Amendment
Bill No. 7263

Amendment No. 194097

CHAMBER ACTION
Senate		House
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1	Representative(s) Ross offered the following:
2
3	Amendment (with title amendment)
4	Remove everything after the enacting clause and insert:
5	Section 1.  Subsection (10) is added to section 624.155,
6	Florida Statutes, to read:
7	624.155  Civil remedy.--
8	(10)  Notwithstanding the provisions of paragraph (8),
9	before a person may file any statutory or common law cause of
10	action arising out of a violation of this subsection relating to
11	the actons of a motor vehicle insurer or any other cause of
12	action alleging that a motor vehicle insurer did not act in good
13	faith or fairly and honestly toward its insured or with due
14	regard for the insured's interests, the notice requirements
15	pursuant to paragraph (3)(a) must be met. These requirements
16	apply to a claim made by a third party.
17	Section 2.  Section 627.731, Florida Statutes, is amended
18	to read:
19	627.731  Purpose.--The purpose of ss. 627.730-627.7405 is
20	to provide for medical, surgical, funeral, and disability
21	insurance benefits without regard to fault, and to require motor
22	vehicle insurance securing such benefits, for motor vehicles
23	required to be registered in this state and, with respect to
24	motor vehicle accidents, a limitation on the right to claim non-
25	economic or general damages, including, but not limited to,
26	damages for pain, suffering, mental anguish, physical
27	impairment, loss of capacity to enjoy life, and inconvenience.
28	Section 3.  Section 627.732, Florida Statutes, is amended
29	to read:
30	627.732  Definitions.--As used in ss. 627.730-627.7405, the
31	term:
32	(1)  "Broker" means an individual, person, or entity acting
33	as an intermediary for compensation and arranging for services
34	to be performed by another individual, person, or entity any
35	person not possessing a license under chapter 395, chapter 400,
36	chapter 458, chapter 459, chapter 460, chapter 461, or chapter
37	641 who charges or receives compensation for any use of medical
38	equipment and is not the 100-percent owner or the 100-percent
39	lessee of such equipment. For purposes of this section, such
40	owner or lessee may be an individual, a corporation, a
41	partnership, or any other entity and any of its 100-percent-
42	owned affiliates and subsidiaries. For purposes of this
43	subsection, the term "lessee" means a long-term lessee under a
44	capital or operating lease, but does not include a part-time
45	lessee. The term "broker" does not include a hospital or
46	physician management company whose medical equipment is
47	ancillary to the practices managed, a debt collection agency, or
48	an entity that has contracted with the insurer to obtain a
49	discounted rate for such services; nor does the term include a
50	management company that has contracted to provide general
51	management services for a licensed physician or health care
52	facility and whose compensation is not materially affected by
53	the usage or frequency of usage of medical equipment or an
54	entity that is 100-percent owned by one or more hospitals or
55	physicians. The term "broker" does not include a person or
56	entity that certifies, upon request of an insurer, that:
57	(a)  It is a clinic licensed under ss. 400.990-400.995;
58	(b)  It is a 100-percent owner of medical equipment; and
59	(c)  The owner's only part-time lease of medical equipment
60	for personal injury protection patients is on a temporary basis
61	not to exceed 30 days in a 12-month period, and such lease is
62	solely for the purposes of necessary repair or maintenance of
63	the 100-percent-owned medical equipment or pending the arrival
64	and installation of the newly purchased or a replacement for the
65	100-percent-owned medical equipment, or for patients for whom,
66	because of physical size or claustrophobia, it is determined by
67	the medical director or clinical director to be medically
68	necessary that the test be performed in medical equipment that
69	is open-style. The leased medical equipment cannot be used by
70	patients who are not patients of the registered clinic for
71	medical treatment of services. Any person or entity making a
72	false certification under this subsection commits insurance
73	fraud as defined in s. 817.234. However, the 30-day period
74	provided in this paragraph may be extended for an additional 60
75	days as applicable to magnetic resonance imaging equipment if
76	the owner certifies that the extension otherwise complies with
77	this paragraph.
78	(2)  "Medically necessary" means refers to a medical
79	service or supply that a prudent physician would provide for the
80	purpose of preventing, diagnosing, or treating an illness,
81	injury, disease, or symptom in a manner that is:
82	(a)  In accordance with generally accepted standards of
83	medical practice;
84	(b)  Clinically appropriate in terms of type, frequency,
85	extent, site, and duration; and
86	(c)  Not primarily for the convenience of the patient,
87	physician, or other health care provider.
