Senate Bill sb2114c1
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Florida Senate - 2006 CS for SB 2114
By the Committee on Banking and Insurance
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1 A bill to be entitled
2 An act relating to motor vehicle insurance;
3 reorganizing provisions pertaining to personal
4 injury protection benefits under the Florida
5 Motor Vehicle No-Fault Law for the purpose of
6 clarifying its meaning and intent and for the
7 purpose of better comprehension; amending s.
8 627.736, F.S.; providing that a self-employed
9 injured person or an injured person owning 25
10 percent or more interest in an employer offer
11 proof of income and lost wages to insurers as a
12 condition precedent for payment; providing for
13 a statement of earnings; requiring an insured
14 to notify an insurer in writing of election to
15 reserve benefits for lost wages; specifying
16 that such notification takes priority over
17 other claims, except specified hospital liens;
18 providing for Medicaid benefits; requiring the
19 Department of Health to determine by rule tests
20 deemed not to be medically necessary; providing
21 guidance as to criteria to be considered;
22 providing for required payment of benefits;
23 authorizing a parent or legal guardian of an
24 injured minor to complete application for
25 personal injury protection benefits; providing
26 for changes for treatment of injured persons;
27 providing requirements for compliance with
28 billing procedures; specifying the time period
29 within which a health care provider or other
30 specified provider must submit a statement of
31 charges; prohibiting providers from billing an
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1 injured person under specified conditions for
2 emergency services and care; requiring a
3 provider to submit a written bill at the time
4 of treatment which the injured patient must
5 sign; providing exceptions; requiring insurers
6 to provide specified documents to insureds;
7 requiring that amounts repayable to an insurer
8 include the statutory interest penalty;
9 increasing the time period for an insurer to
10 respond to a demand letter; providing
11 requirements for the production and inspection
12 of an injured person's medical records from a
13 provider; eliminating the application of a
14 contingency risk multiplier as to attorney-fee
15 awards in specified disputes; providing that
16 persons notifying insurers of improper billing
17 may obtain a reward; restricting venue for any
18 personal injury protection claim to specified
19 jurisdictions and providing for costs of
20 transferring venue; amending s. 316.068, F.S.;
21 specifying information to be included in a
22 crash report; creating a rebuttable presumption
23 regarding the existence of passengers;
24 specifying conditions relating to reporting
25 passengers; amending s. 322.26, F.S.; providing
26 an additional circumstance relating to
27 insurance crimes for mandatory revocation of a
28 person's driver's license; amending s. 817.234,
29 F.S.; revising provisions specifying material
30 omission and insurance fraud; prohibiting
31 scheming to create documentation of a motor
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1 vehicle crash that did not occur; providing a
2 criminal penalty; amending s. 817.2361, F.S.;
3 providing that creating, marketing, or
4 presenting fraudulent proof of motor vehicle
5 insurance is a felony of the third degree;
6 providing appropriations for law enforcement
7 and investigative personnel in the Division of
8 Insurance Fraud and for assistant state
9 attorney positions in specified circuits;
10 abrogating the repeal of provisions pertaining
11 to the Florida Motor Vehicle No-Fault Law;
12 providing an effective date.
13
14 Be It Enacted by the Legislature of the State of Florida:
15
16 Section 1. Section 627.736, Florida Statutes, is
17 amended to read:
18 627.736 Required personal injury protection benefits;
19 exclusions; priority; claims.--
20 (1) REQUIRED PERSONAL INJURY PROTECTION
21 BENEFITS.--Every insurance policy complying with the security
22 requirements of s. 627.733 shall provide personal injury
23 protection to the named insured, relatives residing in the
24 same household, persons operating the insured motor vehicle,
25 passengers in such motor vehicle, and other persons struck by
26 such motor vehicle and suffering bodily injury while not an
27 occupant of a self-propelled vehicle, subject to the
28 provisions of subsections (3) subsection (2) and (6) paragraph
29 (4)(d), to a limit of $10,000 for loss sustained by any such
30 person as a result of bodily injury, sickness, disease, or
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1 death arising out of the ownership, maintenance, or use of a
2 motor vehicle as follows:
3 (a) Medical benefits.--Eighty percent of all
4 reasonable expenses for medically necessary medical, surgical,
5 X-ray, dental, and rehabilitative services, including
6 prosthetic devices, and medically necessary ambulance,
7 hospital, and nursing services. Such benefits shall also
8 include necessary remedial treatment and services recognized
9 and permitted under the laws of the state for an injured
10 person who relies upon spiritual means through prayer alone
11 for healing, in accordance with his or her religious beliefs;
12 however, this sentence does not affect the determination of
13 what other services or procedures are medically necessary.
14 (b) Disability benefits.--
15 1. Sixty percent of any loss of gross income and loss
16 of earning capacity per injured person individual from
17 inability to work proximately caused by the injury sustained
18 by the injured person, plus all expenses reasonably incurred
19 in obtaining from others ordinary and necessary services in
20 lieu of those that, but for the injury, the injured person
21 would have performed without income for the benefit of his or
22 her household. All disability benefits payable under this
23 provision shall be paid not less than every 2 weeks.
24 2. For an injured person who is self employed or an
25 injured person who owns over a 25-percent interest in his or
26 her employer, as a condition precedent to payment for lost
27 wages, the injured person must produce to the insurer
28 reasonable proof as to the injured person's income and loss of
29 earning capacity or additional expense, such that the insurer
30 may reasonably calculate the amount of the loss of income.
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1 3. Every employer shall, if a request is made by an
2 insurer providing personal injury protection benefits under
3 ss. 627.730-627.7405 against whom a claim has been made,
4 furnish forthwith, in a form approved by the office, a sworn
5 statement of the earnings, since the time of the bodily injury
6 and for a 13-week time period before the injury, of the person
7 upon whose injury the claim is based.
8 4. If the insured elects to have disability benefits
9 reserved for lost wages, the insured shall notify the insurer
10 in writing, which shall be binding on the insurer. Receipt of
11 such notification shall take priority over all claims subject
12 to an assignment of benefits received after receipt of such
13 notice, except that receipt by the insurer of a properly
14 perfected hospital lien, prior to payment of the lost wage
15 claim, shall take priority over the insured's election to
16 reserve all benefits for lost wages.
17 (c) Death benefits.--The insurer shall pay death
18 benefits in the amount of $5,000 per individual. The insurer
19 may pay such benefits to the executor or administrator of the
20 deceased, to any of the deceased's relatives by blood or legal
21 adoption or connection by marriage, or to any person appearing
22 to the insurer to be equitably entitled thereto.
23 (d) Medicaid benefits.--When the Agency for Health
24 Care Administration provides, pays, or becomes liable for
25 medical assistance under the Medicaid program related to
26 injury, sickness, disease, or death arising out of the
27 ownership, maintenance, or use of a motor vehicle, benefits
28 under ss. 627.730-627.7405 shall be subject to the provisions
29 of the Medicaid program.
30 (2) AMOUNT OF PROPERTY DAMAGE COVERAGE.--
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1 (a) Only insurers writing motor vehicle liability
2 insurance in this state may provide the required benefits of
3 this section, and no such insurer shall require the purchase
4 of any other motor vehicle coverage other than the purchase of
5 property damage liability coverage as required by s. 627.7275
6 as a condition for providing such required benefits.
7 (b) Insurers may not require that property damage
8 liability insurance in an amount greater than $10,000 be
9 purchased in conjunction with personal injury protection.
10 Such insurers shall make benefits and required property damage
11 liability insurance coverage available through normal
12 marketing channels. Any insurer writing motor vehicle
13 liability insurance in this state who fails to comply with
14 such availability requirement as a general business practice
15 shall be deemed to have violated part IX of chapter 626, and
16 such violation shall constitute an unfair method of
17 competition or an unfair or deceptive act or practice
18 involving the business of insurance; and any such insurer
19 committing such violation shall be subject to the penalties
20 afforded in such part, as well as those which may be afforded
21 elsewhere in the insurance code.
22 (3)(2) AUTHORIZED EXCLUSIONS.--Any insurer may exclude
23 benefits:
24 (a) For injury sustained by the named insured and
25 relatives residing in the same household while occupying
26 another motor vehicle owned by the named insured and not
27 insured under the policy or for injury sustained by any person
28 operating the insured motor vehicle without the express or
29 implied consent of the insured.
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1 (b) To any injured person, if such person's conduct
2 contributed to his or her injury under any of the following
3 circumstances:
4 1. Causing injury to himself or herself intentionally;
5 or
6 2. Being injured while committing a felony.
7
8 Whenever an insured is charged with conduct as set forth in
9 subparagraph 2., the 30-day payment provision of subsection
10 (8) paragraph (4)(b) shall be held in abeyance, and the
11 insurer shall withhold payment of any personal injury
12 protection benefits pending the outcome of the case at the
13 trial level. If the charge is nolle prossed or dismissed or
14 the insured is acquitted, the 30-day payment provision shall
15 run from the date the insurer is notified of such action.
16 (4)(3) INSURED'S RIGHTS TO RECOVERY OF SPECIAL DAMAGES
17 IN TORT CLAIMS.--No insurer shall have a lien on any recovery
18 in tort by judgment, settlement, or otherwise for personal
19 injury protection benefits, whether suit has been filed or
20 settlement has been reached without suit. An injured person
21 party who is entitled to bring suit under the provisions of
22 ss. 627.730-627.7405, or his or her legal representative, has
23 shall have no right to recover any damages for which personal
24 injury protection benefits are paid or payable. The plaintiff
25 may prove all of his or her special damages notwithstanding
26 this limitation, but if special damages are introduced in
27 evidence, the trier of facts, whether judge or jury, shall not
28 award damages for personal injury protection benefits paid or
29 payable. In all cases in which a jury is required to fix
30 damages, the court shall instruct the jury that the plaintiff
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1 shall not recover such special damages for personal injury
2 protection benefits paid or payable.
3 (5) NONREIMBURSABLE SERVICES.--The Department of
4 Health, in consultation with the appropriate professional
5 licensing boards, shall adopt, by rule, a list of diagnostic
6 tests deemed not to be medically necessary as defined in s.
