GEICO GENERAL INSURANCE COMPANY
v.
HALLANDALE BEACH ORTHOPEDICS, INC. A/A/O FRITZNIE JARBATH
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Geico General Insurance Company appealed a county court summary judgment order requiring it to pay 100% of amounts billed by Hallandale Beach Orthopedics, Inc. The Fourth District Court of Appeal addressed whether Florida's PIP statute permitted Geico to limit reimbursement to 80% of a fee schedule. The court reversed and remanded because the record did not establish whether the billed amount was less than 80% of 200% of the statutory fee schedule.
The court reversed the summary judgment and remanded for further proceedings because the record did not establish whether the billed amount was less than 80% of 200% of the fee schedule. If such a finding is made on remand, the insurer may pay either the billed amount in full or 80% of the maximum charges under the statute.
[1] Under Florida's PIP statute, an insurer may limit reimbursement to 80% of an amount set by fee schedule by electing to do so in its policy, but if the provider's billed a…
[2] Summary judgment is inappropriate in a PIP reimbursement dispute when the factual record does not establish whether the provider's billed amount falls below the threshold…
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Join FLexlaw to unlock all legal intelligence“under the PIP statute, if the billed amounts are less than 80% of the fee schedule, the insurer may pay the billed amounts in full or pay the 80% reimbursement rate of maximum charges.”
Court's statement of the applicable legal standard from Muransky
Geico sought to limit reimbursement to healthcare provider Hallandale Beach Orthopedics, Inc. under Florida's PIP insurance statute. The county court …
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KUNTZ, J. Geico General Insurance Company appeals the county court’s summary judgment order. We only address whether the insurance policy required Geico to pay 100% of the amount billed by the provider, Hallandale Beach Orthopedics, Inc. “The Florida PIP statute authorizes insurers to limit reimbursement to 80% of an amount set by a fee schedule, see § 627.736(5)(a)1.a.–f., by electing to do so in its policy, see § 627.736(5)(a) 5.” Geico Indem. Co. v. Muransky Chiropractic P.A., No. 4D21-457, 2021 WL 2584107, at *3 (Fla. 4th DCA June 24, 2021). In Muransky, we held that “under the PIP statute, if the billed amounts are less than 80% of the fee schedule, the insurer may pay the billed amounts in full or pay the 80% reimbursement rate of maximum charges.” Id. at *4 (citing Geico Indem. Co. v. Accident & Inj. Clinic, Inc., 290 So. 3d 980, 984 (Fla. 5th DCA 2019)).
Our holding in Muransky is binding on this case. In re Rule 9.331, Determination of Causes by a Dist. Ct. of Appeal En Banc, Fla. R. App. P., 416 So. 2d 1127, 1128 (Fla. 1982). But the facts of this case require a different outcome. In Muransky, the record established that the provider billed an amount less than 80% of 200% of the applicable statutory fee schedule. 2021 WL 2584107, at *1. As a result, in that case, the answer to the legal question was dispositive. Here, the record does not establish whether the amount billed was less than 80% of 200% of the statutory fee schedule. For this reason, we reverse the court’s judgment and remand for further proceedings. If the amount billed was less than 80% of 200% of the fee schedule, the ultimate result will be the same as in Muransky.
Reversed and remanded. DAMOORGIAN and ARTAU, JJ., concur. * * * Not final until disposition of timely filed motion for rehearing.
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Progressive Am. Ins. Co. v. Back on Track, 336 So. 3d 404 (Fla. 2d DCA 2022)…nder the statutory schedule of maximum charges. The court entered an order denying Progressive's motion and granting BOT's motion; the order states that the ruling was based on Geico Indemnity Co. v. Accident & Injury Clinic, Inc. ex rel. Irizarry, 290 So. 3d 980 (Fla. 5th DCA 2019), and reflects the court's conclusion that Progressive "was required to pay 80% of the applicable fee schedule amount for [BOT's] charges . . . or to pay the charge at 100% of the full amount billed for those charges billed below…
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Geico Gen. Ins. Co. v. Hallandale Beach Orthopedics, Inc., 290 So. 3d 980 (Fla. 4th DCA 2021)…PIP statute, if the billed amounts are less than 80% of the fee schedule, the insurer may pay the billed amounts in full or pay the 80% reimbursement rate of maximum charges.” Id. at *4 (citing Geico Indem. Co. v. Accident & Inj. Clinic, Inc., 290 So. 3d 980, 984 (Fla. 5th DCA 2019)). 2 Our holding in Muransky is binding on this case. In re Rule 9.331, Determination of Causes by a Dist. Ct. of Appeal En Banc, Fla. R. App. P., 416 So. 2d 1127, 1128 (Fla. 1982). But the facts of this case req…
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Progressive Am. Ins. Co. v. Express Care of Belleview, LLC, 49 Fla. L. Weekly S113 (Fla. 5th DCA 2024)…ty Healthcare Ctr. at Waterford Lakes, PL, 336 So. 3d 404, 406 (Fla. 5th DCA 2022) (“Affinity”); Hands On Chiropractic PL v. GEICO Gen. Ins. Co., 327 So. 3d 439, 444 (Fla. 5th DCA 2021) (“Hands On”); Geico Indem. Co. v. Accident & Inj. Clinic, Inc., 290 So. 3d 980, 984 (Fla. 5th DCA 2019) (“Irizarry”). We reverse based on our supreme court’s recent decision in Allstate Insurance Co. v. Revival Chiropractic, LLC, 49 Fla. L. Weekly S113 (Fla. Apr. 25, 2024), where the court rejected any interpretation of “subs…
Previewing 3 of 9 citing cases — full citator treatment, depth of discussion, and citing context are member features.
Join FLexlaw to unlock all legal intelligenceAuthorities Cited
- In re Rule 9.331, 416 So. 2d 1127 (Fla. 1982)
- Geico Gen. Ins. Co. v. Hallandale Beach Orthopedics, Inc., 290 So. 3d 980 (Fla. 4th DCA 2021)
- Geico Indem. Co. v. Total Orthopaedics Care P.A. (Fla. 4th DCA 2021)