Allstate Indemnity Company v. Markley Chiropractic & Acupuncture, LLC, 226 So. 3d 262

Allstate issued PIP policies to Ilene Chavez and Yosley Gonzalez; both were injured in covered automobile accidents and assigned benefits to their medical providers (Markley and Diagnostic).
Providers billed for services; Allstate paid less than 80% of billed charges, relying on section 627.736(5)(a)(2)(f)’s permissive Medicare-based fee schedule (200% of Medicare Part B) as implemented by policy endorsements.
Providers sued Allstate for breach of contract, seeking 80% of billed amounts under the policies and section 627.736(1). The disputed unpaid benefits totaled under $264.
The trial courts granted summary judgment for the providers, finding Allstate’s policy language insufficiently clear to elect the Medicare fee-schedule methodology; Allstate appealed.
The Second District certified a question of great public importance: whether policy language stating that amounts payable “shall be subject to any and all limitations authorized by Fla. Stat. § 627.736 … including, but not limited to, all fee schedules” clearly and unambiguously notifies insureds of the insurer’s methodology for limiting PIP reimbursement.
The Second District reversed, holding that Allstate’s endorsement provided legally sufficient notice of its election to use the fee-schedule methodology and remanded; it certified conflict with a Fourth DCA decision.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Allstate's policy language clearly notifies insureds/providers that reimbursements will be limited by the Medicare-based fee schedule under §627.736(5)(a)(2)(f)	Policy language is ambiguous and does not expressly elect the permissive Medicare/fee-schedule methodology; relying on Virtual Imaging, provider argues insurer must clearly state use of that alternative	Endorsement stating that amounts “shall be subject to any and all limitations authorized by §627.736 … including, but not limited to, all fee schedules” is clear notice and valid election to apply the Medicare fee schedules	Reversed trial court: endorsement is sufficiently clear to notify insureds/providers of Allstate’s election to use fee-schedule limitations; remanded; certified conflict with Orthopedic Specialists v. Allstate

Geico Gen. Ins. Co. v. Virtual Imaging Servs., Inc., 141 So. 3d 147 (Fla. 2013) (insurer must give notice of election to use permissive Medicare-based fee-schedule method; general statutory reference was insufficient in that case)
Ivey v. Allstate Ins. Co., 774 So. 2d 679 (Fla. 2000) (PIP statute aims to provide swift, automatic payment of benefits)
Gov’t Emps. Ins. Co. v. Gonzalez, 512 So. 2d 269 (Fla. 3d DCA 1987) (discussing prompt PIP payment purpose)
Orthopedic Specialists v. Allstate Ins. Co., 177 So. 3d 19 (Fla. 4th DCA 2015) (concluded identical policy language was unclear; certified conflict with this opinion)