Volume 24

24 Fla. L. Weekly Supp. 766b

Online Reference: FLWSUPP 2409DEYInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — Insurer that incorporated Medicare fee schedule into PIP policy may utilize Medicare coding policies and payment methodologies, including Multiple Procedure Payment Reduction, to determine appropriate amount of reimbursement so long as methodology applied is not utilization limit — MPPR is payment methodology, not utilization limit

24 Fla. L. Weekly Supp. 171a

Online Reference: FLWSUPP 2402RREGInsurance — Personal injury protection — Coverage — Medical expenses — Medicare Multiple Procedure Payment Reduction is payment methodology, not utilization limit, and may be relied upon in paying PIP claims — PIP policy endorsement that states that charges will be subject to CMS coding policies and payment methodologies, including MPPR, clearly and unambiguously elects to rely on MPPR when calculating reimbursements — Consistent with section 627.736(5)(a)2, insurer properly paid claim at 2007 fee schedule rate where that rate was higher than 2014 rate that was in effect at time services were rendered

24 Fla. L. Weekly Supp. 165b

Online Reference: FLWSUPP 2402ABROInsurance — Personal injury protection — Coverage — Medical expenses — Insurer was authorized to apply Medicare Multiple Procedure Payment Reduction to medical provider’s bills where PIP statute authorizes use of Medicare coding policies — MPPR is not utilization limit prohibited by PIP statute — No merit to claim that insurer misapplied MPPR by imposing 2013 MPPR on 2007 Medicare fee schedule where PIP statute’s requirement that allowable amount may not be less than 2007 Medicare fee schedule refers to base reimbursement amount and does not require substitution of 2007 coding policies and payment methodologies if those would result in higher amounts than use of current policies and methodologies

24 Fla. L. Weekly Supp. 165a

Online Reference: FLWSUPP 2402ASSAInsurance — Personal injury protection — Coverage — Medical expenses — Motion for relief from erroneous findings — Trial court will issue amended order to correct its erroneous assumption that medical providers stipulated that insurers properly elected to limit reimbursement to permissive statutory fee schedule when litigating insurers’ authorization to apply Medicare Multiple Procedure Payment Reduction to providers’ bills, but rejects assertions of possible fraud on court

24 Fla. L. Weekly Supp. 163b

Online Reference: FLWSUPP 2402YASSInsurance — 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 on notice that MPPR will be utilized in determining appropriate reimbursement — MPPR is not per se limitation on utilization prohibited by PIP statute

24 Fla. L. Weekly Supp. 977a

Online Reference: FLWSUPP 2411JLOGInsurance — Personal injury protection — Coverage — Medical expenses — Insurer was permitted to apply Multiple Procedure Payment Reductions to secondary codes as outlined in its explanation of benefits — Application of MPPR is not a utilization limit

24 Fla. L. Weekly Supp. 306a

Online Reference: FLWSUPP 2404REYEInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Medical provider’s motion for summary judgment on issue of reasonableness of x-ray charges is denied where affidavit filed by provider expresses opinion premised solely on what other providers charge and does not take into consideration reimbursements accepted by provider, reimbursement levels in community, or federal and state medical fee schedules, and opposing affidavit filed by insurer presents opinion that is based on all of those factors — Fact that insurer previously issued payment on claim does not preclude it from disputing reasonableness of charges

24 Fla. L. Weekly Supp. 990c

Online Reference: FLWSUPP 2411MEROInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Affidavit of medical provider that merely tracks language of section 627.736(5)(a)1 and attaches bills submitted to insurer without addressing any specifics of treatment and rates in community fails to establish that no genuine issue of fact exists as to reasonableness of charges — Motion for summary judgment is denied

24 Fla. L. Weekly Supp. 787a

Online Reference: FLWSUPP 2410SANCInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — In granting motion for summary judgment in favor of medical provider, trial court erred in considering affidavits that contained conclusions relying on hearsay without conducting Daubert hearing to determine if affiants were expert witnesses who could properly render opinions — Further, reasonableness of charges is factual issue for jury, and trial court should act with caution in granting motion for summary judgment on issue

24 Fla. L. Weekly Supp. 343a

Online Reference: FLWSUPP 2405NMARInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issue of reasonableness of charges where affiant relied on Medicare and pre-negotiated health insurer rates that were not relevant to determination of reasonableness of PIP charges