7 627.732 for use in either the diagnosis or treatment of
8 persons sustaining bodily injury covered by personal injury
9 protection benefits under this section. The list shall be
10 revised from time to time as determined by the Department of
11 Health, in consultation with the appropriate professional
12 licensing boards. In determining whether a test is medically
13 necessary for purposes of this subsection, the department may
14 consider the degree of positive diagnostic or treatment
15 benefits in relation to costs; whether there is substantial
16 demonstrated medical value for the injured person; the
17 availability of alternative methods of treatment or diagnosis;
18 the immediacy or remoteness of likely benefit for the injured
19 person; whether there is evidence of overuse by providers
20 primarily for financial gain; whether there is acceptance of
21 the use of the tests for injured persons; and whether there
22 are reservations regarding such use as reported to the
23 department by the appropriate professional licensing boards.
24 The department shall give greater weight to the advice of the
25 appropriate licensing boards on whether a test is medically
26 unnecessary than to a degree of acceptance by some individuals
27 or groups within the relevant provider communities.
28 (6) REQUIRED PAYMENT OF BENEFITS.--The insurer of the
29 owner of a motor vehicle shall pay personal injury protection
30 benefits for:
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1 (a) Accidental bodily injury sustained in this state
2 by the owner while occupying a motor vehicle, or while not an
3 occupant of a self-propelled vehicle if the injury is caused
4 by physical contact with a motor vehicle.
5 (b) Accidental bodily injury sustained outside this
6 state, but within the United States of America or its
7 territories or possessions or Canada, by the owner while
8 occupying the owner's motor vehicle.
9 (c) Accidental bodily injury sustained by a relative
10 of the owner residing in the same household, under the
11 circumstances described in paragraphs (a) and (b), provided
12 the relative at the time of the accident is domiciled in the
13 owner's household and is not himself or herself the owner of a
14 motor vehicle with respect to which security is required under
15 ss. 627.730-627.7405.
16 (d) Accidental bodily injury sustained in this state
17 by any other person while occupying the owner's motor vehicle
18 or, if a resident of this state, while not an occupant of a
19 self-propelled vehicle, if the injury is caused by physical
20 contact with such motor vehicle, provided the injured person
21 is not himself or herself:
22 1. The owner of a motor vehicle with respect to which
23 security is required under ss. 627.730-627.7405; or
24 2. Entitled to personal injury benefits from the
25 insurer of the owner or owners of such a motor vehicle.
26 (e) If two or more insurers are liable to pay personal
27 injury protection benefits for the same injury to any one
28 person, the maximum payable shall be as specified in
29 subsection (1), and any insurer paying the benefits shall be
30 entitled to recover from each of the other insurers an
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1 equitable pro rata share of the benefits paid and expenses
2 incurred in processing the claim.
3 (7) CLAIMS SUBMISSION (4) BENEFITS; WHEN
4 DUE.--Benefits due from an insurer under ss. 627.730-627.7405
5 shall be primary, except that benefits received under any
6 workers' compensation law shall be credited against the
7 benefits provided by subsection (1), and shall be due and
8 payable as loss accrues, upon receipt of reasonable proof of
9 such loss and the amount of expenses and loss incurred which
10 are covered by the policy issued under ss. 627.730-627.7405,
11 subject to the following:. When the Agency for Health Care
12 Administration provides, pays, or becomes liable for medical
13 assistance under the Medicaid program related to injury,
14 sickness, disease, or death arising out of the ownership,
15 maintenance, or use of a motor vehicle, benefits under ss.
16 627.730-627.7405 shall be subject to the provisions of the
17 Medicaid program.
18 (a) Personal injury protection application.--An
19 insurer may require written notice to be given as soon as
20 practicable after an accident involving a motor vehicle with
21 respect to which the policy affords the security required by
22 ss. 627.730-627.7405. If the injured person is a minor, the
23 parent or legal guardian of the minor, if requested by the
24 insurer, must accurately complete the personal injury
25 protection application.
26 (b) Charges for treatment of injured persons; billing
27 requirements.--
28 1. Any physician, hospital, clinic, or other person or
29 institution lawfully rendering treatment to an injured person
30 for a bodily injury covered by personal injury protection
31 insurance may charge the insurer and injured party only a
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1 reasonable amount pursuant to this section for the services
2 and supplies rendered, and the insurer providing such coverage
3 may pay for such charges directly to such person or
4 institution lawfully rendering such treatment, if the insured
5 receiving such treatment or his or her guardian has
6 countersigned the properly completed invoice, bill, or claim
7 form approved by the office upon which such charges are to be
8 paid for as having actually been rendered, to the best
9 knowledge of the insured or his or her guardian. In no event,
10 however, may such a charge be in excess of the amount the
11 person or institution customarily charges for like services or
12 supplies. With respect to a determination of whether a charge
13 for a particular service, treatment, or otherwise is
14 reasonable, consideration may be given to evidence of usual
15 and customary charges and payments accepted by the provider
16 involved in the dispute, and reimbursement levels in the
17 community and various federal and state medical fee schedules
18 applicable to automobile and other insurance coverages, and
19 other information relevant to the reasonableness of the
20 reimbursement for the service, treatment, or supply.
21 2. All statements and bills for medical services
22 rendered by any physician, hospital, clinic, or other person
23 or institution shall be submitted to the insurer on a properly
24 completed Centers for Medicare and Medicaid Services (CMS)
25 1500 form or its successor or a UB 92 form or its successor.
26 3. All billings for such services, procedures, and
27 supplies submitted by health care providers and medical
28 suppliers shall comply with the Healthcare Correct Procedural
29 Coding System (HCPCS) and International Classification of
30 Diseases (ICD-9-CM) or their successors in effect at the time
31 of patient discharge, if applicable, or when the service was
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1 rendered, if applicable, for the year in which services are
2 rendered.
3 4. All claims forms submitted by health care providers
4 and medical suppliers other than hospitals shall include on
5 the applicable claim form the signature and professional
6 license number of the provider who rendered services in the
7 line or space provided for "Signature of Physician or
8 Supplier, Including Degrees or Credentials" and the date of
9 the signature.
10 5. In determining compliance with applicable HCPCS and
11 ICD-9-CM coding, or their successors, guidance shall be
12 provided by the Healthcare Correct Procedural Coding System
13 (HCPCS) or its successor, International Classification of
14 Diseases (ICD-9-CM) or its successor, the Office of the
15 Inspector General (OIG), Physicians Compliance Guidelines,
16 rules of the Agency for Health Care Administration, the
17 Florida Health Information Management Association (FHIMA), and
18 other authoritative treatises.
19 6. Charges for medically necessary cephalic
20 thermograms, peripheral thermograms, spinal ultrasounds,
21 extremity ultrasounds, video fluoroscopy, and surface
22 electromyography shall not exceed the maximum reimbursement
23 allowance for such procedures as set forth in the applicable
24 fee schedule or other payment methodology established pursuant
25 to s. 440.13.
26 7. Allowable amounts that may be charged to a personal
27 injury protection insurance insurer and insured for medically
28 necessary nerve conduction testing when done in conjunction
29 with a needle electromyography procedure and both are
30 performed and billed solely by a physician licensed under
31 chapter 458, chapter 459, chapter 460, or chapter 461 who is
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1 also certified by the American Board of Electrodiagnostic
2 Medicine or by a board recognized by the American Board of
3 Medical Specialties or the American Osteopathic Association or
4 who holds diplomate status with the American Chiropractic
5 Neurology Board or its predecessors shall not exceed 200
6 percent of the allowable amount under the participating
7 physician fee schedule of Medicare Part B for year 2001, for
8 the area in which the treatment was rendered, adjusted
9 annually on August 1 to reflect the prior calendar year's
10 changes in the annual Medical Care Item of the Consumer Price
11 Index for All Urban Consumers in the South Region as
12 determined by the Bureau of Labor Statistics of the United
13 States Department of Labor.
14 8. Allowable amounts that may be charged to a personal
15 injury protection insurance insurer and insured for medically
16 necessary nerve conduction testing that does not meet the
17 requirements of subparagraph 7. shall not exceed the
18 applicable fee schedule or other payment methodology
19 established pursuant to s. 440.13.
20 9. Allowable amounts that may be charged to a personal
21 injury protection insurance insurer and insured for magnetic
22 resonance imaging services shall not exceed 175 percent of the
23 allowable amount under the participating physician fee
24 schedule of Medicare Part B for year 2001, for the area in
25 which the treatment was rendered, adjusted annually on August
26 1 to reflect the prior calendar year's changes in the annual
27 Medical Care Item of the Consumer Price Index for All Urban
28 Consumers in the South Region as determined by the Bureau of
29 Labor Statistics of the United States Department of Labor for
30 the 12-month period ending June 30 of that year, except that
31 allowable amounts that may be charged to a personal injury
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1 protection insurance insurer and insured for magnetic
2 resonance imaging services provided in facilities accredited
3 by the Accreditation Association for Ambulatory Health Care,
4 the American College of Radiology, or the Joint Commission on
5 Accreditation of Healthcare Organizations shall not exceed 200
6 percent of the allowable amount under the participating
7 physician fee schedule of Medicare Part B for year 2001, for
8 the area in which the treatment was rendered, adjusted
9 annually on August 1 to reflect the prior calendar year's
10 changes in the annual Medical Care Item of the Consumer Price
11 Index for All Urban Consumers in the South Region as
12 determined by the Bureau of Labor Statistics of the United
13 States Department of Labor for the 12-month period ending June
14 30 of that year. This paragraph does not apply to charges for
15 magnetic resonance imaging services and nerve conduction
16 testing for inpatients and emergency services and care as
17 defined in chapter 395 rendered by facilities licensed under
18 chapter 395.
19 10. A statement of medical services may not include
20 charges for medical services of a person or entity that
21 rendered such services without possessing all valid
22 qualifications and licenses required to lawfully provide and
23 bill for such services.
