Florida Senate - 2006 SENATOR AMENDMENT
Bill No. HB 561, 1st Eng.
Barcode 892546
CHAMBER ACTION
Senate House
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05/04/2006 02:53 PM .
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11 Senator Campbell moved the following amendment:
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13 Senate Amendment (with title amendment)
14 Delete lines 361-362
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16 and insert:
17 Section 13. Subsections (3), (6), and (7) of section
18 627.736, Florida Statutes, are amended, present subsections
19 (12), and (13), and (14) are renumbered as subsections (15)
20 and (16), respectively, and new subsections (12), (13), and
21 (14) are added to that section, to read:
22 627.736 Required personal injury protection benefits;
23 exclusions; priority; claims.--
24 (3) INSURED'S RIGHTS TO RECOVERY OF SPECIAL DAMAGES IN
25 TORT CLAIMS.--No insurer shall have a lien on any recovery in
26 tort by judgment, settlement, or otherwise for personal injury
27 protection benefits, whether suit has been filed or settlement
28 has been reached without suit. An injured party who is
29 entitled to bring suit under the provisions of ss.
30 627.730-627.7405, or his or her legal representative, shall
31 have no right to recover any damages for which personal injury
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. HB 561, 1st Eng.
Barcode 892546
1 protection benefits are paid or payable. The plaintiff may
2 prove all of his or her special damages notwithstanding this
3 limitation, but if special damages are introduced in evidence,
4 the trier of facts, whether judge or jury, shall not award
5 damages for personal injury protection benefits paid or
6 payable. In all cases in which a jury is required to fix
7 damages, the court shall instruct the jury that the plaintiff
8 shall not recover such special damages for personal injury
9 protection benefits paid or payable.
10 (6) REQUEST FOR DOCUMENTATION BY INSURER DISCOVERY OF
11 FACTS ABOUT AN INJURED PERSON; DISPUTES.--
12 (a) Every employer shall, if a request is made by an
13 insurer providing personal injury protection benefits under
14 ss. 627.730-627.7405 against whom a claim has been made,
15 furnish forthwith, in a form approved by the office, a sworn
16 statement of the earnings, since the time of the bodily injury
17 and for a reasonable period before the injury, of the person
18 upon whose injury the claim is based.
19 (b) Every physician, hospital, clinic, or other
20 medical institution providing, before or after bodily injury
21 upon which a claim for personal injury protection insurance
22 benefits is based, any products, services, or accommodations
23 in relation to that or any other injury, or in relation to a
24 condition claimed to be connected with that or any other
25 injury, shall, if requested to do so by the insurer against
26 whom the claim has been made:,
27 1. Furnish forthwith a written report of the history,
28 condition, treatment, dates, and costs of such treatment of
29 the injured person and why the items identified by the insurer
30 were reasonable in amount and medically necessary.,
31 2. Provide together with a sworn statement that the
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. HB 561, 1st Eng.
Barcode 892546
1 treatment or services rendered were reasonable and necessary
2 with respect to the bodily injury sustained. Such sworn
3 statement must read as follows: "Under penalty of perjury, I
4 declare that I have read the forgoing, and the facts alleged
5 are true, to the best of my knowledge and belief."
6 3. Identify and identifying which portion of the
7 expenses for such treatment or services was incurred as a
8 result of such bodily injury., and
9 4. Produce forthwith, and permit the inspection and
10 copying of, his or her or its records regarding such history,
11 condition, treatment, dates, and costs of treatment; provided
12 that this shall not limit the introduction of evidence at
13 trial. Such sworn statement shall read as follows: "Under
14 penalty of perjury, I declare that I have read the foregoing,
15 and the facts alleged are true, to the best of my knowledge
16 and belief."
17 (c) However, if the records are maintained at an
18 alternative location, the requested records shall made
19 available at the principal place of business within 25 working
20 days after the request.
21 (d) A No cause of action for violation of the
22 physician-patient privilege or invasion of the right of
23 privacy is not shall be permitted against any physician,
24 hospital, clinic, or other medical institution complying with
25 the provisions of this section.
