CODING: Words stricken are deletions; words underlined are additions.House Bill 0821
Florida House of Representatives - 1997 HB 821
By Representative Bainter
1 A bill to be entitled
2 An act relating to personal injury protection
3 benefits; amending s. 627.736, F.S.; limiting
4 payment of interest on overdue payments under
5 certain circumstances; providing criteria and
6 procedures for payment of charges for treatment
7 of injured persons; providing for arbitration;
8 providing an effective date.
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10 Be It Enacted by the Legislature of the State of Florida:
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12 Section 1. Paragraph (c) of subsection (4) and
13 subsection (5) of section 627.736, Florida Statutes, 1996
14 Supplement, are amended to read:
15 627.736 Required personal injury protection benefits;
16 exclusions; priority.--
17 (4) BENEFITS; WHEN DUE.--Benefits due from an insurer
18 under ss. 627.730-627.7405 shall be primary, except that
19 benefits received under any workers' compensation law shall be
20 credited against the benefits provided by subsection (1) and
21 shall be due and payable as loss accrues, upon receipt of
22 reasonable proof of such loss and the amount of expenses and
23 loss incurred which are covered by the policy issued under ss.
24 627.730-627.7405. When the Department of Health and
25 Rehabilitative Services provides, pays, or becomes liable for
26 medical assistance under the Medicaid program related to
27 injury, sickness, disease, or death arising out of the
28 ownership, maintenance, or use of a motor vehicle, benefits
29 under ss. 627.730-627.7405 shall be subject to the provisions
30 of the Medicaid program.
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Florida House of Representatives - 1997 HB 821
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1 (c) All overdue payments shall bear simple interest at
2 the rate of 10 percent per year, provided interest on an
3 overdue payment shall not be payable unless the amount of such
4 interest exceeds $5.
5 (5) CHARGES FOR TREATMENT OF INJURED PERSONS.--
6 (a) Any physician, hospital, clinic, or other person
7 or institution lawfully rendering treatment to an injured
8 person for a bodily injury covered by personal injury
9 protection insurance may charge only a reasonable amount for
10 the products, services, and accommodations rendered, and the
11 insurer providing such coverage may pay for such charges
12 directly to such person or institution lawfully rendering such
13 treatment, if the insured receiving such treatment or his
14 guardian has countersigned the invoice, bill, or claim form
15 approved by the Department of Insurance upon which such
16 charges are to be paid for as having actually been rendered,
17 to the best knowledge of the insured or his guardian. In no
18 event, however, may such a charge be in excess of the amount
19 the person or institution customarily charges for like
20 products, services, or accommodations in cases involving no
21 insurance, provided that no charges, including charges for
22 cephalic thermograms and peripheral thermograms, shall not
23 exceed the maximum reimbursement allowance for such procedures
24 as set forth in the applicable fee schedule established
25 pursuant to s. 440.13.
26 (b) An insurer shall have no obligation to pay for
27 such charges to the injured person or the person or
28 institution rendering treatment or performing diagnostic
29 testing services unless, by the close of the twenty-first day
30 following the first treatment, such person or institution
31 furnishes to the insurer a notice of treatment and services on
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Florida House of Representatives - 1997 HB 821
143-219-97
1 forms prescribed by the department. This provision does not
2 apply to hospital emergency room services.
3 (c) The person or institution rendering treatment
4 shall, if requested by the insurer, provide to the insurer an
5 itemized statement of the specified services rendered and the
6 charge for each such service and the written records
7 justifying the course of treatment which the person rendering
8 treatment is required to keep under s. 458.331, s. 459.015, s.
9 460.413, s. 461.013, or s. 466.018. If an insurer makes a
10 written request for documentation under this paragraph or
11 paragraph (6)(b) within 30 days after having received notice
12 of treatment and services by such person or institution under
13 paragraph (5)(b), the amount or partial amount of covered loss
14 to which such documentation relates shall not be deemed to be
15 overdue for purposes of paragraph (4)(b) until 30 days after
16 the insurer is furnished with such requested documentation.
17 (d) Every insurer shall include a provision in its
18 policy for personal injury protection benefits for binding
19 arbitration of any claims dispute involving medical benefits
20 arising between the insurer and any person providing medical
21 services or supplies if that person has agreed to accept
22 assignment of personal injury protection benefits. The insurer
23 may include a provision in its policy for mandatory binding
24 arbitration of any claims dispute involving medical benefits
25 arising between the insurer and the insureds and claimants
26 under the policy. Such provision shall be binding on all
27 insureds, claimants, and persons providing medical services
28 and supplies. The provision shall specify that the provisions
29 of chapter 682 relating to arbitration shall apply. The
30 prevailing party shall be entitled to attorney's fees and
31 costs. The prevailing party is the claimant or provider when
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Florida House of Representatives - 1997 HB 821
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1 the award is at least the full amount of the claim asserted by
2 the claimant or provider at arbitration. The prevailing party
3 is the insurer when the award is no more than the amount
4 offered by the insurer at arbitration. There is no prevailing
5 party and attorney's fees shall not be awarded when the amount
6 of the award is less than the full amount of the claim
7 asserted by the claimant or provider at arbitration and more
8 than the amount offered by the insurer at arbitration. The
9 policy may authorize the arbitrator to award attorney's fees
10 and costs to the prevailing party, if any.
11 Section 2. This act shall take effect October 1, 1997.
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14 HOUSE SUMMARY
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Limits payment of interest on overdue payments if less
16 than $5. Revises provisions for payment of charges for
treatment of injured persons to provide criteria and
17 procedures for payments. Provides for arbitration of
disputed claims. See bill for details.
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