Volume 26

26 Fla. L. Weekly Supp. 121c

Online Reference: FLWSUPP 2602MERCInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Notice to insured — PIP policy that states that insurer will determine to be unreasonable any charges that exceed maximum charges set forth in section 627.736(5)(a)2 and will limit reimbursement to 80% of schedule of maximum charges provided adequate notice to insured that insurer could limit payment pursuant to the schedule of maximum charges — Inclusion in policy of statement that insurer may use fact-based method to determine reasonableness of charges does not render policy language ambiguous

26 Fla. L. Weekly Supp. 35a

Online Reference: FLWSUPP 2601LGATInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — Notice to insured — Incorporation of Office of Insurance Regulation’s sample endorsement into insurer’s 9810A policy was not sufficient to comply with statute requiring that policy include notice at time of issuance or renewal that insurer may limit payment pursuant to statutory schedule of charges — Approval of policy by OIR does not constitute finding of compliance with statutory notice requirements — Language of policy at issue incorporates an unauthorized hybrid methodology for calculating PIP reimbursement — Provider’s motion for summary judgment as to application of Medicare fee schedule granted — Motion for summary judgment as to reasonableness, relatedness, and necessity of medical services denied

26 Fla. L. Weekly Supp. 29a

Online Reference: FLWSUPP 2601RENEInsurance — 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 — Mere approval of PIP policy by Office of Insurance Regulation does not establish that policy makes proper election for payment under permissive statutory fee schedule

26 Fla. L. Weekly Supp. 466b

Online Reference: FLWSUPP 2606LOUIInsurance — Personal injury protection — Coverage — Medical benefits — Statutory fee schedules — Both 2013 version of statute and unambiguous Form 9810A PIP policy allow insurer to use Medicare coding policies and payment methodologies of Federal Centers for Medicare and Medicaid Services — Insurer satisfied 2013 statutory notice requirement by having policy approved by Office of Insurance Regulation — Policy permitted insurer to limit reimbursements utilizing 2007 Medicare Part B physician’s fee schedule and Medicare’s Multiple Procedure Payment Reduction

26 Fla. L. Weekly Supp. 972c

Online Reference: FLWSUPP 2612BEECInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedules — Fact that policy states that insurer will not pay unreasonable benefits and will contest them does not render election of method of reimbursement ambiguous where policy defines unreasonable benefits as any charges that exceed amount to be paid under statutory fee schedules

PAMELA KENT, an Insured Individual by and through his/her Assignee, CHIROPRACTIC CENTER OF LAKELAND SOUTH, INC. d/b/a LOVE CHIROPRACTIC, Plaintiff, v. PROGRESSIVE SELECT INSURANCE COMPANY, Defendant.

26 Fla. L. Weekly Supp. 401a

Online Reference: FLWSUPP 2605MONTInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that provides that insurer will determine to be unreasonable any charges that exceed maximum charges set forth in PIP statute and will limit reimbursement to 80% of schedule of maximum charges clearly and unambiguously elects to limit reimbursement to statutory fee schedules

26 Fla. L. Weekly Supp. 127a

Online Reference: FLWSUPP 2602MJOSInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that states that insurer will determine to be unreasonable any charges that exceed maximum charges set forth in section 627.736(5)(a)2 and will limit reimbursement to 80% of schedule of maximum charges provides clear and unambiguous notice that insurer will limit reimbursement through use of permissive statutory fee schedules — Conclusory self-serving affidavit filed by medical provider on issue of whether insurer correctly calculated reimbursement amount is stricken — Summary judgment is entered in favor of insurer

26 Fla. L. Weekly Supp. 54a

Online Reference: FLWSUPP 2601EBANInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that tracks verbatim the language of section 627.736(5)(a) provides clear and unambiguous notice of election to limit reimbursement to permissive statutory fee schedules — No merit to argument that policy language regarding application of deductible creates competing payment methodology where language merely expresses insurer’s intent to apply deductible to fee schedule amount

26 Fla. L. Weekly Supp. 950a

Online Reference: FLWSUPP 2612ALCIInsurance — Personal injury protection — Coverage — Medical expenses — Limitation — Statutory fee schedules — Sufficiency of notice