Senate Bill sb2114c3
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Florida Senate - 2006 CS for CS for CS for SB 2114
By the Committees on Judiciary; Health Care; and Banking and
Insurance
590-2344-06
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
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1 injured person under specified conditions for
2 emergency services and care; requiring insurers
3 to provide specified documents to insureds;
4 requiring that amounts repayable to an insurer
5 include the statutory interest penalty;
6 increasing the time period for an insurer to
7 respond to a demand letter; providing
8 requirements for the production and inspection
9 of an injured person's medical records from a
10 provider; providing a right of compensation to
11 health care providers for responding to
12 requests for information by insurers; providing
13 for application of attorney's fees; providing
14 that persons notifying insurers of improper
15 billing may obtain a reward; restricting venue
16 for any personal injury protection claim to
17 specified jurisdictions and providing for costs
18 of transferring venue; amending s. 316.068,
19 F.S.; specifying information to be included in
20 a crash report; creating a rebuttable
21 presumption regarding the existence of
22 passengers; specifying conditions relating to
23 reporting passengers; amending s. 322.26, F.S.;
24 providing an additional circumstance relating
25 to insurance crimes for mandatory revocation of
26 a person's driver's license; amending s.
27 817.234, F.S.; revising provisions specifying
28 material omission and insurance fraud;
29 prohibiting scheming to create documentation of
30 a motor vehicle crash that did not occur;
31 providing a criminal penalty; amending s.
2
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1 817.2361, F.S.; providing that creating,
2 marketing, or presenting fraudulent proof of
3 motor vehicle insurance is a felony of the
4 third degree; providing appropriations;
5 authorizing positions and a salary rate;
6 abrogating the repeal of provisions pertaining
7 to the Florida Motor Vehicle No-Fault Law;
8 providing an effective date.
9
10 Be It Enacted by the Legislature of the State of Florida:
11
12 Section 1. Section 627.736, Florida Statutes, is
13 amended to read:
14 627.736 Required personal injury protection benefits;
15 exclusions; priority; claims.--
16 (1) REQUIRED PERSONAL INJURY PROTECTION
17 BENEFITS.--Every insurance policy complying with the security
18 requirements of s. 627.733 shall provide personal injury
19 protection to the named insured, relatives residing in the
20 same household, persons operating the insured motor vehicle,
21 passengers in such motor vehicle, and other persons struck by
22 such motor vehicle and suffering bodily injury while not an
23 occupant of a self-propelled vehicle, subject to the
24 provisions of subsections (3) subsection (2) and (6) paragraph
25 (4)(d), to a limit of $10,000 for loss sustained by any such
26 person as a result of bodily injury, sickness, disease, or
27 death arising out of the ownership, maintenance, or use of a
28 motor vehicle as follows:
29 (a) Medical benefits.--Eighty percent of all
30 reasonable expenses for medically necessary medical, surgical,
31 X-ray, dental, and rehabilitative services, including
3
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1 prosthetic devices, and medically necessary ambulance,
2 hospital, and nursing services. Such benefits shall also
3 include necessary remedial treatment and services recognized
4 and permitted under the laws of the state for an injured
5 person who relies upon spiritual means through prayer alone
6 for healing, in accordance with his or her religious beliefs;
7 however, this sentence does not affect the determination of
8 what other services or procedures are medically necessary.
9 (b) Disability benefits.--
10 1. Sixty percent of any loss of gross income and loss
11 of earning capacity per injured person individual from
12 inability to work proximately caused by the injury sustained
13 by the injured person, plus all expenses reasonably incurred
14 in obtaining from others ordinary and necessary services in
15 lieu of those that, but for the injury, the injured person
16 would have performed without income for the benefit of his or
17 her household. All disability benefits payable under this
18 provision shall be paid not less than every 2 weeks.
19 2. For an injured person who is self employed or an
20 injured person who owns over a 25-percent interest in his or
21 her employer, as a condition precedent to payment for lost
22 wages, the injured person must produce to the insurer
23 reasonable proof as to the injured person's income and loss of
24 earning capacity or additional expense, such that the insurer
25 may reasonably calculate the amount of the loss of income.
26 3. Every employer shall, if a request is made by an
27 insurer providing personal injury protection benefits under
28 ss. 627.730-627.7405 against whom a claim has been made,
29 furnish forthwith, in a form approved by the office, a sworn
30 statement of the earnings, since the time of the bodily injury
31
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1 and for a 13-week time period before the injury, of the person
2 upon whose injury the claim is based.
3 4. If the insured elects to have disability benefits
4 reserved for lost wages, the insured shall notify the insurer
5 in writing, which shall be binding on the insurer. Receipt of
6 such notification shall take priority over all claims subject
7 to an assignment of benefits received after receipt of such
8 notice, except that receipt by the insurer of a properly
9 perfected hospital lien, prior to payment of the lost wage
10 claim, shall take priority over the insured's election to
11 reserve all benefits for lost wages.
12 (c) Death benefits.--The insurer shall pay death
13 benefits in the amount of $5,000 per individual. The insurer
14 may pay such benefits to the executor or administrator of the
15 deceased, to any of the deceased's relatives by blood or legal
16 adoption or connection by marriage, or to any person appearing
17 to the insurer to be equitably entitled thereto.
18 (d) Medicaid benefits.--When the Agency for Health
19 Care Administration provides, pays, or becomes liable for
20 medical assistance under the Medicaid program related to
21 injury, sickness, disease, or death arising out of the
22 ownership, maintenance, or use of a motor vehicle, benefits
23 under ss. 627.730-627.7405 shall be subject to the provisions
24 of the Medicaid program.
25 (2) AMOUNT OF PROPERTY DAMAGE COVERAGE.--
26 (a) Only insurers writing motor vehicle liability
27 insurance in this state may provide the required benefits of
28 this section, and no such insurer shall require the purchase
29 of any other motor vehicle coverage other than the purchase of
30 property damage liability coverage as required by s. 627.7275
31 as a condition for providing such required benefits.
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1 (b) Insurers may not require that property damage
2 liability insurance in an amount greater than $10,000 be
3 purchased in conjunction with personal injury protection.
4 Such insurers shall make benefits and required property damage
5 liability insurance coverage available through normal
6 marketing channels. Any insurer writing motor vehicle
7 liability insurance in this state who fails to comply with
8 such availability requirement as a general business practice
9 shall be deemed to have violated part IX of chapter 626, and
10 such violation shall constitute an unfair method of
11 competition or an unfair or deceptive act or practice
12 involving the business of insurance; and any such insurer
13 committing such violation shall be subject to the penalties
14 afforded in such part, as well as those which may be afforded
15 elsewhere in the insurance code.
16 (3)(2) AUTHORIZED EXCLUSIONS.--Any insurer may exclude
17 benefits:
18 (a) For injury sustained by the named insured and
19 relatives residing in the same household while occupying
20 another motor vehicle owned by the named insured and not
21 insured under the policy or for injury sustained by any person
22 operating the insured motor vehicle without the express or
23 implied consent of the insured.
24 (b) To any injured person, if such person's conduct
25 contributed to his or her injury under any of the following
26 circumstances:
27 1. Causing injury to himself or herself intentionally;
28 or
29 2. Being injured while committing a felony.
30
31
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1 Whenever an insured is charged with conduct as set forth in
2 subparagraph 2., the 30-day payment provision of subsection
3 (8) paragraph (4)(b) shall be held in abeyance, and the
4 insurer shall withhold payment of any personal injury
5 protection benefits pending the outcome of the case at the
6 trial level. If the charge is nolle prossed or dismissed or
7 the insured is acquitted, the 30-day payment provision shall
8 run from the date the insurer is notified of such action.
9 (4)(3) INSURED'S RIGHTS TO RECOVERY OF SPECIAL DAMAGES
10 IN TORT CLAIMS.--No insurer shall have a lien on any recovery
11 in tort by judgment, settlement, or otherwise for personal
12 injury protection benefits, whether suit has been filed or
13 settlement has been reached without suit. An injured person
14 party who is entitled to bring suit under the provisions of
15 ss. 627.730-627.7405, or his or her legal representative, has
16 shall have no right to recover any damages for which personal
17 injury protection benefits are paid or payable. The plaintiff
18 may prove all of his or her special damages notwithstanding
19 this limitation, but if special damages are introduced in
20 evidence, the trier of facts, whether judge or jury, shall not
21 award damages for personal injury protection benefits paid or
22 payable. In all cases in which a jury is required to fix
23 damages, the court shall instruct the jury that the plaintiff
24 shall not recover such special damages for personal injury
25 protection benefits paid or payable.
26 (5) NONREIMBURSABLE SERVICES.--The Department of
27 Health, in consultation with the appropriate professional
28 licensing boards, shall adopt, by rule, a list of diagnostic
29 tests deemed not to be medically necessary as defined in s.
30 627.732 for use in either the diagnosis or treatment of
31 persons sustaining bodily injury covered by personal injury
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1 protection benefits under this section. The list shall be
2 revised from time to time as determined by the Department of
3 Health, in consultation with the appropriate professional
4 licensing boards. In determining whether a test is medically
5 necessary for purposes of this subsection, the department may
6 consider the degree of positive diagnostic or treatment
7 benefits in relation to costs; whether there is substantial
8 demonstrated medical value for the injured person; the
9 availability of alternative methods of treatment or diagnosis;
10 the immediacy or remoteness of likely benefit for the injured
11 person; whether there is evidence of overuse by providers
12 primarily for financial gain; whether there is acceptance of
13 the use of the tests for injured persons; and whether there
14 are reservations regarding such use as reported to the
15 department by the appropriate professional licensing boards.