88	(3)  "Motor vehicle" means any self-propelled vehicle with
89	four or more wheels which is of a type both designed and
90	required to be licensed for use on the highways of this state
91	and any trailer or semitrailer designed for use with such
92	vehicle and includes:
93	(a)  A "private passenger motor vehicle," which is any
94	motor vehicle which is a sedan, station wagon, or jeep-type
95	vehicle and, if not used primarily for occupational,
96	professional, or business purposes, a motor vehicle of the
97	pickup, panel, van, camper, or motor home type.
98	(b)  A "commercial motor vehicle," which is any motor
99	vehicle which is not a private passenger motor vehicle.
100
101	The term "motor vehicle" does not include a mobile home or any
102	motor vehicle which is used in mass transit, other than public
103	school transportation, and designed to transport more than five
104	passengers exclusive of the operator of the motor vehicle and
105	which is owned by a municipality, a transit authority, or a
106	political subdivision of the state.
107	(4)  "Named insured" means a person, usually the owner of a
108	vehicle, identified in a policy by name as the insured under the
109	policy.
110	(5)  "Owner" means a person who holds the legal title to a
111	motor vehicle; or, in the event a motor vehicle is the subject
112	of a security agreement or lease with an option to purchase with
113	the debtor or lessee having the right to possession, then the
114	debtor or lessee shall be deemed the owner for the purposes of
115	ss. 627.730-627.7405.
116	(6)  "Relative residing in the same household" means a
117	relative of any degree by blood or by marriage who usually makes
118	her or his home in the same family unit, whether or not
119	temporarily living elsewhere.
120	(7)  "Certify" means to swear or attest to being true or
121	represented in writing.
122	(8)  "Immediate personal supervision," as it relates to the
123	performance of medical services by nonphysicians not in a
124	hospital, means that an individual licensed to perform the
125	medical service or provide the medical supplies must be present
126	within the confines of the physical structure where the medical
127	services are performed or where the medical supplies are
128	provided such that the licensed individual can respond
129	immediately to any emergencies if needed.
130	(9)  "Incident," with respect to services considered as
131	incident to a physician's professional service, for a physician
132	licensed under chapter 458, chapter 459, chapter 460, or chapter
133	461, if not furnished in a hospital, means such services must be
134	an integral, even if incidental, part of a covered physician's
135	service.
136	(10)  "Knowingly" means that a person, with respect to
137	information, has actual knowledge of the information; acts in
138	deliberate ignorance of the truth or falsity of the information;
139	or acts in reckless disregard of the information, and proof of
140	specific intent to defraud is not required.
141	(11)  "Lawful" or "lawfully" means in substantial
142	compliance with all relevant applicable criminal, civil, and
143	administrative requirements of state and federal law related to
144	the provision of medical services or treatment.
145	(12)  "Hospital" means a facility that, at the time
146	services or treatment were rendered, was licensed under chapter
147	395.
148	(13)  "Properly completed" means providing truthful,
149	substantially complete, and substantially accurate responses as
150	to all material elements to each applicable request for
151	information or statement by a means that may lawfully be
152	provided and that complies with this section, or as agreed by
153	the parties.
154	(14)  "Upcoding" means an action that submits a billing
155	code that would result in payment greater in amount than would
156	be paid using a billing code that accurately describes the
157	services performed. The term does not include an otherwise
158	lawful bill by a magnetic resonance imaging facility, which
159	globally combines both technical and professional components, if
160	the amount of the global bill is not more than the components if
161	billed separately; however, payment of such a bill constitutes
162	payment in full for all components of such service.
163	(15)  "Unbundling" means an action that submits a billing
164	code that is properly billed under one billing code, but that
165	has been separated into two or more billing codes, and would
166	result in payment greater in amount than would be paid using one
167	billing code.
168	(16)  "Services" includes treatment, procedures, supplies,
169	and equipment.
170	(17)  "Contracted services" means goods or services
171	provided or performed by anyone other than a statutory employee
172	of the supplier or provider.
173	(18)  "Rendered" means actually performed a treatment or a
174	service.