24 11. For purposes of subsection (8), an insurer shall
25 not be considered to have been furnished with notice of the
26 amount of covered loss or medical bills due unless the
27 statements or bills comply with this paragraph, and unless the
28 statements or bills are properly completed in their entirety
29 as to all material provisions, with all required information
30 being provided therein.
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1 12. An insurer may not systematically downcode with
2 the intent to deny reimbursement otherwise due. Such action
3 constitutes a material misrepresentation under s.
4 626.9541(1)(i)2.
5 (c) Direct billing an insurer for personal injury
6 protection benefits.--
7 1. The insurer providing coverage may pay for charges
8 directly to the insured or the insured's assignee.
9 2. Except for hospital and emergency services and care
10 rendered pursuant to s. 395.002, the insured receiving such
11 treatment or his or her guardian, if a minor, shall
12 countersign the properly completed CMS 1500 form or its
13 successor or UB 92 form or its successor submitted for
14 payment. Health care providers or service providers who do not
15 render services in the presence of the insured are not
16 required to comply with this paragraph.
17 (d) Timely billing for nonemergency services.--With
18 respect to any treatment or service, other than medical
19 services billed by a hospital or other provider for emergency
20 services as defined in s. 395.002 or inpatient services
21 rendered at a hospital-owned facility, the statement of
22 charges must be furnished to the insurer by the provider and
23 may not include, and the insurer is not required to pay,
24 charges for treatment or services rendered more than 35 days
25 before the postmark date of the statement, except for the
26 following:
27 1. Past due amounts previously billed on a timely
28 basis under this subsection.
29 2. If the provider submits to the insurer a notice of
30 initiation of treatment within 21 days after its first
31 examination or treatment of the claimant, the statement may
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1 include charges for treatment or services rendered up to, but
2 not more than, 50 days before the postmark date of the
3 statement. The injured person is not liable for, and the
4 provider shall not bill the injured person for, charges that
5 are unpaid because of the provider's failure to comply with
6 this paragraph. Any agreement requiring the injured person or
7 insured to pay for such charges is unenforceable.
8 3. If the insured fails to furnish the provider with
9 the correct name and address of the insured's personal injury
10 protection insurer, the provider has 35 days from the date the
11 provider obtains the correct information to furnish the
12 insurer with a statement of the charges. The insurer is not
13 required to pay for such charges unless the provider includes
14 with the statement documentary evidence that was provided by
15 the insured during the 35-day period demonstrating that the
16 provider reasonably relied on erroneous information from the
17 insured and either:
18 a. A denial letter from the incorrect insurer; or
19 b. Proof of mailing, which may include an affidavit
20 under penalty of perjury, reflecting timely mailing to the
21 incorrect address or insurer.
22 (e) Timely billing for emergency services.--
23 1. For emergency services and care as defined in s.
24 395.002 rendered in a hospital emergency department or for
25 transport and treatment rendered by an ambulance provider
26 licensed pursuant to part III of chapter 401, the provider is
27 not required to furnish the statement of charges within the
28 time periods established by this subsection; however, such
29 charges must be submitted within 75 days after the date the
30 treatment was rendered, and the insurer shall not be
31 considered to have been furnished with notice of the amount of
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1 covered loss for purposes of subsection (8) until it receives
2 a statement complying with subsection (7), or copy thereof,
3 which specifically identifies the place of service to be a
4 hospital emergency department or an ambulance.
5 2. The injured person is not liable for, and the
6 provider shall not bill the injured person for, charges that
7 are unpaid because of the provider's failure to comply with
8 this paragraph. Any agreement requiring the injured person or
9 insured to pay for such charges is unenforceable.
10 (f) Billing notice and disclosures.--
11 1. Each notice of insured's rights under s. 627.7401
12 must include the following statement in type no smaller than
13 12-point font:
14
15 BILLING REQUIREMENTS.--Florida Statutes provide
16 that with respect to any treatment or services,
17 other than certain hospital and emergency
18 services, the statement of charges furnished to
19 the insurer by the provider may not include,
20 and the insurer and the injured person are not
21 required to pay, charges for treatment or
22 services rendered more than 35 days before the
23 postmark date of the statement, except for past
24 due amounts previously billed on a timely
25 basis, and except that, if the provider submits
26 to the insurer a notice of initiation of
27 treatment within 21 days after its first
28 examination or treatment of the claimant, the
29 statement may include charges for treatment or
30 services rendered up to, but not more than, 50
31 days before the postmark date of the statement.
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1
2 2. Except for hospital and emergency services and care
3 rendered pursuant to s. 395.002, on each date services are
4 rendered the health care provider shall provide to the insured
5 patient a written bill, superbill, fee slip, or other similar
6 document that establishes in plain language a detailed
7 description of the service provided and the cost associated
8 with the service. The insured must sign the written bill,
9 superbill, fee slip, or other similar document immediately
10 after having received services. Copies of such disclosures
11 shall be maintained as part of the patient's medical records
12 in accordance with minimal record keeping standards. Health
13 care providers or service providers who do not render services
14 in the presence of the insured are not required to comply with
15 this section.
16 (g) Upon request, the insured and his or her assigns
17 shall be sent a letter containing a payment log itemizing all
18 payments made, the applicable insurance declarations page, and
19 a copy of the insurance policy within 30 days after the
20 written request. Such request shall state that it is a
21 "request under s. 627.736(7)" and shall state with
22 specificity:
23 1. The name of the insured upon whom such benefits are
24 being sought, including a copy of the assignment giving rights
25 to the claimant if the claimant is not the insured.
26 2. The claim number or policy number upon which such
27 claim was originally submitted to the insurer.
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29 Such request must be sent to the person and address specified
30 by the insurer for the purposes of receiving notices or
31 requests under this section.
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1 (h) Benefits shall not be due or payable to or on the
2 behalf of an insured person if that person has committed, by a
3 material act or omission, any insurance fraud relating to
4 personal injury protection coverage under his or her policy,
5 if the fraud is admitted to in a sworn statement by the
6 insured or if it is established in a court of competent
7 jurisdiction. Any insurance fraud shall void all coverage
8 arising from the claim related to such fraud under the
9 personal injury protection coverage of the insured person who
10 committed the fraud, irrespective of whether a portion of the
11 insured person's claim may be legitimate, and any benefits
12 paid prior to the discovery of the insured person's insurance
13 fraud shall be recoverable by the insurer from the person who
14 committed insurance fraud in their entirety. The prevailing
15 party is entitled to its costs and attorney's fees in any
16 action in which it prevails in an insurer's action to enforce
17 its right of recovery under this paragraph.
18 (8) OVERDUE PERSONAL INJURY PROTECTION BENEFITS.--
19 (a)(b) Personal injury protection insurance benefits
20 paid pursuant to this section shall be overdue if not paid
21 within 30 days after the insurer is furnished written notice
22 of the amount fact of a covered loss, including a properly
23 completed CMS 1500 form or its successor or UB 92 form or its
24 successor, assignment of benefits, or, in the case of
25 disability benefits, proper written documentation of the claim
26 and of the amount of same. If such written notice is not
27 furnished to the insurer as to the entire claim, any partial
28 amount supported by written notice is overdue if not paid
29 within 30 days after such written notice is furnished to the
30 insurer. Any part or all of the remainder of the claim that
31 is subsequently supported by written notice is overdue if not
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1 paid within 30 days after such written notice is furnished to
2 the insurer. When an insurer pays only a portion of a claim or
3 rejects a claim, the insurer shall provide at the time of the
4 partial payment or rejection an itemized specification of each
5 item that the insurer had reduced, omitted, or declined to pay
6 and any information that the insurer desires the claimant to
7 consider related to the medical necessity of the denied
8 treatment or to explain the reasonableness of the reduced
9 charge, provided that this shall not limit the introduction of
10 evidence at trial; and the insurer shall include the name and
11 address of the person to whom the claimant should respond and
12 a claim number to be referenced in future correspondence.
13 However, notwithstanding the fact that written notice has been
14 furnished to the insurer, any payment shall not be deemed
15 overdue when the insurer has reasonable proof to establish
16 that the insurer is not responsible for the payment. For the
17 purpose of calculating the extent to which any benefits are
18 overdue, payment shall be treated as being made on the date a
19 draft or other valid instrument which is equivalent to payment
20 was placed in the United States mail in a properly addressed,
21 postpaid envelope or, if not so posted, on the date of
22 delivery.
23 (b) Timely payment by an insurer This paragraph does
24 not preclude or limit the ability of the insurer to assert
25 that the claim was unrelated, was for services not lawfully
26 performed, was not medically necessary, or was unreasonable or
27 that the amount of the charge was in excess of that permitted
28 under, or in violation of, this section subsection (5). Such
29 assertion by the insurer may be made at any time, including
30 after payment of the claim or after the 30-day time period for
31 payment set forth in this subsection paragraph.
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1 (c) All overdue payments shall bear simple interest at
2 the rate established under s. 55.03 or the rate established in
3 the insurance contract, whichever is greater, for the year in
4 which the payment became overdue, calculated from the date the
5 insurer was furnished with written notice of the amount of
6 covered loss. Interest shall be due at the time payment of the
7 overdue claim is made.
8 (d) The insurer of the owner of a motor vehicle shall
9 pay personal injury protection benefits for:
10 1. Accidental bodily injury sustained in this state by
11 the owner while occupying a motor vehicle, or while not an
12 occupant of a self-propelled vehicle if the injury is caused
13 by physical contact with a motor vehicle.
14 2. Accidental bodily injury sustained outside this
15 state, but within the United States of America or its
16 territories or possessions or Canada, by the owner while
17 occupying the owner's motor vehicle.
18 3. Accidental bodily injury sustained by a relative of
19 the owner residing in the same household, under the
20 circumstances described in subparagraph 1. or subparagraph 2.,
21 provided the relative at the time of the accident is domiciled
22 in the owner's household and is not himself or herself the
23 owner of a motor vehicle with respect to which security is
24 required under ss. 627.730-627.7405.