16 The department shall give greater weight to the advice of the
17 appropriate licensing boards on whether a test is medically
18 unnecessary than to a degree of acceptance by some individuals
19 or groups within the relevant provider communities.
20 Notwithstanding a test's inclusion on a fee schedule in this
21 section, an insurer or an insured is not required to pay any
22 charges or reimburse claims for any diagnostic test determined
23 not medically necessary by the Department of Health.
24 (6) REQUIRED PAYMENT OF BENEFITS.--The insurer of the
25 owner of a motor vehicle shall pay personal injury protection
26 benefits for:
27 (a) Accidental bodily injury sustained in this state
28 by the owner while occupying a motor vehicle, or while not an
29 occupant of a self-propelled vehicle if the injury is caused
30 by physical contact with a motor vehicle.
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1 (b) Accidental bodily injury sustained outside this
2 state, but within the United States of America or its
3 territories or possessions or Canada, by the owner while
4 occupying the owner's motor vehicle.
5 (c) Accidental bodily injury sustained by a relative
6 of the owner residing in the same household, under the
7 circumstances described in paragraphs (a) and (b), provided
8 the relative at the time of the accident is domiciled in the
9 owner's household and is not himself or herself the owner of a
10 motor vehicle with respect to which security is required under
11 ss. 627.730-627.7405.
12 (d) Accidental bodily injury sustained in this state
13 by any other person while occupying the owner's motor vehicle
14 or, if a resident of this state, while not an occupant of a
15 self-propelled vehicle, if the injury is caused by physical
16 contact with such motor vehicle, provided the injured person
17 is not himself or herself:
18 1. The owner of a motor vehicle with respect to which
19 security is required under ss. 627.730-627.7405; or
20 2. Entitled to personal injury benefits from the
21 insurer of the owner or owners of such a motor vehicle.
22 (e) If two or more insurers are liable to pay personal
23 injury protection benefits for the same injury to any one
24 person, the maximum payable shall be as specified in
25 subsection (1), and any insurer paying the benefits shall be
26 entitled to recover from each of the other insurers an
27 equitable pro rata share of the benefits paid and expenses
28 incurred in processing the claim.
29 (7)(4) CLAIMS SUBMISSION BENEFITS; WHEN DUE.--Benefits
30 due from an insurer under ss. 627.730-627.7405 shall be
31 primary, except that benefits received under any workers'
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1 compensation law shall be credited against the benefits
2 provided by subsection (1), and shall be due and payable as
3 loss accrues, upon receipt of reasonable proof of such loss
4 and the amount of expenses and loss incurred which are covered
5 by the policy issued under ss. 627.730-627.7405, subject to
6 the following:. When the Agency for Health Care Administration
7 provides, pays, or becomes liable for medical assistance under
8 the Medicaid program related to injury, sickness, disease, or
9 death arising out of the ownership, maintenance, or use of a
10 motor vehicle, benefits under ss. 627.730-627.7405 shall be
11 subject to the provisions of the Medicaid program.
12 (a) Medicaid reimbursement.--Medical benefits payable
13 under s. 627.736 shall reimburse fully any payment made by the
14 Medicaid program, up to the limits of coverage.
15 (b)(a) Personal injury protection application.--An
16 insurer may require written notice to be given as soon as
17 practicable after an accident involving a motor vehicle with
18 respect to which the policy affords the security required by
19 ss. 627.730-627.7405. If the injured person is a minor, the
20 parent or legal guardian of the minor, if requested by the
21 insurer, must accurately complete the personal injury
22 protection application.
23 (c) Charges for treatment of injured persons; billing
24 requirements.--
25 1. Any physician, hospital, clinic, or other person or
26 institution lawfully rendering treatment to an injured person
27 for a bodily injury covered by personal injury protection
28 insurance may charge the insurer and injured party only a
29 reasonable amount pursuant to this section for the services
30 and supplies rendered, and the insurer providing such coverage
31 may pay for such charges directly to such person or
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1 institution lawfully rendering such treatment, if the insured
2 receiving such treatment or his or her guardian has
3 countersigned the properly completed invoice, bill, or claim
4 form approved by the office upon which such charges are to be
5 paid for as having actually been rendered, to the best
6 knowledge of the insured or his or her guardian. In no event,
7 however, may such a charge be in excess of the amount the
8 person or institution customarily charges for like services or
9 supplies. With respect to a determination of whether a charge
10 for a particular service, treatment, or otherwise is
11 reasonable, consideration may be given to evidence of usual
12 and customary charges and payments accepted by the provider
13 involved in the dispute, and reimbursement levels in the
14 community and various federal and state medical fee schedules
15 applicable to automobile and other insurance coverages, and
16 other information relevant to the reasonableness of the
17 reimbursement for the service, treatment, or supply.
18 2. All statements and bills for medical services
19 rendered by any physician, hospital, clinic, or other person
20 or institution shall be submitted to the insurer on a properly
21 completed Centers for Medicare and Medicaid Services (CMS)
22 1500 form or its successor or a UB 92 form or its successor.
23 3. All billings for such services, procedures, and
24 supplies submitted by health care providers and medical
25 suppliers shall comply with the Healthcare Correct Procedural
26 Coding System (HCPCS) and International Classification of
27 Diseases (ICD-9-CM) or their successors in effect at the time
28 of patient discharge, if applicable, or when the service was
29 rendered, if applicable, for the year in which services are
30 rendered.
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1 4. All claims forms submitted by health care
2 providers, medical suppliers other than ambulance providers
3 licensed under part III of chapter 401, hospitals, and
4 physicians providing emergency care as defined in s. 395.002
5 shall include on the applicable claim form the signature and
6 professional license number of the provider who rendered
7 services in the line or space provided for "Signature of
8 Physician or Supplier, Including Degrees or Credentials" and
9 the date of the signature.
10 5. In determining compliance with applicable HCPCS and
11 ICD-9-CM coding, or their successors, guidance shall be
12 provided by the Healthcare Correct Procedural Coding System
13 (HCPCS) or its successor, International Classification of
14 Diseases (ICD-9-CM) or its successor, the Office of the
15 Inspector General (OIG), Physicians Compliance Guidelines,
16 rules of the Agency for Health Care Administration, the
17 Florida Health Information Management Association (FHIMA), and
18 other authoritative treatises.
19 6. Charges for medically necessary cephalic
20 thermograms, peripheral thermograms, spinal ultrasounds,
21 extremity ultrasounds, video fluoroscopy, and surface
22 electromyography shall not exceed the maximum reimbursement
23 allowance for such procedures as set forth in the applicable
24 fee schedule or other payment methodology established pursuant
25 to s. 440.13.
26 7. Allowable amounts that may be charged to a personal
27 injury protection insurance insurer and insured for medically
28 necessary nerve conduction testing when done in conjunction
29 with a needle electromyography procedure and both are
30 performed and billed solely by a physician licensed under
31 chapter 458, chapter 459, chapter 460, or chapter 461 who is
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1 also certified by the American Board of Electrodiagnostic
2 Medicine or by a board recognized by the American Board of
3 Medical Specialties or the American Osteopathic Association or
4 who holds diplomate status with the American Chiropractic
5 Neurology Board or its predecessors shall not exceed 200
6 percent of the allowable amount under the participating
7 physician fee schedule of Medicare Part B for year 2001, for
8 the area in which the treatment was rendered, adjusted
9 annually on August 1 to reflect the prior calendar year's
10 changes in the annual Medical Care Item of the Consumer Price
11 Index for All Urban Consumers in the South Region as
12 determined by the Bureau of Labor Statistics of the United
13 States Department of Labor.
14 8. Allowable amounts that may be charged to a personal
15 injury protection insurance insurer and insured for medically
16 necessary nerve conduction testing that does not meet the
17 requirements of subparagraph 7. shall not exceed the
18 applicable fee schedule or other payment methodology
19 established pursuant to s. 440.13.
20 9. Allowable amounts that may be charged to a personal
21 injury protection insurance insurer and insured for magnetic
22 resonance imaging services shall not exceed 175 percent of the
23 allowable amount under the participating physician fee
24 schedule of Medicare Part B for year 2001, for the area in
25 which the treatment was rendered, adjusted annually on August
26 1 to reflect the prior calendar year's changes in the annual
27 Medical Care Item of the Consumer Price Index for All Urban
28 Consumers in the South Region as determined by the Bureau of
29 Labor Statistics of the United States Department of Labor for
30 the 12-month period ending June 30 of that year, except that
31 allowable amounts that may be charged to a personal injury
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1 protection insurance insurer and insured for magnetic
2 resonance imaging services provided in facilities accredited
3 by the Accreditation Association for Ambulatory Health Care,
4 the American College of Radiology, or the Joint Commission on
5 Accreditation of Healthcare Organizations shall not exceed 200
6 percent of the allowable amount under the participating
7 physician fee schedule of Medicare Part B for year 2001, for
8 the area in which the treatment was rendered, adjusted
9 annually on August 1 to reflect the prior calendar year's
10 changes in the annual Medical Care Item of the Consumer Price
11 Index for All Urban Consumers in the South Region as
12 determined by the Bureau of Labor Statistics of the United
13 States Department of Labor for the 12-month period ending June
14 30 of that year. This paragraph does not apply to charges for
15 magnetic resonance imaging services and nerve conduction
16 testing for inpatients and emergency services and care as
17 defined in chapter 395 rendered by facilities licensed under
18 chapter 395.
19 10. A statement of medical services may not include
20 charges for medical services of a person or entity that
21 rendered such services without possessing all valid
22 qualifications and licenses required to lawfully provide and
23 bill for such services. However, a physician licensed under
24 chapter 458, chapter 459, chapter 460, or chapter 466 may
25 delegate diagnostic or treatment tasks to an employee to be
26 performed under the supervision of the physician in accordance
27 with the requirements and provisions of the applicable
28 licensing section.