175	(19)  "Licensed facility" means a facility licensed under
176	chapter 395 at the time services were rendered.
177	(20)  "Clinic" for the purposes of personal injury
178	protection insurance means those entities defined in s.
179	400.9905(4).
180	(21)  "Procedurally appropriate" means that care which
181	ensures a reasonable standard of care for the health and well
182	being of the patient and:
183	a.  Is performed in conformity with the treatment protocols
184	generally recognized within the licensing chapter of the
185	provider;
186	b.  Is generally recommended for treatment of similar
187	injuries by licensed professionals, licensed under the same
188	chapter; and
189	c.  Follows an appropriate system, rule, guide, policy or
190	method for which an unavoidable, essential or urgent need is
191	established.
192	(22) "Noneconomic" or "general" damages means all damages,
193	by whatever name, that are indefinite or for which an actual
194	dollar figure cannot be measured, including damages for pain,
195	suffering, mental anguish, physical impairment, loss of capacity
196	to enjoy life, and inconvenience arising from bodily injury,
197	sickness, or disease arising out of the ownership, maintenance,
198	operation, or use of a motor vehicle. The term also includes
199	damages under derivative suits for general or non-economic
200	damages such as damages for loss of consortium.
201	(23)  "Florida Diagnostic Testing Facility" means a clinic
202	licensed pursuant to s. 400.991 that performs the technical
203	component of magnetic resonance imaging, computed  tomography or
204	position emission tomography and also provides the professional
205	components of such services through either an employee or
206	independent contractor, in a fixed facility, that is accredited
207	by the Joint Commission on Accreditation of Healthcare
208	Organizations and the American College of Radiology and:
209	(a)  Does not accept patient referrals prohibited by s.
210	456.053(5);
211	(b)  Does not directly or indirectly provide any services
212	to patients other than magnetic resonance imaging, computed
213	tomography or position emission tomography; and
214	(c)  Is affiliated through joint indirect or direct
215	ownership of no less than 50 percent, with 4 or more other
216	clinics that meet the requirements of this section.
217	Section 4.  Effective October 1, 2006, section 627.736,
218	Florida Statutes, is amended to read:
219	(Substantial rewording of section. See s.
220	627.736, F.S., for current text.)
221	627.736  Required personal injury protection benefits;
222	exclusions; priority; claims.--
223	(1)  REQUIRED PERSONAL INJURY PROTECTION BENEFITS.--Every
224	insurance policy complying with the security requirements of s.
225	627.733 shall provide personal injury protection to the named
226	insured, relatives residing in the same household, persons
227	operating the insured motor vehicle, passengers in such motor
228	vehicle, and other persons struck by such motor vehicle and
229	suffering bodily injury while not an occupant of a self-
230	propelled vehicle, subject to the provisions of this section to
231	a limit of $10,000 for loss sustained by any such person as a
232	result of bodily injury, sickness, disease, or death arising out
233	of the ownership, maintenance, or use of a motor vehicle as
234	follows:
235	(a)  Medical benefits.--Eighty percent of all reasonable
236	expenses for medically necessary medical, surgical, X-ray,
237	dental, and rehabilitative services, including prosthetic
238	devices, and medically necessary ambulance, hospital, and
239	nursing services. Such benefits shall also include necessary
240	remedial treatment and services recognized and permitted under
241	the laws of the state for an injured person who relies upon
242	spiritual means through prayer alone for healing, in accordance
243	with his or her religious beliefs; however, this sentence does
244	not affect the determination of what other services or
245	procedures are medically necessary.
246	(b)1.  Disability benefits.--Sixty percent of any loss of
247	gross income and loss of earning capacity per individual from
248	inability to work proximately caused by the injury sustained by
249	the injured person, plus all expenses reasonably incurred in
250	obtaining from others ordinary and necessary services in lieu of
251	those that, but for the injury, the injured person would have
252	performed without income for the benefit of his or her
253	household. All disability benefits payable under this provision
254	shall be paid not less than every 2 weeks.
255	2.  An injured person who is self employed or an injured
256	person who owns over a 25-percent interest in his or her
257	employer, as a condition precedent to payment for lost wages,
258	must produce to the insurer reasonable proof as to the injured
259	person's net income and loss of earning capacity or additional
260	expense, such that the insurer may reasonably calculate the
261	amount of the loss of income.
