Volume 24

24 Fla. L. Weekly Supp. 536b

Online Reference: FLWSUPP 2407DAVIInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that provides that insurer will pay 80% of reasonable charges and also provides that in no event will insurer pay more than 80% of 200% of Medicare Part B fee schedule does not unambiguously elect to limit reimbursement to 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. 159b

Online Reference: FLWSUPP 2402ACEVInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election — PIP policy that gives insurer unbridled discretion to consider various factors found in reasonable amount method of reimbursement and in permissive fee schedule method of reimbursement does not provide clear and unambiguous notice of intent to limit reimbursement to fee schedule — Approval by Office of Insurance Regulation does not validate policy

24 Fla. L. Weekly Supp. 533a

Online Reference: FLWSUPP 2407ALTEInsurance — Personal injury protection — Coverage — Medical expenses — Under 2012 amendments to PIP statute, insurer is only required to provide notice that it may limit reimbursement to permissive statutory fee schedule, not clear and unambiguous notice required by Virtual Imaging in respect to 2008 amendments to PIP statute — PIP policy that provides that insurer will not pay charges deemed to be unreasonable, will determine to be unreasonable any charges in excess of maximum charges set forth in No-Fault Act, and will limit reimbursement to no more than 80% of 200% of Medicare Part fee schedule gave sufficient notice of intent to utilize permissive statutory fee schedule

24 Fla. L. Weekly Supp. 1002a

Online Reference: FLWSUPP 2411RAYHInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer

24 Fla. L. Weekly Supp. 996a

Online Reference: FLWSUPP 2411WOODInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — Policy language listed in insurer’s 9811B policy clearly and unambiguously gave insurer the option of using “any fee specified in any fee schedule” in determining reasonable expenses and to reimburse the lowest amount for those medical services — Summary judgment entered in favor of insurer

24 Fla. L. Weekly Supp. 995a

Online Reference: FLWSUPP 2411HICKInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that contains both reasonableness factors established under section 627.736(5)(a) and schedule of charges established under section 627.736(5)(a)1 elects both reimbursement methods simultaneously and fails to clearly and unambiguously elect fee schedule method of reimbursement

24 Fla. L. Weekly Supp. 991a

Online Reference: FLWSUPP 2411ROUSInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that states that insurer will limit reimbursement to 80% of properly billed reasonable charge but in no event will pay more than 80% of schedule of maximum charges clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule

24 Fla. L. Weekly Supp. 982a

Online Reference: FLWSUPP 2411FAUSInsurance — Personal injury protection — Coverage — Medical expenses — Where insurer placed notice on declaration page of renewed policy advising insured of limitation of payment to schedule of maximum charges and that policy form was filed with and approved by Office of Insurance Regulation, insurer satisfied requirements of section 627.736(5)(a)5 and may limit reimbursement based on permissive statutory fee schedule — No merit to argument that insurer has impermissibly created “hybrid” payment methodology by agreeing to pay reasonable amount in one portion of policy while later limiting reimbursement to fee schedule where requirement of Virtual Imaging that insurer elect one reimbursement method to exclusion of the other is not applicable under new election procedure of section 627.736(5)(a)5

24 Fla. L. Weekly Supp. 980b

Online Reference: FLWSUPP 2411MERRInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that states that insurer will limit reimbursement to 80% of properly billed reasonable charge but in no event will pay more than 80% of schedule of maximum charges provided legally sufficient notice of intent to limit reimbursement to statutory fee schedule

24 Fla. L. Weekly Supp. 970a

Online Reference: FLWSUPP 2411HALLInsurance — Personal injury protection — Coverage — Medical expenses — Approval of PIP policy by Office of Insurance Regulation does not constitute explicit approval of policy as properly electing to limit reimbursement to permissive statutory fee schedule — 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, provides clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule