Allstate Insurance Company v. Orthopedic Specialists, etc., 212 So. 3d 973

Providers (Orthopedic Specialists et al.) challenged Allstate’s PIP reimbursements, arguing Allstate’s policy did not clearly elect to use the permissive Medicare fee schedules under § 627.736(5)(a)2. to limit payments.
Allstate’s policy promised 80% of reasonable medical expenses and included an endorsement: “Any amounts payable under this coverage shall be subject to any and all limitations, authorized by section 627.736... including, but not limited to, all fee schedules.”
The Fourth DCA held the endorsement ambiguous under Geico v. Virtual Imaging and refused to allow Allstate to rely on Medicare fee schedules without clearer election; it viewed the language as merely reserving a right to apply limitations.
The First DCA (Stand-Up MRI) had reached the opposite conclusion, finding identical language sufficient notice of an election to use fee schedules.
The Florida Supreme Court granted review to resolve the conflict and applied de novo review of statutory and contract interpretation.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Allstate’s PIP policy language gives legally sufficient notice that Allstate elected the permissive Medicare fee-schedule methodology under § 627.736(5)(a)2.	Policy is ambiguous; phrase “shall be subject to” and “all fee schedules” only reserve a right and do not state Allstate will apply Medicare fee schedules exclusively.	The endorsement unambiguously mandates that “any amounts payable” are subject to statutory limitations, including fee schedules; read in context, “shall be subject to” is mandatory and provides the required election notice.	Court held Allstate’s policy provides legally sufficient notice; quashed Fourth DCA and approved First DCA.

Geico Gen. Ins. Co. v. Virtual Imaging Servs., Inc., 141 So.3d 147 (Fla. 2013) (held insurer must elect permissive Medicare fee-schedule method in policy to rely on it)
Allstate Fire & Cas. Ins. Co. v. Stand-Up MRI of Tallahassee, P.A., 188 So.3d 1 (Fla. 1st DCA 2015) (held identical Allstate language gave sufficient notice of election)
Orthopedic Specialists v. Allstate Ins. Co., 177 So.3d 19 (Fla. 4th DCA 2015) (held policy language ambiguous; certified conflict)
Washington Nat. Ins. Corp. v. Ruderman, 117 So.3d 943 (Fla. 2013) (principles: plain policy language controls; courts must give effect to unambiguous terms)
Travelers Indem. Co. v. PCR, Inc., 889 So.2d 779 (Fla. 2004) (policy language is ambiguous if it admits more than one reasonable interpretation)
Auto-Owners Ins. Co. v. Anderson, 756 So.2d 29 (Fla. 2000) (ambiguities in insurance policies construed against drafter)