29 11. For purposes of subsection (8), an insurer shall
30 not be considered to have been furnished with notice of the
31 amount of covered loss or medical bills due unless the
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1 statements or bills comply with this paragraph, and unless the
2 statements or bills are properly completed in their entirety
3 as to all material provisions, with all required information
4 being provided therein.
5 12. An insurer may not systematically downcode with
6 the intent to deny reimbursement otherwise due. Such action
7 constitutes a material misrepresentation under s.
8 626.9541(1)(i)2.
9 (d) Direct billing an insurer for personal injury
10 protection benefits.--The insurer providing coverage may pay
11 for charges directly to the insured or the insured's assignee.
12 (e) Timely billing for nonemergency services.--With
13 respect to any treatment or service, other than medical
14 services billed by an ambulance provider licensed pursuant to
15 part III of chapter 401, a hospital or other provider for
16 emergency services as defined in s. 395.002, or inpatient
17 services rendered at a hospital-owned facility, the statement
18 of charges must be furnished to the insurer by the provider
19 and may not include, and the insurer is not required to pay,
20 charges for treatment or services rendered more than 35 days
21 before the postmark date of the statement, except for the
22 following:
23 1. Past due amounts previously billed on a timely
24 basis under this subsection.
25 2. If the provider submits to the insurer a notice of
26 initiation of treatment within 21 days after its first
27 examination or treatment of the claimant, the statement may
28 include charges for treatment or services rendered up to, but
29 not more than, 50 days before the postmark date of the
30 statement. The injured person is not liable for, and the
31 provider shall not bill the injured person for, charges that
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1 are unpaid because of the provider's failure to comply with
2 this paragraph. Any agreement requiring the injured person or
3 insured to pay for such charges is unenforceable.
4 3. If the insured fails to furnish the provider with
5 the correct name and address of the insured's personal injury
6 protection insurer, the provider has 35 days from the date the
7 provider obtains the correct information to furnish the
8 insurer with a statement of the charges. The insurer is not
9 required to pay for such charges unless the provider includes
10 with the statement documentary evidence that was provided by
11 the insured during the 35-day period demonstrating that the
12 provider reasonably relied on erroneous information from the
13 insured and either:
14 a. A denial letter from the incorrect insurer; or
15 b. Proof of mailing, which may include an affidavit
16 under penalty of perjury, reflecting timely mailing to the
17 incorrect address or insurer.
18 (f) Timely billing for emergency services.--
19 1. For emergency services and care as defined in s.
20 395.002 rendered in a hospital emergency department or for
21 transport and treatment rendered by an ambulance provider
22 licensed pursuant to part III of chapter 401, the provider is
23 not required to furnish the statement of charges within the
24 time periods established by this subsection; however, such
25 charges must be submitted within 75 days after the date the
26 treatment was rendered, and the insurer shall not be
27 considered to have been furnished with notice of the amount of
28 covered loss for purposes of subsection (8) until it receives
29 a statement complying with subsection (7), or copy thereof,
30 which specifically identifies the place of service to be a
31 hospital emergency department or an ambulance.
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1 2. If the insured fails to furnish the provider with
2 the correct name and address of the insured's personal injury
3 protection insurer, the provider has 75 days following the
4 date the provider obtains the correct information to furnish
5 the insurer with a statement of the charges. The insurer is
6 not required to pay for such charges unless the provider
7 includes with the statement:
8 a. Documentary evidence that was provided by the
9 insured during the 75-day period demonstrating that the
10 provider reasonably relied on erroneous information from the
11 insured;
12 b. A denial letter from the incorrect insurer; or
13 c. Proof of mailing, which may include an affidavit
14 under penalty of perjury, reflecting timely mailing to the
15 incorrect address or insurer.
16 (g) Billing notice and disclosures.--
17 1. Each notice of insured's rights under s. 627.7401
18 must include the following statement in type no smaller than
19 12-point font:
20
21 BILLING REQUIREMENTS.--Florida Statutes provide
22 that with respect to any treatment or services,
23 other than certain hospital and emergency
24 services, the statement of charges furnished to
25 the insurer by the provider may not include,
26 and the insurer and the injured person are not
27 required to pay, charges for treatment or
28 services rendered more than 35 days before the
29 postmark date of the statement, except for past
30 due amounts previously billed on a timely
31 basis, and except that, if the provider submits
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1 to the insurer a notice of initiation of
2 treatment within 21 days after its first
3 examination or treatment of the claimant, the
4 statement may include charges for treatment or
5 services rendered up to, but not more than, 50
6 days before the postmark date of the statement.
7
8 2. Except for ambulance transport and treatment or
9 hospital and emergency services and care rendered pursuant to
10 s. 395.002, on each date services are rendered the health care
11 provider shall provide to the insured patient a written bill,
12 superbill, fee slip, or other similar document that
13 establishes in plain language a detailed description of the
14 service provided and the cost associated with the service. The
15 insured must sign the written bill, superbill, fee slip, or
16 other similar document immediately after having received
17 services. Copies of such disclosures shall be maintained as
18 part of the patient's medical records in accordance with
19 minimal record keeping standards. Health care providers or
20 service providers who do not render services in the presence
21 of the insured are not required to comply with this section.
22 (h) Upon request, the insured and his or her assigns
23 shall be sent a letter containing a payment log itemizing all
24 payments made, the applicable insurance declarations page, and
25 a copy of the insurance policy within 30 days after the
26 written request. Such request shall state that it is a
27 "request under s. 627.736(7)" and shall state with
28 specificity:
29 1. The name of the insured upon whom such benefits are
30 being sought, including a copy of the assignment giving rights
31 to the claimant if the claimant is not the insured.
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1 2. The claim number or policy number upon which such
2 claim was originally submitted to the insurer.
3
4 Such request must be sent to the person and address specified
5 by the insurer for the purposes of receiving notices or
6 requests under this section.
7 (i) Benefits shall not be due or payable to or on the
8 behalf of an insured person if that person has committed, by a
9 material act or omission, any insurance fraud relating to
10 personal injury protection coverage under his or her policy,
11 if the fraud is admitted to in a sworn statement by the
12 insured or if it is established in a court of competent
13 jurisdiction. Any insurance fraud shall void all coverage
14 arising from the claim related to such fraud under the
15 personal injury protection coverage of the insured person who
16 committed the fraud, irrespective of whether a portion of the
17 insured person's claim may be legitimate, and any benefits
18 paid prior to the discovery of the insured person's insurance
19 fraud shall be recoverable by the insurer from the person who
20 committed insurance fraud in their entirety. The prevailing
21 party is entitled to its costs and attorney's fees in any
22 action in which it prevails in an insurer's action to enforce
23 its right of recovery under this paragraph.
24 (8) OVERDUE PERSONAL INJURY PROTECTION BENEFITS.--
25 (a)(b) Personal injury protection insurance benefits
26 paid pursuant to this section shall be overdue if not paid
27 within 30 days after the insurer is furnished written notice
28 of the amount fact of a covered loss, including a properly
29 completed CMS 1500 form or its successor or UB 92 form or its
30 successor, assignment of benefits, or, in the case of
31 disability benefits, proper written documentation of the claim
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1 and of the amount of same. If such written notice is not
2 furnished to the insurer as to the entire claim, any partial
3 amount supported by written notice is overdue if not paid
4 within 30 days after such written notice is furnished to the
5 insurer. Any part or all of the remainder of the claim that
6 is subsequently supported by written notice is overdue if not
7 paid within 30 days after such written notice is furnished to
8 the insurer. When an insurer pays only a portion of a claim or
9 rejects a claim, the insurer shall provide at the time of the
10 partial payment or rejection an itemized specification of each
11 item that the insurer had reduced, omitted, or declined to pay
12 and any information that the insurer desires the claimant to
13 consider related to the medical necessity of the denied
14 treatment or to explain the reasonableness of the reduced
15 charge, provided that this shall not limit the introduction of
16 evidence at trial; and the insurer shall include the name and
17 address of the person to whom the claimant should respond and
18 a claim number to be referenced in future correspondence.
19 However, notwithstanding the fact that written notice has been
20 furnished to the insurer, any payment shall not be deemed
21 overdue when the insurer has reasonable proof to establish
22 that the insurer is not responsible for the payment. For the
23 purpose of calculating the extent to which any benefits are
24 overdue, payment shall be treated as being made on the date a
25 draft or other valid instrument which is equivalent to payment
26 was placed in the United States mail in a properly addressed,
27 postpaid envelope or, if not so posted, on the date of
28 delivery.
29 (b) Timely payment by an insurer This paragraph does
30 not preclude or limit the ability of the insurer to assert
31 that the claim was unrelated, was for services not lawfully
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1 performed, was not medically necessary, or was unreasonable or
2 that the amount of the charge was in excess of that permitted
3 under, or in violation of, this section subsection (5). Such
4 assertion by the insurer may be made at any time, including
5 after payment of the claim or after the 30-day time period for
6 payment set forth in this subsection paragraph.
7 (c) All overdue payments shall bear simple interest at
8 the rate established under s. 55.03 or the rate established in
9 the insurance contract, whichever is greater, for the year in
10 which the payment became overdue, calculated from the date the
11 insurer was furnished with written notice of the amount of
12 covered loss. Interest shall be due at the time payment of the
13 overdue claim is made.
14 (d) The insurer of the owner of a motor vehicle shall
15 pay personal injury protection benefits for:
16 1. Accidental bodily injury sustained in this state by
17 the owner while occupying a motor vehicle, or while not an
18 occupant of a self-propelled vehicle if the injury is caused
19 by physical contact with a motor vehicle.