26 (e) The person requesting such records and such sworn
27 statement shall pay all reasonable costs connected therewith.
28 (f) If an insurer makes a written request for
29 documentation or information under this paragraph within 30
30 days after having received notice of the amount of a covered
31 loss under subsection (7) paragraph (4)(a), the amount or the
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. HB 561, 1st Eng.
Barcode 892546
1 partial amount that which is the subject of the insurer's
2 inquiry shall become overdue if the insurer does not pay in
3 accordance with paragraph (4)(b) or within 15 10 days after
4 the insurer's receipt of the requested documentation or
5 information, whichever occurs later. For purposes of this
6 paragraph, the term "receipt" includes, but is not limited to,
7 inspection and copying pursuant to this subsection paragraph.
8 (g) Any insurer that requests documentation or
9 information pertaining to reasonableness of charges or medical
10 necessity under this subsection paragraph without a reasonable
11 basis for such requests as a general business practice is
12 engaging in an unfair trade practice under the insurance code.
13 (h)(c) In the event of any dispute regarding an
14 insurer's right to request patient diagnostic or treatment
15 information discovery of facts under this section, the insurer
16 may petition a court of competent jurisdiction to enter an
17 order permitting such request for patient diagnostic or
18 treatment information discovery. The order may be made only
19 on motion for good cause shown and upon notice to all persons
20 having an interest, and it shall specify the time, place,
21 manner, conditions, and scope of the request for patient
22 diagnostic or treatment information discovery. Such court may,
23 in order to protect against annoyance, embarrassment, or
24 oppression, as justice requires, enter an order refusing the
25 request for patient diagnostic or treatment information
26 discovery or specifying conditions of discovery and may order
27 payments of costs and expenses of the proceeding, including
28 reasonable fees for the appearance of attorneys at the
29 proceedings, as justice requires.
30 (i)(d) The injured person shall be furnished, upon
31 request, a copy of all information obtained by the insurer
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. HB 561, 1st Eng.
Barcode 892546
1 under the provisions of this section, and shall pay a
2 reasonable charge, if required by the insurer.
3 (j) A health care provider is entitled to reasonable
4 compensation for complying with a request for information by
5 an insurer.
6 (k)(e) Notice to an insurer of the existence of a
7 claim shall not be unreasonably withheld by an insured.
8 (7) MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON;
9 REPORTS.--
10 (a) Whenever the mental or physical condition of an
11 injured person covered by personal injury protection is
12 material to any claim that has been or may be made for past or
13 future personal injury protection insurance benefits, such
14 person shall, upon the request of an insurer, submit to mental
15 or physical examination by a physician or physicians. The
16 costs of any examinations requested by an insurer shall be
17 borne entirely by the insurer. Such examination shall be
18 conducted within the municipality where the insured is
19 receiving treatment, or in a location reasonably accessible to
20 the insured, which, for purposes of this paragraph, means any
21 location within the municipality in which the insured resides,
22 or any location within 10 miles by road of the insured's
23 residence, provided such location is within the county in
24 which the insured resides. If the examination is to be
25 conducted in a location reasonably accessible to the insured,
26 and if there is no qualified physician to conduct the
27 examination in a location reasonably accessible to the
28 insured, then such examination shall be conducted in an area
29 of the closest proximity to the insured's residence. Personal
30 protection insurers are authorized to include reasonable
31 provisions in personal injury protection insurance policies
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. HB 561, 1st Eng.
