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Summary Judgment in Personal Injury Protection Case

Michael Walsh, of the Ft. Lauderdale office, obtained a Summary Judgment on an issue of first impression in the entire State of Florida. The issue in question was whether the phrase “allowable amount under the applicable schedule of Medicare Part B for 2007” as used in Florida Statute § 627.736(5)(a)(2)(2012), refers to Medicare’s “Participating/Non-Participating” Fee Schedule or the “Limiting Charge” amount. As part of the Summary Judgment hearing, Michael was successful in striking the Plaintiff’s expert affidavit as it failed to comply with the Daubert Standard.

As it relates to the Summary Judgment, Michael successfully argued that application of the participating/nonparticipating fee schedule was consistent with Florida Personal Injury Protection (PIP) law. Michael argued that the “Limiting Charge” is inconsistent with the PIP Statute as it is premised in the absence of an assignment of benefits; the “Limiting Charge” is a surcharge borne/paid by the Medicare insured; application of the “Limiting Charge” amount is inconsistent with the PIP Statute as it attempts to interchange the obligation of the Medicare insured with that of the Florida PIP insured when an assignment of benefits exists and Legislative history, construction, and intent support the incorporation of the “Participating” fee schedule into Florida Statute Section 627.736(5)(a)(2).

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