House Bill 3889e2
CODING: Words stricken are deletions; words underlined are additions.
HB 3889, Second Engrossed
1 A bill to be entitled
2 An act relating to motor vehicle insurance;
3 amending s. 627.7295, F.S.; authorizing certain
4 fees to be collected by general lines agents;
5 amending s. 627.736, F.S.; prohibiting a
6 provider's statement of charges from including
7 certain charges for services covered by
8 personal injury protection benefits; specifying
9 which party is the prevailing party in
10 arbitration of disputes relating to personal
11 injury protection claims; specifying
12 requirements for arbitration; prescribing forms
13 for submission of medical services; specifying
14 payment time limitations; specifying where an
15 independent medical examination of a claimant
16 may be conducted; specifying applicability of
17 amendments made by this act; providing an
18 effective date.
19
20 Be It Enacted by the Legislature of the State of Florida:
21
22 Section 1. Subsection (5) of section 627.7295, Florida
23 Statutes, is amended to read:
24 627.7295 Motor vehicle insurance contracts.--
25 (5)(a) A licensed general lines agent may charge a
26 per-policy fee not to exceed $10 to cover the administrative
27 costs of the agent associated with selling the motor vehicle
28 insurance policy if the policy covers only personal injury
29 protection coverage as provided by s. 627.736 and property
30 damage liability coverage as provided by s. 627.7275 and if no
31 other insurance is sold or issued in conjunction with or
1
CODING: Words stricken are deletions; words underlined are additions.
HB 3889, Second Engrossed
1 collateral to the policy. The per-policy fee must be a
2 component of the insurer's rate filing and may not be charged
3 by an agent unless the fee is included in the filing. The fee
4 is not considered part of the premium except for purposes of
5 the department's review of expense factors in a filing made
6 pursuant to s. 627.062.
7 (b) To the extent that a licensed general agent's cost
8 of obtaining motor vehicle reports on applicants for motor
9 vehicle insurance is not otherwise compensated, the agent may,
10 in addition to any other fees authorized by law, charge an
11 applicant for motor vehicle insurance a reasonable,
12 nonrefundable fee to reimburse the agent the actual cost of
13 obtaining the report for each licensed driver when the motor
14 vehicle report is obtained by the agent simultaneously with
15 the preparation of the application for use in the calculation
16 of premium or in the proper placement of the risk. The amount
17 of the fee may not exceed the agent's actual cost in obtaining
18 the report which is not otherwise compensated. Actual cost is
19 the cost of obtaining the report on an individual driver basis
20 when so obtained or the pro rata cost per driver when the
21 report is obtained on more than one driver; however, in no
22 case may actual cost include subscription or access fees
23 associated with obtaining motor vehicle reports on-line though
24 any electronic transmissions program.
25 Section 2. Subsection (5), paragraph (b) of subsection
26 (6), and paragraph (a) of subsection (7) of section 627.736,
27 Florida Statutes, are amended to read:
28 627.736 Required personal injury protection benefits;
29 exclusions; priority.--
30 (5) CHARGES FOR TREATMENT OF INJURED PERSONS.--
31
2
CODING: Words stricken are deletions; words underlined are additions.
HB 3889, Second Engrossed
1 (a) Any physician, hospital, clinic, or other person
2 or institution lawfully rendering treatment to an injured
3 person for a bodily injury covered by personal injury
4 protection insurance may charge only a reasonable amount for
5 the products, services, and accommodations rendered, and the
6 insurer providing such coverage may pay for such charges
7 directly to such person or institution lawfully rendering such
8 treatment, if the insured receiving such treatment or his or
9 her guardian has countersigned the invoice, bill, or claim
10 form approved by the Department of Insurance upon which such
11 charges are to be paid for as having actually been rendered,
12 to the best knowledge of the insured or his or her guardian.
13 In no event, however, may such a charge be in excess of the
14 amount the person or institution customarily charges for like
15 products, services, or accommodations in cases involving no
16 insurance, provided that charges for cephalic thermograms and
17 peripheral thermograms shall not exceed the maximum
18 reimbursement allowance for such procedures as set forth in
19 the applicable fee schedule established pursuant to s. 440.13.
20 (b) With respect to any treatment or service, other
21 than medical services billed by a hospital for services
22 rendered at a hospital-owned facility, the statement of
23 charges must be furnished to the insurer by the provider and
24 may not include, and the insurer is not required to pay,
25 charges for treatment or services rendered more than 30 days
26 before the postmark date of the statement, except for past due
27 amounts previously billed on a timely basis under this
28 paragraph, and except that, if the provider submits to the
29 insurer a notice of initiation of treatment within 21 days
30 after its first examination or treatment of the claimant, the
31 statement may include charges for treatment or services
3
CODING: Words stricken are deletions; words underlined are additions.
