Florida Supreme Court Rules on PIP Insurance Reimbursements

The Florida Supreme Court has resolved a significant legal question regarding the reimbursement strategies of personal injury protection (PIP) insurance in the case of Allstate Insurance Company vs. Revival Chiropractic, LLC. This decision stems from a dispute about the amounts insurers are obligated to pay under PIP policies, which was escalated to the Supreme Court from the Eleventh Circuit Court.

The core of the dispute was whether Allstate could pay only 80% of a lower submitted charge by Revival Chiropractic, even when that charge was below the higher permissible limit defined by the statutory schedule of maximum charges. The Supreme Court confirmed that Allstate’s actions were consistent with Florida law, which allows insurers to pay a lesser percentage if that’s what the policy stipulates and the charges submitted fall under the scheduled maximums.

This decision reaffirms the insurer’s ability to use a hybrid-payment methodology, allowing them to choose between paying up to the scheduled maximum or paying a percentage of the actual charges submitted, which could be less than the maximum. The ruling supports insurers’ flexibility in managing reimbursements under the statutory framework of Florida’s PIP statute, reinforcing that the schedule of maximum charges serves as a ceiling, not a floor, for payments.