Volume 27

27 Fla. L. Weekly Supp. 742a

Online Reference: FLWSUPP 2708CALOInsurance — Personal injury protection — Coverage — Medical expenses — Multiple Procedure Payment Reductions — PIP insurer may apply MPPR when reimbursing chiropractor for physical therapy services — Insurer properly reimbursed code that is considered to be noncompensable bundled code by Medicare pursuant to workers’ compensation fee schedule

27 Fla. L. Weekly Supp. 731a

Online Reference: FLWSUPP 2708BEAUInsurance — Personal injury protection — Coverage — Chiropractic services — Medicare fee schedule — Private insurers are not entitled to the 2% reduction in payment for chiropractic treatment implemented by Medicare — The 2% reduction is specifically reserved only for claims that Medicare is required to reimburse

27 Fla. L. Weekly Supp. 416a

Online Reference: FLWSUPP 2704VOLTInsurance — Personal injury protection — Coverage — Medical expenses — Chiropractic services — Multiple procedure payment reduction — Chiropractic provider’s challenge to insurer’s use of MPPR to reduce amount it reimbursed provider below 200% of allowable amount under physicians fee schedule of Medicare Part B — Where insurer’s only basis for using MPPR is that it is a Medicare payment methodology, insurer was required to apply the payment method in the same manner as Medicare — Since the MPPR only applies to services for which Medicare does not reimburse chiropractors, the MPPR cannot apply to chiropractors — In other words, a reduction in reimbursement cannot be applied when no reimbursement is permitted for that service

27 Fla. L. Weekly Supp. 205a

Online Reference: FLWSUPP 2702HOLBInsurance — Personal injury protection — Coverage — Medical expenses — Multiple Procedure Payment Reductions — PIP insurer may apply MPPR when reimbursing chiropractor for physical therapy services — No merit to argument that therapy services not rendered pursuant to therapy plan of care required by Medicare must be reimbursed at full fee schedule amount without application of MPPR — Insurer properly reimbursed code that is considered to be noncompensable bundled code by Medicare pursuant to workers’ compensation fee schedule

27 Fla. L. Weekly Supp. 544a

Online Reference: FLWSUPP 2706RAFFInsurance — Personal injury protection — Coverage — Medical expenses — Initial services and care by qualified medical professional — Where advanced registered nurse practitioner and supervising physician who provided initial services to insured failed to file required protocol of supervision with Board of Medicine, medical provider is not entitled to PIP benefits for initial care and services provided by ARNP — Where there was no referral by physician for follow-up services by ARNP, insurer is not required to provide coverage for those services — Affidavit filed in opposition to insurer’s motion for summary judgment by registered chiropractic physician’s assistant who is supervised by physician and who also provided services to insured on initial date of service is sufficient to preclude summary judgment as to services that affiant provided

27 Fla. L. Weekly Supp. 651a

Online Reference: FLWSUPP 2707SUNCInsurance — Personal injury protection — Coverage — Medical expenses — Where PIP policy provided that charge submitted for amount less than amount allowed by schedule of maximum charges will be paid in amount of charge submitted, insurer was required to pay 100% of charge that was less than 200% of Medicare fee schedule, not 80% of that charge

27 Fla. L. Weekly Supp. 324a

Online Reference: FLWSUPP 2703LPHAInsurance — Personal injury protection — Coverage — Medical expenses — Where PIP policy provides that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of charge

27 Fla. L. Weekly Supp. 239a Online Reference: FLWSUPP 2703IRIZInsurance — Personal injury protection — Coverage — Medical expenses — Where PIP policy provides that

27 Fla. L. Weekly Supp. 486a

Online Reference: FLWSUPP 2705RIVAInsurance — Personal injury protection — Coverage — Medical expenses — Where PIP policy provides that charge submitted for amount less than amount allowed under fee schedule shall be paid in amount of charge submitted, insurer is required to pay full amount of charge that was less than allowed amount — Insurer’s affidavit in opposition to summary judgment is not considered where exhibits referenced in affidavit were not attached to copy filed with court — Although affidavit with attached exhibits was served on medical provider by email, affidavit will not be considered where format of email did not comply with rule 2.516

27 Fla. L. Weekly Supp. 79a

Online Reference: FLWSUPP 2701LOPEInsurance — Personal injury protection — Where sole issue raised by medical provider in PIP case was whether insurer had sufficiently elected use of statutory fee schedules for reimbursement of PIP benefits, and only after Florida Supreme Court decision in Orthopedic Specialists regarding sufficiency of insurer’s policy language to elect use of statutory fee schedules was decided adversely to provider’s position did provider raise unpled issue of misapplication of deductible, motion to strike or exclude unpled issues is granted