Volume 25

25 Fla. L. Weekly Supp. 556a

Online Reference: FLWSUPP 2506ALFOInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules

25 Fla. L. Weekly Supp. 554a

Online Reference: FLWSUPP 2506DUDLInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that states that insurer will pay 80% of 200% of allowable amount under participating physician fee schedule of Medicare Part B clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedule — Policy containing general references to coding policies and procedures does not clearly elect use of multiple procedure rule to reduce payment below permissive statutory fee schedule

25 Fla. L. Weekly Supp. 537a

Online Reference: FLWSUPP 2506VJOHInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that states that insurer will limit reimbursement to 80% of reasonable expenses but in no event will pay any amount in excess of 80% of schedule of maximum charges and makes specific reference to Medicare fee schedules clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedules

25 Fla. L. Weekly Supp. 478a

Online Reference: FLWSUPP 2505SDIAInsurance — 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, 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 does not authorize insurer to utilize permissive statutory fee schedules

25 Fla. L. Weekly Supp. 474b

Online Reference: FLWSUPP 2505JANVInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — Use of permissive statutory fee schedules to calculate reimbursement of PIP claims is only available when insurer has unambiguously elected use of fee schedules as exclusive form 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 statutory fee schedules — Where definition of “reasonable charge” in PIP policy commingles factors found in reasonable amount method of reimbursement and provisions from fee schedule method of reimbursement, policy did not make clear and unequivocal election of fee schedule method of reimbursement

25 Fla. L. Weekly Supp. 386a

Online Reference: FLWSUPP 2504POWEInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that states that insurer will pay reasonable charges and defines “reasonable charge” as amount determined by insurer pursuant to all factors discussed in section 627.736(5)(a) as well as No-Fault Act schedule of maximum charges does not clearly and unambiguously elect to limit reimbursement to permissive statutory fee schedules — Compliance with Office of Insurance Regulation requirements for insurance and mere approval by OIR of policy form does not validate policy as complying with requirement that it provide unambiguous notice of intent to limit reimbursement to permissive statutory fee schedules

25 Fla. L. Weekly Supp. 384b

Online Reference: FLWSUPP 2504HANLInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that states that insurer will pay reasonable charges and defines “reasonable charge” as amount determined by insurer pursuant to all factors discussed in section 627.736(5)(a) as well as No-Fault Act schedule of maximum charges does not clearly and unambiguously elect to limit reimbursement to permissive statutory fee schedules — Compliance with Office of Insurance Regulation requirements for insurance and mere approval by OIR of policy form does not validate policy as complying with requirement that it provide unambiguous notice of intent to limit reimbursement to permissive statutory fee schedules

25 Fla. L. Weekly Supp. 381a

Online Reference: FLWSUPP 2504DTHOInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules

25 Fla. L. Weekly Supp. 363a

Online Reference: FLWSUPP 2504MARTInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Insurer did not properly elect permissive fee schedule method found in section 627.736(5)(a)(1) in its 9810A policy and, accordingly, improperly relied on the fee schedule methodology to limit reimbursement

25 Fla. L. Weekly Supp. 361a

Online Reference: FLWSUPP 2504SEWEInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Notice — Policy which clearly states that it will be using schedule satisfies notice requirement