Volume 23

23 Fla. L. Weekly Supp. 595a

Online Reference: FLWSUPP 2306MENAInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that states unequivocally that medical benefits shall be payable at lesser of 80% of actual charges or 80% of schedule of maximum charges contained in section 627.736(5)(a)1 clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

23 Fla. L. Weekly Supp. 265a

Online Reference: FLWSUPP 2303SIKEInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule

23 Fla. L. Weekly Supp. 62a

Online Reference: FLWSUPP 2301BALDInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy endorsement that states that insurer will pay benefits at 80% of maximum charges set forth by PIP law and 80% of other reasonable expenses clearly and unambiguously elects to limit reimbursement for services covered by statutory fee schedule to amount established by that fee schedule

23 Fla. L. Weekly Supp. 5a

Online Reference: FLWSUPP 2301HENDInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy provided sufficient notice of election to limit reimbursement to permissive statutory fee schedule

23 Fla. L. Weekly Supp. 61a

Online Reference: FLWSUPP 2301HENRInsurance — Personal injury protection — Standing — Fictitious name — Insurer’s motion for summary judgment based on medical provider suing under registered fictitious name is denied where insurer did not make specific negative averment challenging provider’s capacity to sue, invoice and explanation of reimbursement reveal that parties utilized provider’s fictitious name in conducting their business, and Fictitious Name Act provides statutory basis for properly registered fictitious name to file suit

23 Fla. L. Weekly Supp. 360a

Online Reference: FLWSUPP 2304RENTInsurance — Personal injury protection — Coverage — Medical expenses — Where 2012 amendment to PIP statute and policy endorsement allow insurer to utilize Medicare coding policies and payment methodologies to limit payment of medical expenses, insurer did not breach policy by applying multiple procedure payment reduction to claim — Application of multiple procedure payment reduction to claim to reduce payment for second MRI performed on same patient by same physician in same session is application of payment modifier, not utilization limit

23 Fla. L. Weekly Supp. 857b

Online Reference: FLWSUPP 2308ASSANOT FINAL VERSION OF OPINION
Subsequent Changes at 24 Fla. L. Weekly Supp. 163bInsurance — Personal injury protection — Coverage — Medical expenses — Insurers were authorized to apply Medicare Multiple Procedure Payment Reduction to medical providers’ bills where PIP statute authorizes use of Medicare coding policies, including MPPR, and insurers have placed insureds and providers on notice that MPPR will be utilized in determining appropriate reimbursement — MPPR is not per se limitation on utilization prohibited by PIP statute

23 Fla. L. Weekly Supp. 855a

Online Reference: FLWSUPP 2308LOUIInsurance — Personal injury protection — Coverage — Medical expenses — Multiple Procedure Payment Reduction — PIP policy that clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule and contains general references to Medicare coding policies and procedures does not clearly elect application of MPPR — Moreover, MPPR is utilization limit prohibited by PIP statute, and even if MPPR were not prohibited by statute, insurer misapplied MPPR by superimposing 2013 MPPR on 2007 Medicare fee schedule — Insurer that paid claims based on fee schedule without disputing relatedness or necessity of treatment pre-suit may not contest relatedness and necessity

23 Fla. L. Weekly Supp. 371a

Online Reference: FLWSUPP 2304CHARInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Affidavit filed by insurer in opposition to motion for summary judgment is rejected where affiant failed to establish his relationship to geographical area at issue, referred to table not attached to affidavit, rendered opinion on reasonableness of charges that directly contradicted his opinion in another PIP suit, used flawed methodology, and opined that charges were irrelevant

23 Fla. L. Weekly Supp. 357a

Online Reference: FLWSUPP 2304HOOKInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Opposing affidavits filed by insurer do not preclude partial summary judgment in favor of medical provider on issue of reasonableness of charges that insurer concedes are necessary and related where affidavits are conclusory and self-serving and rely on Medicare and workers’ compensation fee schedules not elected in policy and negotiated contract rates that are irrelevant under section 627.736(5)(a)1