Volume 25

25 Fla. L. Weekly Supp. 659a

Online Reference: FLWSUPP 2507LAGOInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that chooses to determine reasonable charge using fact-dependant analysis while also attempting to cap payment using schedule of maximum charges does not clearly and unambiguously elect to reimburse in accordance with permissive statutory fee schedules — Approval of policy by Office of Insurance Regulation is not impenetrable proof that policy satisfies requirement to provide notice of election of fee schedule method of reimbursement

25 Fla. L. Weekly Supp. 837b

Online Reference: FLWSUPP 2509ROBIInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Because 2% reduction applied by Centers for Medicaid and Medicare Services to physician fee schedule payment amounts for CPT codes for chiropractic manipulation is explicit part of formula for calculating fee schedule payment amounts for those CPT codes, PIP insurer is entitled to apply 2% reduction in reimbursing for chiropractic services under PIP policy adopting statutory fee schedules — July 1, 2014, removal of 2% reduction represents subsequent unforeseeable change in fee schedule and is not applicable to charges at issue

25 Fla. L. Weekly Supp. 109a

Online Reference: FLWSUPP 2501WELCInsurance — Personal injury protection — Coverage — Medical expenses — In provision of PIP statute allowing for use of alternate method of calculating reimbursement in event provider submits charge for an amount that is “less than the amount allowed under subparagraph 1.” and similar provision of PIP policy, “amount allowed under subparagraph 1.” is 80% of 200% of allowable amount under Medicare fee schedule, not 80% of fee schedule amount — Where billed amount exceeds 80% of 200% of allowed amount under Medicare fee schedule, insurer was required to pay 80% of 200% of fee schedule amount, not 80% of billed amount

25 Fla. L. Weekly Supp. 874b

Online Reference: FLWSUPP 2510MAGOInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules

25 Fla. L. Weekly Supp. 390a

Online Reference: FLWSUPP 2504LEMOInsurance — Personal injury protection — Coverage — Medical benefits — Standing — Assignment to provider of benefits under policy for services rendered and covered by PIP coverage under the insured’s name was valid assignment — Motion to dismiss for lack of standing denied

25 Fla. L. Weekly Supp. 361b

Online Reference: FLWSUPP 2504MATTInsurance — Personal injury protection — Coverage — Medical expenses — Provider’s suit against insurer not precluded by fact that amount due is de minimus — Statutory fee schedules — Policy clearly stated insurer’s intent to limit payment pursuant to statutory fee schedules

25 Fla. L. Weekly Supp. 195c

Online Reference: FLWSUPP 2502ABREInsurance — Personal injury protection — Coverage — Resident of household — Daughter of insured was resident relative residing in her parents’/insureds’ household at time of automobile accident, although she was also associated with her boyfriend’s address at the time — Factors considered include close kinship and fact that daughter maintained key to residence and enjoyed unrestricted use of her bedroom, entire house, and all of its utilities

25 Fla. L. Weekly Supp. 558a

NOT FINAL VERSION OF OPINION
Subsequent Changes at 26 Fla. L. Weekly Supp. 871aOnline Reference: FLWSUPP 2506JSANInsurance — Personal injury protection — Coverage — Medical expenses — Multiple Procedure Payment Reduction — Clear and unambiguous election by insurer — PIP policy containing general references to Medicare coding policies and procedures does not clearly elect use of Medicare MPPR rule to reduce payment below permissive statutory fee schedule

25 Fla. L. Weekly Supp. 553a

Online Reference: FLWSUPP 2506SGORInsurance — Personal injury protection — Coverage — Medical expenses — Multiple Procedure Payment Reduction — Clear and unambiguous election by insurer — PIP policy containing general references to Medicare coding policies and procedures does not clearly elect use of Medicare MPPR rule to reduce payment below permissive statutory fee schedule

25 Fla. L. Weekly Supp. 122b

Online Reference: FLWSUPP 2501NESMInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — Insurer that incorporated Medicare fee schedule into PIP policy and specifically referenced Multiple Procedure Payment Reduction may use MPPR to calculate reimbursement — MPPR is payment methodology, not utilization limit