HB 3889, Second Engrossed
1 rendered up to, but not more than, 60 days before the postmark
2 date of the statement. The injured party is not liable for,
3 and the provider shall not bill the injured party for, charges
4 that are unpaid because of the provider's failure to comply
5 with this paragraph. Any agreement requiring the injured
6 person or insured to pay for such charges is unenforceable.
7 For emergency services and care as defined in s. 395.002
8 rendered in a hospital emergency department or for transport
9 and treatment rendered by an ambulance provider licensed
10 pursuant to part III of chapter 401, the provider is not
11 required to furnish the statement of charges within the time
12 periods established by this paragraph; and the insurer shall
13 not be considered to have been furnished with notice of the
14 amount of covered loss for purposes of paragraph (4)(b) until
15 it receives a statement complying with paragraph (5)(d), or
16 copy thereof, which specifically identifies the place of
17 service to be a hospital emergency department or an ambulance
18 in accordance with billing standards recognized by the Health
19 Care Finance Administration. Each notice of insured's rights
20 under s. 627.7401 must include the following statement in type
21 no smaller than 12 points:
22 BILLING REQUIREMENTS.--Florida Statutes provide
23 that with respect to any treatment or services,
24 other than certain hospital and emergency
25 services, the statement of charges furnished to
26 the insurer by the provider may not include,
27 and the insurer and the injured party are not
28 required to pay, charges for treatment or
29 services rendered more than 30 days before the
30 postmark date of the statement, except for past
31 due amounts previously billed on a timely
4
CODING: Words stricken are deletions; words underlined are additions.
HB 3889, Second Engrossed
1 basis, and except that, if the provider submits
2 to the insurer a notice of initiation of
3 treatment within 21 days after its first
4 examination or treatment of the claimant, the
5 statement may include charges for treatment or
6 services rendered up to, but not more than, 60
7 days before the postmark date of the statement.
8 (c) Every insurer shall include a provision in its
9 policy for personal injury protection benefits for binding
10 arbitration of any claims dispute involving medical benefits
11 arising between the insurer and any person providing medical
12 services or supplies if that person has agreed to accept
13 assignment of personal injury protection benefits. The
14 provision shall specify that the provisions of chapter 682
15 relating to arbitration shall apply. The prevailing party
16 shall be entitled to attorney's fees and costs. For purposes
17 of the award of attorney's fees and costs, the prevailing
18 party shall be determined as follows:
19 1. When the amount of personal injury protection
20 benefits determined by arbitration exceeds the sum of the
21 amount offered by the insurer at arbitration plus 50 percent
22 of the difference between the amount of the claim asserted by
23 the claimant at arbitration and the amount offered by the
24 insurer at arbitration, the claimant is the prevailing party.
25 2. When the amount of personal injury protection
26 benefits determined by arbitration is less than the sum of the
27 amount offered by the insurer at arbitration plus 50 percent
28 of the difference between the amount of the claim asserted by
29 the claimant at arbitration and the amount offered by the
30 insurer at arbitration, the insurer is the prevailing party.
31
5
CODING: Words stricken are deletions; words underlined are additions.
HB 3889, Second Engrossed
1 3. When neither subparagraph 1. nor subparagraph 2.
2 applies, there is no prevailing party. For purposes of this
3 paragraph, the amount of the offer or claim at arbitration is
4 the amount of the last written offer or claim made at least 30
5 days prior to the arbitration.
6 4. In the demand for arbitration, the party requesting
7 arbitration must include a statement specifically identifying
8 the issues for arbitration for each examination or treatment
9 in dispute. The other party must subsequently issue a
10 statement specifying any other examinations or treatment and
11 any other issues that it intends to raise in the arbitration.
12 The parties may amend their statements up to 30 days prior to
13 arbitration, provided that arbitration shall be limited to
14 those identified issues and neither party may add additional
15 issues during arbitration.
16 (d) All statements and bills for medical services
17 rendered by any physician, hospital, clinic, or other person
18 or institution shall be submitted to the insurer on an Health
19 Care Finance Administration 1500 form, UB 92 forms, or any
20 other standard form approved by the department for purposes of
21 this paragraph. All billings for such services shall, to the
22 extent applicable, follow the Physicians' Current Procedural
23 Terminology (CPT) in the year in which services are rendered.
24 No statement of medical services may include charges for
25 medical services of a person or entity that performed such
26 services without possessing the valid licenses required to
27 perform such services. For purposes of paragraph (4)(b), an
28 insurer shall not be considered to have been furnished with
29 notice of the amount of covered loss or medical bills due
30 unless the statements or bills comply with this paragraph.
