Volume 23

24 Fla. L. Weekly Supp. 860a

Online Reference: FLWSUPP 2410LOUIInsurance — Personal injury protection — Coverage — Medical expenses — Where PIP policy provides that insurer will limit reimbursement to 80% of fee schedule and also states that insurer retains right to reduce charges on any submitted bill it deems unreasonable and by any amount it chooses, policy commingles language from both payment methodologies and fails to make clear and unambiguous election of reimbursement method — Fact that policy defines unreasonable charge as any charge that exceeds maximum charges in fee schedule does not create clear and unambiguous election

24 Fla. L. Weekly Supp. 731b

Online Reference: FLWSUPP 2409SALIInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — PIP policy providing that insurer will calculate reimbursement pursuant to permissive statutory fee schedule while reserving insurer’s right to adjust any payment to medical provider by amounts insurer deems to be unreasonable commingles statutory payment methodologies and does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 540c

Online Reference: FLWSUPP 2407FLANInsurance — Personal injury protection — Coverage — Medical expenses — Where PIP policy notifies insured that benefits will be paid at 80% of rate of schedule of maximum charges pursuant to PIP statute and will only be paid at 80% of reasonable amount billed if schedule does not apply to covered medical expenses or does not exist, policy clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 532a

Online Reference: FLWSUPP 2407PHARInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy providing that insurer will pay 80% of reasonable charges and that in no event will insurer pay more than 80% of PIP statute’s schedules of maximum charges, but also incorporating reasonableness analysis in definition section of policy provides clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule despite commingling payment methodologies

24 Fla. L. Weekly Supp. 512a

Online Reference: FLWSUPP 2407MRIInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that adopts hybrid method of calculating reimbursement that includes elements of both Medicare fee schedule and reasonable amount method does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 536a

Online Reference: FLWSUPP 2407WHEAInsurance — Affirmative defenses — Insurer’s withdrawal of all affirmative defenses without prejudice rendered motion to strike affirmative defenses moot — Insurer is under no affirmative duty to withdraw its affirmative defenses with prejudice

24 Fla. L. Weekly Supp. 863a

Online Reference: FLWSUPP 2410BACAInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy providing that insurer will pay 80% of reasonable charges and 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 PIP 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

24 Fla. L. Weekly Supp. 857b

Online Reference: FLWSUPP 2410LHERInsurance — 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 — Neither approval of PIP policy by Office of Insurance Regulation nor incorporation of OIR sample form in policy is dispositive as to whether policy makes proper election for payment under permissive statutory fee schedule

24 Fla. L. Weekly Supp. 855a

Online Reference: FLWSUPP 2410UMBEInsurance — 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 — Neither approval of PIP policy by Office of Insurance Regulation nor incorporation of OIR sample form in policy is dispositive as to whether policy makes proper election for payment under permissive statutory fee schedule

24 Fla. L. Weekly Supp. 760b

Online Reference: FLWSUPP 2409LABBInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — Insurer failed to make, clear, exclusive, and unambiguous election that it would utilize permissive Medicare fee schedule of maximum charges contained in statutes to limit reimbursement of properly submitted bill for medical services — Policy language indicating insured would pay both 80% of properly billed and documented reasonable charge and also stating that insurer would not pay more than 80% of certain No-Fault Act schedule of maximum charges created an impermissible hybrid methodology — Stamped approval of policy by Office of Insurance Regulation did not establish unambiguous election of Medicare Fee Schedule Methodology by insurer