25 4. Accidental bodily injury sustained in this state by
26 any other person while occupying the owner's motor vehicle or,
27 if a resident of this state, while not an occupant of a
28 self-propelled vehicle, if the injury is caused by physical
29 contact with such motor vehicle, provided the injured person
30 is not himself or herself:
31
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1 a. The owner of a motor vehicle with respect to which
2 security is required under ss. 627.730-627.7405; or
3 b. Entitled to personal injury benefits from the
4 insurer of the owner or owners of such a motor vehicle.
5 (e) If two or more insurers are liable to pay personal
6 injury protection benefits for the same injury to any one
7 person, the maximum payable shall be as specified in
8 subsection (1), and any insurer paying the benefits shall be
9 entitled to recover from each of the other insurers an
10 equitable pro rata share of the benefits paid and expenses
11 incurred in processing the claim.
12 (c)(f) It is a violation of the insurance code for an
13 insurer to fail to timely provide benefits as required by this
14 section with such frequency as to constitute a general
15 business practice.
16 (9) CALCULATION OF TIME OF PAYMENT.--For the purpose
17 of calculating the extent to which any benefits are overdue,
18 payment shall be treated as being made on the date a draft or
19 other valid instrument that is equivalent to payment was
20 placed in the United States mail in a properly addressed,
21 postpaid envelope or, if not so posted, on the date of
22 delivery.
23 (10) INTEREST ON OVERDUE PAYMENTS.--All overdue
24 payments shall bear simple interest at the rate established
25 under s. 55.03 or the rate established in the insurance
26 contract, whichever is greater, for the year in which the
27 payment became overdue, calculated from the date the insurer
28 was furnished with written notice of the amount of covered
29 loss. In the case of payment made by an insurer to the
30 insured, or insured's assignee, interest shall be due at the
31 time payment of the overdue claim is made. All amounts
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1 repayable to the insurer shall bear simple interest at the
2 rate established under s. 55.03 for the year in which the
3 payment became repayable, calculated from the date the insurer
4 tendered payment.
5 (g) Benefits shall not be due or payable to or on the
6 behalf of an insured person if that person has committed, by a
7 material act or omission, any insurance fraud relating to
8 personal injury protection coverage under his or her policy,
9 if the fraud is admitted to in a sworn statement by the
10 insured or if it is established in a court of competent
11 jurisdiction. Any insurance fraud shall void all coverage
12 arising from the claim related to such fraud under the
13 personal injury protection coverage of the insured person who
14 committed the fraud, irrespective of whether a portion of the
15 insured person's claim may be legitimate, and any benefits
16 paid prior to the discovery of the insured person's insurance
17 fraud shall be recoverable by the insurer from the person who
18 committed insurance fraud in their entirety. The prevailing
19 party is entitled to its costs and attorney's fees in any
20 action in which it prevails in an insurer's action to enforce
21 its right of recovery under this paragraph.
22 (5) CHARGES FOR TREATMENT OF INJURED PERSONS.--
23 (a) Any physician, hospital, clinic, or other person
24 or institution lawfully rendering treatment to an injured
25 person for a bodily injury covered by personal injury
26 protection insurance may charge the insurer and injured party
27 only a reasonable amount pursuant to this section for the
28 services and supplies rendered, and the insurer providing such
29 coverage may pay for such charges directly to such person or
30 institution lawfully rendering such treatment, if the insured
31 receiving such treatment or his or her guardian has
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1 countersigned the properly completed invoice, bill, or claim
2 form approved by the office upon which such charges are to be
3 paid for as having actually been rendered, to the best
4 knowledge of the insured or his or her guardian. In no event,
5 however, may such a charge be in excess of the amount the
6 person or institution customarily charges for like services or
7 supplies. With respect to a determination of whether a charge
8 for a particular service, treatment, or otherwise is
9 reasonable, consideration may be given to evidence of usual
10 and customary charges and payments accepted by the provider
11 involved in the dispute, and reimbursement levels in the
12 community and various federal and state medical fee schedules
13 applicable to automobile and other insurance coverages, and
14 other information relevant to the reasonableness of the
15 reimbursement for the service, treatment, or supply.
16 (11) CLAIMS NOT PROPERLY PAYABLE.--
17 (b)1. An insurer or insured is not required to pay a
18 claim or charges:
19 (a)a. Made by a broker or by a person making a claim
20 on behalf of a broker;
21 (b)b. For any service or treatment that was not lawful
22 at the time rendered;
23 (c)c. To any person who knowingly submits a false or
24 misleading statement relating to the claim or charges;
25 (d)d. With respect to a bill or statement that does
26 not substantially meet the applicable requirements of
27 paragraph (7)(b) (d);
28 (e)e. For any treatment or service that is upcoded, or
29 that is unbundled when such treatment or services should be
30 bundled, in accordance with subsection (7) paragraph (d). To
31 facilitate prompt payment of lawful services, an insurer may
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1 change codes that it determines to have been improperly or
2 incorrectly upcoded or unbundled, and may make payment based
3 on the changed codes, without affecting the right of the
4 provider to dispute the change by the insurer, provided that
5 before doing so, the insurer must contact the health care
6 provider and discuss the reasons for the insurer's change and
7 the health care provider's reason for the coding, or make a
8 reasonable good faith effort to do so, as documented in the
9 insurer's file; and
10 (f)f. For medical services or treatment billed by a
11 physician and not provided in a hospital unless such services
12 are rendered by the physician or are incident to his or her
13 professional services and are included on the physician's
14 bill, including documentation verifying that the physician is
15 responsible for the medical services that were rendered and
16 billed.
17 2. Charges for medically necessary cephalic
18 thermograms, peripheral thermograms, spinal ultrasounds,
19 extremity ultrasounds, video fluoroscopy, and surface
20 electromyography shall not exceed the maximum reimbursement
21 allowance for such procedures as set forth in the applicable
22 fee schedule or other payment methodology established pursuant
23 to s. 440.13.
24 3. Allowable amounts that may be charged to a personal
25 injury protection insurance insurer and insured for medically
26 necessary nerve conduction testing when done in conjunction
27 with a needle electromyography procedure and both are
28 performed and billed solely by a physician licensed under
29 chapter 458, chapter 459, chapter 460, or chapter 461 who is
30 also certified by the American Board of Electrodiagnostic
31 Medicine or by a board recognized by the American Board of
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1 Medical Specialties or the American Osteopathic Association or
2 who holds diplomate status with the American Chiropractic
3 Neurology Board or its predecessors shall not exceed 200
4 percent of the allowable amount under the participating
5 physician fee schedule of Medicare Part B for year 2001, for
6 the area in which the treatment was rendered, adjusted
7 annually on August 1 to reflect the prior calendar year's
8 changes in the annual Medical Care Item of the Consumer Price
9 Index for All Urban Consumers in the South Region as
10 determined by the Bureau of Labor Statistics of the United
11 States Department of Labor.
12 4. Allowable amounts that may be charged to a personal
13 injury protection insurance insurer and insured for medically
14 necessary nerve conduction testing that does not meet the
15 requirements of subparagraph 3. shall not exceed the
16 applicable fee schedule or other payment methodology
17 established pursuant to s. 440.13.
18 5. Allowable amounts that may be charged to a personal
19 injury protection insurance insurer and insured for magnetic
20 resonance imaging services shall not exceed 175 percent of the
21 allowable amount under the participating physician fee
22 schedule of Medicare Part B for year 2001, for the area in
23 which the treatment was rendered, adjusted annually on August
24 1 to reflect the prior calendar year's changes in the annual
25 Medical Care Item of the Consumer Price Index for All Urban
26 Consumers in the South Region as determined by the Bureau of
27 Labor Statistics of the United States Department of Labor for
28 the 12-month period ending June 30 of that year, except that
29 allowable amounts that may be charged to a personal injury
30 protection insurance insurer and insured for magnetic
31 resonance imaging services provided in facilities accredited
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1 by the Accreditation Association for Ambulatory Health Care,
2 the American College of Radiology, or the Joint Commission on
3 Accreditation of Healthcare Organizations shall not exceed 200
4 percent of the allowable amount under the participating
5 physician fee schedule of Medicare Part B for year 2001, for
6 the area in which the treatment was rendered, adjusted
7 annually on August 1 to reflect the prior calendar year's
8 changes in the annual Medical Care Item of the Consumer Price
9 Index for All Urban Consumers in the South Region as
10 determined by the Bureau of Labor Statistics of the United
11 States Department of Labor for the 12-month period ending June
12 30 of that year. This paragraph does not apply to charges for
13 magnetic resonance imaging services and nerve conduction
14 testing for inpatients and emergency services and care as
15 defined in chapter 395 rendered by facilities licensed under
16 chapter 395.
17 6. The Department of Health, in consultation with the
18 appropriate professional licensing boards, shall adopt, by
19 rule, a list of diagnostic tests deemed not to be medically
20 necessary for use in the treatment of persons sustaining
21 bodily injury covered by personal injury protection benefits
22 under this section. The initial list shall be adopted by
23 January 1, 2004, and shall be revised from time to time as
24 determined by the Department of Health, in consultation with
25 the respective professional licensing boards. Inclusion of a
26 test on the list of invalid diagnostic tests shall be based on
27 lack of demonstrated medical value and a level of general
28 acceptance by the relevant provider community and shall not be
29 dependent for results entirely upon subjective patient
30 response. Notwithstanding its inclusion on a fee schedule in
31 this subsection, an insurer or insured is not required to pay
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1 any charges or reimburse claims for any invalid diagnostic
2 test as determined by the Department of Health.
3 (c)1. With respect to any treatment or service, other
4 than medical services billed by a hospital or other provider
5 for emergency services as defined in s. 395.002 or inpatient
6 services rendered at a hospital-owned facility, the statement
7 of charges must be furnished to the insurer by the provider
8 and may not include, and the insurer is not required to pay,
9 charges for treatment or services rendered more than 35 days
10 before the postmark date of the statement, except for past due
11 amounts previously billed on a timely basis under this
12 paragraph, and except that, if the provider submits to the
13 insurer a notice of initiation of treatment within 21 days
14 after its first examination or treatment of the claimant, the
15 statement may include charges for treatment or services
16 rendered up to, but not more than, 75 days before the postmark
17 date of the statement. The injured party is not liable for,
18 and the provider shall not bill the injured party for, charges
19 that are unpaid because of the provider's failure to comply
20 with this paragraph. Any agreement requiring the injured
21 person or insured to pay for such charges is unenforceable.