Barcode 892546
1 for mental and physical examination of those claiming personal
2 injury protection insurance benefits. An insurer may not deny
3 or withdraw payment of a treating physician without the
4 consent of the injured person covered by the personal injury
5 protection, unless the insurer first obtains a valid report by
6 a Florida physician licensed under the same chapter as the
7 treating physician whose treatment authorization is sought to
8 be withdrawn, stating that treatment was not reasonable,
9 related, or necessary. A valid report that is reasonable proof
10 to timely deny or withdraw payment is one that is prepared and
11 signed by the physician examining the injured person or by a
12 physician who has not examined the patient but has reviewed
13 complete reviewing the treatment records of the injured person
14 and is factually supported by the examination and treatment
15 records if reviewed and that has not been modified by anyone
16 other than the physician. The physician preparing the report
17 must be in active practice, unless the physician is physically
18 disabled. Active practice means that during the 3 years
19 immediately preceding the date of the physical examination or
20 review of the treatment records the physician must have
21 devoted professional time to the active clinical practice of
22 evaluation, diagnosis, or treatment of medical conditions or
23 to the instruction of students in an accredited health
24 professional school or accredited residency program or a
25 clinical research program that is affiliated with an
26 accredited health professional school or teaching hospital or
27 accredited residency program. The physician preparing a report
28 at the request of an insurer and physicians rendering expert
29 opinions on behalf of persons claiming medical benefits for
30 personal injury protection, or on behalf of an insured through
31 an attorney or another entity, shall maintain, for at least 3
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. HB 561, 1st Eng.
Barcode 892546
1 years, copies of all examination reports as medical records
2 and shall maintain, for at least 3 years, records of all
3 payments for the examinations and reports. Neither an insurer
4 nor any person acting at the direction of or on behalf of an
5 insurer may materially change an opinion in a report prepared
6 under this paragraph or direct the physician preparing the
7 report to change such opinion. The denial of a payment as the
8 result of such a changed opinion constitutes a material
9 misrepresentation under s. 626.9541(1)(i)2.; however, this
10 provision does not preclude the insurer from calling to the
11 attention of the physician errors of fact in the report based
12 upon information in the claim file.
13 (b) If requested by the person examined, a party
14 causing an examination to be made shall deliver to him or her
15 a copy of every written report concerning the examination
16 rendered by an examining physician, at least one of which
17 reports must set out the examining physician's findings and
18 conclusions in detail. After such request and delivery, the
19 party causing the examination to be made is entitled, upon
20 request, to receive from the person examined every written
21 report available to him or her or his or her representative
22 concerning any examination, previously or thereafter made, of
23 the same mental or physical condition. By requesting and
24 obtaining a report of the examination so ordered, or by taking
25 the deposition of the examiner, the person examined waives any
26 privilege he or she may have, in relation to the claim for
27 benefits, regarding the testimony of every other person who
28 has examined, or may thereafter examine, him or her in respect
29 to the same mental or physical condition. If a person
30 unreasonably refuses to submit to an examination, the personal
31 injury protection carrier is no longer liable for subsequent
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. HB 561, 1st Eng.
Barcode 892546
1 personal injury protection benefits.
2 (12) VENUE.--Venue for any personal injury protection
3 benefits claim for an assignee of benefits shall be in the
4 jurisdiction where the insured resides, where the accident
5 occurs, where health care services were provided, or in a
6 forum convenient for material witnesses.
7 (13) JOINDER OF POTENTIAL CLAIMS.--The filing of a
8 lawsuit claiming personal injury protection benefits, brought
9 pursuant to 627.736, shall include all personal injury
10 protection benefit claims the plaintiff has standing to file
11 and for which all conditions precedent to file the lawsuit
12 have been met by the plaintiff at the time the lawsuit if
13 filed.
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16 ================ T I T L E A M E N D M E N T ===============
17 And the title is amended as follows:
18 On line 48, after the second semicolon,
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20 insert:
21 amending s. 627.736, F.S.; revising provisions
22 governing insured's rights to recovery of
23 special damages in tort; revising provisions
24 governing requests to a medical institution by
25 an insurer for documentation concerning a claim
26 for personal injury protection benefits;
27 providing for resolution of disputes involving
28 such requests; providing for compensation for a
29 health care provider's response to an insurer's
30 requests for information; clarifying provisions
31 governing when an insurer may withdraw payment
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. HB 561, 1st Eng.
Barcode 892546
1 to a treating physician; authorizing denial of
2 such payment in circumstance when withdrawal of
3 payment is authorized; providing for venue,
4 requiring joinder of certain claims;
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