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Medical Provider's Argument that Florida PIP Statute Requires Insurers to Choose Only One PIP Reimbursement Method Flatly Rejected By Supreme Court

December 9, 2021

In MRI Associates of Tampa, Inc. v. State Farm Mutual Automobile Insurance Company, No. SC18-1390 (Fla. Dec. 9, 2021), the Florida Supreme Court weighed in for the first time as to the validity of a State Farm policy’s Personal Injury Protection (PIP) coverage provisions following the 2012 amendment to the Florida PIP Statute (§ 627.736(5), Fla. Stat.). Following the 2012 amendment, State Farm updated its policy language, which tracked the new statutory language found in both subsection (5)(a)—containing the “reasonable charge reimbursement methodology”—and subsection (5)(a)1—containing the schedule of maximum charges reimbursement methodology—either of which may be used to determine the reasonableness of medical charge reimbursements. The Appellant, a medical provider, argued that State Farm must elect only one reimbursement methodology in its policy and that, by incorporating both into its policy language, State Farm created an unlawful hybrid reimbursement methodology not allowed under Florida’s PIP Statute. The Florida Supreme Court soundly rejected the medical provider’s argument, concluding that a simple reading of the 2012 amendment to the PIP statute reflects that the two reimbursement methodologies discussed in the statute are not mutually exclusive methodologies for determining the reasonableness of reimbursements. Moreover, the 2012 amendment to the PIP Statute states that an insurer may limit PIP reimbursement payments as outlined in the statute only if the insurance policy includes a notice stating that the insurer may limit such payments pursuant to the schedule of charges discussed in the statute. State Farm’s policy did just that. The Court affirmed the Second District’s opinion (252 So. 2d 773 (Fla. 2d DCA 2018)) in favor of State Farm. View here.


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