FPCA Automobile Division: Fourth District Court of Appeal Rules insurance carrier may not utilize PIP Fee Schedule unless statutory fee schedule is explicitly part of policy language

Jan 19, 2012


Florida Property and Casualty Association Automobile Division Members:

In a unanimous opinion the Fourth District Court of Appeal ruled yesterday, January 18, 2012, that an insurance carrier may not utilize the PIP Fee Schedule unless the statutory fee schedule is explicitly part of the policy language.  The opinion in DCI MRI, Inc. v. Geico Indemnity Company, authored by Judge May was said to be “dictated” by the Fourth District’s earlier opinion in Kingsway Amigo Insurance Co. v. Ocean Health, Inc., 63 So. 3d 63 (Fla.4th DCA 2011).  Specifically, the court stated:

As in Kingsway, the policy here provided that it would pay 80% of reasonable medical expenses. The fact that the 2008 statute would allow the insurer to opt for another lesser amount does not permit the insurer to do so when the policy specifically provides for payment of 80% of reasonable expenses incurred. Simply indicating that the insurer would pay in accordance with the law “as amended,” is insufficient to place the insured on notice of its intent to pay less than 80% of reasonable expenses incurred as stated in the policy.

Although not unexpected, this ruling further confuses the already muddied PIP Fee Schedule waters.  By suggesting that the PIP Fee Schedule is “less than 80% of reasonable expenses” the Court may be opening up a whole new can of worms regarding the validity of the PIP Fee Schedule payments, even when the language has been incorporated into a policy.  One reason for the court’s confusion may be that the parties stipulated that the bills at issue were reasonable, related and necessary in order to isolate the appellate issue regarding the need to have the language in the fee schedule. The decision is not final until the time for filing motions for hearing has passed.

A copy of the ruling is attached for review.


Should you have any questions or comments, please contact Maria Elena Abate (mabate@cftlaw.com) at Colodny Fass.