Volume 27

27 Fla. L. Weekly Supp. 831b

Online Reference: FLWSUPP 2709ZHERInsurance — Personal injury protection — Where parties stipulated that sole legal issue to be resolved in case is sufficiency of insurer’s policy language to elect use of statutory fee schedules for reimbursement of PIP benefits, which issue has been resolved by Florida Supreme Court decision in Orthopedic Specialists, and medical provider raised unpled deductible issue only after appellate case was decided adversely to provider’s position, motion to strike or exclude unpled issues is granted — Final judgment is entered in favor of insurer

27 Fla. L. Weekly Supp. 316a

Online Reference: FLWSUPP 2703HANSInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Medicare fee schedule in place on March 1, 2014, applies for full 12-month period and is applicable to services rendered in February 2015 — Where PIP policy provides that charge submitted for amount less than allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer properly applied entire amount of charge to 200% of allowable amount under fee schedule and then subjected it to coinsurance provision of policy

27 Fla. L. Weekly Supp. 130a

Online Reference: FLWSUPP 2702JPERInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Election by insurer

27 Fla. L. Weekly Supp. 305a

Online Reference: FLWSUPP 2703PLATInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that limits reimbursement to 200% of allowable amount under Medicare Part B fee schedules clearly and unambiguously elects to limit reimbursement to statutory fee schedules

27 Fla. L. Weekly Supp. 414a

Online Reference: FLWSUPP 2704GOLDInsurance — Personal injury protection — Where trial court granted final judgment in favor of medical provider, finding that insurer had not properly elected use of statutory fee schedules, and, while action was pending in district court of appeal, Florida Supreme Court issued decision in Orthopedic Specialists determining that insurer’s policy language was sufficient to elect use of fee schedules, provider’s argument on remand from district court of appeal that issue of alleged misapplication of deductible remains to be litigated and prevents entry of final judgment in favor of insurer is rejected — Provider who prosecuted action to final adjudication on merits of sole issue presented to trial court abandoned any other claims it may have had and is prohibited from raising any other issue — Final summary judgment is entered in favor of insurer

27 Fla. L. Weekly Supp. 781a

Online Reference: FLWSUPP 2709WELLInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that stated that medical benefits would be limited to 80% of “following schedule of maximum charges” and then specifically referenced 200% of allowable amount under Medicare Part B fee schedule, clearly and unambiguously elected to limit reimbursement to permissive statutory fee schedule

27 Fla. L. Weekly Supp. 638a

Online Reference: FLWSUPP 2707ODONInsurance — Personal injury protection — Stay — Denial — Motion to stay PIP case pending resolution by Florida Supreme Court of certified question as to whether 2013 PIP statute permits insurer to limit payment to 80% of reasonable charges while also limiting payment to 80% of statutory fee schedule is denied where district court of appeal that certified question focused on whether language of the policy before it permitted both methods of reimbursement

27 Fla. L. Weekly Supp. 637a

Online Reference: FLWSUPP 2707NORTInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — Motion to stay proceedings pending Florida Supreme Court’s resolution of question certified by district court of appeal denied — Because there are material differences between the certified question and the issue before the court in the instant case, it is clear that Florida Supreme Court’s decision will not affect outcome of lawsuit

27 Fla. L. Weekly Supp. 593a

Online Reference: FLWSUPP 2707PHERInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that expressly gives insurer discretion to alternate between reasonableness method and permissive statutory fee schedule method of reimbursement is ambiguous and fails to provide clear notice of election of fee schedule method of reimbursement — Remand with instructions to enter summary judgment in favor of medical provider

27 Fla. L. Weekly Supp. 607a

Online Reference: FLWSUPP 2707ILIEInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — Declaratory action — Where PIP policy 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, trial court erred in determining that policy did not clearly and unambiguously elect statutory fee schedules and created hybrid methodology of calculating reimbursement — Approval of policy by Office of Insurance Regulation is not mandatory for election of fee schedules to be valid — Failure of policy to incorporate statutory language prohibiting utilization limits does not render policy ambiguous — Statement of intent to utilize CMS coding policies does not render PIP policy ambiguous in absence of any evidence that utilizing coding policies violated statutory prohibition of utilization limits — Remand to enter judgment for insurer