31
6
CODING: Words stricken are deletions; words underlined are additions.
HB 3889, Second Engrossed
1 (6) DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
2 DISPUTES.--
3 (b) Every physician, hospital, clinic, or other
4 medical institution providing, before or after bodily injury
5 upon which a claim for personal injury protection insurance
6 benefits is based, any products, services, or accommodations
7 in relation to that or any other injury, or in relation to a
8 condition claimed to be connected with that or any other
9 injury, shall, if requested to do so by the insurer against
10 whom the claim has been made, furnish forthwith a written
11 report of the history, condition, treatment, dates, and costs
12 of such treatment of the injured person, together with a sworn
13 statement that the treatment or services rendered were
14 reasonable and necessary with respect to the bodily injury
15 sustained and identifying which portion of the expenses for
16 such treatment or services was incurred as a result of such
17 bodily injury, and produce forthwith, and permit the
18 inspection and copying of, his or her or its records regarding
19 such history, condition, treatment, dates, and costs of
20 treatment. Such sworn statement shall read as follows: "Under
21 penalty of perjury, I declare that I have read the foregoing,
22 and the facts alleged are true, to the best of my knowledge
23 and belief." No cause of action for violation of the
24 physician-patient privilege or invasion of the right of
25 privacy shall be permitted against any physician, hospital,
26 clinic, or other medical institution complying with the
27 provisions of this section. The person requesting such records
28 and such sworn statement shall pay all reasonable costs
29 connected therewith. If an insurer makes a written request for
30 documentation under this paragraph within 20 days after having
31 received notice of the amount of a covered loss under s.
7
CODING: Words stricken are deletions; words underlined are additions.
HB 3889, Second Engrossed
1 627.736(4)(a), the insurer shall pay the amount or partial
2 amount of covered loss to which such documentation relates in
3 accordance with s. 627.736(4)(b) or within 10 days after the
4 insurer's receipt of the requested documentation, whichever
5 occurs later. For purposes of this paragraph, the term
6 "receipt" includes, but is not limited to, inspection and
7 copying pursuant to this paragraph.
8 (7) MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON;
9 REPORTS.--
10 (a) Whenever the mental or physical condition of an
11 injured person covered by personal injury protection is
12 material to any claim that has been or may be made for past or
13 future personal injury protection insurance benefits, such
14 person shall, upon the request of an insurer, submit to mental
15 or physical examination by a physician or physicians. The
16 costs of any examinations requested by an insurer shall be
17 borne entirely by the insurer. Such examination shall be
18 conducted within the municipality of residence of the insured
19 or in the municipality where the insured is receiving
20 treatment, or in a location reasonably accessible to the
21 insured, which, for purposes of this paragraph, means any
22 location within the municipality in which the insured resides,
23 or any location within 10 miles by road of the insured's
24 residence, provided such location is within the county in
25 which the insured resides. If the examination is to be
26 conducted in a location reasonably accessible to the insured,
27 within the municipality of residence of the insured and if
28 there is no qualified physician to conduct the examination in
29 a location reasonably accessible to the insured within such
30 municipality, then such examination shall be conducted in an
31 area of the closest proximity to the insured's residence.
8
CODING: Words stricken are deletions; words underlined are additions.
HB 3889, Second Engrossed
1 Personal protection insurers are authorized to include
2 reasonable provisions in personal injury protection insurance
3 policies for mental and physical examination of those claiming
4 personal injury protection insurance benefits. An insurer may
5 not withdraw payment of a treating physician without the
6 consent of the injured person covered by the personal injury
7 protection, unless the insurer first obtains a report by a
8 physician licensed under the same chapter as the treating
9 physician whose treatment authorization is sought to be
10 withdrawn, stating that treatment was not reasonable, related,
11 or necessary.
12 Section 3. (1) Paragraph (5)(c) of s. 627.736,
13 Florida Statutes, as amended by section 2 of this act, shall
14 apply to arbitrations commenced on or after the effective date
15 of this act.
16 (2) Paragraph (7)(a) of s. 627.736, Florida Statutes,
17 as amended by section 2 of this act, shall apply to new and
18 renewal policies with an effective date on or after the
19 effective date of this act.
20 (3) All other provisions of section 2 of this act
21 shall apply to accidents occurring on or after the effective
22 date of this act.
23 Section 4. This act shall take effect October 1, 1998.
24
25
26
27
28
29
30
31
9