Volume 25

25 Fla. L. Weekly Supp. 840b

Online Reference: FLWSUPP 2509LAUEInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedule — Clear and unambiguous election by insurer — Policy at issue provided clear and unambiguous notice of insurer’s intent to limit reimbursement to the schedule of maximum charges found in No-Fault Law

25 Fla. L. Weekly Supp. 831b

Online Reference: FLWSUPP 2509OSAInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedule — Clear and unambiguous election by insurer — Policy at issue provided clear and unambiguous notice of insurer’s intent to limit reimbursement to the schedule of maximum charges found in No-Fault Law

25 Fla. L. Weekly Supp. 831a

Online Reference: FLWSUPP 2509PLANInsurance — Personal injury protection — Coverage — Medical expenses — Policy adequately put insureds on notice that, if applicable, insurer would use Medicare coding policies and payment methodologies, including applicable modifiers, to determine reimbursement for claims involving medical services, supplies, and/or care — Policy permitted insurer to reimburse provider below Medicare Part B fee schedule through application of Medicare’s Multiple Procedure Payment Reduction

25 Fla. L. Weekly Supp. 820a

Online Reference: FLWSUPP 2509BELIInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — 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 and policy also states that in no event will insurer pay more than 80% of schedule of maximum charges, policy is ambiguous as to reimbursement method and did not specifically elect fee schedule method of reimbursement — Approval of PIP policy by Office of Insurance Regulation is not dispositive as to whether policy makes proper election for payment under permissive statutory fee schedules

25 Fla. L. Weekly Supp. 817a

Online Reference: FLWSUPP 2509AGUIInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that states that in no event will insurer pay more than schedule of maximum charges clearly and unambiguously elects to limit reimbursement to statutory fee schedules — Insurer’s placement of notice of limitation to statutory fee schedules on declarations page when policy was renewed and use of policy form approved by Office of Insurance Regulation satisfies requirements of section 627.736(5)(a)5 and allows insurer to limit reimbursement to statutory fee schedules

25 Fla. L. Weekly Supp. 816c

Online Reference: FLWSUPP 2509PAGAInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that provides that insurer will limit reimbursement of medical expenses to 80% of reasonable charge but in no event will pay more than 80% of schedule of maximum charges set forth in PIP statute clearly and unambiguously elects to limit payment based on statutory fee schedules

25 Fla. L. Weekly Supp. 807b

Online Reference: FLWSUPP 2509LOWEInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedule — Clear and unambiguous election by insurer — Policy at issue provided clear and unambiguous notice of insurer’s intent to limit reimbursement to the schedule of maximum charges found in No-Fault Law

25 Fla. L. Weekly Supp. 807a

Online Reference: FLWSUPP 2509STOKInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedule — Clear and unambiguous election by insurer — Policy at issue provided clear and unambiguous notice of insurer’s intent to limit reimbursement to the schedule of maximum charges found in No-Fault Law, including use of Medicare coding policies and payment methodologies

25 Fla. L. Weekly Supp. 640a

Online Reference: FLWSUPP 2507PANInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Policy at issue failed to reflect clear and unambiguous election by insurer to limit reimbursement to statutory fee schedules

25 Fla. L. Weekly Supp. 564a

Online Reference: FLWSUPP 2506ILIEInsurance — Personal injury protection — Coverage — Medical expenses — Policy and endorsement form did not clearly and unambiguously invoke Medicare Fee Schedule Method as insurer’s choice of particular method of calculating PIP benefits to exclusion of all others — Insurer is not lawfully authorized to pay claims submitted under this policy and endorsement pursuant to hybrid method described in that policy and must instead use reasonable amount method described in statute 627.736(5)(a) — Questions certified: (a) Whether Progressive’s Insurance Policy and Endorsement Form A085 fail to clearly and unambiguously elect the Medicare Fee Schedule Method under the PIP statute’s schedule of maximum charges as Progressive’s exclusive method of calculating PIP benefits? and (b) Whether Progressive is prohibited from paying PIP claims submitted under the Insurance Policy and Endorsement Form A085 pursuant to the hybrid method described therein, and must instead pay such claims pursuant to the Reasonable Amount Method described in Section 627.736(5)(a) by default?