Florida Supreme Court Rules in Favor of Providers in PIP Deductible Case

Just before the close of 2018, and in an unusual unanimous decision by the Florida Supreme Court, the long issue of contention in how a PIP insurer should apply the deductible to medical bills was finally decided in favor of the providers.  In the case, “Progressive Select Ins. Co. v. Florida Hospital Medical Center, 44 Fla. L. Weekly S59a (Fla. December 28, 2018), it meant the difference of $200 each and every time Progressive improperly calculated the $1,000 deductible.

At issue was whether a carrier could reduce a bill to its fee schedule before applying that bill toward a deductible.  The answer was litigated to be a definite NO.  100% of the charge is to be first applied toward a deductible until the deductible is satisfied.  Only then may a carrier begin paying submitted charges in accordance with the fee schedule.

This case with Progressive, coming out of the Fifth District Court of Appeal, arose in 2014 while alongside an appellate case from the Fourth District Court of Appeal against State Farm with the identical issue yet differing results.  Providers can now use this decision to collect any improperly calculated reimbursements from patients with PIP deductibles.  Unlike legislation with an effective date, and unlike most court decisions allowing for motions for rehearing, the Florida Supreme Court specifically stated in its order that, “NO MOTION FOR REHEARING WILL BE ALLOWED.”  Therefore, this decision should be effective upon the rendition of the order – December 28, 2018.

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