262	3.  Every employer shall, if a request is made by an
263	insurer providing personal injury protection benefits under ss.
264	627.730-627.7405 against whom a claim has been made, furnish
265	expeditiously, in a form approved by the office, a sworn
266	statement of the earnings, since the time of the bodily injury
267	and for a 13 week period before the injury, of the person upon
268	whose injury the claim is based.
269	4.  If the insured elects to have disability benefits
270	reserved for lost wages, the insured shall notify the insurer in
271	writing. Receipt of such notification shall take priority over
272	all claims subject to an assignment of benefits received after
273	receipt of such notice, except that receipt of a properly
274	perfected hospital lien received by the insurer shall take
275	priority over the insured's election to reserve all benefits for
276	lost wages.
277	(c)  Death benefits.--Death benefits of $5,000 per
278	individual. The insurer may pay such benefits to the executor or
279	administrator of the deceased, to any of the deceased's
280	relatives by blood or legal adoption or connection by marriage,
281	or to any person appearing to the insurer to be equitably
282	entitled thereto.
283
284	Only insurers writing motor vehicle liability insurance in this
285	state may provide the required benefits of this section, and no
286	such insurer shall require the purchase of any other motor
287	vehicle coverage other than the purchase of property damage
288	liability coverage as required by s. 627.7275 as a condition for
289	providing such required benefits. Insurers may not require that
290	property damage liability insurance in an amount greater than
291	$10,000 be purchased in conjunction with personal injury
292	protection. Such insurers shall make benefits and required
293	property damage liability insurance coverage available through
294	normal marketing channels. Any insurer writing motor vehicle
295	liability insurance in this state who fails to comply with such
296	availability requirement as a general business practice shall be
297	deemed to have violated part IX of chapter 626, and such
298	violation shall constitute an unfair method of competition or an
299	unfair or deceptive act or practice involving the business of
300	insurance; and any such insurer committing such violation shall
301	be subject to the penalties afforded in such part, as well as
302	those which may be afforded elsewhere in the insurance code.
303	(2)  AMOUNT OF PROPERTY DAMAGE COVERAGE.--
304	(a)  Only insurers writing motor vehicle liability
305	insurance in this state may provide the required benefits of
306	this section, and no such insurer shall require the purchase of
307	any other motor vehicle coverage other than the purchase of
308	property damage liability coverage as required by s. 627.7275 as
309	a condition for providing such required benefits.
310	(b)  Insurers may not require that property damage
311	liability insurance in an amount greater than $10,000 be
312	purchased in conjunction with personal injury protection. Such
313	insurers shall make benefits and required property damage
314	liability insurance coverage available through normal marketing
315	channels. Any insurer writing motor vehicle liability insurance
316	in this state who fails to comply with such availability
317	requirement as a general business practice shall be deemed to
318	have violated part IX of chapter 626, and such violation shall
319	constitute an unfair method of competition or an unfair or
320	deceptive act or practice involving the business of insurance;
321	and any such insurer committing such violation shall be subject
322	to the penalties afforded in such part, as well as those which
323	may be afforded elsewhere in the insurance code.
324	(3)  AUTHORIZED EXCLUSIONS.--Any insurer may exclude
325	benefits:
326	(a)  For injury sustained by the named insured and
327	relatives residing in the same household while occupying another
328	motor vehicle owned by the named insured and not insured under
329	the policy or for injury sustained by any person operating the
330	insured motor vehicle without the express or implied consent of
331	the insured.
332	(b)  To any injured person, if such person's conduct
333	contributed to his or her injury under any of the following
334	circumstances:
335	1.  Intentionally causing injury or making a claim for an
336	injury to himself or herself;
337	2.  Being injured while committing a felony; or
338	3.  Being injured while attempting to flee or elude arrest
339	or detainment by a law enforcement officer.
340
341	Whenever an insured is charged with conduct as set forth in this
342	subsection, the 30-day payment provision of paragraph (4)(b)
343	shall be held in abeyance, and the insurer shall withhold
344	payment of any personal injury protection benefits pending the
345	outcome of the case at the trial level. If the charge is nolle
346	prossed or dismissed or the insured is acquitted, the 30-day
347	payment provision shall run from the date the insurer is
348	notified of such action.
