PIP Fee Schedule Update: Fourth DCA First to Rule

On May 18, 2011, the Fourth District Court of Appeal issued the first decision in the ongoing debate about the PIP fee schedules.  The dispute has been raging in the county courts for over three years, since the Legislature amended the PIP statute to provide that an “insurer may limit reimbursement to 80 percent of the following schedule of maximum charges… 200 percent of Medicare Part B…”

In Kingsway Amigo Ins. Co. v. Ocean Health, Inc., Case No. 4D10-4887, the court held that an insurer is required to elect the fee schedules by writing its election into the insurance policy.  Our firm, representing Kingsway Amigo, argued that the statute plainly allows an insurer to limit reimbursement at the time of payment, without having specified the payment methodology in the policy.  The Fourth DCA disagreed.

But the debate is far from over.  The Fourth DCA’s decision is not yet final.  And our firm is handling a case in the Third District Court of Appeal that raises the same issue, U.S. Security Ins. Co. v. Professional Medical Group, Inc., Case No. 3D10-2881.  I argued the case before Judges Shepherd, Emas and Schwartz on April 27, 2011.

The Third DCA very well could reach a different conclusion than the Fourth DCA.  If that happens, the fee schedule issue could be headed to the Florida Supreme Court based on the court’s jurisdiction to review DCA decisions that expressly and directly conflict.

I’ll keep you posted.