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Geico Gen. Ins. Co. v. Virtual Imaging Servs.

Supreme Court of Florida

July 3, 2013, Decided

No. SC12-905

Opinion

 [*149]  PARIENTE, J.

The issue presented to the Court is whether the Medicare fee schedules set forth in section 627.736(5)(a), Florida Statutes (2008), authorized an insurer to limit reimbursements for medical services rendered to an insured without giving notice in the insurance policy of the insurer's election to use the Medicare fee schedules as the basis for  [**3] calculating reimbursements.1 In Geico General Insurance Co. v. Virtual Imaging Services, Inc. ("Virtual II"), 90 So. 3d 321, 322-23 (Fla. 3d DCA 2012), the Third District Court of Appeal answered this question in the negative, concluding that the insurer, GEICO General Insurance Company, could not limit reimbursements without providing notice through an election in its policy. The Third District's conclusion was consistent with the holdings of three previous district court of appeal cases that addressed the same issue. See DCI MRI, Inc. v. Geico Indem. Co., 79 So. 3d 840, 842 (Fla. 4th DCA 2012); Geico Indem. Co. v. Virtual Imaging Servs., Inc. ("Virtual I"), 79 So. 3d 55, 58 (Fla. 3d DCA 2011); Kingsway Amigo Ins. Co. v. Ocean Health, Inc., 63 So. 3d 63, 67 (Fla. 4th DCA 2011).

Because the Third District determined that this issue was recurring statewide with respect to personal injury protection (PIP) policies issued after January 1, 2008, the district court certified a question of great public importance to this Court.2  [*150]  We rephrase the certified question3 as follows:

WITH RESPECT TO PIP POLICIES ISSUED AFTER JANUARY 1, 2008, MAY AN INSURER LIMIT REIMBURSEMENTS BASED ON THE MEDICARE FEE SCHEDULES IDENTIFIED IN SECTION 627.736(5)(a), FLORIDA STATUTES, WITHOUT PROVIDING NOTICE IN ITS POLICY OF AN ELECTION TO USE THE MEDICARE FEE SCHEDULES AS THE BASIS FOR CALCULATING  [**5] REIMBURSEMENTS?

We have jurisdiction. See art. V, § 3(b)(4), Fla. Const.

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141 So. 3d 147 *; 2013 Fla. LEXIS 1387 **; 38 Fla. L. Weekly S 517; 2013 WL 3332385

GEICO GENERAL INSURANCE COMPANY, Petitioner, vs. VIRTUAL IMAGING SERVICES, INC., etc., Respondent.

Prior History:  [**1] Application for Review of the Decision of the District Court of Appeal - Certified Great Public Importance. Third District - Case No. 3D11-581. (Dade County).

Geico Gen. Ins. Co. v. Virtual Imaging Servs., 90 So. 3d 321, 2012 Fla. App. LEXIS 6387 (Fla. Dist. Ct. App. 3d Dist., 2012)

CORE TERMS

insurer, reimbursements, fee schedule, election, medical expenses, motor vehicle, provider, supplied, benefits, coverage, reasonable expenses, notice, calculating, charges, percent, methodology, Imaging, medical services, medically necessary, allowable amount, personal injury, No-Fault Law, terms, insurance policy, injured person, words, statutory provisions, certified question, insured's policy, policy provision

Insurance Law, No Fault Coverage, Personal Injury Protection, Medical Benefits, Motor Vehicle Insurance, Obligations, Notice Requirements, General Overview, Civil Procedure, Appeals, Standards of Review, De Novo Review, Claim, Contract & Practice Issues, Policy Interpretation, Question of Law, Coverage, Governments, Legislation, Interpretation, Exclusions, Plain Language