Senate Bill 2052c1
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Florida Senate - 1998 CS for SB 2052
By the Committee on Banking and Insurance and Senator
Diaz-Balart
311-1887E-98
1 A bill to be entitled
2 An act relating to insurance; amending s.
3 627.7295, F.S.; authorizing certain fees to be
4 collected by general lines agents; amending s.
5 627.736, F.S.; prohibiting a provider's
6 statement of charges from including certain
7 charges for services covered by personal injury
8 protection benefits; specifying which party is
9 the prevailing party in arbitration of disputes
10 relating to personal injury protection claims;
11 specifying requirements for arbitration;
12 prescribing forms for submission of medical
13 services; specifying payment time limitations;
14 specifying where an independent medical
15 examination of a claimant may be conducted;
16 providing an effective date.
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18 Be It Enacted by the Legislature of the State of Florida:
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20 Section 1. Subsection (5) of section 627.7295, Florida
21 Statutes, is amended to read:
22 627.7295 Motor vehicle insurance contracts.--
23 (5)(a) A licensed general lines agent may charge a
24 per-policy fee not to exceed $10 to cover the administrative
25 costs of the agent associated with selling the motor vehicle
26 insurance policy if the policy covers only personal injury
27 protection coverage as provided by s. 627.736 and property
28 damage liability coverage as provided by s. 627.7275 and if no
29 other insurance is sold or issued in conjunction with or
30 collateral to the policy. The per-policy fee must be a
31 component of the insurer's rate filing and may not be charged
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Florida Senate - 1998 CS for SB 2052
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1 by an agent unless the fee is included in the filing. The fee
2 is not considered part of the premium except for purposes of
3 the department's review of expense factors in a filing made
4 pursuant to s. 627.062.
5 (b) To the extent that a licensed general agent's cost
6 of obtaining motor vehicle reports on applicants for motor
7 vehicle insurance is not otherwise compensated, the agent may,
8 in addition to any other fees authorized by law, charge an
9 applicant for motor vehicle insurance a reasonable,
10 nonrefundable fee to reimburse the agent the actual cost of
11 obtaining the report for each licensed driver when the motor
12 vehicle report is obtained by the agent simultaneously with
13 the preparation of the application for use in the calculation
14 of premium or in the proper placement of the risk. The amount
15 of the fee may not exceed the agent's actual cost in obtaining
16 the report which is not otherwise compensated. Actual cost is
17 the cost of obtaining the report on an individual driver basis
18 when so obtained or the pro rata cost per driver when the
19 report is obtained on more than one driver; however, in no
20 case may actual cost include subscription or access fees
21 associated with obtaining motor vehicle reports on-line though
22 any electronic transmissions program.
23 Section 2. Subsection (5), paragraph (b) of subsection
24 (6), and paragraph (a) of subsection (7) of section 627.736,
25 Florida Statutes, are amended to read:
26 627.736 Required personal injury protection benefits;
27 exclusions; priority.--
28 (5) CHARGES FOR TREATMENT OF INJURED PERSONS.--
29 (a) Any physician, hospital, clinic, or other person
30 or institution lawfully rendering treatment to an injured
31 person for a bodily injury covered by personal injury
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Florida Senate - 1998 CS for SB 2052
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1 protection insurance may charge only a reasonable amount for
2 the products, services, and accommodations rendered, and the
3 insurer providing such coverage may pay for such charges
4 directly to such person or institution lawfully rendering such
5 treatment, if the insured receiving such treatment or his or
6 her guardian has countersigned the invoice, bill, or claim
7 form approved by the Department of Insurance upon which such
8 charges are to be paid for as having actually been rendered,
9 to the best knowledge of the insured or his or her guardian.
10 In no event, however, may such a charge be in excess of the
11 amount the person or institution customarily charges for like
12 products, services, or accommodations in cases involving no
13 insurance, provided that charges for cephalic thermograms and
14 peripheral thermograms shall not exceed the maximum
15 reimbursement allowance for such procedures as set forth in
16 the applicable fee schedule established pursuant to s. 440.13.
17 (b) With respect to any treatment or service, other
18 than hospital services provided within the first 30 days after
19 the accident, the statement of charges must be furnished to
20 the insurer by the provider and may not include, and the
21 insurer is not required to pay, charges for treatment or
22 services rendered more than 30 days before the postmark date
23 of the statement, except for past due amounts previously
24 billed on a timely basis under this paragraph, and except
25 that, if the provider submits to the insurer a notice of
26 initiation of treatment within 21 days after its first
27 examination or treatment of the claimant, the statement may
28 include charges for treatment or services rendered up to, but
29 not more than, 60 days before the postmark date of the
30 statement. The injured party is not liable for, and the
31 provider shall not bill the injured party for, charges that
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Florida Senate - 1998 CS for SB 2052
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1 are unpaid because of the provider's failure to comply with
2 this paragraph. Any agreement requiring the injured person or
3 insured to pay for such charges is unenforceable. Each notice
4 of insured's rights under s. 627.7401 must include the
5 following statement in type no smaller than 12 points:
6 BILLING REQUIREMENTS.--Florida Statutes provide
7 that with respect to any treatment or services,
8 other than certain hospital services, the
9 statement of charges furnished to the insurer
10 by the provider may not include, and the
11 insurer and the injured party are not required
12 to pay, charges for treatment or services
13 rendered more than 30 days before the postmark
14 date of the statement, except for past due
15 amounts previously billed on a timely basis,
16 and except that, if the provider submits to the
17 insurer a notice of initiation of treatment
18 within 21 days after its first examination or
19 treatment of the claimant, the statement may
20 include charges for treatment or services
21 rendered up to, but not more than, 60 days
22 before the postmark date of the statement.
23 (c) Every insurer shall include a provision in its
24 policy for personal injury protection benefits for binding
25 arbitration of any claims dispute involving medical benefits
26 arising between the insurer and any person providing medical
27 services or supplies if that person has agreed to accept
28 assignment of personal injury protection benefits. The
29 provision shall specify that the provisions of chapter 682
30 relating to arbitration shall apply. The prevailing party
31 shall be entitled to attorney's fees and costs. For purposes
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Florida Senate - 1998 CS for SB 2052
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1 of the award of attorney's fees and costs, the prevailing
2 party shall be determined as follows:
3 1. When the amount of personal injury protection
4 benefits determined by arbitration exceeds the sum of the
5 amount offered by the insurer at arbitration plus 50 percent
6 of the difference between the amount of the claim asserted by
7 the claimant at arbitration and the amount offered by the
8 insurer at arbitration, the claimant is the prevailing party.
9 2. When the amount of personal injury protection
10 benefits determined by arbitration is less than the sum of the
11 amount offered by the insurer at arbitration plus 50 percent
12 of the difference between the amount of the claim asserted by
13 the claimant at arbitration and the amount offered by the
14 insurer at arbitration, the insurer is the prevailing party.
15 3. When neither subparagraph 1. nor subparagraph 2.
16 applies, there is no prevailing party. For purposes of this
17 paragraph, the amount of the offer or claim at arbitration is
18 the amount of the last written offer or claim made more than
19 30 days prior to the arbitration.
20 4. In the demand for arbitration, the party requesting
21 arbitration must include a statement specifically identifying
22 the issues for arbitration for each examination or treatment
23 in dispute. The other party must subsequently issue a
24 statement specifying any other examinations or treatment and
25 any other issues that it intends to raise in the arbitration.
26 The parties may amend their statements up to 30 days prior to
27 arbitration, provided that arbitration shall be limited to
28 those identified issues and neither party may add additional
29 issues during arbitration.
30 (d) All statements and bills for medical services
31 rendered by any physician, hospital, clinic, or other person
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1 or institution shall be submitted to the insurer on an HCFA
2 1500 form, UB 92 forms, or any other standard form approved by
3 the department for purposes of this paragraph. All billings
4 for such services shall, to the extent applicable, follow the
5 appropriate physicians' current procedural terminology (CPT)
6 in the year in which services are rendered. No statement of
7 medical services may include charges for medical services of a
8 person or entity that performed such services without
9 possessing the valid licenses required to perform such
10 services. For purposes of paragraph (4)(b), an insurer shall
11 not be considered to have been furnished with notice of the
12 amount of covered loss or medical bills due unless the
13 statements or bills comply with this paragraph.
14 (6) DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
15 DISPUTES.--
16 (b) Every physician, hospital, clinic, or other
17 medical institution providing, before or after bodily injury
18 upon which a claim for personal injury protection insurance
19 benefits is based, any products, services, or accommodations
20 in relation to that or any other injury, or in relation to a
21 condition claimed to be connected with that or any other
22 injury, shall, if requested to do so by the insurer against
23 whom the claim has been made, furnish forthwith a written
24 report of the history, condition, treatment, dates, and costs
25 of such treatment of the injured person, together with a sworn
26 statement that the treatment or services rendered were
27 reasonable and necessary with respect to the bodily injury
28 sustained and identifying which portion of the expenses for
29 such treatment or services was incurred as a result of such
30 bodily injury, and produce forthwith, and permit the
31 inspection and copying of, his or her or its records regarding
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1 such history, condition, treatment, dates, and costs of
2 treatment. Such sworn statement shall read as follows: "Under
3 penalty of perjury, I declare that I have read the foregoing,
4 and the facts alleged are true, to the best of my knowledge
5 and belief." No cause of action for violation of the
6 physician-patient privilege or invasion of the right of
7 privacy shall be permitted against any physician, hospital,
8 clinic, or other medical institution complying with the
9 provisions of this section. The person requesting such records
10 and such sworn statement shall pay all reasonable costs
11 connected therewith. If an insurer makes a written request for
12 documentation under this paragraph within 20 days after having
13 received notice of the amount of a covered loss under s.
14 627.736(4)(a), the insurer shall pay the amount or partial
15 amount of covered loss to which such documentation relates in
16 accordance with s. 627.736(4)(b) or within 10 days after the
17 insurer's receipt of the requested documentation, whichever
18 occurs later. For purposes of this paragraph, the term
19 "receipt" includes, but is not limited to, inspection and
20 copying pursuant to this paragraph.
21 (7) MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON;
22 REPORTS.--
23 (a) Whenever the mental or physical condition of an
24 injured person covered by personal injury protection is
25 material to any claim that has been or may be made for past or
26 future personal injury protection insurance benefits, such
27 person shall, upon the request of an insurer, submit to mental
28 or physical examination by a physician or physicians. The
29 costs of any examinations requested by an insurer shall be
30 borne entirely by the insurer. Such examination shall be
31 conducted within the municipality of residence of the insured
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Florida Senate - 1998 CS for SB 2052
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1 or in the municipality where the insured is receiving
2 treatment, or in a location reasonably accessible to the
3 insured, which, for purposes of this paragraph, means any
4 location within the municipality in which the insured resides,
5 or any location within 10 miles by road of the insured's
6 residence, provided such location is within the county in
7 which the insured resides. If the examination is to be
8 conducted in a location reasonably accessible to the insured,
9 within the municipality of residence of the insured and if
10 there is no qualified physician to conduct the examination in
11 a location reasonably accessible to the insured within such
12 municipality, then such examination shall be conducted in an
13 area of the closest proximity to the insured's residence.
14 Personal protection insurers are authorized to include
15 reasonable provisions in personal injury protection insurance
16 policies for mental and physical examination of those claiming
17 personal injury protection insurance benefits. An insurer may
18 not withdraw payment of a treating physician without the
19 consent of the injured person covered by the personal injury
20 protection, unless the insurer first obtains a report by a
21 physician licensed under the same chapter as the treating
22 physician whose treatment authorization is sought to be
23 withdrawn, stating that treatment was not reasonable, related,
24 or necessary.
25 Section 3. This act shall take effect October 1, 1998.
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Florida Senate - 1998 CS for SB 2052
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1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 Senate Bill 2052
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4 Deletes the provision relating to basic homeowners' insurance
policies.
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Allows general lines insurance agents to charge an applicant
6 for motor vehicle insurance a reasonable, nonrefundable fee to
obtain a motor vehicle report (MVR) to reimburse the agent the
7 actual cost of obtaining the MVR.
8 Requires medical providers to submit treatment bills directly
to insurer within 30 days of service for personal injury
9 protection (PIP) insurance benefits. Alternatively, if the
provider furnishes the insurer with 21 days notice of
10 initiation of treatment, the provider may submit medical bills
within 60 days of service date. Neither the insurer nor the
11 injured person is required to pay medical bills untimely
submitted.
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Specifies a method to determine who is the "prevailing party"
13 entitled to attorneys fees and costs when a dispute between an
insurer and a medical provider is arbitrated pursuant to the
14 PIP law. Specifies time limits as to submission of issues,
offers and claims for purposes of arbitration.
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Provides the time period within which payment is due for a
16 claim for PIP benefits under circumstances when an insurer
makes a discovery request to a provider.
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Provides that an insurer's independent medical examination
18 (IME) be conducted within the municipality where the injured
person is being treated, within the municipality where the
19 injured person resides, or within 10 miles of the injured
person's home, provided the location is within the insured's
20 county of residence.
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