Volume 27

27 Fla. L. Weekly Supp. 562a

Online Reference: FLWSUPP 2706JOSEInsurance — Personal injury protection — Coverage — Where there is conflict between PIP statute and policy regarding which Medicare fee schedule to use to determine amount of reimbursement, policy language that provides for higher amount of reimbursement controls

27 Fla. L. Weekly Supp. 899a

Online Reference: FLWSUPP 2710MONTInsurance — Personal injury protection — Provider’s action against insurer — Standing — Corporations — Medical provider that is administratively dissolved corporation may bring action for unpaid PIP benefits in its own name where action is necessary for provider to wind up its business

27 Fla. L. Weekly Supp. 897a

Online Reference: FLWSUPP 2710MAESInsurance — Personal injury protection — Provider’s action against insurer — Standing — Corporations — Medical provider that is administratively dissolved corporation may bring action for unpaid PIP benefits in its own name where action is necessary for provider to wind up its business

27 Fla. L. Weekly Supp. 433b

Online Reference: FLWSUPP 2705TRINInsurance — Personal injury protection — Coverage — Medical expenses — Multiple Procedure Payment Reduction is coding policy/payment methodology and not utilization limit

27 Fla. L. Weekly Supp. 19a

Online Reference: FLWSUPP 2701LASAInsurance — Personal injury protection — Coverage — Medical expenses — Multiple Procedure Payment Reduction is a coding policy/payment methodology and not an improper utilization limit — Insurer was not prohibited from using Medicare coding policies and payment methdologies of the CMS and applicable modifiers where policy clearly and unambiguously elected statutory fee schedule, and plain language of policy met notice requirements of Virtual Imaging and policy complied with statutory notice provision

27 Fla. L. Weekly Supp. 289a

Online Reference: FLWSUPP 2703PERRInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that states that insurer will limit reimbursement to, and pay no more than, 80% of 200% of allowable amount under Medicare Part B participating physicians fee schedule satisfies requirement to give “simple notice” of intent to utilize Medicare fee schedule — Applying Multiple Procedure Payment Reduction is not utilization limit prohibited by PIP statute — Affidavit filed by medical provider in support of argument that there are additional dates of service that were not reimbursed by insurer is insufficient to defeat summary judgment where there are no bills or medical records attached to verify claims made in affidavit, and affidavit contains hearsay allegations — Summary judgment is entered in favor of insurer

27 Fla. L. Weekly Supp. 286a

Online Reference: FLWSUPP 2703COLSInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that states that insurer will limit reimbursement to, and pay no more than, 80% of 200% of allowable amount under Medicare Part B participating physicians fee schedule satisfies requirement to give “simple notice” of intent to utilize Medicare fee schedule — Applying Multiple Procedure Payment Reduction is not utilization limit prohibited by PIP statute — Summary judgment is entered in favor of insurer

27 Fla. L. Weekly Supp. 93b

Online Reference: FLWSUPP 2701ANDRInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Multiple Procedure Payment Reduction — Where PIP statute states that fee schedule or payment limitation to be used when using schedule of maximum charges may not be less than allowable amount under applicable schedule for 2007 Medicare Part B, and PIP policy states that applicable fee schedule or payment limitation will not be less than applicable schedule of Medicare Part B for 2007, insurer was not allowed to apply MPPR to result in reimbursement of less than amount allowed under 2007 Medicare Part B fee schedule

27 Fla. L. Weekly Supp. 998a

Online Reference: FLWSUPP 2712DUDLInsurance — Personal injury protection — Coverage — Medical expenses — Reimbursement — Multiple Procedure Payment Reduction — Insurance policy gave adequate notice of insurer’s use of MPPR where policy clearly and unambiguously elected the use of Medicare coding policies and payment methodologies, which includes utilization of the MPPR method — A specific reference to MPPR was not required — MPPR should not be considered an improper utilization limit

27 Fla. L. Weekly Supp. 641b

Online Reference: FLWSUPP 2707LAWSInsurance — Personal injury protection — Coverage — Medical expenses — PIP policy and statute allow insurer who has elected statutory fee schedule method of reimbursement to apply Medicare Advanced Registered Nurse Practitioner payment methodology to charges — Application of methodology does not result in utilization limit