GEICO GENERAL INSURANCE COMPANY v. HALLANDALE BEACH ORTHOPEDICS INC (2021)

Geico General Insurance Company appeals the county court's summary judgment order. We only address whether the insurance policy required Geico to pay 100% of the amount billed by the provider, Hallandale Beach Orthopedics, Inc.

“The Florida PIP statute authorizes insurers to limit reimbursement to 80% of an amount set by a fee schedule, see § 627.736(5)(a)1.a.–f., by electing to do so in its policy, see § 627.736(5)(a) 5.” Geico Indem. Co. v. Muransky Chiropractic P.A., No. 4D21-457, 323 So.3d 742, 747 (Fla. 4th DCA June 24, 2021). In Muransky, we held that “under the PIP statute, if the billed amounts are less than 80% of the fee schedule, the insurer may pay the billed amounts in full or pay the 80% reimbursement rate of maximum charges.” Id. at 747 (citing Geico Indem. Co. v. Accident & Inj. Clinic, Inc., 290 So. 3d 980, 984 (Fla. 5th DCA 2019)).

Our holding in Muransky is binding on this case. In re Rule 9.331, Determination of Causes by a Dist. Ct. of Appeal En Banc, Fla. R. App. P., 416 So. 2d 1127, 1128 (Fla. 1982). But the facts of this case require a different outcome.

In Muransky, the record established that the provider billed an amount less than 80% of 200% of the applicable statutory fee schedule. 323 So.3d at 744. As a result, in that case, the answer to the legal question was dispositive. Here, the record does not establish whether the amount billed was less than 80% of 200% of the statutory fee schedule. For this reason, we reverse the court's judgment and remand for further proceedings. If the amount billed was less than 80% of 200% of the fee schedule, the ultimate result will be the same as in Muransky.

Reversed and remanded.

Kuntz, J.

Damoorgian and Artau, JJ., concur.