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Florida Supreme Court resolves DCA conflict, rules that PIP insurer must apply PIP deductible before reduction based on statutory schedule of maximum charges

On December 28, 2018, in Progressive Select Insurance Company v. Florida Hospital Medical Center, No. SC18-278, the Florida Supreme Court resolved a conflict between the Fourth and Fifth DCAs, affirming a ruling by the Fifth DCA that a PIP insurer was required to apply the PIP deductible before reduction of a medical provider’s bill based on the statutory schedule of maximum charges contained in Section 627.736(5)(a)1, Florida Statutes. Under the statutory schedule, the hospital’s reimbursement for emergency services and care was limited to 80% of 75% of the hospital’s usual and customary charges for the emergency care provided. The applicable PIP deductible was $1,000 (the maximum amount allowed under Florida law). Applying the deductible before the reimbursement limitation increased the hospital’s recovery by $200.

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