Florida’s statutory scheme for medical care through PIP allows 80% reimbursement of charges but limited by the statutory maximum benefit amount if the insurer had that provision in its policy.

This matter was on appeal from the Circuit Court for Volusia County. The issue on appeal involved “the amount of reimbursement that an insurer providing Personal Injury Protection (PIP) benefits must pay when the health care provider submits a bill for treating its insured which is less than the statutory schedule of maximum charges which the insurer utilized in its policy as its limit of PIP reimbursement.” Summary judgment was initially entered in favor of Belleview Imaging. However, the issue in this case was settled by the Florida Supreme Court in Allstate Insurance Co. v. Revival Chiropractic, LLC, 385 So. 3d 107 (Fla 2024). As such, the Fifth District Court of Appeal reversed summary judgment and remanded for entry of summary judgment in favor of First Acceptance Insurance.

Belleview Imaging submitted charges to First Acceptance in an amount less than the insurer’s maximum reimbursement rate. First Acceptance reimbursed Belleview at the statutory rate of 80% of the billed amount. Belleview sued, alleging it was entitled to the full amount of its charges because the charges were below the statutory maximum scheduled amount for services that First Acceptance had adopted. 

In Revival Chiropractic, the Florida Supreme Court held that Florida’s statutory scheme for medical care through PIP allowed for 80% reimbursement of charges, limited by the statutory maximum benefit amount if the insurer had that provision in its policy. The court further held that the fact that a health care provider submitted a request for reimbursement for an amount lower than the maximum did not entitle the provider to payment of its full charges up to the maximum amount. It would still receive 80% of the amount billed up to the statutory maximum amount. 

Based on the ruling in Revival Chiropractic, the court remanded for entry of summary judgment in favor of First Acceptance. 

_{Legal Update for Florida Coverage & Property Litigation – August 2024 is prepared by Marshall Dennehey to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. We would be pleased to provide such legal assistance as you require on these and other subjects when called upon. ATTORNEY ADVERTISING pursuant to New York RPC 7.1 Copyright © 2024 Marshall Dennehey, all rights reserved. No part of this publication may be reprinted without the express written permission of our firm. For reprints or inquiries, or if you wish to be removed from this mailing list, contact tamontemuro@mdwcg.com.}