Volume 25

25 Fla. L. Weekly Supp. 188a

Online Reference: FLWSUPP 2502NOVOInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy providing that insurer will pay 80% of reasonable charges and also providing that in no event will insurer pay more than 80% of No-Fault Act schedule of maximum charges commingles language from “permissive” and “reasonableness” methods of reimbursement and does not provide clear and unambiguous notice of intent to limit reimbursement to permissive statutory fee schedule

25 Fla. L. Weekly Supp. 183a

Online Reference: FLWSUPP 2502GAMOInsurance — Personal injury protection — Policy form 9810.7 and amendatory endorsement did not clearly and unambiguously incorporate schedule of maximum charges — Issues of reasonableness, relatedness, and medical necessity remain at issue

25 Fla. L. Weekly Supp. 86a

Online Reference: FLWSUPP 2501PRADInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy does not clearly and unambiguously incorporate schedule of maximum charges

25 Fla. L. Weekly Supp. 61a

Online Reference: FLWSUPP 2501ABREInsurance — Personal injury protection — Coverage — Medical expenses — Insurer failed to make clear and unambiguous election to utilized permissive statutory fee schedule to reimburse bills for medical services — Policy language indicating that insurer would pay 80% of reasonable charges and also stating that insurer would not pay more than 80% of schedule of maximum charges created impermissible hybrid reimbursement methodology — Further, PIP policy includes significant impermissible deviations from PIP statute that purport to allow insurer to rely on fee schedules not listed in statute and Medicare payment methodologies and policies to pay even less than minimum amount allowed under PIP statute and to provide for reductions in insured’s coinsurance amount — Approval of policy by Office of Insurance Regulation does not automatically validate legal sufficiency or enforceability of contents of policy

25 Fla. L. Weekly Supp. 51a

Online Reference: FLWSUPP 2501WILLInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that not only complies with notice provision of section 627.736(5)(a)5 but also clearly advises that in no event will insurer pay any amount above fee schedule amount provided sufficient notice of insurer’s intent to limit reimbursement to permissive statutory fee schedule

25 Fla. L. Weekly Supp. 50a

Online Reference: FLWSUPP 2501CASAInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that not only complies with notice provision of section 627.736(5)(a)5 but also clearly advises that insurer will limit reimbursement to schedule of maximum charges provided sufficient notice of insurer’s intent to limit reimbursement to permissive statutory fee schedule

25 Fla. L. Weekly Supp. 48a

Online Reference: FLWSUPP 2501JONEInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy that not only complies with notice provision of section 627.736(5)(a)5 but also clearly advises that in no event will insurer pay any amount above fee schedule amount provided sufficient notice of insurer’s intent to limit reimbursement to permissive statutory fee schedule

25 Fla. L. Weekly Supp. 46a

Online Reference: FLWSUPP 2501SBROInsurance — Personal injury protection — Coverage — Medical benefits — Statutory fee schedules — Insurer made clear and unambiguous election to limit reimbursement based on various fee schedules where policy stated that in no event would it pay more than the amounts allowed in permissive payment methodology

25 Fla. L. Weekly Supp. 774a

Online Reference: FLWSUPP 2509SIASInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — Insurer gave adequate notice of its election of fee schedules to limit its payments where policy included under “Limits” heading the provision that it would in no event “pay more than 80% of the following No-Fault Act ‘schedule of maximum charges’ ” and immediately thereafter recited statutory language of the fee schedules — Further, statute provides that policy form approved by Office of Insurance Regulation satisfies notice requirement — Fact that policy definition of “reasonable charge” included consideration of not just fee schedules, but also factors such as usual and customary charges, payments accepted by provider, and reimbursement levels in community does not change result

25 Fla. L. Weekly Supp. 223a

Online Reference: FLWSUPP 2503GENOInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that defines medical benefits as 80% of all reasonable expenses incurred but which also states that insurer will refuse to pay for medical benefits that are unreasonable or unnecessary and that any charges that exceed the maximum charges of permissive statutory fee schedule will be deemed unreasonable clearly and unambiguously elects to limit reimbursement to statutory fee schedule — Trial court erred in finding policy language to be ambiguous