Medicare Fee Schedule and Florida PIP Coverage


In the state of Florida and other states that use no-fault auto insurance systems, specific issues involving insurance payouts are often part of traffic accident personal injury claims. Florida personal injury lawyers need to address these issues from a local and state perspective to help represent their clients’ interests in court. These kinds of issues are often at the heart of how settlements or payouts cover the costs of an injury, especially those related to medical bills.

1782406PIP Coverage

Personal Injury Protection (PIP) coverage was put in place in no-fault systems to help provide payouts to traffic accident injury victims. Various rules were set for evaluating accidents and adjusting payouts. These are often integrated into a traffic accident personal injury case, where the responsibility for compensating injured parties has to be worked out between various companies and individuals. Amendments to FS §627.736(5)(a) permitted insurance companies to significantly limit payment of certain expenses.

Medicare Fee Schedules

Florida insurance companies have used Medicare fee schedules to adjust personal injury protection claims. While this may be applicable in some instances, Florida courts have challenged some uses of Medicare fee schedules, because they may not be in keeping with the broader principles of PIP coverage. Medicare provides a different payment model that has specific applications to a “full practice” care provider’s business. In some cases, there’s the question of whether a Medicare payment model would unfairly restrict amounts of money paid for post-accident and recovery care.



DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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