Allstate Insurance Co. v. Revival Chiropractic, LLC
On a certified question from the Eleventh Circuit, the Florida Supreme Court held that a PIP insurer whose policy gives notice that it may limit payment under the statutory schedule of maximum charges may nonetheless pay 80% of the provider's submitted charge even where that amount is less than 80% of the scheduled maximum. Extending MRI Associates, the Court held that section 627.736(5)(a)5.'s statement that the insurer 'may pay the amount of the charge submitted' is purely permissive and does not require payment of 100% of the billed charge; the surplusage canon cannot convert 'may pay' into 'must pay.'
Key facts
- Allstate Insurance Company issued a PIP policy to Revival Chiropractic, LLC that promised to pay 80% of reasonable charges for chiropractic services, with notice that it could limit reimbursement under the statutory schedule of maximum charges.
- Revival Chiropractic submitted charges below the statutory fee schedule maximum, and Allstate paid 80% of the submitted charges rather than 80% of the scheduled maximum amount, resulting in a dispute over the proper reimbursement calculation.
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Why it matters
This decision resolves a recurring, high-volume PIP reimbursement dispute in insurers' favor and effectively disapproves the Fourth and Fifth DCA decisions (Hands On and Muransky) that providers had relied on to demand… — full analysis with a trial
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