Volume 23

23 Fla. L. Weekly Supp. 1055a

Online Reference: FLWSUPP 2310MUSUInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that provides that insurer will pay lesser of 80% of actual charge or 80% of schedule of maximum charges contained in section 627.736(5)(a)2 clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

23 Fla. L. Weekly Supp. 487a

Online Reference: FLWSUPP 2305HARRInsurance — 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 limitations” authorized by PIP statute does not provide clear and unambiguous notice of intent to limit reimbursement to Medicare Part B fee schedule

23 Fla. L. Weekly Supp. 481a

Online Reference: FLWSUPP 2305ALVAInsurance — 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 limitations” authorized by PIP statute does not provide clear and unambiguous notice of intent to limit reimbursement to Medicare Part B fee schedule

23 Fla. L. Weekly Supp. 154a

Online Reference: FLWSUPP 2302LEVIInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that states that insurer will pay 80% of the rate of schedule of maximum charges pursuant to No-Fault Law and references Medicare, workers’ compensation, and No-Fault Law schedule clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

23 Fla. L. Weekly Supp. 772a

Online Reference: FLWSUPP 2307TLEWInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that subjects payments to applicable fee schedules and states that methodology for determining amount insurer will pay shall be limited to 80% of 200% of Medicare Part B fee schedule or to 80% of maximum reimbursable allowance under workers’ compensation if item is not reimbursable under Medicare Part B clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

23 Fla. L. Weekly Supp. 637b

Online Reference: FLWSUPP 2306WHITInsurance — 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 limitations” authorized by PIP statute does not provide clear and unambiguous notice of intent to limit reimbursement to Medicare Part B fee schedule — Fact that policy was approved by Office of Insurance Regulation does not compel finding that policy correctly invokes fee schedule limitations where there is nothing in insurer’s submission to OIR or in OIR’s response to indicate that OIR is approving policy language as election to limit reimbursement to fee schedule

23 Fla. L. Weekly Supp. 793b

Online Reference: FLWSUPP 2307BAPTInsurance — Personal injury protection — Coverage — Medical expenses — Both applicable 2013 version of PIP statute and amendatory endorsement to PIP policy allow insurer to apply Medicare Part B fee schedules and Outpatient Prospective Payment System cap to calculate reimbursement of claim

23 Fla. L. Weekly Supp. 1087a

Online Reference: FLWSUPP 2310DEROInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy providing that insurer will pay 80% of reasonable expenses but 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 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 where it is not clear from insurer’s letter requesting approval or OIR’s letter of approval that OIR was approving language as election to limit payment pursuant to fee schedule

23 Fla. L. Weekly Supp. 1052a

Online Reference: FLWSUPP 2310SIASInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that gives insurer unbridled discretion to consider various factors found in reasonable amount method of reimbursement and in permissive fee schedule method of reimbursement does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule — Approval by Office of Insurance Regulation does not validate policy

23 Fla. L. Weekly Supp. 1043a

Online Reference: FLWSUPP 2310ROYInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that gives insurer unbridled discretion to consider various factors found in reasonable amount method of reimbursement and in permissive fee schedule method of reimbursement does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule — Approval by Office of Insurance Regulation does not validate policy and notice or render them invulnerable to judicial invalidation