Settlement Class Members who did not exclude themselves from the Settlement and who timely submitted a Valid Settlement Claim Form will be eligible to receive Settlement Relief from The GEICO Companies, subject to the requirements and terms of the Settlement. The Settlement Relief includes Readjustment of Claims, Enhanced Relief (Interest), and Submission Compensation, determined as follows:
Readjustment of PIP Claims
The GEICO Companies will readjust settlement claims as follows: For each qualifying claim number/line item charge on a PIP insurance claim, The GEICO Companies will reimburse each Settlement Class Member that submits a Valid Settlement Claim an amount calculated at 20% of the amount billed by the Settlement Class Member for each claim where GEICO utilized the code “BA” with respect to the payment of the claim where the billing provider billed at less than 100% of the schedule of maximum charges as defined by Section 627.736(5)(a)1., Florida Statutes and The GEICO Companies paid the provider 80% of the amount billed on the claim.
Settlement Class Members who submit a Valid Settlement Claim will also receive an enhanced relief amount calculated as ten percent (10%) of the additional amount paid on a Valid Settlement Claim.
Settlement Class Members who submit a Valid Claim Form by U.S. Mail shall also receive a payment to offset postage and time in the flat amount of nine dollars ($9.00) per separate Valid Claim Form that has been submitted by U.S. Mail (i.e. if a provider has treated three separate insureds and thereby must submit 3 separate Settlement Claim Forms, that provider will be entitled to $27.00 in Submission Compensation upon submission of the three Valid Claim Forms). Settlement Claim Forms submitted by U.S. Mail that are otherwise qualifying, but for which no other payment will be made due to exhaustion of benefits, will nonetheless receive the Submission Compensation.
Additional Terms Applicable to Calculation of Settlement Relief
All coverage terms or payment limitations provided under the applicable insurance policy and the Florida Motor Vehicle No-Fault Law shall continue to apply. The GEICO Companies waive the defenses of reasonableness, relatedness, and medical necessity for purposes of this Settlement only. The GEICO Companies shall further continue to apply any defenses arising from GEICO claims that were adjusted and paid under an applicable out of state policy; the GEICO insurance claim having been previously resolved, discharged, settled, or released; or where the BA code was not actually applied to the qualifying patient/line item charge on the GEICO insurance claim.
The coverage benefits remaining under the applicable policy limits as of the date the Settlement Claim Form is deemed submitted shall be applied and shall be the maximum amount of recovery available under the Settlement. Exhaustion of benefits and other limits on the amounts payable under the applicable policy on claims arising after the Settlement Claim Form is deemed submitted shall not be applied as a further limitation on the amount of a Settlement Relief payment, but in no event shall The GEICO Companies be responsible for paying greater than the applicable policy limits on the claim for Settlement Relief, or greater than the coverage benefits applicable to that claim remaining under the applicable insurance policy in response to a claim for Settlement Relief. Settlement Claim Forms shall be deemed submitted based upon their postmark date or online submission date, plus 30 days for purposes of determining the PIP benefits that remain under the applicable insurance policy.
No interest, costs, attorneys’ fees or other extra-contractual payments, except as expressly provided in the Settlement Agreement, shall be payable with respect to any Settlement Relief, and Settlement Class Members waive any claim to such interest, costs, attorneys’ fees, or other extra-contractual payments.
The Settlement does not waive or impair The GEICO Companies’ right at any time, during or after the Class Period, to challenge a Settlement Class Member’s claim for entitlement to Settlement Relief or other insurance benefits on the basis of the Settlement Class Member’s violation of Section 817.234, Florida Statutes, in connection with the claim for insurance benefits underlying the Settlement Claim Form submission.