Volume 23

24 Fla. L. Weekly Supp. 715a

Online Reference: FLWSUPP 2409DTHONOT FINAL VERSION OF OPINION
Subsequent Changes at 25 Fla. L. Weekly Supp. 381aInsurance — 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 — Approval of notice form or PIP policy form by Office of Insurance Regulation does not automatically validate legal sufficiency or enforceability of contents of policy

24 Fla. L. Weekly Supp. 709a

Online Reference: FLWSUPP 2409BARRInsurance — 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. 253a

Online Reference: FLWSUPP 2403SIMIInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Insurer did not clearly and unambiguously elect to limit reimbursement to statutory fee schedules where policy as a whole indicated that insurer could calculate reimbursement through either a fact dependent inquiry or through Medicare fee schedules — Safe harbor — 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

24 Fla. L. Weekly Supp. 622a

Online Reference: FLWSUPP 2408HIGGInsurance — 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 commingles permissive and default payment options and does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule — 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

24 Fla. L. Weekly Supp. 621a

Online Reference: FLWSUPP 2408SENGInsurance — Personal injury protection — Coverage — Medical expenses — Office of Insurance Regulation memorandum containing multiple warnings is not explicit approval of insurer’s policy as satisfying requirement to provide clear and unambiguous notice of election to use permissive statutory fee schedule — PIP policy providing that insurer will pay 80% of reasonable charges, 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

24 Fla. L. Weekly Supp. 620a

Online Reference: FLWSUPP 2408PALMInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy providing that insurer will pay 80% of reasonable charges, 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 — 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

24 Fla. L. Weekly Supp. 619b

Online Reference: FLWSUPP 2408RENEInsurance — Personal injury protection — Coverage — Medical expenses — Approval of PIP policy by Office of Insurance Regulation does not constitute de facto proper election to limit reimbursement to permissive statutory fee schedule — PIP policy providing that insurer will pay 80% of reasonable charges, 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

24 Fla. L. Weekly Supp. 618a

Online Reference: FLWSUPP 2408RIZZInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy providing that insurer will calculate reimbursement pursuant to permissive statutory fee schedule, but also reserving insurer’s right to determine whether charge is reasonable, commingles statutory payment methodologies and does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule — 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

24 Fla. L. Weekly Supp. 616a

Online Reference: FLWSUPP 2408WESTInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that includes reasonableness factors of section 627.736(5)(a) as well as schedule of maximum charges of No-Fault Act and Medicare coding policies and payment methodologies in its definition of “reasonable charge” commingles payment methodologies and 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 automatically validate contents of policy as providing unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 567a

Online Reference: FLWSUPP 2407ARTYInsurance — 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 where there is nothing in insurer’s submission to OIR or in OIR’s response to insurer asserting that reason for approval was insurer’s proper election of permissive statutory fee schedule