20 2. Accidental bodily injury sustained outside this
21 state, but within the United States of America or its
22 territories or possessions or Canada, by the owner while
23 occupying the owner's motor vehicle.
24 3. Accidental bodily injury sustained by a relative of
25 the owner residing in the same household, under the
26 circumstances described in subparagraph 1. or subparagraph 2.,
27 provided the relative at the time of the accident is domiciled
28 in the owner's household and is not himself or herself the
29 owner of a motor vehicle with respect to which security is
30 required under ss. 627.730-627.7405.
31
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1 4. Accidental bodily injury sustained in this state by
2 any other person while occupying the owner's motor vehicle or,
3 if a resident of this state, while not an occupant of a
4 self-propelled vehicle, if the injury is caused by physical
5 contact with such motor vehicle, provided the injured person
6 is not himself or herself:
7 a. The owner of a motor vehicle with respect to which
8 security is required under ss. 627.730-627.7405; or
9 b. Entitled to personal injury benefits from the
10 insurer of the owner or owners of such a motor vehicle.
11 (e) If two or more insurers are liable to pay personal
12 injury protection benefits for the same injury to any one
13 person, the maximum payable shall be as specified in
14 subsection (1), and any insurer paying the benefits shall be
15 entitled to recover from each of the other insurers an
16 equitable pro rata share of the benefits paid and expenses
17 incurred in processing the claim.
18 (c)(f) It is a violation of the insurance code for an
19 insurer to fail to timely provide benefits as required by this
20 section with such frequency as to constitute a general
21 business practice.
22 (9) CALCULATION OF TIME OF PAYMENT.--For the purpose
23 of calculating the extent to which any benefits are overdue,
24 payment shall be treated as being made on the date a draft or
25 other valid instrument that is equivalent to payment was
26 placed in the United States mail in a properly addressed,
27 postpaid envelope or, if not so posted, on the date of
28 delivery.
29 (10) INTEREST ON OVERDUE PAYMENTS.--All overdue
30 payments shall bear simple interest at the rate established
31 under s. 55.03 or the rate established in the insurance
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1 contract, whichever is greater, for the year in which the
2 payment became overdue, calculated from the date the insurer
3 was furnished with written notice of the amount of covered
4 loss. In the case of payment made by an insurer to the
5 insured, or insured's assignee, interest shall be due at the
6 time payment of the overdue claim is made. All amounts
7 repayable to the insurer shall bear simple interest at the
8 rate established under s. 55.03 for the year in which the
9 payment became repayable, calculated from the date the insurer
10 tendered payment.
11 (g) Benefits shall not be due or payable to or on the
12 behalf of an insured person if that person has committed, by a
13 material act or omission, any insurance fraud relating to
14 personal injury protection coverage under his or her policy,
15 if the fraud is admitted to in a sworn statement by the
16 insured or if it is established in a court of competent
17 jurisdiction. Any insurance fraud shall void all coverage
18 arising from the claim related to such fraud under the
19 personal injury protection coverage of the insured person who
20 committed the fraud, irrespective of whether a portion of the
21 insured person's claim may be legitimate, and any benefits
22 paid prior to the discovery of the insured person's insurance
23 fraud shall be recoverable by the insurer from the person who
24 committed insurance fraud in their entirety. The prevailing
25 party is entitled to its costs and attorney's fees in any
26 action in which it prevails in an insurer's action to enforce
27 its right of recovery under this paragraph.
28 (5) CHARGES FOR TREATMENT OF INJURED PERSONS.--
29 (a) Any physician, hospital, clinic, or other person
30 or institution lawfully rendering treatment to an injured
31 person for a bodily injury covered by personal injury
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1 protection insurance may charge the insurer and injured party
2 only a reasonable amount pursuant to this section for the
3 services and supplies rendered, and the insurer providing such
4 coverage may pay for such charges directly to such person or
5 institution lawfully rendering such treatment, if the insured
6 receiving such treatment or his or her guardian has
7 countersigned the properly completed invoice, bill, or claim
8 form approved by the office upon which such charges are to be
9 paid for as having actually been rendered, to the best
10 knowledge of the insured or his or her guardian. In no event,
11 however, may such a charge be in excess of the amount the
12 person or institution customarily charges for like services or
13 supplies. With respect to a determination of whether a charge
14 for a particular service, treatment, or otherwise is
15 reasonable, consideration may be given to evidence of usual
16 and customary charges and payments accepted by the provider
17 involved in the dispute, and reimbursement levels in the
18 community and various federal and state medical fee schedules
19 applicable to automobile and other insurance coverages, and
20 other information relevant to the reasonableness of the
21 reimbursement for the service, treatment, or supply.
22 (11) CLAIMS NOT PROPERLY PAYABLE.--
23 (b)1. An insurer or insured is not required to pay a
24 claim or charges:
25 (a)a. Made by a broker or by a person making a claim
26 on behalf of a broker;
27 (b)b. For any service or treatment that was not lawful
28 at the time rendered;
29 (c)c. To any person who knowingly submits a false or
30 misleading statement relating to the claim or charges;
31
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1 (d)d. With respect to a bill or statement that does
2 not substantially meet the applicable requirements of
3 paragraph (7)(b) (d);
4 (e)e. For any treatment or service that is upcoded, or
5 that is unbundled when such treatment or services should be
6 bundled, in accordance with subsection (7) paragraph (d). To
7 facilitate prompt payment of lawful services, an insurer may
8 change codes that it determines to have been improperly or
9 incorrectly upcoded or unbundled, and may make payment based
10 on the changed codes, without affecting the right of the
11 provider to dispute the change by the insurer, provided that
12 before doing so, the insurer must contact the health care
13 provider and discuss the reasons for the insurer's change and
14 the health care provider's reason for the coding, or make a
15 reasonable good faith effort to do so, as documented in the
16 insurer's file; and
17 (f)f. For medical services or treatment billed by a
18 physician and not provided in a hospital unless such services
19 are rendered by the physician or are incident to his or her
20 professional services and are included on the physician's
21 bill, including documentation verifying that the physician is
22 responsible for the medical services that were rendered and
23 billed.
24 2. Charges for medically necessary cephalic
25 thermograms, peripheral thermograms, spinal ultrasounds,
26 extremity ultrasounds, video fluoroscopy, and surface
27 electromyography shall not exceed the maximum reimbursement
28 allowance for such procedures as set forth in the applicable
29 fee schedule or other payment methodology established pursuant
30 to s. 440.13.
31
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1 3. Allowable amounts that may be charged to a personal
2 injury protection insurance insurer and insured for medically
3 necessary nerve conduction testing when done in conjunction
4 with a needle electromyography procedure and both are
5 performed and billed solely by a physician licensed under
6 chapter 458, chapter 459, chapter 460, or chapter 461 who is
7 also certified by the American Board of Electrodiagnostic
8 Medicine or by a board recognized by the American Board of
9 Medical Specialties or the American Osteopathic Association or
10 who holds diplomate status with the American Chiropractic
11 Neurology Board or its predecessors shall not exceed 200
12 percent of the allowable amount under the participating
13 physician fee schedule of Medicare Part B for year 2001, for
14 the area in which the treatment was rendered, adjusted
15 annually on August 1 to reflect the prior calendar year's
16 changes in the annual Medical Care Item of the Consumer Price
17 Index for All Urban Consumers in the South Region as
18 determined by the Bureau of Labor Statistics of the United
19 States Department of Labor.
20 4. Allowable amounts that may be charged to a personal
21 injury protection insurance insurer and insured for medically
22 necessary nerve conduction testing that does not meet the
23 requirements of subparagraph 3. shall not exceed the
24 applicable fee schedule or other payment methodology
25 established pursuant to s. 440.13.
26 5. Allowable amounts that may be charged to a personal
27 injury protection insurance insurer and insured for magnetic
28 resonance imaging services shall not exceed 175 percent of the
29 allowable amount under the participating physician fee
30 schedule of Medicare Part B for year 2001, for the area in
31 which the treatment was rendered, adjusted annually on August
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1 1 to reflect the prior calendar year's changes in the annual
2 Medical Care Item of the Consumer Price Index for All Urban
3 Consumers in the South Region as determined by the Bureau of
4 Labor Statistics of the United States Department of Labor for
5 the 12-month period ending June 30 of that year, except that
6 allowable amounts that may be charged to a personal injury
7 protection insurance insurer and insured for magnetic
8 resonance imaging services provided in facilities accredited
9 by the Accreditation Association for Ambulatory Health Care,
10 the American College of Radiology, or the Joint Commission on
11 Accreditation of Healthcare Organizations shall not exceed 200
12 percent of the allowable amount under the participating
13 physician fee schedule of Medicare Part B for year 2001, for
14 the area in which the treatment was rendered, adjusted
15 annually on August 1 to reflect the prior calendar year's
16 changes in the annual Medical Care Item of the Consumer Price
17 Index for All Urban Consumers in the South Region as
18 determined by the Bureau of Labor Statistics of the United
19 States Department of Labor for the 12-month period ending June
20 30 of that year. This paragraph does not apply to charges for
21 magnetic resonance imaging services and nerve conduction
22 testing for inpatients and emergency services and care as
23 defined in chapter 395 rendered by facilities licensed under
24 chapter 395.
25 6. The Department of Health, in consultation with the
26 appropriate professional licensing boards, shall adopt, by
27 rule, a list of diagnostic tests deemed not to be medically
28 necessary for use in the treatment of persons sustaining
29 bodily injury covered by personal injury protection benefits
30 under this section. The initial list shall be adopted by
31 January 1, 2004, and shall be revised from time to time as
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1 determined by the Department of Health, in consultation with
2 the respective professional licensing boards. Inclusion of a
3 test on the list of invalid diagnostic tests shall be based on
4 lack of demonstrated medical value and a level of general
5 acceptance by the relevant provider community and shall not be
6 dependent for results entirely upon subjective patient
7 response. Notwithstanding its inclusion on a fee schedule in
8 this subsection, an insurer or insured is not required to pay
9 any charges or reimburse claims for any invalid diagnostic
10 test as determined by the Department of Health.
