House Bill 3889er

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    ENROLLED

    1998 Legislature                     HB 3889, Second Engrossed



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  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.

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20  Be It Enacted by the Legislature of the State of Florida:

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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


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    ENROLLED

    1998 Legislature                     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.--

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    ENROLLED

    1998 Legislature                     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


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    ENROLLED

    1998 Legislature                     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


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    ENROLLED

    1998 Legislature                     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.

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    ENROLLED

    1998 Legislature                     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.

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    ENROLLED

    1998 Legislature                     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.


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    ENROLLED

    1998 Legislature                     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.


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    ENROLLED

    1998 Legislature                     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.

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