80% of 200% of Medicare: Florida's PIP Fee Schedule Floor Explained

Key Takeaways

• Florida’s Fifth DCA held that a PIP insurer electing the fee schedule method must pay 80% of 200% of the applicable Medicare fee schedule — not 80% of the billed amount.
• GEICO had paid 80% of a bill that was already below the fee schedule; the court found nothing in the statute permitting that approach.
• The underpayment was small; the attorney fee exposure was six figures — a recurring economics lesson in PIP litigation.
• The decision also explores certiorari and the post-2021 plenary jurisdiction of Florida’s District Courts of Appeal over county court matters.

The Decision

HANDS ON CHIROPRACTIC PL A/A/O JUSTIN WICK vs GEICO GENERAL INSURANCE COMPANY, Case No. 5D20-2705 (Fla 5th DCA 2021)

GEICO, regardless of where they do business, always has their own view of the law. Here, the provider submitted a bill less than the fee schedule. GEICO decided to pay it at 80% of the billed amount. The rule in Fla is that the floor is the lesser of the bill or 80% of 200% of the FS. Simple issue but now GEICO has a $100,000 attorney fee bill to pay on this I am sure.

“We hold that when an insurer chooses to reimburse according to scheduled rates, it must pay 80 percent of 200 percent of the statutorily adopted applicable fee schedule.1 There is nothing in the statutory scheme that permits a PIP insurer to limit reimbursements to 80 percent of the billed amount.”

The case is interesting because it construes certiori (which was granted) and then constures the new post 2021 plenary jurisdiction that the District Courts of Appeal have over County Court matter. Procedural fans will love the case; statutory textualists will ask what the heck GEICO was doing. Common sense always ask when you are looking at 6 figure attorney fee awards on a $10k policy, why fight some of these issues?

The Legal Framework: How Florida’s PIP Fee Schedule Works

Florida PIP pays 80% of reasonable medical expenses, up to the $10,000 policy limit. An insurer has two ways to determine what is “reasonable”: litigate reasonableness the old-fashioned way, or elect in its policy to reimburse under the statutory fee schedule method. Under the fee schedule method, the benchmark for most services is 200% of the applicable Medicare Part B fee schedule — and the carrier pays 80% of that figure.

The wrinkle in Hands On Chiropractic arose because the provider billed less than the schedule amount. GEICO seized on that and paid 80% of the lower billed charge. The Fifth DCA’s answer was textual and unequivocal: a carrier that elects the schedule must pay 80% of 200% of Medicare. The statute contains no authorization to substitute the billed amount as the reimbursement base once the schedule election is made.

For New York readers, the architecture rhymes with our own system, where reimbursement is pegged to the workers’ compensation fee schedule and fee schedule defenses are among the most heavily litigated issues in no-fault practice. In both states, the fee schedule is a creature of statute and regulation — a carrier cannot improvise a more favorable payment methodology than the one the law prescribes.

The Procedural Layer: Certiorari and Plenary DCA Jurisdiction

The opinion has a second life as a procedure case. The dispute began in county court — Florida’s small-claims trial forum for PIP suits — and reached the Fifth DCA through certiorari, which the court granted. The opinion then works through the 2021 jurisdictional reform giving Florida’s District Courts of Appeal plenary appellate jurisdiction over county court matters, replacing the old circuit-court appellate layer.

That change mattered enormously for PIP practice: it meant fee schedule and reimbursement questions that had been percolating inconsistently through circuit appellate panels would now generate uniform, binding DCA precedent. Hands On Chiropractic is an early example of the new pipeline at work.

Why This Matters: The Economics of Fighting Small Issues

The substantive holding is almost the least interesting part. The underpayment on a single chiropractic claim is measured in hundreds of dollars; the attorney fee award that follows a provider’s win under Florida’s fee-shifting regime is measured in six figures. When a carrier litigates a textually weak position to a DCA on a $10,000 policy, the fee exposure dwarfs the indemnity many times over.

That asymmetry is the engine of PIP litigation in Florida — and the cautionary tale for claims professionals everywhere. Positions should be stress-tested against the statutory text before they become portfolio-wide payment practices, because a systematic underpayment methodology multiplies the exposure across every claim paid that way.

New York practitioners will recognize the dynamic in mirror image: our no-fault system caps attorney fees in most first-party disputes, which suppresses the fee-driven litigation economics — but disputes over the correct fee schedule rate, modifier, or region code remain a daily battleground in New York no-fault litigation.

Practice Pointers

• Carriers: if the policy elects the fee schedule method, pay 80% of 200% of the applicable schedule. Paying 80% of a below-schedule bill is now squarely foreclosed in the Fifth DCA.
• Providers: billing below the schedule does not lower the statutory reimbursement floor once the carrier has made the schedule election — audit EOBs for this exact underpayment pattern.
• Both sides: run the fee-exposure math before appealing small-dollar reimbursement issues; the indemnity is rarely the real number in the case.

Frequently Asked Questions

What does “80% of 200% of Medicare” mean in Florida PIP?

It is the reimbursement formula when a Florida PIP insurer elects the statutory fee schedule method: the allowed amount for most services is 200% of the applicable Medicare Part B fee schedule, and PIP pays 80% of that allowed amount.

Can a PIP insurer pay 80% of the billed amount instead when the bill is below the fee schedule?

No. In Hands On Chiropractic v GEICO, Florida’s Fifth DCA held there is “nothing in the statutory scheme” permitting an insurer that elected scheduled rates to limit reimbursement to 80% of the billed amount.

How does this compare to New York’s no-fault fee schedule?

New York pegs no-fault reimbursement to the workers’ compensation fee schedule rather than Medicare, but the principle is the same: the schedule is mandatory once applicable, and carriers and providers litigate constantly over correct rates, codes, and ground rules.

Related Resources

• Fee Schedule Defense in No-Fault Insurance — the firm’s cluster hub on fee schedule litigation
• The firm’s Legal Encyclopedia
• No-Fault Defense practice
• New York No-Fault Insurance Law
• Personal Injury Practice Areas
• Employment Discrimination
• Contact the Law Office of Jason Tenenbaum