11 (c)1. With respect to any treatment or service, other
12 than medical services billed by a hospital or other provider
13 for emergency services as defined in s. 395.002 or inpatient
14 services rendered at a hospital-owned facility, the statement
15 of charges must be furnished to the insurer by the provider
16 and may not include, and the insurer is not required to pay,
17 charges for treatment or services rendered more than 35 days
18 before the postmark date of the statement, except for past due
19 amounts previously billed on a timely basis under this
20 paragraph, and except that, if the provider submits to the
21 insurer a notice of initiation of treatment within 21 days
22 after its first examination or treatment of the claimant, the
23 statement may include charges for treatment or services
24 rendered up to, but not more than, 75 days before the postmark
25 date of the statement. The injured party is not liable for,
26 and the provider shall not bill the injured party for, charges
27 that are unpaid because of the provider's failure to comply
28 with this paragraph. Any agreement requiring the injured
29 person or insured to pay for such charges is unenforceable.
30 2. If, however, the insured fails to furnish the
31 provider with the correct name and address of the insured's
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1 personal injury protection insurer, the provider has 35 days
2 from the date the provider obtains the correct information to
3 furnish the insurer with a statement of the charges. The
4 insurer is not required to pay for such charges unless the
5 provider includes with the statement documentary evidence that
6 was provided by the insured during the 35-day period
7 demonstrating that the provider reasonably relied on erroneous
8 information from the insured and either:
9 a. A denial letter from the incorrect insurer; or
10 b. Proof of mailing, which may include an affidavit
11 under penalty of perjury, reflecting timely mailing to the
12 incorrect address or insurer.
13 3. For emergency services and care as defined in s.
14 395.002 rendered in a hospital emergency department or for
15 transport and treatment rendered by an ambulance provider
16 licensed pursuant to part III of chapter 401, the provider is
17 not required to furnish the statement of charges within the
18 time periods established by this paragraph; and the insurer
19 shall not be considered to have been furnished with notice of
20 the amount of covered loss for purposes of paragraph (4)(b)
21 until it receives a statement complying with paragraph (d), or
22 copy thereof, which specifically identifies the place of
23 service to be a hospital emergency department or an ambulance
24 in accordance with billing standards recognized by the Health
25 Care Finance Administration.
26 4. Each notice of insured's rights under s. 627.7401
27 must include the following statement in type no smaller than
28 12 points:
29
30 BILLING REQUIREMENTS.--Florida Statutes provide
31 that with respect to any treatment or services,
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1 other than certain hospital and emergency
2 services, the statement of charges furnished to
3 the insurer by the provider may not include,
4 and the insurer and the injured party are not
5 required to pay, charges for treatment or
6 services rendered more than 35 days before the
7 postmark date of the statement, except for past
8 due amounts previously billed on a timely
9 basis, and except that, if the provider submits
10 to the insurer a notice of initiation of
11 treatment within 21 days after its first
12 examination or treatment of the claimant, the
13 statement may include charges for treatment or
14 services rendered up to, but not more than, 75
15 days before the postmark date of the statement.
16
17 (d) All statements and bills for medical services
18 rendered by any physician, hospital, clinic, or other person
19 or institution shall be submitted to the insurer on a properly
20 completed Centers for Medicare and Medicaid Services (CMS)
21 1500 form, UB 92 forms, or any other standard form approved by
22 the office or adopted by the commission for purposes of this
23 paragraph. All billings for such services rendered by
24 providers shall, to the extent applicable, follow the
25 Physicians' Current Procedural Terminology (CPT) or Healthcare
26 Correct Procedural Coding System (HCPCS), or ICD-9 in effect
27 for the year in which services are rendered and comply with
28 the Centers for Medicare and Medicaid Services (CMS) 1500 form
29 instructions and the American Medical Association Current
30 Procedural Terminology (CPT) Editorial Panel and Healthcare
31 Correct Procedural Coding System (HCPCS). All providers other
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1 than hospitals shall include on the applicable claim form the
2 professional license number of the provider in the line or
3 space provided for "Signature of Physician or Supplier,
4 Including Degrees or Credentials." In determining compliance
5 with applicable CPT and HCPCS coding, guidance shall be
6 provided by the Physicians' Current Procedural Terminology
7 (CPT) or the Healthcare Correct Procedural Coding System
8 (HCPCS) in effect for the year in which services were
9 rendered, the Office of the Inspector General (OIG),
10 Physicians Compliance Guidelines, and other authoritative
11 treatises designated by rule by the Agency for Health Care
12 Administration. No statement of medical services may include
13 charges for medical services of a person or entity that
14 performed such services without possessing the valid licenses
15 required to perform such services. For purposes of paragraph
16 (4)(b), an insurer shall not be considered to have been
17 furnished with notice of the amount of covered loss or medical
18 bills due unless the statements or bills comply with this
19 paragraph, and unless the statements or bills are properly
20 completed in their entirety as to all material provisions,
21 with all relevant information being provided therein.
22 (12) DEMAND LETTER.--
23 (a) As a condition precedent to filing any action for
24 benefits under this section, the insurer must be provided with
25 written notice of an intent to initiate litigation. Such
26 notice may not be sent until the claim is overdue, including
27 any additional time the insurer has to pay the claim pursuant
28 to subsection (8).
29 (b) The notice required shall state that it is a
30 "demand letter under s. 627.736(14)" and shall state with
31 specificity:
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1 1. The name of the insured upon whom such benefits are
2 being sought, including a copy of the assignment giving rights
3 to the claimant if the claimant is not the insured.
4 2. The claim number or policy number upon which such
5 claim was originally submitted to the insurer.
6 3. To the extent applicable, the name of any medical
7 provider who rendered to an insured the treatment, services,
8 accommodations, or supplies that form the basis of such claim;
9 and an itemized statement specifying each exact amount, the
10 date of treatment, service, or accommodation, and the type of
11 benefit claimed to be due. A completed form satisfying the
12 requirements of subsection (7) or the lost-wage statement
13 previously submitted may be used as the itemized statement. To
14 the extent that the demand involves an insurer's withdrawal of
15 payment under subsection (15) for future treatment not yet
16 rendered, the claimant shall attach a copy of the insurer's
17 notice withdrawing such payment and an itemized statement of
18 the type, frequency, and duration of future treatment claimed
19 to be reasonable and medically necessary.
20 (c) Each notice required by this subsection must be
21 delivered to the insurer by United States certified or
22 registered mail, return receipt requested. Such postal costs
23 shall be reimbursed by the insurer if so requested by the
24 claimant in the notice, when the insurer pays the claim. Such
25 notice must be sent to the person and address specified by the
26 insurer for the purposes of receiving notices under this
27 subsection. Each licensed insurer, whether domestic, foreign,
28 or alien, shall file with the office designation of the name
29 and address of the person to whom notices pursuant to this
30 subsection shall be sent which the office shall make available
31 on its Internet website. The name and address on file with the
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1 office pursuant to s. 624.422 shall be deemed the authorized
2 representative to accept notice pursuant to this subsection in
3 the event no other designation has been made.
4 (d) If, within 21 days after receipt of notice by the
5 insurer, the overdue claim specified in the notice is paid by
6 the insurer together with applicable interest and a penalty of
7 10 percent of the overdue amount paid by the insurer, subject
8 to a maximum penalty of $250, no action may be brought against
9 the insurer. If the demand involves an insurer's withdrawal of
10 payment under subsection (15) for future treatment not yet
11 rendered, no action may be brought against the insurer if,
12 within 21 days after its receipt of the notice, the insurer
13 mails to the person filing the notice a written statement of
14 the insurer's agreement to pay for such treatment in
15 accordance with the notice and to pay a penalty of 10 percent,
16 subject to a maximum penalty of $250, when it pays for such
17 future treatment in accordance with the requirements of this
18 section. To the extent the insurer determines not to pay any
19 amount demanded, the penalty shall not be payable in any
20 subsequent action. For purposes of this subsection, payment or
21 the insurer's agreement shall be treated as being made on the
22 date a draft or other valid instrument that is equivalent to
23 payment, or the insurer's written statement of agreement, is
24 placed in the United States mail in a properly addressed,
25 postpaid envelope, or if not so posted, on the date of
26 delivery. The insurer is not obligated to pay any attorney's
27 fees if the insurer pays the claim or mails its agreement to
28 pay for future treatment within the time prescribed by this
29 subsection.
30
31
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1 (e) The applicable statute of limitation for an action
2 under this section shall be tolled for a period of 21 business
3 days by the mailing of the notice required by this subsection.
4 (f) Any insurer making a general business practice of
5 not paying valid claims until receipt of the notice required
6 by this subsection is engaging in an unfair trade practice
7 under the insurance code.
8 (13) DISCLOSURE AND ACKNOWLEDGEMENT FORM.--
9 (a)(e)1. At the initial treatment or service provided,
10 each physician, other licensed professional, clinic, or other
11 medical institution providing medical services upon which a
12 claim for personal injury protection benefits is based shall
13 require an insured person, or his or her guardian, to execute
14 a disclosure and acknowledgment form, which reflects at a
15 minimum that:
16 1.a. The insured, or his or her guardian, must
17 countersign the form attesting to the fact that the services
18 set forth therein were actually rendered;
19 2.b. The insured, or his or her guardian, has both the
20 right and affirmative duty to confirm that the services were
21 actually rendered;
22 3.c. The insured, or his or her guardian, was not
23 solicited by any person to seek any services from the medical
24 provider;
25 4.d. That the physician, other licensed professional,
26 clinic, or other medical institution rendering services for
27 which payment is being claimed explained the services to the
28 insured or his or her guardian; and
29 5.e. If the insured notifies the insurer in writing of
30 a billing error, the insured may be entitled to a certain
31
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1 percentage of a reduction in the amounts paid by the insured's
2 motor vehicle insurer.
