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Florida Fifth DCA rules that when PIP insurer chooses to reimburse health care provider according to scheduled rates, it must pay 80 percent of 200 percent of the statutorily adopted applicable fee schedule.

On September 10, 2021, in Hands On Chiropractic PL A/A/O Justin Wick v. Geico General Insurance Company, No. 5D20-2705, the Florida Fifth DCA held that when Personal Injury Protection (PIP) insurer chooses to reimburse a health care providr according to scheduled rates, it must pay 80 percent of 200 percent of the statutorily adopted applicable fee schedule. The “applicable fee schedule” is based upon the fee schedule or payment limitations under Medicare Part B (as further described and defined in section 627.736(5)(a)2., Florida Statutes (2019)). The Court concluded that there is nothing in the statutory scheme that permits a PIP insurer to limit reimbursements to 80 percent of the billed amount.

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