Personal Injury Protection (PIP) Insurance Fee Schedule Issue Certified to Florida Supreme Court
Apr 26, 2012
In the case of Geico v. Virtual Imaging, No. 3D11-581, the Third District Court of Appeal has certified the following question to the Florida Supreme Court as being one of great public importance:
“WITH RESPECT TO PIP POLICIES ISSUED AFTER JANUARY 1, 2008, MAY THE INSURER COMPUTE PROVIDER REIMBURSEMENTS BASED ON THE FEE SCHEDULES IDENTIFIED IN SECTION 627.736(5)(a), FLORIDA STATUTES, EVEN IF THE POLICY DOES NOT CONTAIN A PROVISION SPECIFICALLY ELECTING THOSE SCHEDULES RATHER THAN ‘REASONABLE MEDICAL EXPENSES’ COVERAGE BASED ON SECTION 627.736(1)(a)?”
While recognizing that its prior opinion in the case had already answered the question in the negative, the Third District Court of Appeal noted: “[t]hat opinion does not mean, however, that the issue is so free from debate, unimportant, or unlikely to recur as to preclude further consideration by the Florida courts.”
Indeed, the Court went on to recognize that continuing litigation over such mundane matters as what a reasonable charge is for an MRI test is “contrary to the original, no-fault objectives of the PIP statute.”
The opinion was authored by Judge Vance E. Salter and a lengthy and impassioned concurring decision was authored by Judge Leslie B. Rothenberg. In her concurrence, Judge Rothenberg reminds that she disagreed with the original panel decision, which she contends is wrongly decided. Her 20-page concurring opinion sets forth a reasoned road map for the Florida Supreme Court and points out that, because of the $10,000 limit in Personal Injury Protection (“PIP”) insurance coverage, “interpreting PIP insurance policies in favor of the insureds actually requires reading the policies to cover the lowest amount possible.”
In other words, it would be more beneficial to insureds to allow companies to apply the fee schedule to a given bill for services, regardless of whether the policy incorporates the fee schedule language.
This opinion was filed on April 25, 2012 and is not final until motions for rehearing, if any, are disposed of.
A copy of the opinion is attached for review.
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