Recent cases from Florida’s District Courts of Appeal underscore the caution insurers must take when calculating reimbursement for personal injury protection (PIP) benefits. The 3rd and 4th District Courts of Appeal have both held that if an insurer wants to reimburse according to the Medicare Part B fee schedule provided in the 2007 amendments to the PIP statute, the relevant policy must expressly provide that reimbursement will be made in this manner.
Florida Statute 627.736 states that insurers must provide PIP benefits as follows: “80 percent of all reasonable expenses for medically necessary medical, surgical, X-ray, dental, and rehabilitative services, including prosthetic devices, and medically necessary ambulance, hospital and nursing services.”
