The Fourth District Court of Appeal resolved an ongoing dispute regarding whether personal injury protection (“PIP”) insurers are to apply policy deductibles to the medical provider’s total billed charges or only after that billed amount is adjusted based on the fee schedule set forth in section 627.739, Florida Statutes. Agreeing with the Institute’s arguments as amicus, the Fourth District ruled that an insurer must reduce the provider’s charges to the statutorily-approved fee schedule before applying the deductible. The Fourth District reasoned that such a result is demanded by the plain language of the statute and is also consistent with the traditional law concerning insurance deductibles, which are intended to apply only to amounts actually payable under the insurance policy. Amounts which exceed the “reasonable” value of medical services as determined by the statutory fee schedule are not amounts payable under the policy.
FJRI represented by Peter J. Valeta of Cozen O’Connor.