3 (b)2. The physician, other licensed professional,
4 clinic, or other medical institution rendering services for
5 which payment is being claimed has the affirmative duty to
6 explain the services rendered to the insured, or his or her
7 guardian, so that the insured, or his or her guardian,
8 countersigns the form with informed consent.
9 (c)3. Countersignature by the insured, or his or her
10 guardian, is not required for the reading of diagnostic tests
11 or other services that are of such a nature that they are not
12 required to be performed in the presence of the insured.
13 (d)4. The licensed medical professional rendering
14 treatment for which payment is being claimed must sign, by his
15 or her own hand, the form complying with this subsection
16 paragraph.
17 (e)5. The original completed disclosure and
18 acknowledgment form shall be furnished to the insurer pursuant
19 to subsection (8) paragraph (4)(b) and may not be
20 electronically furnished.
21 (f)6. This disclosure and acknowledgment form is not
22 required for services billed by a provider for emergency
23 services as defined in s. 395.002, for emergency services and
24 care as defined in s. 395.002 rendered in a hospital emergency
25 department, or for transport and treatment rendered by an
26 ambulance provider licensed pursuant to part III of chapter
27 401.
28 (g)7. The Financial Services Commission shall adopt,
29 by rule, a standard disclosure and acknowledgment form that
30 shall be used to fulfill the requirements of this subsection
31 paragraph, effective 90 days after such form is adopted and
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1 becomes final. The commission shall adopt a proposed rule by
2 October 1, 2003. Until the rule is final, the provider may use
3 a form of its own which otherwise complies with the
4 requirements of this paragraph.
5 (h)8. As used in this subsection paragraph,
6 "countersigned" means a second or verifying signature, as on a
7 previously signed document, and is not satisfied by the
8 statement "signature on file" or any similar statement.
9 (i)9. The requirements of This subsection applies
10 paragraph apply only with respect to the initial treatment or
11 service of the insured by a provider. For subsequent
12 treatments or service, the provider must maintain a patient
13 log signed by the patient, in chronological order by date of
14 service, that is consistent with the services being rendered
15 to the patient as claimed. The requirements of this paragraph
16 subparagraph for maintaining a patient log signed by the
17 patient may be met by a hospital that maintains medical
18 records as required by s. 395.3025 and applicable rules and
19 makes such records available to the insurer upon request.
20 (f) Upon written notification by any person, an
21 insurer shall investigate any claim of improper billing by a
22 physician or other medical provider. The insurer shall
23 determine if the insured was properly billed for only those
24 services and treatments that the insured actually received. If
25 the insurer determines that the insured has been improperly
26 billed, the insurer shall notify the insured, the person
27 making the written notification and the provider of its
28 findings and shall reduce the amount of payment to the
29 provider by the amount determined to be improperly billed. If
30 a reduction is made due to such written notification by any
31 person, the insurer shall pay to the person 20 percent of the
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1 amount of the reduction, up to $500. If the provider is
2 arrested due to the improper billing, then the insurer shall
3 pay to the person 40 percent of the amount of the reduction,
4 up to $500.
5 (g) An insurer may not systematically downcode with
6 the intent to deny reimbursement otherwise due. Such action
7 constitutes a material misrepresentation under s.
8 626.9541(1)(i)2.
9 (6) DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
10 DISPUTES.--
11 (a) Every employer shall, if a request is made by an
12 insurer providing personal injury protection benefits under
13 ss. 627.730-627.7405 against whom a claim has been made,
14 furnish forthwith, in a form approved by the office, a sworn
15 statement of the earnings, since the time of the bodily injury
16 and for a reasonable period before the injury, of the person
17 upon whose injury the claim is based.
18 (14) DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
19 DISPUTES.--
20 (a)(b) Every physician, hospital, clinic, or other
21 medical institution providing, before or after bodily injury
22 upon which a claim for personal injury protection insurance
23 benefits is based, any products, services, or accommodations
24 in relation to that or any other injury, or in relation to a
25 condition claimed to be connected with that or any other
26 injury, shall, if requested to do so by the insurer against
27 whom the claim has been made:,
28 1. Furnish forthwith a written report of the history,
29 condition, treatment, dates, and costs of such treatment of
30 the injured person and why the items identified by the insurer
31 were reasonable in amount and medically necessary.,
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1 2. Provide together with a sworn statement that the
2 treatment or services rendered were reasonable and necessary
3 with respect to the bodily injury sustained. Such sworn
4 statement shall read as follows: "Under penalty of perjury, I
5 declare that I have read the foregoing, and the facts alleged
6 are true, to the best of my knowledge and belief."
7 3. Identify and identifying which portion of the
8 expenses for such treatment or services was incurred as a
9 result of such bodily injury.,
10 4. and Produce forthwith, and permit the inspection
11 and copying of, his or her or its records regarding such
12 history, condition, treatment, dates, and costs of treatment;
13 provided that this shall not limit the introduction of
14 evidence at trial. Such sworn statement shall read as follows:
15 "Under penalty of perjury, I declare that I have read the
16 foregoing, and the facts alleged are true, to the best of my
17 knowledge and belief."
18 (b) However, if the records are maintained at an
19 alternative location, the requested records shall be made
20 available at the principal place of business within 25 working
21 days after the request. If the requested records are not made
22 available within this time period and such records are later
23 admitted into evidence or otherwise used to support a claim by
24 the health care provider against the insurer, the court shall
25 not award attorney's fees to the provider pursuant to this
26 section or s. 627.428. At the time of the records inspection,
27 the health care provider shall allow the insurer to inspect
28 records and photograph the equipment and associated documents
29 associated with the insured's treatment, services, or
30 supplies.
31
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1 (c) A No cause of action for violation of the
2 physician-patient privilege or invasion of the right of
3 privacy is not shall be permitted against any physician,
4 hospital, clinic, or other medical institution complying with
5 the provisions of this section.
6 (d) The person requesting such records and such sworn
7 statement shall pay all reasonable costs connected therewith.
8 (e) If an insurer makes a written request for
9 documentation or information under this paragraph within 30
10 days after having received notice of the amount of a covered
11 loss under subsection (7) paragraph (4)(a), the amount or the
12 partial amount that which is the subject of the insurer's
13 inquiry shall become overdue if the insurer does not pay in
14 accordance with subsection (8) paragraph (4)(b) or within 15
15 10 days after the insurer's receipt of the requested
16 documentation or information, whichever occurs later. For
17 purposes of this paragraph, the term "receipt" includes, but
18 is not limited to, inspection and copying pursuant to this
19 subsection paragraph.
20 (f) Any insurer that requests documentation or
21 information pertaining to reasonableness of charges or medical
22 necessity under this subsection paragraph without a reasonable
23 basis for such requests as a general business practice is
24 engaging in an unfair trade practice under the insurance code.
25 (g)(c) In the event of any dispute regarding an
26 insurer's right to discovery of facts under this section, the
27 insurer may petition a court of competent jurisdiction to
28 enter an order permitting such discovery. The order may be
29 made only on motion for good cause shown and upon notice to
30 all persons having an interest, and it shall specify the time,
31 place, manner, conditions, and scope of the discovery. Such
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1 court may, in order to protect against annoyance,
2 embarrassment, or oppression, as justice requires, enter an
3 order refusing discovery or specifying conditions of discovery
4 and may order payments of costs and expenses of the
5 proceeding, including reasonable fees for the appearance of
6 attorneys at the proceedings, as justice requires.
7 (h) A health care provider is entitled to reasonable
8 compensation for complying with a request for information by
9 an insurer.
10 (i)(d) The injured person shall be furnished, upon
11 request, a copy of all information obtained by the insurer
12 under the provisions of this section, and shall pay a
13 reasonable charge, if required by the insurer.
14 (j)(e) Notice to an insurer of the existence of a
15 claim shall not be unreasonably withheld by an insured.
16 (15)(7) MENTAL AND PHYSICAL EXAMINATION OF INJURED
17 PERSON; REPORTS.--
18 (a) Whenever the mental or physical condition of an
19 injured person covered by personal injury protection is
20 material to any claim that has been or may be made for past or
21 future personal injury protection insurance benefits, such
22 person shall, upon the request of an insurer, submit to mental
23 or physical examination by a physician or physicians.
24 (b) The costs of any examinations requested by an
25 insurer shall be borne entirely by the insurer.
26 (c) Such examination shall be conducted within the
27 municipality where the insured is receiving treatment, or in a
28 location reasonably accessible to the insured, which, for
29 purposes of this paragraph, means any location within the
30 municipality in which the insured resides, or any location
31 within 10 miles by road of the insured's residence, provided
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1 such location is within the county in which the insured
2 resides.
3 (d) If the examination is to be conducted in a
4 location reasonably accessible to the insured, and if there is
5 no qualified physician to conduct the examination in a
6 location reasonably accessible to the insured, then such
7 examination shall be conducted in an area of the closest
8 proximity to the insured's residence.
9 (e) Personal protection Insurers are authorized to
10 include reasonable provisions in personal injury protection
11 insurance policies for mental and physical examination of
12 those claiming personal injury protection insurance benefits.
