Senate Bill sb2114c1

CODING: Words stricken are deletions; words underlined are additions.
    Florida Senate - 2006                           CS for SB 2114

    By the Committee on Banking and Insurance





    597-2092-06

  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

                                  1

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  2

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

31  

                                  3

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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.

31  

                                  4

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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.--

31  

                                  5

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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.

30  

31  

                                  6

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

31  

                                  7

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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:

31  

                                  8

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

31  

                                  9

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  10

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  11

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  12

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  13

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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.

31  

                                  14

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  15

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  16

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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.

                                  17

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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.

28  

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.

                                  18

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  19

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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.

                                  20

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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  

                                  21

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  22

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  23

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  24

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  25

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  26

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  27

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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:

                                  28

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  29

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  30

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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;

                                  31

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  32

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  33

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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  

                                  34

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  35

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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.--

                                  36

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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.,

31  

                                  37

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  38

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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.

                                  39

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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.

31  

                                  40

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  41

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

31  

                                  42

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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.

31  

                                  43

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

31  

                                  44

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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,

                                  45

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

31  

                                  46

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

                                  47

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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,

                                  48

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

31  

                                  49

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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.

                                  50

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

31  

                                  51

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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

31  

                                  52

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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,

                                  53

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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.

 8  

 9  

10  

11  

12  

13  

14  

15  

16  

17  

18  

19  

20  

21  

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  

                                  54

CODING: Words stricken are deletions; words underlined are additions.






    Florida Senate - 2006                           CS for SB 2114
    597-2092-06




 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."
                                  55

CODING: Words stricken are deletions; words underlined are additions.






    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.

 9  

10  

11  

12  

13  

14  

15  

16  

17  

18  

19  

20  

21  

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  

                                  56

CODING: Words stricken are deletions; words underlined are additions.