22 2. If, however, the insured fails to furnish the
23 provider with the correct name and address of the insured's
24 personal injury protection insurer, the provider has 35 days
25 from the date the provider obtains the correct information to
26 furnish the insurer with a statement of the charges. The
27 insurer is not required to pay for such charges unless the
28 provider includes with the statement documentary evidence that
29 was provided by the insured during the 35-day period
30 demonstrating that the provider reasonably relied on erroneous
31 information from the insured and either:
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1 a. A denial letter from the incorrect insurer; or
2 b. Proof of mailing, which may include an affidavit
3 under penalty of perjury, reflecting timely mailing to the
4 incorrect address or insurer.
5 3. For emergency services and care as defined in s.
6 395.002 rendered in a hospital emergency department or for
7 transport and treatment rendered by an ambulance provider
8 licensed pursuant to part III of chapter 401, the provider is
9 not required to furnish the statement of charges within the
10 time periods established by this paragraph; and the insurer
11 shall not be considered to have been furnished with notice of
12 the amount of covered loss for purposes of paragraph (4)(b)
13 until it receives a statement complying with paragraph (d), or
14 copy thereof, which specifically identifies the place of
15 service to be a hospital emergency department or an ambulance
16 in accordance with billing standards recognized by the Health
17 Care Finance Administration.
18 4. Each notice of insured's rights under s. 627.7401
19 must include the following statement in type no smaller than
20 12 points:
21
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 35 days before the
30 postmark date of the statement, except for past
31 due amounts previously billed on a timely
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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, 75
7 days before the postmark date of the statement.
8
9 (d) All statements and bills for medical services
10 rendered by any physician, hospital, clinic, or other person
11 or institution shall be submitted to the insurer on a properly
12 completed Centers for Medicare and Medicaid Services (CMS)
13 1500 form, UB 92 forms, or any other standard form approved by
14 the office or adopted by the commission for purposes of this
15 paragraph. All billings for such services rendered by
16 providers shall, to the extent applicable, follow the
17 Physicians' Current Procedural Terminology (CPT) or Healthcare
18 Correct Procedural Coding System (HCPCS), or ICD-9 in effect
19 for the year in which services are rendered and comply with
20 the Centers for Medicare and Medicaid Services (CMS) 1500 form
21 instructions and the American Medical Association Current
22 Procedural Terminology (CPT) Editorial Panel and Healthcare
23 Correct Procedural Coding System (HCPCS). All providers other
24 than hospitals shall include on the applicable claim form the
25 professional license number of the provider in the line or
26 space provided for "Signature of Physician or Supplier,
27 Including Degrees or Credentials." In determining compliance
28 with applicable CPT and HCPCS coding, guidance shall be
29 provided by the Physicians' Current Procedural Terminology
30 (CPT) or the Healthcare Correct Procedural Coding System
31 (HCPCS) in effect for the year in which services were
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1 rendered, the Office of the Inspector General (OIG),
2 Physicians Compliance Guidelines, and other authoritative
3 treatises designated by rule by the Agency for Health Care
4 Administration. No statement of medical services may include
5 charges for medical services of a person or entity that
6 performed such services without possessing the valid licenses
7 required to perform such services. For purposes of paragraph
8 (4)(b), an insurer shall not be considered to have been
9 furnished with notice of the amount of covered loss or medical
10 bills due unless the statements or bills comply with this
11 paragraph, and unless the statements or bills are properly
12 completed in their entirety as to all material provisions,
13 with all relevant information being provided therein.
14 (12) DEMAND LETTER.--
15 (a) As a condition precedent to filing any action for
16 benefits under this section, the insurer must be provided with
17 written notice of an intent to initiate litigation. Such
18 notice may not be sent until the claim is overdue, including
19 any additional time the insurer has to pay the claim pursuant
20 to subsection (8).
21 (b) The notice required shall state that it is a
22 "demand letter under s. 627.736(14)" and shall state with
23 specificity:
24 1. The name of the insured upon whom such benefits are
25 being sought, including a copy of the assignment giving rights
26 to the claimant if the claimant is not the insured.
27 2. The claim number or policy number upon which such
28 claim was originally submitted to the insurer.
29 3. To the extent applicable, the name of any medical
30 provider who rendered to an insured the treatment, services,
31 accommodations, or supplies that form the basis of such claim;
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1 and an itemized statement specifying each exact amount, the
2 date of treatment, service, or accommodation, and the type of
3 benefit claimed to be due. A completed form satisfying the
4 requirements of subsection (7) or the lost-wage statement
5 previously submitted may be used as the itemized statement. To
6 the extent that the demand involves an insurer's withdrawal of
7 payment under subsection (15) for future treatment not yet
8 rendered, the claimant shall attach a copy of the insurer's
9 notice withdrawing such payment and an itemized statement of
10 the type, frequency, and duration of future treatment claimed
11 to be reasonable and medically necessary.
12 (c) Each notice required by this subsection must be
13 delivered to the insurer by United States certified or
14 registered mail, return receipt requested. Such postal costs
15 shall be reimbursed by the insurer if so requested by the
16 claimant in the notice, when the insurer pays the claim. Such
17 notice must be sent to the person and address specified by the
18 insurer for the purposes of receiving notices under this
19 subsection. Each licensed insurer, whether domestic, foreign,
20 or alien, shall file with the office designation of the name
21 and address of the person to whom notices pursuant to this
22 subsection shall be sent which the office shall make available
23 on its Internet website. The name and address on file with the
24 office pursuant to s. 624.422 shall be deemed the authorized
25 representative to accept notice pursuant to this subsection in
26 the event no other designation has been made.
27 (d) If, within 21 days after receipt of notice by the
28 insurer, the overdue claim specified in the notice is paid by
29 the insurer together with applicable interest and a penalty of
30 10 percent of the overdue amount paid by the insurer, subject
31 to a maximum penalty of $250, no action may be brought against
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1 the insurer. If the demand involves an insurer's withdrawal of
2 payment under subsection (15) for future treatment not yet
3 rendered, no action may be brought against the insurer if,
4 within 21 days after its receipt of the notice, the insurer
5 mails to the person filing the notice a written statement of
6 the insurer's agreement to pay for such treatment in
7 accordance with the notice and to pay a penalty of 10 percent,
8 subject to a maximum penalty of $250, when it pays for such
9 future treatment in accordance with the requirements of this
10 section. To the extent the insurer determines not to pay any
11 amount demanded, the penalty shall not be payable in any
12 subsequent action. For purposes of this subsection, payment or
13 the insurer's agreement shall be treated as being made on the
14 date a draft or other valid instrument that is equivalent to
15 payment, or the insurer's written statement of agreement, is
16 placed in the United States mail in a properly addressed,
17 postpaid envelope, or if not so posted, on the date of
18 delivery. The insurer is not obligated to pay any attorney's
19 fees if the insurer pays the claim or mails its agreement to
20 pay for future treatment within the time prescribed by this
21 subsection.
22 (e) The applicable statute of limitation for an action
23 under this section shall be tolled for a period of 21 business
24 days by the mailing of the notice required by this subsection.
25 (f) Any insurer making a general business practice of
26 not paying valid claims until receipt of the notice required
27 by this subsection is engaging in an unfair trade practice
28 under the insurance code.
29 (13) DISCLOSURE AND ACKNOWLEDGEMENT FORM.--
30 (a)(e)1. At the initial treatment or service provided,
31 each physician, other licensed professional, clinic, or other
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1 medical institution providing medical services upon which a
2 claim for personal injury protection benefits is based shall
3 require an insured person, or his or her guardian, to execute
4 a disclosure and acknowledgment form, which reflects at a
5 minimum that:
6 1.a. The insured, or his or her guardian, must
7 countersign the form attesting to the fact that the services
8 set forth therein were actually rendered;
9 2.b. The insured, or his or her guardian, has both the
10 right and affirmative duty to confirm that the services were
11 actually rendered;
12 3.c. The insured, or his or her guardian, was not
13 solicited by any person to seek any services from the medical
14 provider;
15 4.d. That the physician, other licensed professional,
16 clinic, or other medical institution rendering services for
17 which payment is being claimed explained the services to the
18 insured or his or her guardian; and
19 5.e. If the insured notifies the insurer in writing of
20 a billing error, the insured may be entitled to a certain
21 percentage of a reduction in the amounts paid by the insured's
22 motor vehicle insurer.
23 (b)2. The physician, other licensed professional,
24 clinic, or other medical institution rendering services for
25 which payment is being claimed has the affirmative duty to
26 explain the services rendered to the insured, or his or her
27 guardian, so that the insured, or his or her guardian,
28 countersigns the form with informed consent.
29 (c)3. Countersignature by the insured, or his or her
30 guardian, is not required for the reading of diagnostic tests
31
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1 or other services that are of such a nature that they are not
2 required to be performed in the presence of the insured.
3 (d)4. The licensed medical professional rendering
4 treatment for which payment is being claimed must sign, by his
5 or her own hand, the form complying with this subsection
6 paragraph.
7 (e)5. The original completed disclosure and
8 acknowledgment form shall be furnished to the insurer pursuant
9 to subsection (8) paragraph (4)(b) and may not be
10 electronically furnished.
11 (f)6. This disclosure and acknowledgment form is not
12 required for services billed by a provider for emergency
13 services as defined in s. 395.002, for emergency services and
14 care as defined in s. 395.002 rendered in a hospital emergency
15 department, or for transport and treatment rendered by an
16 ambulance provider licensed pursuant to part III of chapter
17 401.
