The Florida Supreme Court recently issued its decision on one of the most longstanding issues in Florida PIP law by ruling in favor of Allstate in Allstate Insurance v. Revival Chiropractic, No. SC2022-0735 (Fla. Apr 25, 2024). The “billed amount” issue deals with both policy language and Section 627.736(5)(a)(5) of the PIP statute. In plain language, the issue can be summarized as whether an insurer is eligible to reimburse a bill at 80% of the amount billed when that amount is less than 200% of the Medicare fee schedule rate for the corresponding year for which the service was rendered.

The analysis of the various arguments both in favor of and against reimbursing 80% of a billed amount for a charge involves the complex interplay between several sections of Fla. Stat. 627.736 (the Florida PIP statute) and specific policy language regarding adoption of the payment methodologies it enumerates.