Volume 23

23 Fla. L. Weekly Supp. 1038a

Online Reference: FLWSUPP 2310STANInsurance — 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 or use of OIR sample form does not constitute per se compliance with requirement that policy provide unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule

23 Fla. L. Weekly Supp. 982b

Online Reference: FLWSUPP 2309RONDInsurance — Personal injury protection — Coverage — Medical Expenses — Where definition of “reasonable charge” in PIP policy is hybrid of factors found in reasonable amount method of reimbursement and provisions from fee schedule method of reimbursement, policy is ambiguous as to reimbursement method and did not specifically elect fee schedule method of reimbursement

23 Fla. L. Weekly Supp. 853a

Online Reference: FLWSUPP 2308MURPInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that includes fact-dependent factors in one policy endorsement and tracks Office of Insurance Regulation’s sample fee schedule endorsement language in second conjunctive endorsement commingles payment methodologies and does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule

23 Fla. L. Weekly Supp. 550a

Online Reference: FLWSUPP 2306BROWInsurance — Personal injury protection — Coverage — Medical expenses — Neither approval of PIP policy by Office of Insurance Regulation, nor use of OIR sample language in policy constitutes per se compliance with requirement that policy provide unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule — PIP policy that includes fact-dependent factors in its definition of “reasonable charge” while also attempting to reimburse in accordance with statutory fee schedule commingles payment methodologies and does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule

23 Fla. L. Weekly Supp. 880a

Online Reference: FLWSUPP 2308WEBEInsurance — Personal injury protection — Coverage — Medical expenses — Policy endorsement providing that any and all amounts payable “shall be subject to any and all limitations authorized by section 627.736… or any other provisions of Florida Motor Vehicle No-Fault Law, … including, but not limited to, all fee schedules” does not make it clear whether insurer is actually electing to limit its reimbursement to Medicare fee schedule or is simply reserving right to elect to do so — Letter from Office of Insurance Regulation approving endorsement does not make endorsement a clear and specific election of fee schedule

23 Fla. L. Weekly Supp. 833a

Online Reference: FLWSUPP 2308BEALInsurance — Personal injury protection — Coverage — Medical expenses — Neither approval of PIP policy by Office of Insurance Regulation, nor use of OIR sample language in policy constitutes per se compliance with requirement that policy provide unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule — PIP policy that includes fact-dependent factors in its definition of “reasonable charge” while also attempting to reimburse in accordance with statutory fee schedule commingles payment methodologies and does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule — Requirement of clear and unambiguous notice of election to use statutory fee schedule enunciated by Florida Supreme Court in Virtual Imaging relative to 2008 version of PIP statute is equally applicable to 2012 amendments to PIP statute

23 Fla. L. Weekly Supp. 776a

Online Reference: FLWSUPP 2307HAZLInsurance — 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 permissive statutory fee schedule — Approval of policy endorsement 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. 775a

Online Reference: FLWSUPP 2307PADRInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy does not provide clear and unambiguous notice of intent to limit reimbursement to Medicare fee schedule — Insurer waived argument that policy language has been approved by Office of Insurance Regulation, and thus complies with 2012 amendment to PIP statute, where argument was not preserved in joint pretrial stipulation

23 Fla. L. Weekly Supp. 943a

Online Reference: FLWSUPP 2309ADAMInsurance — Personal injury protection — Coverage — Medical expenses — Neither approval of PIP policy by Office of Insurance Regulation nor use of OIR sample language in policy constitutes per se compliance with requirement that policy provide unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule — PIP policy that includes fact-dependent factors in its definition of “reasonable charge” while also attempting to reimburse in accordance with statutory fee schedule commingles payment methodologies and does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule — Requirement of clear and unambiguous notice of election to use statutory fee schedule enunciated by Florida Supreme Court in Virtual Imaging relative to 2008 version of PIP statute is equally applicable to 2012 amendments to PIP statute

23 Fla. L. Weekly Supp. 637a

Online Reference: FLWSUPP 2306ROSEInsurance — Personal injury protection — Coverage — Medical expenses — Summary judgment — Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider where affidavit is opinion of expert who was not disclosed in pretrial stipulation and who, consequently, is not permitted to testify at trial