18 (g)7. The Financial Services Commission shall adopt,
19 by rule, a standard disclosure and acknowledgment form that
20 shall be used to fulfill the requirements of this subsection
21 paragraph, effective 90 days after such form is adopted and
22 becomes final. The commission shall adopt a proposed rule by
23 October 1, 2003. Until the rule is final, the provider may use
24 a form of its own which otherwise complies with the
25 requirements of this paragraph.
26 (h)8. As used in this subsection paragraph,
27 "countersigned" means a second or verifying signature, as on a
28 previously signed document, and is not satisfied by the
29 statement "signature on file" or any similar statement.
30 (i)9. The requirements of This subsection applies
31 paragraph apply only with respect to the initial treatment or
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1 service of the insured by a provider. For subsequent
2 treatments or service, the provider must maintain a patient
3 log signed by the patient, in chronological order by date of
4 service, that is consistent with the services being rendered
5 to the patient as claimed. The requirements of this paragraph
6 subparagraph for maintaining a patient log signed by the
7 patient may be met by a hospital that maintains medical
8 records as required by s. 395.3025 and applicable rules and
9 makes such records available to the insurer upon request.
10 (f) Upon written notification by any person, an
11 insurer shall investigate any claim of improper billing by a
12 physician or other medical provider. The insurer shall
13 determine if the insured was properly billed for only those
14 services and treatments that the insured actually received. If
15 the insurer determines that the insured has been improperly
16 billed, the insurer shall notify the insured, the person
17 making the written notification and the provider of its
18 findings and shall reduce the amount of payment to the
19 provider by the amount determined to be improperly billed. If
20 a reduction is made due to such written notification by any
21 person, the insurer shall pay to the person 20 percent of the
22 amount of the reduction, up to $500. If the provider is
23 arrested due to the improper billing, then the insurer shall
24 pay to the person 40 percent of the amount of the reduction,
25 up to $500.
26 (g) An insurer may not systematically downcode with
27 the intent to deny reimbursement otherwise due. Such action
28 constitutes a material misrepresentation under s.
29 626.9541(1)(i)2.
30 (6) DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
31 DISPUTES.--
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1 (a) Every employer shall, if a request is made by an
2 insurer providing personal injury protection benefits under
3 ss. 627.730-627.7405 against whom a claim has been made,
4 furnish forthwith, in a form approved by the office, a sworn
5 statement of the earnings, since the time of the bodily injury
6 and for a reasonable period before the injury, of the person
7 upon whose injury the claim is based.
8 (14) DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
9 DISPUTES.--
10 (a)(b) Every physician, hospital, clinic, or other
11 medical institution providing, before or after bodily injury
12 upon which a claim for personal injury protection insurance
13 benefits is based, any products, services, or accommodations
14 in relation to that or any other injury, or in relation to a
15 condition claimed to be connected with that or any other
16 injury, shall, if requested to do so by the insurer against
17 whom the claim has been made:,
18 1. Furnish forthwith a written report of the history,
19 condition, treatment, dates, and costs of such treatment of
20 the injured person and why the items identified by the insurer
21 were reasonable in amount and medically necessary.,
22 2. Provide together with a sworn statement that the
23 treatment or services rendered were reasonable and necessary
24 with respect to the bodily injury sustained. Such sworn
25 statement shall read as follows: "Under penalty of perjury, I
26 declare that I have read the foregoing, and the facts alleged
27 are true, to the best of my knowledge and belief."
28 3. Identify and identifying which portion of the
29 expenses for such treatment or services was incurred as a
30 result of such bodily injury.,
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1 4. and Produce forthwith, and permit the inspection
2 and copying of, his or her or its records regarding such
3 history, condition, treatment, dates, and costs of treatment;
4 provided that this shall not limit the introduction of
5 evidence at trial. Such sworn statement shall read as follows:
6 "Under penalty of perjury, I declare that I have read the
7 foregoing, and the facts alleged are true, to the best of my
8 knowledge and belief."
9 (b) However, if the records are maintained at an
10 alternative location, the requested records shall be made
11 available at the principal place of business within 25 working
12 days after the request. If the requested records are not made
13 available within this time period and such records are later
14 admitted into evidence or otherwise used to support a claim by
15 the health care provider against the insurer, the court shall
16 not award attorney's fees to the provider pursuant to this
17 section or s. 627.428. At the time of the records inspection,
18 the health care provider shall allow the insurer to inspect
19 records and photograph the equipment and associated documents
20 associated with the insured's treatment, services, or
21 supplies.
22 (c) A No cause of action for violation of the
23 physician-patient privilege or invasion of the right of
24 privacy is not shall be permitted against any physician,
25 hospital, clinic, or other medical institution complying with
26 the provisions of this section.
27 (d) The person requesting such records and such sworn
28 statement shall pay all reasonable costs connected therewith.
29 (e) If an insurer makes a written request for
30 documentation or information under this paragraph within 30
31 days after having received notice of the amount of a covered
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1 loss under subsection (7) paragraph (4)(a), the amount or the
2 partial amount that which is the subject of the insurer's
3 inquiry shall become overdue if the insurer does not pay in
4 accordance with subsection (8) paragraph (4)(b) or within 15
5 10 days after the insurer's receipt of the requested
6 documentation or information, whichever occurs later. For
7 purposes of this paragraph, the term "receipt" includes, but
8 is not limited to, inspection and copying pursuant to this
9 subsection paragraph.
10 (f) Any insurer that requests documentation or
11 information pertaining to reasonableness of charges or medical
12 necessity under this subsection paragraph without a reasonable
13 basis for such requests as a general business practice is
14 engaging in an unfair trade practice under the insurance code.
15 (g)(c) In the event of any dispute regarding an
16 insurer's right to discovery of facts under this section, the
17 insurer may petition a court of competent jurisdiction to
18 enter an order permitting such discovery. The order may be
19 made only on motion for good cause shown and upon notice to
20 all persons having an interest, and it shall specify the time,
21 place, manner, conditions, and scope of the discovery. Such
22 court may, in order to protect against annoyance,
23 embarrassment, or oppression, as justice requires, enter an
24 order refusing discovery or specifying conditions of discovery
25 and may order payments of costs and expenses of the
26 proceeding, including reasonable fees for the appearance of
27 attorneys at the proceedings, as justice requires.
28 (h)(d) The injured person shall be furnished, upon
29 request, a copy of all information obtained by the insurer
30 under the provisions of this section, and shall pay a
31 reasonable charge, if required by the insurer.
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1 (i)(e) Notice to an insurer of the existence of a
2 claim shall not be unreasonably withheld by an insured.
3 (15)(7) MENTAL AND PHYSICAL EXAMINATION OF INJURED
4 PERSON; REPORTS.--
5 (a) Whenever the mental or physical condition of an
6 injured person covered by personal injury protection is
7 material to any claim that has been or may be made for past or
8 future personal injury protection insurance benefits, such
9 person shall, upon the request of an insurer, submit to mental
10 or physical examination by a physician or physicians.
11 (b) The costs of any examinations requested by an
12 insurer shall be borne entirely by the insurer.
13 (c) Such examination shall be conducted within the
14 municipality where the insured is receiving treatment, or in a
15 location reasonably accessible to the insured, which, for
16 purposes of this paragraph, means any location within the
17 municipality in which the insured resides, or any location
18 within 10 miles by road of the insured's residence, provided
19 such location is within the county in which the insured
20 resides.
21 (d) If the examination is to be conducted in a
22 location reasonably accessible to the insured, and if there is
23 no qualified physician to conduct the examination in a
24 location reasonably accessible to the insured, then such
25 examination shall be conducted in an area of the closest
26 proximity to the insured's residence.
27 (e) Personal protection Insurers are authorized to
28 include reasonable provisions in personal injury protection
29 insurance policies for mental and physical examination of
30 those claiming personal injury protection insurance benefits.
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1 (f) An insurer may not withdraw payment of a treating
2 physician without the consent of the injured person covered by
3 the personal injury protection, unless the insurer first
4 obtains a valid report by a Florida physician licensed under
5 the same chapter as the treating physician whose treatment
6 authorization is sought to be withdrawn, stating that
7 treatment was not reasonable, related, or necessary.
8 (g) A valid report is one that is prepared and signed
9 by the physician examining the injured person or reviewing the
10 treatment records of the injured person and is factually
11 supported by the examination and treatment records if reviewed
12 and that has not been modified by anyone other than the
13 physician.
14 (h) The physician preparing the report must be in
15 active practice, unless the physician is physically disabled.
16 Active practice means that during the 3 years immediately
17 preceding the date of the physical examination or review of
18 the treatment records the physician must have devoted
19 professional time to the active clinical practice of
20 evaluation, diagnosis, or treatment of medical conditions or
21 to the instruction of students in an accredited health
22 professional school or accredited residency program or a
23 clinical research program that is affiliated with an
24 accredited health professional school or teaching hospital or
25 accredited residency program.
26 (i) The physician preparing a report at the request of
27 an insurer and physicians rendering expert opinions on behalf
28 of persons claiming medical benefits for personal injury
29 protection, or on behalf of an insured through an attorney or
30 another entity, shall maintain, for at least 3 years, copies
31 of all examination reports as medical records and shall
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1 maintain, for at least 3 years, records of all payments for
2 the examinations and reports.
3 (j) Neither an insurer nor any person acting at the
4 direction of or on behalf of an insurer may materially change
5 an opinion in a report prepared under this subsection
6 paragraph or direct the physician preparing the report to
7 change such opinion. The denial of a payment as the result of
8 such a changed opinion constitutes a material
9 misrepresentation under s. 626.9541(1)(i)2.; however, this
10 provision does not preclude the insurer from calling to the
11 attention of the physician errors of fact in the report based
12 upon information in the claim file.
