Volume 23

23 Fla. L. Weekly Supp. 157a

Online Reference: FLWSUPP 2302VANDInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Because insurer is mandated by statute to reserve $5,000 for emergency service providers, insurer should not have applied claim by plaintiff provider within that classification to deductible — Emergency service provider’s bill will be held until such time as deductible is satisfied by non-protected providers’ bills

23 Fla. L. Weekly Supp. 913b

Online Reference: FLWSUPP 2309BUNDInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Although insurer is mandated by statute to reserve $5,000 for emergency service providers, insurer correctly applied claim by provider within that classification to deductible

23 Fla. L. Weekly Supp. 204a

Online Reference: FLWSUPP 2303DAMUInsurance — Personal injury protection — Coverage — Emergency services — Deductible — Statute lacks language exempting emergency service providers, for whom insurer is mandated to reserve $5,000, from application to deductible and does not specify how insurer is to apply claims to deductible — Trial court did not err in enforcing legislative intent to afford full reimbursement to emergency service providers — Where insurer received claims from emergency service provider and from other medical providers on same date, insurer improperly applied claim from emergency service provider to deductible

23 Fla. L. Weekly Supp. 985a

Online Reference: FLWSUPP 2309BARDNOT FINAL VERSION OF OPINION
Subsequent Changes at 24 Fla. L. Weekly Supp. 383aInsurance — Personal injury protection — Deductible — PIP insurer improperly applied statutory fee schedule to reduce bills before applying those bills to deductible — Pursuant to both PIP statute and policy terms, fee schedule may only be applied to bills for which benefits are actually paid

23 Fla. L. Weekly Supp. 841a

Online Reference: FLWSUPP 2308BOUCInsurance — Personal injury protection — Deductible — PIP insurer that clearly and unambiguously elected to reimburse in accordance with permissive statutory fee schedule correctly applied Medicare Part B fee schedule to medical provider’s charges to determine reasonableness of charges and then applied 100% of those reduced amounts to deductible

23 Fla. L. Weekly Supp. 771a

Online Reference: FLWSUPP 2307FRAZInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy providing that insurer will pay 80% of reasonable expenses but also providing that reasonable expenses shall mean lesser of amount provided by any fee schedule, whether mandatory or permissive, contained in PIP statute improperly seeks to utilize both reasonable amount method and fee schedule method of reimbursement and does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule method — Deductible — Even assuming insurer properly elected to use statutory fee schedule, it improperly applied fee schedule reductions prior to subtracting deductible

23 Fla. L. Weekly Supp. 588a

Online Reference: FLWSUPP 2306DIAZInsurance — Personal injury protection — Coverage — Medical expenses — Insurer that breached contract by utilizing statutory fee schedule not incorporated in policy when processing medical provider’s bill is not entitled to challenge reasonableness of charges — Deductible — Insurer’s application of deductible to reduced charges does not comply with requirement of PIP statute that deductible be applied to 100% of expenses and losses — Insurer breached policy by applying deductible of $1.001.34 when policy provides for $1,000.00 deductible

23 Fla. L. Weekly Supp. 355a

Online Reference: FLWSUPP 2304PENAInsurance — Personal injury protection — Coverage — Medical expenses — Deductible — Insurer is not permitted to apply statutory fee schedule to medical provider’s bills that fall under deductible — Reduction is only permitted as to bills for which insurer is paying benefits under policy

23 Fla. L. Weekly Supp. 708a

Online Reference: FLWSUPP 2307MCCLInsurance — Personal injury protection — Coverage — Deductible — Where PIP policy clearly defines “reasonable fees” in accordance with statutory fee schedule, insurer properly determined reasonable fee for medical provider’s services under fee schedule, applied deductible to that amount and reduced resulting difference by 80% — Policy language providing that deductible will be deducted from total amount of medical benefits before application of any percentage limitation did not require insurer to apply deductible before application of statutory fee schedule where policy specifically defines medical benefits as “reasonable fees,” which are in turn defined by policy by use of statutory fee schedule

23 Fla. L. Weekly Supp. 707a

Online Reference: FLWSUPP 2307CHRIInsurance — Personal injury protection — Deductible — Proper formula for payment of PIP claim under policy that elects usage of permissive statutory fee schedule requires that insurer determine reasonable expense per statutory fee schedule, apply deductible to that reasonable expense, and pay 80% of that amount