349	(4)  INSURED'S RIGHTS TO RECOVERY OF SPECIAL DAMAGES IN
350	TORT CLAIMS.--No insurer shall have a lien on any recovery in
351	tort by judgment, settlement, or otherwise for personal injury
352	protection benefits, whether suit has been filed or settlement
353	has been reached without suit. An injured person who is entitled
354	to bring suit under ss. 627.730-627.7405, or his or her legal
355	representative, has no right to recover any damages for which
356	personal injury protection benefits are paid, payable, or
357	otherwise available. The plaintiff may prove all of his or her
358	special damages notwithstanding this limitation, but if special
359	damages are introduced in evidence, the trier of facts, whether
360	judge or jury, shall not award damages for personal injury
361	protection benefits paid, payable, or otherwise available.
362	Effective October 1, 2006, only a physician licensed under
363	chapter 458 or chapter 459 may render an opinion as to whether
364	the requirements of s. 627.737(2)(b) have been met. In all cases
365	in which a jury is required to fix damages, the court shall
366	instruct the jury that the plaintiff shall not recover such
367	special damages for personal injury protection benefits paid,
368	payable, otherwise available, or for damages not lawfully
369	rendered or not compensable under s. 627.736.
370	(5)  MEDICAL FEE SCHEDULE.--As used in this section, the
371	term "reasonable amount" shall not be an amount in excess of the
372	following:
373	(a)  For hospitals licensed pursuant to this chapter, 75
374	percent of billed charges, except as otherwise provided. In no
375	event may billed charges be in excess of the amount the hospital
376	charges other patients.
377	(b)  For a health care provider providing treatment of an
378	emergency medical condition as defined in s. 395.002(9) within
379	48 hours of the date of loss, usual and customary charges for
380	the provision of such treatment.
381	(c)  Except for emergency services and care provided
382	pursuant to s. 395.002 within 48 hours after the date of a loss,
383	a health care provider or service provider's charges in excess
384	of 200 percent of the maximum allowance for each procedure as
385	set forth in the Medicare Part B participating fee schedule in
386	effect at the time services are performed for the region in
387	which services are performed are presumed to be unreasonable.
388	The presumptions provided in the subsection do not limit the
389	introduction of other evidence regarding whether the charges
390	were reasonable in amount for like services provided in the same
391	geographic region.
392	(6)  NONREIMBURSABLE SERVICES.--The Department of Health,
393	in consultation with the appropriate professional licensing
394	boards, shall adopt, by rule, a list of diagnostic tests deemed
395	not to be medically necessary for use in the treatment of
396	persons sustaining bodily injury covered by personal injury
397	protection benefits under this section. The list shall be
398	revised from time to time as determined by the Department of
399	Health, in consultation with the respective professional
400	licensing boards. Inclusion of a test on the list of invalid
401	diagnostic tests shall be based on lack of demonstrated medical
402	value and a level of general acceptance by the relevant provider
403	community and shall not be dependent for results entirely upon
404	subjective patient response. Notwithstanding its inclusion on a
405	fee schedule in this section, an insurer or insured is not
406	required to pay any charges or reimburse claims for any invalid
407	diagnostic test as determined by the Department of Health.
408	(7)  REQUIRED PAYMENT OF BENEFITS.--The insurer of the
409	owner of a motor vehicle shall pay personal injury protection
410	benefits for:
411	(a)  Accidental bodily injury sustained in this state by
412	the owner while occupying a motor vehicle, or while not an
413	occupant of a self-propelled vehicle if the injury is caused by
414	physical contact with a motor vehicle.
415	(b)  Accidental bodily injury sustained outside this state,
416	but within the United States of America or its territories or
417	possessions or Canada, by the owner while occupying the owner's
418	motor vehicle or if the injury is caused by physical contact
419	with a motor vehicle.
420	(c)  Accidental bodily injury sustained by a relative of
421	the owner residing in the same household, under the
422	circumstances described in paragraphs (a) and (b), provided the
423	relative at the time of the accident is domiciled in the owner's
424	household and is not the owner of a motor vehicle with respect
425	to which security is required under ss. 627.730-627.7405.
426	(d)  Accidental bodily injury sustained in this state by
427	any other person while occupying the owner's motor vehicle or,
428	if a resident of this state, while not an occupant of a self-
429	propelled vehicle, if the injury is caused by physical contact
430	with such motor vehicle, provided the injured person is not:
431	1.  The owner of a motor vehicle with respect to which
432	security is required under ss. 627.730-627.7405; or
433	2.  Entitled to personal injury benefits from the insurer
434	of the owner or owners of such a motor vehicle.
