Posted in on October 1, 2011
In Nationwide Mut. Fire Ins. Co. v. AFO Imaging, 36 Fla. L. Weekly D1463 (Fla. 2nd DCA, July 6, 2011), the Second District Court of Appeal held that the phrase, “allowable amount under the participating physicians schedule of Medicare Part B”, under the Florida No-Fault Statute, Fla. Stat. § 627.736(5)(a)(2)(f) and (5)(a)(3), does not include amounts payable under the OPPS fee schedule because it is “an entirely separate component of the Medicare Part B program from the participating physicians schedule.” The Second District held that it would have to ignore the phrase “under the participating physicians schedule,” in order to read the provision in the manner suggested by the carriers. Accordingly, the District Court held that under subsections (5)(a)(2)(f) and (5)(a)(3),a PIP carrier cannot cap reimbursement by using OPPS. The question remains, however, whether this case will have any weight with regard to a PIP carrier’s statutory right to pay what is “reasonable” under subsections (1)(a) and (5)(a)(1).