Volume 25

25 Fla. L. Weekly Supp. 297a

Online Reference: FLWSUPP 2503ARMAInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — Where PIP policy states that in no event will insurer pay more than 80% of No-Fault Act schedule of maximum charges, and policy was approved by Office of Insurance Regulation, insurer has clearly and unambiguously elected to limit reimbursement to permissive statutory fee schedules

25 Fla. L. Weekly Supp. 295a

Online Reference: FLWSUPP 2503BOWEInsurance — 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 amount it deems reasonable, that insurer will consider multiple factors when calculating what reasonable amount will be and that in no event will insurer pay more than 80% of amounts listed in schedule of maximum charges clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedules

25 Fla. L. Weekly Supp. 287a

Online Reference: FLWSUPP 2503STRIInsurance — 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 of 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 is not dispositive as to whether policy makes proper election for payment under permissive statutory fee schedule

25 Fla. L. Weekly Supp. 285b

Online Reference: FLWSUPP 2503MELGInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — Where PIP policy provides that insurer will pay 80% of reasonable medical expenses but also states that in no event will insurer pay more than schedule of maximum charges, and policy was approved by Office of Insurance Regulation, insurer may limit reimbursement to permissive statutory fee schedules — No merit to argument that, by including language regarding payment of reasonable amount and language placing limitation on that amount, insurer failed to make clear and unambiguous election

25 Fla. L. Weekly Supp. 277a

Online Reference: FLWSUPP 2503MURIInsurance — 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 reasonable charge but in no event will insurer pay more than 80% of schedule of maximum charges clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedules

25 Fla. L. Weekly Supp. 285a

Online Reference: FLWSUPP 2503GRASInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy and endorsement do not clearly and unambiguously elect use of permissive statutory fee schedules

25 Fla. L. Weekly Supp. 276a

Online Reference: FLWSUPP 2503BERNInsurance — 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 reasonable charge but in no event will insurer pay more than 80% of No-Fault Act schedule of maximum charges clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedules

25 Fla. L. Weekly Supp. 273a

Online Reference: FLWSUPP 2503LDIAInsurance — Personal injury protection — Insurer is entitled to summary judgment determining that it has paid in compliance with Florida Statutes for medical services rendered, has not violated the statutes, and has not breached the policy of insurance sued upon — Insurer’s policy preserves and adheres to PIP statute’s basic mandate that a carrier pay 80% of reasonable charges, contains a definition of a “reasonable charge” that is consistent with the nearly identical definition in the statute, and utilizes clear and unambiguous language in adopting PIP statute’s permissive fee schedule limitation — As a matter of law, insurer’s 6126LS Endorsement which was approved by Office of Insurance Regulation, satisfies the requirement of giving notice of insurer’s intention to limit reimbursement of medical expenses by applying the schedule of maximum charges — Because insurer paid plaintiff the maximum amount as calculated pursuant to schedule of maximum charges, plaintiff is not entitled to payment of any additional PIP benefits for charges set forth in its bills — Jurisdiction over propriety of insurer’s notice rests with OIR, not with court

25 Fla. L. Weekly Supp. 272a

Online Reference: FLWSUPP 2503LEGEInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy and endorsement, when read together, clearly and unambiguously elect to limit reimbursement to permissive statutory fee schedules

25 Fla. L. Weekly Supp. 204a

Online Reference: FLWSUPP 2502MICKInsurance — 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 but in no event will pay more than 80% of No-Fault Act schedule of maximum charges clearly and unambiguously elects to pay in accordance with permissive statutory fee schedules — Neither fact that policy also states that insurer will pay 80% of medical expenses incurred nor fact that policy references fee schedules in its definition of “reasonable charges” creates ambiguity