435	(e)  If two or more insurers are liable to pay personal
436	injury protection benefits for the same injury to any one
437	person, the maximum payable shall be as specified in subsection
438	(1), and any insurer paying the benefits shall be entitled to
439	recover from each of the other insurers an equitable pro rata
440	share of the benefits paid and expenses incurred in processing
441	the claim.
442	(8)  CLAIMS SUBMISSION.--Benefits due from an insurer under
443	ss. 627.730-627.7405 shall be primary, except that benefits
444	received under any workers' compensation law shall be credited
445	against the benefits provided by subsection (1) and shall be due
446	and payable as loss accrues, upon receipt of reasonable proof of
447	such loss and the amount of expenses and loss incurred which are
448	covered by the policy issued under ss. 627.730-627.7405, subject
449	to the following:
450	(a)  Personal injury protection application.--An insurer
451	may require written notice to be given as soon as practicable
452	after an accident involving a motor vehicle with respect to
453	which the policy affords the security required by ss. 627.730-
454	627.7405. If the injured person is a minor, the parent or legal
455	guardian of the minor, if requested by the insurer, shall
456	accurately complete the personal injury protection application.
457	(b)  Billing requirements; charges for treatment of injured
458	persons.--
459	1.  Any physician, hospital, clinic, or other person or
460	institution lawfully rendering treatment to an injured person
461	for a bodily injury covered by personal injury protection
462	insurance may charge the insurer and injured party only a
463	reasonable amount pursuant to this section for the services and
464	supplies rendered, and the insurer providing such coverage may
465	pay for such charges directly to the person or institution
466	lawfully rendering such treatment, if the insured receiving the
467	treatment, or his or her guardian has authorized by
468	countersigning the properly completed invoice, bill, or claim
469	form approved by the office upon which such charges are to be
470	paid as having actually been rendered, to the best knowledge of
471	the insured or his or her guardian. In no event, however, may a
472	charge be in excess of the amount the person or institution
473	customarily charges for like services or supplies. With respect
474	to a determination of whether a charge for a particular service,
475	treatment, or otherwise is reasonable, consideration may be
476	given to evidence of usual and customary charges and payments
477	accepted by the provider involved in the dispute, and
478	reimbursement levels in the community, and various federal and
479	state medical fee schedules applicable to automobile and other
480	insurance coverages, and other information relevant to the
481	reasonableness of the reimbursement for the service, treatment,
482	or supply.
483	2.  All statements and bills for medical services rendered
484	by any physician, hospital, clinic, or other person or
485	institution shall be submitted to the insurer on a properly
486	completed Centers for Medicare and Medicaid Services (CMS) 1500
487	form or a UB 92 form, or successor forms for such forms, or any
488	other standard form approved by the office or adopted by the
489	commission.
490	3.  All billings for such services, procedures, and
491	supplies submitted by health care providers and medical
492	suppliers shall comply with the Healthcare Correct Procedural
493	Coding System (HCPCS) and International Classification of
494	Diseases (ICD-9-CM) in effect for the year in which services are
495	rendered.
496	4.  All claims forms submitted by health care providers and
497	medical suppliers other than hospitals and physicians providing
498	emergency care and services shall include on the applicable
499	claim form the signature and professional license number of the
500	provider who rendered the service in the line or space provided
501	for "Signature of Physician or Supplier, Including Degrees or
502	Credentials" and the date of the signature.
503	5.  Charges for medically necessary cephalic thermograms,
504	peripheral thermograms, spinal ultrasounds, extremity
505	ultrasounds, video fluoroscopy, and surface electromyography
506	shall not exceed the maximum reimbursement allowance for such
507	procedures as set forth in the applicable fee schedule or other
508	payment methodology established pursuant to s. 440.13.
