Volume 24

24 Fla. L. Weekly Supp. 838a

Online Reference: FLWSUPP 2410MLOPInsurance — Personal injury protection — Coverage — Medical expenses — Deductible — PIP statute requires that deductible be applied to 100% of expenses and losses incurred before application of fee schedule reductions — Insurer was free to challenge that loss was not compensable or that charges were not reasonable, related and medically necessary at time charges were submitted, but it cannot raise those challenges after it has applied bill to deductible

24 Fla. L. Weekly Supp. 825a

Online Reference: FLWSUPP 2410WOLFInsurance — Personal injury protection — Coverage — Medical expenses — Deductible — Amount to be applied to PIP policy deductible is 100% of reasonable expenses, not 100% of amount billed by medical provider

24 Fla. L. Weekly Supp. 1000a

Online Reference: FLWSUPP 2411CELEInsurance — Personal injury protection — Coverage — Medical expenses — Deductible — Insurer correctly applied statutory fee schedule to amount billed by medical provider before applying reduced amount to deductible

24 Fla. L. Weekly Supp. 964b

Online Reference: FLWSUPP 2411GHERInsurance — Personal injury protection — Coverage — Medical expenses — Deductible — PIP statute requires insurer to apply deductible to 100% of reasonable, related and necessary medical expenses rather than to entire amount billed by medical provider irrespective of compensability — Reasonableness of charges is issue for factfinder in instant case — Insurer’s initial decision to reimburse provider according to a fee-schedule-based formula did not preclude it from subsequently challenging reasonableness of charges

24 Fla. L. Weekly Supp. 766a

Online Reference: FLWSUPP 2409DUMEInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that provides that insurer will pay no more than 80% of 200% of allowable amount under Medicare Part B fee schedule clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule — Deductible — Proper formula for payment of PIP claim requires that statutory reductions be applied to charges before deductible is subtracted from resulting amount

24 Fla. L. Weekly Supp. 739a

Online Reference: FLWSUPP 2409MOREInsurance — 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 — Question certified: Pursuant to Fla. Stat. §627.739, is an insurer required to apply the deductible to 100% of an insured’s expenses and losses prior to applying any permissive fee schedule payment limitation found in §627.736(5)(a)(1), Fla. Stat. (2013)?

24 Fla. L. Weekly Supp. 732a

Online Reference: FLWSUPP 2409SIFOInsurance — Personal injury protection — Coverage — Emergency medical condition — Under amendments to PIP statute requiring PIP insurer to pay benefits up to $10,000 if qualified medical provider has determined that claimant had emergency medical condition and limiting reimbursement to $2,500 if qualified provider has determined that claimant did not have emergency medical condition, insurer properly limited benefits to $2,500 where qualified provider has not determined that insured suffered emergency medical condition — No merit to argument that insurer was required to pay benefits up to $10,000 unless there was determination of absence of emergency medical condition — Deductible — PIP insurer properly applied statutory fee schedule that was clearly elected in policy to reduce medical provider’s bill before applying bill to deductible

24 Fla. L. Weekly Supp. 631b

Online Reference: FLWSUPP 2408COOKInsurance — Personal injury protection — Coverage — Medical expenses — Deductible was properly applied to amount remaining after claim was reduced by percentage described in PIP statute — Policy language provided sufficient notice to insured that insurer would use statutory fee schedules to determine reasonableness of medical expenses

24 Fla. L. Weekly Supp. 541a

Online Reference: FLWSUPP 2407GRAYInsurance — Personal injury protection — Coverage — Medical expenses — Deductible — Insurer correctly applied statutory fee schedule to amount billed by medical provider before applying reduced amount to deductible — PIP policy that provides that, in determining whether charges for medical expenses are reasonable, insurer may reduce payments for amounts that are billed to any lesser amount that results from application of any schedule of charges or alternative reimbursement method that is expressly referenced or authorized under No Fault Law clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 467b

Online Reference: FLWSUPP 2406CHARInsurance — Personal injury protection — Coverage — Deductible — Insurer improperly applied fee schedule reductions to medical provider’s charges prior to applying deductible to charges — Insurer should have applied deductible to 100% of expenses