13 (f) An insurer may not withdraw payment of a treating
14 physician without the consent of the injured person covered by
15 the personal injury protection, unless the insurer first
16 obtains a valid report by a Florida physician licensed under
17 the same chapter as the treating physician whose treatment
18 authorization is sought to be withdrawn, stating that
19 treatment was not reasonable, related, or necessary.
20 (g) A valid report is one that is prepared and signed
21 by the physician examining the injured person or reviewing the
22 treatment records of the injured person and is factually
23 supported by the examination and treatment records if reviewed
24 and that has not been modified by anyone other than the
25 physician.
26 (h) The physician preparing the report must be in
27 active practice, unless the physician is physically disabled.
28 Active practice means that during the 3 years immediately
29 preceding the date of the physical examination or review of
30 the treatment records the physician must have devoted
31 professional time to the active clinical practice of
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1 evaluation, diagnosis, or treatment of medical conditions or
2 to the instruction of students in an accredited health
3 professional school or accredited residency program or a
4 clinical research program that is affiliated with an
5 accredited health professional school or teaching hospital or
6 accredited residency program.
7 (i) The physician preparing a report at the request of
8 an insurer and physicians rendering expert opinions on behalf
9 of persons claiming medical benefits for personal injury
10 protection, or on behalf of an insured through an attorney or
11 another entity, shall maintain, for at least 3 years, copies
12 of all examination reports as medical records and shall
13 maintain, for at least 3 years, records of all payments for
14 the examinations and reports.
15 (j) Neither an insurer nor any person acting at the
16 direction of or on behalf of an insurer may materially change
17 an opinion in a report prepared under this subsection
18 paragraph or direct the physician preparing the report to
19 change such opinion. The denial of a payment as the result of
20 such a changed opinion constitutes a material
21 misrepresentation under s. 626.9541(1)(i)2.; however, this
22 provision does not preclude the insurer from calling to the
23 attention of the physician errors of fact in the report based
24 upon information in the claim file.
25 (k)(b) If requested by the person examined, a party
26 causing an examination to be made shall deliver to him or her
27 a copy of every written report concerning the examination
28 rendered by an examining physician, at least one of which
29 reports must set out the examining physician's findings and
30 conclusions in detail. After such request and delivery, the
31 party causing the examination to be made is entitled, upon
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1 request, to receive from the person examined every written
2 report available to him or her or his or her representative
3 concerning any examination, previously or thereafter made, of
4 the same mental or physical condition. By requesting and
5 obtaining a report of the examination so ordered, or by taking
6 the deposition of the examiner, the person examined waives any
7 privilege he or she may have, in relation to the claim for
8 benefits, regarding the testimony of every other person who
9 has examined, or may thereafter examine, him or her in respect
10 to the same mental or physical condition. If a person
11 unreasonably refuses to submit to an examination, the personal
12 injury protection carrier is no longer liable for subsequent
13 personal injury protection benefits.
14 (8) APPLICABILITY OF PROVISION REGULATING ATTORNEY'S
15 FEES.--With respect to any dispute under the provisions of ss.
16 627.730-627.7405 between the insured and the insurer, or
17 between an assignee of an insured's rights and the insurer,
18 the provisions of s. 627.428 shall apply, except as provided
19 in subsection (11).
20 (16)(9) CANCELLATION OR NONRENEWAL.--
21 (a) Each insurer that which has issued a policy
22 providing personal injury protection benefits shall report the
23 renewal, cancellation, or nonrenewal thereof to the Department
24 of Highway Safety and Motor Vehicles within 45 days from the
25 effective date of the renewal, cancellation, or nonrenewal.
26 (b) Upon the issuance of a policy providing personal
27 injury protection benefits to a named insured not previously
28 insured by the insurer thereof during that calendar year, the
29 insurer shall report the issuance of the new policy to the
30 Department of Highway Safety and Motor Vehicles within 30
31 days. The report shall be in such form and format and contain
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1 such information as is may be required by the Department of
2 Highway Safety and Motor Vehicles which shall include a format
3 compatible with the data processing capabilities of such said
4 department, and the Department of Highway Safety and Motor
5 Vehicles is authorized to adopt rules necessary with respect
6 thereto. Failure by an insurer to file proper reports with the
7 Department of Highway Safety and Motor Vehicles as required by
8 this subsection or rules adopted with respect to the
9 requirements of this subsection constitutes a violation of the
10 Florida Insurance Code.
11 (c) Reports of cancellations and policy renewals and
12 reports of the issuance of new policies received by the
13 Department of Highway Safety and Motor Vehicles are
14 confidential and exempt from the provisions of s. 119.07(1).
15 (d) These records are to be used for enforcement and
16 regulatory purposes only, including the generation by the
17 department of data regarding compliance by owners of motor
18 vehicles with financial responsibility coverage requirements.
19 In addition, the Department of Highway Safety and Motor
20 Vehicles shall release, upon a written request by a person
21 involved in a motor vehicle accident, by the person's
22 attorney, or by a representative of the person's motor vehicle
23 insurer, the name of the insurance company and the policy
24 number for the policy covering the vehicle named by the
25 requesting party. The written request must include a copy of
26 the appropriate accident form as provided in s. 316.065, s.
27 316.066, or s. 316.068.
28 (e)(b) Every insurer with respect to each insurance
29 policy providing personal injury protection benefits shall
30 notify the named insured or in the case of a commercial fleet
31 policy, the first named insured in writing that any
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1 cancellation or nonrenewal of the policy will be reported by
2 the insurer to the Department of Highway Safety and Motor
3 Vehicles. The notice shall also inform the named insured that
4 failure to maintain personal injury protection and property
5 damage liability insurance on a motor vehicle when required by
6 law may result in the loss of registration and driving
7 privileges in this state, and the notice shall inform the
8 named insured of the amount of the reinstatement fees required
9 by s. 627.733(7). This notice is for informational purposes
10 only, and no civil liability shall attach to an insurer due to
11 failure to provide this notice.
12 (17) ATTORNEY'S FEES.--With respect to any dispute
13 under ss. 627.730-627.7405 between the insured and the
14 insurer, or between an assignee of an insured's rights and the
15 insurer, s. 627.428 shall apply, except as provided in
16 subsection (12).
17 (18)(10) PREFERRED PROVIDERS.--An insurer may
18 negotiate and enter into contracts with licensed health care
19 providers for the benefits described in this section, referred
20 to in this section as "preferred providers," which shall
21 include health care providers licensed under chapters 458,
22 459, 460, 461, and 463. The insurer may provide an option to
23 an insured to use a preferred provider at the time of purchase
24 of the policy for personal injury protection benefits, if the
25 requirements of this subsection are met. If the insured
26 elects to use a provider who is not a preferred provider,
27 whether the insured purchased a preferred provider policy or a
28 nonpreferred provider policy, the medical benefits provided by
29 the insurer shall be as required by this section. If the
30 insured elects to use a provider who is a preferred provider,
31 the insurer may pay medical benefits in excess of the benefits
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1 required by this section and may waive or lower the amount of
2 any deductible that applies to such medical benefits. If the
3 insurer offers a preferred provider policy to a policyholder
4 or applicant, it must also offer a nonpreferred provider
5 policy. The insurer shall provide each policyholder with a
6 current roster of preferred providers in the county in which
7 the insured resides at the time of purchase of such policy,
8 and shall make such list available for public inspection
9 during regular business hours at the principal office of the
10 insurer within the state.
11 (11) DEMAND LETTER.--
12 (a) As a condition precedent to filing any action for
13 benefits under this section, the insurer must be provided with
14 written notice of an intent to initiate litigation. Such
15 notice may not be sent until the claim is overdue, including
16 any additional time the insurer has to pay the claim pursuant
17 to paragraph (4)(b).
18 (b) The notice required shall state that it is a
19 "demand letter under s. 627.736(11)" and shall state with
20 specificity:
21 1. The name of the insured upon which such benefits
22 are being sought, including a copy of the assignment giving
23 rights to the claimant if the claimant is not the insured.
24 2. The claim number or policy number upon which such
25 claim was originally submitted to the insurer.
26 3. To the extent applicable, the name of any medical
27 provider who rendered to an insured the treatment, services,
28 accommodations, or supplies that form the basis of such claim;
29 and an itemized statement specifying each exact amount, the
30 date of treatment, service, or accommodation, and the type of
31 benefit claimed to be due. A completed form satisfying the
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1 requirements of paragraph (5)(d) or the lost-wage statement
2 previously submitted may be used as the itemized statement. To
3 the extent that the demand involves an insurer's withdrawal of
4 payment under paragraph (7)(a) for future treatment not yet
5 rendered, the claimant shall attach a copy of the insurer's
6 notice withdrawing such payment and an itemized statement of
7 the type, frequency, and duration of future treatment claimed
8 to be reasonable and medically necessary.
9 (c) Each notice required by this subsection must be
10 delivered to the insurer by United States certified or
11 registered mail, return receipt requested. Such postal costs
12 shall be reimbursed by the insurer if so requested by the
13 claimant in the notice, when the insurer pays the claim. Such
14 notice must be sent to the person and address specified by the
15 insurer for the purposes of receiving notices under this
16 subsection. Each licensed insurer, whether domestic, foreign,
17 or alien, shall file with the office designation of the name
18 and address of the person to whom notices pursuant to this
19 subsection shall be sent which the office shall make available
20 on its Internet website. The name and address on file with the
21 office pursuant to s. 624.422 shall be deemed the authorized
22 representative to accept notice pursuant to this subsection in
23 the event no other designation has been made.
