State Farm Wins at 2nd DCA in PIP Payment Dispute

The 2nd DCA recently ruled in favor of State Farm Mutual Automobile Insurance Company in a long-awaited decision!  In State Farm Mutual Automobile Insurance Company v. MRI Associates of Tampa, Inc., d/b/a Park Place MRI, No. 2D16-4036 (Fla. 2nd DCA May 18, 2018), there was a dispute regarding how much should be paid for MRIs performed on State Farm insureds after motor vehicle accidents.  The case stems from 19 MRI claims resulting from motor vehicle accidents in 2013 where the insured had Personal Injury Protection (“PIP”) coverage with State Farm.  State Farm paid the submitted bills pursuant to its policy language, which allows State Farm to limit the payments to the schedule of charges.  Despite the clear language of the policy, the MRI provider challenged the reduced charges, arguing that State Farm’s policy did not properly notify the insureds of its election to pay bills via the schedule of maximum charges.

According to the opinion, “[t]he circuit court ruled that State Farm’s personal injury protection (PIP) policy failed to clearly and unambiguously elect to limit reimbursement payments to the schedule of maximum charges” described in the No-Fault statute.  The 2nd DCA reversed that holding, and found that the express language of State Farm’s PIP policy clearly and unambiguously elected to limit reimbursement payments for medical expenses to the schedule of maximum charges pursuant to the No-Fault statute.

Although we are pleased the 2nd DCA took the correct position regarding State Farm’s policy language and an insurer’s right to limit reimbursement payments to the schedule of maximum charges, the fight isn’t over yet.  The 2nd DCA certified the question to the Florida Supreme Court as a matter of great public importance.   

Click here to view the Opinion.