13 (k)(b) If requested by the person examined, a party
14 causing an examination to be made shall deliver to him or her
15 a copy of every written report concerning the examination
16 rendered by an examining physician, at least one of which
17 reports must set out the examining physician's findings and
18 conclusions in detail. After such request and delivery, the
19 party causing the examination to be made is entitled, upon
20 request, to receive from the person examined every written
21 report available to him or her or his or her representative
22 concerning any examination, previously or thereafter made, of
23 the same mental or physical condition. By requesting and
24 obtaining a report of the examination so ordered, or by taking
25 the deposition of the examiner, the person examined waives any
26 privilege he or she may have, in relation to the claim for
27 benefits, regarding the testimony of every other person who
28 has examined, or may thereafter examine, him or her in respect
29 to the same mental or physical condition. If a person
30 unreasonably refuses to submit to an examination, the personal
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1 injury protection carrier is no longer liable for subsequent
2 personal injury protection benefits.
3 (8) APPLICABILITY OF PROVISION REGULATING ATTORNEY'S
4 FEES.--With respect to any dispute under the provisions of ss.
5 627.730-627.7405 between the insured and the insurer, or
6 between an assignee of an insured's rights and the insurer,
7 the provisions of s. 627.428 shall apply, except as provided
8 in subsection (11).
9 (16)(9) CANCELLATION OR NONRENEWAL.--
10 (a) Each insurer that which has issued a policy
11 providing personal injury protection benefits shall report the
12 renewal, cancellation, or nonrenewal thereof to the Department
13 of Highway Safety and Motor Vehicles within 45 days from the
14 effective date of the renewal, cancellation, or nonrenewal.
15 (b) Upon the issuance of a policy providing personal
16 injury protection benefits to a named insured not previously
17 insured by the insurer thereof during that calendar year, the
18 insurer shall report the issuance of the new policy to the
19 Department of Highway Safety and Motor Vehicles within 30
20 days. The report shall be in such form and format and contain
21 such information as is may be required by the Department of
22 Highway Safety and Motor Vehicles which shall include a format
23 compatible with the data processing capabilities of such said
24 department, and the Department of Highway Safety and Motor
25 Vehicles is authorized to adopt rules necessary with respect
26 thereto. Failure by an insurer to file proper reports with the
27 Department of Highway Safety and Motor Vehicles as required by
28 this subsection or rules adopted with respect to the
29 requirements of this subsection constitutes a violation of the
30 Florida Insurance Code.
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1 (c) Reports of cancellations and policy renewals and
2 reports of the issuance of new policies received by the
3 Department of Highway Safety and Motor Vehicles are
4 confidential and exempt from the provisions of s. 119.07(1).
5 (d) These records are to be used for enforcement and
6 regulatory purposes only, including the generation by the
7 department of data regarding compliance by owners of motor
8 vehicles with financial responsibility coverage requirements.
9 In addition, the Department of Highway Safety and Motor
10 Vehicles shall release, upon a written request by a person
11 involved in a motor vehicle accident, by the person's
12 attorney, or by a representative of the person's motor vehicle
13 insurer, the name of the insurance company and the policy
14 number for the policy covering the vehicle named by the
15 requesting party. The written request must include a copy of
16 the appropriate accident form as provided in s. 316.065, s.
17 316.066, or s. 316.068.
18 (e)(b) Every insurer with respect to each insurance
19 policy providing personal injury protection benefits shall
20 notify the named insured or in the case of a commercial fleet
21 policy, the first named insured in writing that any
22 cancellation or nonrenewal of the policy will be reported by
23 the insurer to the Department of Highway Safety and Motor
24 Vehicles. The notice shall also inform the named insured that
25 failure to maintain personal injury protection and property
26 damage liability insurance on a motor vehicle when required by
27 law may result in the loss of registration and driving
28 privileges in this state, and the notice shall inform the
29 named insured of the amount of the reinstatement fees required
30 by s. 627.733(7). This notice is for informational purposes
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1 only, and no civil liability shall attach to an insurer due to
2 failure to provide this notice.
3 (17) ATTORNEY'S FEES.--With respect to any dispute
4 under ss. 627.730-627.7405 between the insured and the
5 insurer, or between an assignee of an insured's rights and the
6 insurer, s. 627.428 shall apply, except as provided in
7 subsection (12). A contingency risk multiplier shall not be
8 applied to any attorney's fee award in any dispute under ss.
9 627.730-627.7405.
10 (18)(10) PREFERRED PROVIDERS.--An insurer may
11 negotiate and enter into contracts with licensed health care
12 providers for the benefits described in this section, referred
13 to in this section as "preferred providers," which shall
14 include health care providers licensed under chapters 458,
15 459, 460, 461, and 463. The insurer may provide an option to
16 an insured to use a preferred provider at the time of purchase
17 of the policy for personal injury protection benefits, if the
18 requirements of this subsection are met. If the insured
19 elects to use a provider who is not a preferred provider,
20 whether the insured purchased a preferred provider policy or a
21 nonpreferred provider policy, the medical benefits provided by
22 the insurer shall be as required by this section. If the
23 insured elects to use a provider who is a preferred provider,
24 the insurer may pay medical benefits in excess of the benefits
25 required by this section and may waive or lower the amount of
26 any deductible that applies to such medical benefits. If the
27 insurer offers a preferred provider policy to a policyholder
28 or applicant, it must also offer a nonpreferred provider
29 policy. The insurer shall provide each policyholder with a
30 current roster of preferred providers in the county in which
31 the insured resides at the time of purchase of such policy,
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1 and shall make such list available for public inspection
2 during regular business hours at the principal office of the
3 insurer within the state.
4 (11) DEMAND LETTER.--
5 (a) As a condition precedent to filing any action for
6 benefits under this section, the insurer must be provided with
7 written notice of an intent to initiate litigation. Such
8 notice may not be sent until the claim is overdue, including
9 any additional time the insurer has to pay the claim pursuant
10 to paragraph (4)(b).
11 (b) The notice required shall state that it is a
12 "demand letter under s. 627.736(11)" and shall state with
13 specificity:
14 1. The name of the insured upon which such benefits
15 are being sought, including a copy of the assignment giving
16 rights to the claimant if the claimant is not the insured.
17 2. The claim number or policy number upon which such
18 claim was originally submitted to the insurer.
19 3. To the extent applicable, the name of any medical
20 provider who rendered to an insured the treatment, services,
21 accommodations, or supplies that form the basis of such claim;
22 and an itemized statement specifying each exact amount, the
23 date of treatment, service, or accommodation, and the type of
24 benefit claimed to be due. A completed form satisfying the
25 requirements of paragraph (5)(d) or the lost-wage statement
26 previously submitted may be used as the itemized statement. To
27 the extent that the demand involves an insurer's withdrawal of
28 payment under paragraph (7)(a) for future treatment not yet
29 rendered, the claimant shall attach a copy of the insurer's
30 notice withdrawing such payment and an itemized statement of
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1 the type, frequency, and duration of future treatment claimed
2 to be reasonable and medically necessary.
3 (c) Each notice required by this subsection must be
4 delivered to the insurer by United States certified or
5 registered mail, return receipt requested. Such postal costs
6 shall be reimbursed by the insurer if so requested by the
7 claimant in the notice, when the insurer pays the claim. Such
8 notice must be sent to the person and address specified by the
9 insurer for the purposes of receiving notices under this
10 subsection. Each licensed insurer, whether domestic, foreign,
11 or alien, shall file with the office designation of the name
12 and address of the person to whom notices pursuant to this
13 subsection shall be sent which the office shall make available
14 on its Internet website. The name and address on file with the
15 office pursuant to s. 624.422 shall be deemed the authorized
16 representative to accept notice pursuant to this subsection in
17 the event no other designation has been made.
18 (d) If, within 15 days after receipt of notice by the
19 insurer, the overdue claim specified in the notice is paid by
20 the insurer together with applicable interest and a penalty of
21 10 percent of the overdue amount paid by the insurer, subject
22 to a maximum penalty of $250, no action may be brought against
23 the insurer. If the demand involves an insurer's withdrawal of
24 payment under paragraph (7)(a) for future treatment not yet
25 rendered, no action may be brought against the insurer if,
26 within 15 days after its receipt of the notice, the insurer
27 mails to the person filing the notice a written statement of
28 the insurer's agreement to pay for such treatment in
29 accordance with the notice and to pay a penalty of 10 percent,
30 subject to a maximum penalty of $250, when it pays for such
31 future treatment in accordance with the requirements of this
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1 section. To the extent the insurer determines not to pay any
2 amount demanded, the penalty shall not be payable in any
3 subsequent action. For purposes of this subsection, payment or
4 the insurer's agreement shall be treated as being made on the
5 date a draft or other valid instrument that is equivalent to
6 payment, or the insurer's written statement of agreement, is
7 placed in the United States mail in a properly addressed,
8 postpaid envelope, or if not so posted, on the date of
9 delivery. The insurer shall not be obligated to pay any
10 attorney's fees if the insurer pays the claim or mails its
11 agreement to pay for future treatment within the time
12 prescribed by this subsection.
13 (e) The applicable statute of limitation for an action
14 under this section shall be tolled for a period of 15 business
15 days by the mailing of the notice required by this subsection.
16 (f) Any insurer making a general business practice of
17 not paying valid claims until receipt of the notice required
18 by this subsection is engaging in an unfair trade practice
19 under the insurance code.
20 (19)(12) CIVIL ACTION FOR INSURANCE FRAUD.--An insurer
21 shall have a cause of action against any person convicted of,
22 or who, regardless of adjudication of guilt, pleads guilty or
23 nolo contendere to insurance fraud under s. 817.234, patient
24 brokering under s. 817.505, or kickbacks under s. 456.054,
25 associated with a claim for personal injury protection
26 benefits in accordance with this section. An insurer
27 prevailing in an action brought under this subsection may
28 recover compensatory, consequential, and punitive damages
29 subject to the requirements and limitations of part II of
30 chapter 768, and attorney's fees and costs incurred in
31 litigating a cause of action against any person convicted of,
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1 or who, regardless of adjudication of guilt, pleads guilty or
2 nolo contendere to insurance fraud under s. 817.234, patient
3 brokering under s. 817.505, or kickbacks under s. 456.054,
4 associated with a claim for personal injury protection
5 benefits in accordance with this section.
