)2-5 in calculating PIP benefits — Insurers are not allowed to rely on Medicare Outpatient Prospective Payment System to pay less than minimum level under fee schedule methodology

21 Fla. L. Weekly Supp. 586a

Online Reference: FLWSUPP 2106BURTInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy endorsement that specifically states that insurer will pay 80% of schedule of maximum charges contained in section 627.736(5)(A)2 allows insurer to apply permissive statutory fee schedules and limitations

21 Fla. L. Weekly Supp. 925a

Online Reference: FLWSUPP 2109BROWInsurance — Personal injury protection — Coverage — Medical expenses — Policy that provides that insurer may reduce payments to lesser amounts that result from application of fee schedules does not clearly and unambiguously elect to limit reimbursement to permissive statutory fee schedule

21 Fla. L. Weekly Supp. 89a

Online Reference: FLWSUPP 2101YOUNInsurance — Personal injury protection — Coverage — Medical expenses — Where policy cites to permissive statutory fee schedule but allows insurer at its own discretion to choose to reimburse insured according to fee schedule or reimburse reasonable expenses, policy is ambiguous as to reimbursement method for any given claim and does not specifically elect fee schedule method for reimbursement

21 Fla. L. Weekly Supp. 88a

Online Reference: FLWSUPP 2101SIMMInsurance — Personal injury protection — Coverage — Medical expenses — Where policy cites to permissive statutory fee schedule but allows insurer at its own discretion to choose to reimburse insured according to fee schedule or reimburse reasonable expenses, policy is ambiguous as to reimbursement method for any given claim and does not specifically elect fee schedule method for reimbursement

21 Fla. L. Weekly Supp. 434a

Online Reference: FLWSUPP 2105DELGInsurance — Personal injury protection — Coverage — Medical expenses — Insurer’s failure to unambiguously elect permissive payment methodology of section 627.736(5)(a)2. in its policy prevents insurer from limiting reimbursement based on Medicare Part B fee schedule