In the wake of Kingsway Amigo Ins. Co. v. Ocean Health, No. 4D10-4887, and Geico Indemnity Co. v. Virtual Imaging Services, No. 3D10-2595, auto insurance carriers have been left with a great deal of uncertainty regarding whether they may reimburse medical providers according to the Medicare participating physicians fee schedule, when this method of reimbursement is not explicitly incorporated into the contract.
In Kingsway and Virtual Imaging, the Fourth and Third District Courts of Appeal held there are two methods of reimbursement under the personal injury protection (PIP) statute: the Medicare “fee schedule” method and the “reasonableness” method. Kingsway and Virtual Imaging held that in order to reimburse according to the fee schedule method, carriers are required to explicitly incorporate this method into their insurance policies. But these cases did not explicitly state whether, if an insurer uses a fee schedule in paying reimbursement when the contract calls for reimbursement under the “reasonableness” method, the insurer may argue that the reimbursement nonetheless constitutes 80 percent of all reasonable expenses.
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