24 (d) If, within 15 days after receipt of notice by the
25 insurer, the overdue claim specified in the notice is paid by
26 the insurer together with applicable interest and a penalty of
27 10 percent of the overdue amount paid by the insurer, subject
28 to a maximum penalty of $250, no action may be brought against
29 the insurer. If the demand involves an insurer's withdrawal of
30 payment under paragraph (7)(a) for future treatment not yet
31 rendered, no action may be brought against the insurer if,
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1 within 15 days after its receipt of the notice, the insurer
2 mails to the person filing the notice a written statement of
3 the insurer's agreement to pay for such treatment in
4 accordance with the notice and to pay a penalty of 10 percent,
5 subject to a maximum penalty of $250, when it pays for such
6 future treatment in accordance with the requirements of this
7 section. To the extent the insurer determines not to pay any
8 amount demanded, the penalty shall not be payable in any
9 subsequent action. For purposes of this subsection, payment or
10 the insurer's agreement shall be treated as being made on the
11 date a draft or other valid instrument that is equivalent to
12 payment, or the insurer's written statement of agreement, is
13 placed in the United States mail in a properly addressed,
14 postpaid envelope, or if not so posted, on the date of
15 delivery. The insurer shall not be obligated to pay any
16 attorney's fees if the insurer pays the claim or mails its
17 agreement to pay for future treatment within the time
18 prescribed by this subsection.
19 (e) The applicable statute of limitation for an action
20 under this section shall be tolled for a period of 15 business
21 days by the mailing of the notice required by this subsection.
22 (f) Any insurer making a general business practice of
23 not paying valid claims until receipt of the notice required
24 by this subsection is engaging in an unfair trade practice
25 under the insurance code.
26 (19)(12) CIVIL ACTION FOR INSURANCE FRAUD.--An insurer
27 shall have a cause of action against any person convicted of,
28 or who, regardless of adjudication of guilt, pleads guilty or
29 nolo contendere to insurance fraud under s. 817.234, patient
30 brokering under s. 817.505, or kickbacks under s. 456.054,
31 associated with a claim for personal injury protection
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1 benefits in accordance with this section. An insurer
2 prevailing in an action brought under this subsection may
3 recover compensatory, consequential, and punitive damages
4 subject to the requirements and limitations of part II of
5 chapter 768, and attorney's fees and costs incurred in
6 litigating a cause of action against any person convicted of,
7 or who, regardless of adjudication of guilt, pleads guilty or
8 nolo contendere to insurance fraud under s. 817.234, patient
9 brokering under s. 817.505, or kickbacks under s. 456.054,
10 associated with a claim for personal injury protection
11 benefits in accordance with this section.
12 (20)(13) MINIMUM BENEFIT COVERAGE.--If the Financial
13 Services Commission determines that the cost savings under
14 personal injury protection insurance benefits paid by insurers
15 have been realized due to the provisions of this act, prior
16 legislative reforms, or other factors, the commission may
17 increase the minimum $10,000 benefit coverage requirement. In
18 establishing the amount of such increase, the commission must
19 determine that the additional premium for such coverage is
20 approximately equal to the premium cost savings that have been
21 realized for the personal injury protection coverage with
22 limits of $10,000.
23 (21) REWARD.--Upon written notification by any person,
24 an insurer shall investigate any claim of improper billing by
25 a physician or other medical provider. The insurer shall
26 determine if the insured was properly billed for only those
27 services and treatments that the insured actually received. If
28 the insurer determines that the insured has been improperly
29 billed, the insurer shall notify the insured, the person
30 making the written notification and the provider of its
31 findings and shall reduce the amount of payment to the
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1 provider by the amount determined to be improperly billed. If
2 a reduction is made due to such written notification by any
3 person, the insurer shall pay to the person 20 percent of the
4 amount of the reduction up to $500. If the provider is
5 arrested due to the improper billing, the insurer shall pay to
6 the person 40 percent of the amount of the reduction up to
7 $500.
8 (22) VENUE.--Venue for any personal injury protection
9 claim, in the case of an assignment of benefits, shall be in
10 the jurisdiction where the insured resides, where the accident
11 occurs, or where the disputed health care services were
12 performed. Venue may be raised at any time. The cost of
13 transferring venue shall be borne by the plaintiff, and such
14 costs shall not be recoverable as plaintiff's damages.
15 Section 2. Subsection (2) of section 316.068, Florida
16 Statutes, is amended to read:
17 316.068 Crash report forms.--
18 (2) Every crash report required to be made in writing
19 must be made on the appropriate form approved by the
20 department and must contain all the information required
21 therein to include:
22 (a) The date, time, and location of the crash;
23 (b) A description of the vehicles involved;
24 (c) The names and addresses of the parties involved;
25 (d) The names and addresses of all drivers and
26 passengers in the vehicles involved;
27 (e) The names and addresses of witnesses;
28 (f) The name, badge number, and law enforcement agency
29 of the officer investigating the crash; and
30 (g) The names of the insurance companies for the
31 respective parties involved in the crash unless not available.
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1
2 The absence of information in such written crash reports
3 regarding the existence of passengers in the vehicles involved
4 in the crash constitutes a rebuttable presumption that no such
5 passengers were involved in the reported crash.
6 Notwithstanding any other provisions of this section, a crash
7 report produced electronically by a law enforcement officer
8 must, at a minimum, contain the same information as is called
9 for on those forms approved by the department.
10 Section 3. Subsection (9) is added to section 322.26,
11 Florida Statutes, to read:
12 322.26 Mandatory revocation of license by
13 department.--The department shall forthwith revoke the license
14 or driving privilege of any person upon receiving a record of
15 such person's conviction of any of the following offenses:
16 (9) Conviction in any court having jurisdiction over
17 offenses committed under s. 817.234(8) or (9) or s. 817.505.
18 Section 4. Paragraph (a) of subsection (7) and
19 subsection (9) of section 817.234, Florida Statutes, are
20 amended to read:
21 817.234 False and fraudulent insurance claims.--
22 (7)(a) It shall constitute a material omission and
23 insurance fraud, punishable as provided in subsection (11),
24 for any service physician or other provider, other than a
25 hospital, to engage in a general business practice of billing
26 amounts as its usual and customary charge, if such provider
27 has agreed with the insured patient or intends to waive
28 deductibles or copayments, or does not for any other reason
29 intend to collect the total amount of such charge. With
30 respect to a determination as to whether a service physician
31 or other provider has engaged in such general business
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1 practice, consideration shall be given to evidence of whether
2 the physician or other provider made a good faith attempt to
3 collect such deductible or copayment. This paragraph does not
4 apply to physicians or other providers who waive deductibles
5 or copayments or reduce their bills as part of a bodily injury
6 settlement or verdict.
7 (9) A person may not organize, plan, or knowingly
8 participate in an intentional motor vehicle crash or a scheme
9 to create documentation of a motor vehicle crash that did not
10 occur for the purpose of making motor vehicle tort claims or
11 claims for personal injury protection benefits as required by
12 s. 627.736. Any person who violates this subsection commits a
13 felony of the second degree, punishable as provided in s.
14 775.082, s. 775.083, or s. 775.084. A person who is convicted
15 of a violation of this subsection shall be sentenced to a
16 minimum term of imprisonment of 2 years.
17 Section 5. Section 817.2361, Florida Statutes, is
18 amended to read:
19 817.2361 False or fraudulent proof of motor vehicle
20 insurance card.--Any person who, with intent to deceive any
21 other person, creates, markets, or presents a false or
22 fraudulent proof of motor vehicle insurance card commits a
23 felony of the third degree, punishable as provided in s.
24 775.082, s. 775.083, or s. 775.084.
25 Section 6. For the 2006-2007 fiscal year, the sums of
26 $510,276 in recurring funds and $111,455 in nonrecurring funds
27 are appropriated from the Insurance Regulatory Trust Fund of
28 the Department of Financial Services to the Division of
29 Insurance Fraud within the department for the purpose of
30 providing a new fraud unit within the division consisting of
31 six sworn law enforcement officers, one non-sworn
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1 investigator, one crime analyst, and one clerical position. A
2 total of nine full-time equivalent positions and associated
3 salary rate of 381,500 are authorized. This appropriation is
4 for the purposes provided in s. 626.989, Florida Statutes.
5 Section 7. For the 2006-2007 fiscal year, the sums of
6 $415,291 in recurring funds and $52,430 in nonrecurring funds
7 are appropriated from the Insurance Regulatory Trust Fund of
8 the Department of Financial Services to the Division of
9 Insurance Fraud within the department and 10 full-time
10 equivalent positions and associated salary rate of 342,500 are
11 authorized. This appropriation is for the purposes provided in
12 s. 626.989, Florida Statutes.
13 Section 8. Effective January 1, 2009, sections
14 627.730, 627.731, 627.732, 627.733, 627.734, 627.736, 627.737,
15 627.739, 627.7401, 627.7403, and 627.7405, Florida Statutes,
16 constituting the Florida Motor Vehicle No-Fault Law, are
17 repealed, unless reviewed and reenacted by the Legislature
18 before that date.
19 Section 9. Section 19 of chapter 2003-411, Laws of
20 Florida, is repealed.
21 Section 10. This act shall take effect October 1,
22 2006.
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1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 CS for CS for SB 2114
3
4 The committee substitute:
5 -- Restores a provision from existing law that an insurer or
an insured is not required to pay charges or reimburse
6 claims for any diagnostic test determined not medically
necessary by the Department of Health;
7
-- Specifies that a health care provider is entitled to
8 reasonable compensation for complying with a request for
information by an insurer;
9
-- Restores a provision from current law governing
10 attorney's fees in certain disputes between the insured
and the insurer;
11
-- Deletes an appropriation of $1.53 million for a
12 competitive pay adjustment for certain sworn law
enforcement officer positions in the Division of
13 Insurance; and
14 -- Deletes an appropriation of $750,000 for certain state
attorney offices to prosecute insurance fraud cases.
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.