6 (20)(13) MINIMUM BENEFIT COVERAGE.--If the Financial
7 Services Commission determines that the cost savings under
8 personal injury protection insurance benefits paid by insurers
9 have been realized due to the provisions of this act, prior
10 legislative reforms, or other factors, the commission may
11 increase the minimum $10,000 benefit coverage requirement. In
12 establishing the amount of such increase, the commission must
13 determine that the additional premium for such coverage is
14 approximately equal to the premium cost savings that have been
15 realized for the personal injury protection coverage with
16 limits of $10,000.
17 (21) REWARD.--Upon written notification by any person,
18 an insurer shall investigate any claim of improper billing by
19 a physician or other medical provider. The insurer shall
20 determine if the insured was properly billed for only those
21 services and treatments that the insured actually received. If
22 the insurer determines that the insured has been improperly
23 billed, the insurer shall notify the insured, the person
24 making the written notification and the provider of its
25 findings and shall reduce the amount of payment to the
26 provider by the amount determined to be improperly billed. If
27 a reduction is made due to such written notification by any
28 person, the insurer shall pay to the person 20 percent of the
29 amount of the reduction up to $500. If the provider is
30 arrested due to the improper billing, the insurer shall pay to
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1 the person 40 percent of the amount of the reduction up to
2 $500.
3 (22) VENUE.--Venue for any personal injury protection
4 claim, in the case of an assignment of benefits, shall be in
5 the jurisdiction where the insured resides, where the accident
6 occurs, or where the disputed health care services were
7 performed. Venue may be raised at any time. The cost of
8 transferring venue shall be borne by the plaintiff, and such
9 costs shall not be recoverable as plaintiff's damages.
10 Section 2. Subsection (2) of section 316.068, Florida
11 Statutes, is amended to read:
12 316.068 Crash report forms.--
13 (2) Every crash report required to be made in writing
14 must be made on the appropriate form approved by the
15 department and must contain all the information required
16 therein to include:
17 (a) The date, time, and location of the crash;
18 (b) A description of the vehicles involved;
19 (c) The names and addresses of the parties involved;
20 (d) The names and addresses of all drivers and
21 passengers in the vehicles involved;
22 (e) The names and addresses of witnesses;
23 (f) The name, badge number, and law enforcement agency
24 of the officer investigating the crash; and
25 (g) The names of the insurance companies for the
26 respective parties involved in the crash unless not available.
27
28 The absence of information in such written crash reports
29 regarding the existence of passengers in the vehicles involved
30 in the crash constitutes a rebuttable presumption that no such
31 passengers were involved in the reported crash.
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1 Notwithstanding any other provisions of this section, a crash
2 report produced electronically by a law enforcement officer
3 must, at a minimum, contain the same information as is called
4 for on those forms approved by the department.
5 Section 3. Subsection (9) is added to section 322.26,
6 Florida Statutes, to read:
7 322.26 Mandatory revocation of license by
8 department.--The department shall forthwith revoke the license
9 or driving privilege of any person upon receiving a record of
10 such person's conviction of any of the following offenses:
11 (9) Conviction in any court having jurisdiction over
12 offenses committed under s. 817.234(8) or (9) or s. 817.505.
13 Section 4. Paragraph (a) of subsection (7) and
14 subsection (9) of section 817.234, Florida Statutes, are
15 amended to read:
16 817.234 False and fraudulent insurance claims.--
17 (7)(a) It shall constitute a material omission and
18 insurance fraud, punishable as provided in subsection (11),
19 for any service physician or other provider, other than a
20 hospital, to engage in a general business practice of billing
21 amounts as its usual and customary charge, if such provider
22 has agreed with the insured patient or intends to waive
23 deductibles or copayments, or does not for any other reason
24 intend to collect the total amount of such charge. With
25 respect to a determination as to whether a service physician
26 or other provider has engaged in such general business
27 practice, consideration shall be given to evidence of whether
28 the physician or other provider made a good faith attempt to
29 collect such deductible or copayment. This paragraph does not
30 apply to physicians or other providers who waive deductibles
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1 or copayments or reduce their bills as part of a bodily injury
2 settlement or verdict.
3 (9) A person may not organize, plan, or knowingly
4 participate in an intentional motor vehicle crash or a scheme
5 to create documentation of a motor vehicle crash that did not
6 occur for the purpose of making motor vehicle tort claims or
7 claims for personal injury protection benefits as required by
8 s. 627.736. Any person who violates this subsection commits a
9 felony of the second degree, punishable as provided in s.
10 775.082, s. 775.083, or s. 775.084. A person who is convicted
11 of a violation of this subsection shall be sentenced to a
12 minimum term of imprisonment of 2 years.
13 Section 5. Section 817.2361, Florida Statutes, is
14 amended to read:
15 817.2361 False or fraudulent proof of motor vehicle
16 insurance card.--Any person who, with intent to deceive any
17 other person, creates, markets, or presents a false or
18 fraudulent proof of motor vehicle insurance card commits a
19 felony of the third degree, punishable as provided in s.
20 775.082, s. 775.083, or s. 775.084.
21 Section 6. For the 2006-2007 fiscal year, the sum of
22 $1,533,296 million is appropriated on a recurring basis and an
23 associated salary rate of 1,220,000 is authorized from the
24 Insurance Regulatory Trust Fund to the Division of Insurance
25 Fraud within the Department of Financial Services for the
26 purpose of providing a competitive pay adjustment of $10,000
27 plus benefits for each of the existing sworn law enforcement
28 officer positions in the division in order to achieve relative
29 parity with sworn law enforcement investigators who have
30 similar responsibilities at other state agencies. This
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1 appropriation is for the purposes provided in s. 626.989,
2 Florida Statutes.
3 Section 7. For the 2006-2007 fiscal year, the sums of
4 $510,276 in recurring funds and $111,455 in nonrecurring funds
5 are appropriated from the Insurance Regulatory Trust Fund of
6 the Department of Financial Services to the Division of
7 Insurance Fraud within the department for the purpose of
8 providing a new fraud unit within the division consisting of
9 six sworn law enforcement officers, one non-sworn
10 investigator, one crime analyst, and one clerical position. A
11 total of nine full-time equivalent positions and associated
12 salary rate of 381,500 are authorized. This appropriation is
13 for the purposes provided in s. 626.989, Florida Statutes.
14 Section 8. For the 2006-2007 fiscal year, the sums of
15 $415,291 in recurring funds and $52,430 in nonrecurring funds
16 are appropriated from the Insurance Regulatory Trust Fund of
17 the Department of Financial Services to the Division of
18 Insurance Fraud within the department and 10 full-time
19 equivalent positions and associated salary rate of 342,500 are
20 authorized. This appropriation is for the purposes provided in
21 s. 626.989, Florida Statutes.
22 Section 9. For the 2006-2007 fiscal year, the sum of
23 $750,000 in recurring funds is appropriated from the Insurance
24 Regulatory Trust Fund in equal amounts to the State Attorneys
25 for the 4th, 6th, 9th, 13th, 15th, and 17th Circuits to
26 establish and fund an additional assistant state attorney
27 position in each circuit for the purpose of prosecuting cases
28 of insurance fraud.
29 Section 10. Effective January 1, 2009, sections
30 627.730, 627.731, 627.732, 627.733, 627.734, 627.736, 627.737,
31 627.739, 627.7401, 627.7403, and 627.7405, Florida Statutes,
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1 constituting the Florida Motor Vehicle No-Fault Law, are
2 repealed, unless reviewed and reenacted by the Legislature
3 before that date.
4 Section 11. Section 19 of chapter 2003-411, Laws of
5 Florida, is repealed.
6 Section 12. This act shall take effect October 1,
7 2006.
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1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 Senate Bill 2114
3
4 Provides for repeal of the Motor Vehicle No-Fault law to be
effective January 1, 2009.
5
Deletes the provision mandating a medical fee schedule for all
6 health care providers who offer personal injury protection
(PIP) services based on the Medicare fee schedule.
7
Removes the provision allowing an insurer to bring a civil
8 cause of action to recover amounts paid and expenses incurred
under specified circumstances.
9
Deletes requirements for a valid assignment of benefits.
10
Deletes the provision allowing insurers to demand that
11 providers and other parties submit to an examination under
oath.
12
Removes sanctions for insureds who fail to attend an
13 independent medical examination (IME).
14 Deletes the requirement for PIP claims to be filed within one
year of the accident.
15
Extends the time period that medical records be provided from
16 5 days to 25 days and changes the sanction to preclude
attorney fee awards if a claim is later based on the records
17 that are not provided.
18 Deletes the provision that PIP benefits that are "otherwise
available" that could be deducted from damages paid by
19 liability insurers.
20 Revises the provision that self-employed persons must submit
reasonable proof of loss of "gross" income, to delete the
21 term, "gross."
22 Provides exceptions to the requirement that the patient sign
the bill at time of treatment, including hospitals, emergency
23 care providers, and providers who do not render services in
the presence of the insured.
24
Adds standards for the Department of Health to consider in
25 adopting rules for determining which diagnostic tests are not
medically necessary under PIP.
26
Specifies that insurers are bound by a written notice by the
27 insured to have disability benefits reserved for lost wages.
28 Provides that it is a second degree felony for a person to
participate in a scheme to create documentation of a motor
29 vehicle crash that did not occur, subject to a two year
minimum mandatory term of imprisonment.
30
Provides that persons who present false or fraudulent proof of
31 motor vehicle insurance commit a third degree felony, as
currently provided for presenting a false insurance "card."
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Florida Senate - 2006 CS for SB 2114
597-2092-06
1 Requires that crash reports include information on the
passengers in the vehicle if he or she is not listed in the
2 crash report.
3 Authorizes the Department of Highway Safety and Motor Vehicles
to revoke the driver's license of persons convicted of patient
4 brokering, solicitation or participating in a staged motor
vehicle accident.
5
Appropriates $2.62 million to the Division of Insurance Fraud
6 for 19 additional positions and to provide a pay adjustment
for existing sworn law enforcement positions.
7
Appropriates $750,000 to fund 6 additional insurance fraud
8 prosecutors in 6 circuits in Florida.
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CODING: Words stricken are deletions; words underlined are additions.