Personal Injury Blog | Sands, White & Sands, P.A.

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. October 12, 2021

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 ...

Florida Third DCA rules in PIP case that insurance adjuster was qualified to submit affidavit contesting reasonableness of amount of medical provider’s charges September 15, 2021

On August 4, 2021, in United Automobile Insurance Company v. Progressive Health Services, No. 3D21-109, the Florida Third DCA reversed a trial court’s summary judgment in favor of the plaintiff medical provider, the assignee of PIP benefits from the...

Florida Third DCA reverses trial court, rules that summary judgment in PIP case for plaintiff medical provider was in error because plaintiff failed to establish that the injured person, the passenger of a vehicle which was struck by the defendant insurance company’s insured’s vehicle, fit into any of the categories of persons entitled to PIP coverage September 15, 2021

On August 25, 2021, in Geico General Insurance Company v. Hialeah Diagnostics, Inc., No. 3D21-101, the Florida Third DCA reversed a trial court summary judgment in favor of the plaintiff medical provider in a PIP insurance lawsuit against the defendant...

Florida Fourth DCA reverses trial court, rules that defendant PIP insurance carrier was entitled to judgment in its favor in fee dispute with medical provider because it clearly and unambiguously provided notice of its intention to use permissive statutory fee schedules September 15, 2021

On August 25, 2021, in Allstate Property & Casualty Insurance Company v. Marcia C. Sasso, D.C., P.A., No. 4D21-0141, the Florida Fourth DCA reversed a trial court’s summary judgment in favor the plaintiff medical provider in a PIP case against the...

Florida Fifth DCA joins Eleventh Circuit, Third and Fourth DCAs in holding that PIP benefits are limited to $2,500 in the absence of an affirmative determination by a qualifying health care provider that the patient had an emergency medical condition July 12, 2021

On June 4, 2021, in Depositors Insurance Company v. Pasco-Pinellas Hillsborough Community Health System, No. 5D21-71, the Florida Fifth DCA ruled that the benefits payable under a personal injury protection ...

Florida Third DCA rules that PIP insurer was equitably estopped from claiming that medical provider’s late submission of charges precluded payment; Court finds that insurer’s notice to insured that it was denying coverage was the cause of the late submission July 12, 2021

On June 16, 2021, in United Automobile Insurance Company v. Chiropractic Clinics of South Florida, No. 3D21-111, the Florida Third DCA affirmed a final judgment in favor of a medical provider in a case involving a dispute...

Florida Fourth DCA rules that medical provider had improperly “unbundled” billing codes to increase the amount billed to the insurance company July 12, 2021

On June 23, 2021, in Associates inFamily Practice of Broward, LLC v. Allstate Fire and Casualty Insurance Company, No. 4D21-173,a Personal Injury Protection (“PIP”) case, the Florida Fourth DCA affirmed a county court order...

Florida Fourth DCA rules in PIP case that State Farm was entitled to discount payments to MRI provider for three MRIs performed on same day based on Medicare’s Multiple Procedure Payment Reduction July 12, 2021

On May 26, 2021, in State Farm v. Stand Up MRI of Boca Raton, P.A., No. 4D21-310, the Florida Fourth DCA reversed a county court’s summary judgment for the plaintiff medical provider in a Personal Injury Protection...

Florida Fourth DCA rules that medical provider’s PIP lawsuit was premature because provider had failed to respond to insurer’s numerous Fla. Stat. § 627.736(6)(b) requests for “emergency medical condition” documentation July 12, 2021

On June 30, 2021, in Garrison Property & Casualty Insurance Company v. Aventura Orthopedicare Center, P.A., No. 4D21-379, the Florida Fourth DCA reversed a judgment for the medical provider in a case in which...

Florida Fourth DCA rules that PIP insurer was not entitled to reduce payments to health care provider by 2% based on Medicare schedule intended to apply only to Medicare payments June 1, 2021

On May 19, 2021, in Sunrise Chiropractic and Rehabilitation Center, Inc. v. Security National Insurance Company, No. 4D21-188, the Florida Fourth DCA ruled that the defendant insurer in a county court case filed by a medical provider for the recovery of Personal Injury Protection (PIP) benefits...

Florida Third DCA affirms summary judgment for defendant insurance company in PIP lawsuit, finding that the plaintiff’s pre-suit demand letter was statutorily deficient March 12, 2021

On February 24, 2021, in Rivera v. State Farm Mutual Automobile Insurance Company, No. 3D21-27, the Florida Third DCA affirmed a county court’s final judgment for the defendant insurance company in a PIP case...

Florida Fourth DCA rules that PIP policy issued by defendant insurer plainly limited medical provider reimbursement to 80% of statutory fee schedule October 08, 2020

On September 23, 2020, in Plantation Open MEI, LLC., et al. v. Infinity Indemnity Insurance Company, et al., the Florida Fourth DCA affirmed a summary...

Florida First DCA rules that PIP statute does not create a private cause of action for an insured to challenge the reasonableness of a health care provider’s charges April 27, 2020

On March 12, 2020, in MacNeil v. Crestview Hospital Corporation, No. 1D18-1958, the Florida First DCA affirmed a trial court ruling dismissing the plaintiff’s putative class action ...

Florida Fifth DCA rules that Florida’s PIP statute does not preclude an insurer from limiting its reimbursement to 80% of the total billed amount even when the amount billed is less than the statutory fee schedule January 17, 2020

On December 20, 2019, in Geico Indemnity Company v. Accident & Injury Clinic, No. 5D19-1409, the Florida Fifth DCA concluded that that Florida’s PIP statute ...

Florida Second DCA finds that county school board was not exempt from PIP insurer’s reimbursement demand for benefits paid to injured school bus passengers June 13, 2019

On May 24, 2019, in Lee County School Board v. State Farm , No. 2D17-4595, the Florida Second DCA affirmed a trial court order finding the Lee County School Board and its insurer liable to State Farm ...

Florida Supreme Court resolves DCA conflict, rules that PIP insurer must apply PIP deductible before reduction based on statutory schedule of maximum charges January 17, 2019

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, ...

Eleventh Circuit Court of Appeals affirms district court's denial of summary judgment based on qualified immunity to officer who tased plaintiff four times for failing to obey roadside instructions September 18, 2018

On September 12, 2018, in Glasscox v. City of Argo , No. 16-16804, the Eleventh Circuit Court of Appeals affirmed a district court’s denial of the defendant police officer’s motion for summary ...

Florida Second DCA rules that State Farm PIP policy's election to limit reimbursement payments for medical expenses to schedule of maximum charges was enforceable July 17, 2018

On May 18, 2018, in State Farm v. MRI Associates of Tampa, No. 2D16-4036, the Florida Second DCA reversed a trial court’s summary judgment in favor of the defendant, concluding that the State Farm PIP ...

Florida Fourth DCA rules that PIP insurers must reduce a provider's charges to statutory permissive fee schedule before applying deductible, certifies conflict with Fifth DCA March 27, 2018

On March 14, 2018, in State Farm v. Care Wellness Center , No. 4D16-2254, the Florida Fourth DCA ruled that PIP insurers must reduce a provider’s charges under the statutory permissive fee schedule, ...

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