509	6.  Allowable amounts that may be charged to a personal
510	injury protection insurance insurer and insured for medically
511	necessary nerve conduction testing when done in conjunction with
512	a needle electromyography procedure and both are performed and
513	billed solely by a physician licensed under chapter 458, chapter
514	459, chapter 460, or chapter 461 who is also certified by the
515	American Board of Electrodiagnostic Medicine or by a board
516	recognized by the American Board of Medical Specialties or the
517	American Osteopathic Association or who holds diplomate status
518	with the American Chiropractic Neurology Board or its
519	predecessors shall not exceed 200 percent of the allowable
520	amount under the participating physician fee schedule of
521	Medicare Part B for year 2001, for the area in which the
522	treatment was rendered, adjusted annually on August 1 to reflect
523	the prior calendar year's changes in the annual Medical Care
524	Item of the Consumer Price Index for All Urban Consumers in the
525	South Region as determined by the Bureau of Labor Statistics of
526	the United States Department of Labor.
527	7.  Allowable amounts that may be charged to a personal
528	injury protection insurance insurer and insured for medically
529	necessary nerve conduction testing that does not meet the
530	requirements of subparagraph 3 shall not exceed the applicable
531	fee schedule or other payment methodology established pursuant
532	to s. 440.13.
533	8.  Allowable amounts that may be charged to a personal
534	injury protection insurance insurer and insured for magnetic
535	resonance imaging services shall not exceed 175 percent of the
536	allowable amount under the participating physician fee schedule
537	of Medicare Part B for year 2001, for the area in which the
538	treatment was rendered, adjusted annually on August 1 to reflect
539	the prior calendar year's changes in the annual Medical Care
540	Item of the Consumer Price Index for All Urban Consumers in the
541	South Region as determined by the Bureau of Labor Statistics of
542	the United States Department of Labor for the 12-month period
543	ending June 30 of that year, except that allowable amounts that
544	may be charged to a personal injury protection insurance insurer
545	and insured for magnetic resonance imaging services provided in
546	facilities accredited by the Accreditation Association for
547	Ambulatory Health Care, the American College of Radiology, or
548	the Joint Commission on Accreditation of Healthcare
549	Organizations shall not exceed 200 percent of the allowable
550	amount under the participating physician fee schedule of
551	Medicare Part B for year 2001, for the area in which the
552	treatment was rendered, adjusted annually on August 1 to reflect
553	the prior calendar year's changes in the annual Medical Care
554	Item of the Consumer Price Index for All Urban Consumers in the
555	South Region as determined by the Bureau of Labor Statistics of
556	the United States Department of Labor for the 12-month period
557	ending June 30 of that year. This paragraph does not apply to
558	charges for magnetic resonance imaging services and nerve
559	conduction testing for inpatients and treatment for emergency
560	services and care as defined in s. 395.002(10) rendered by
561	facilities licensed under chapter 395.
562	9.  A statement of medical services may not include charges
563	for medical services of a person or entity that rendered such
564	services without possessing all valid qualifications and
565	licenses required to lawfully provide and bill for such
566	services.
567	10.  For purposes of subsection (9), an insurer shall not
568	be considered to have been furnished with notice of the amount
569	of covered loss or medical bills due unless the statements or
570	bills comply with this paragraph, and unless the statements or
571	bills are properly completed in their entirety as to all
572	material provisions, with all required information being
573	provided therein.
574	(c)  Direct billing an insurer for personal injury
575	protection benefits.--
576	1.  The insurer providing such coverage may pay for such
577	charges directly to the insured or the insured's assignee.
578	2.  The insured receiving such treatment or his or her
579	guardian, if a minor, shall countersign the properly completed
580	CMS 1500. This shall not apply to any bill submitted by a
581	hospital licensed pursuant to chapter 395, for emergency
582	services and care as defined in s. 395.002(10), for emergency
583	transport and treatment rendered by an ambulance provider
584	licensed pursuant to part III of chapter 401, or for or for
585	magnetic resonance imaging (MRI), static radiographs (static x
586	ray), computed tomography, position emission tomography and
587	approved diagnostic procedures rendered in a clinic as defined
588	by s. 400.9905(4).
589	3.  Notwithstanding the exhaustion of benefits, to the
590	extent services are not lawfully rendered or not compensable
591	under any section of this statute, the insured is relieved of
592	any responsibility for the services.
593	4.  All health care providers who provide personal injury
594	protection services shall retain all patient medical records
595	that justify the course of treatment of the patient, including,
596	but not limited to, patient histories; examination results; test
597	and laboratory results; records of drugs prescribed, dispensed,
598	or administered; and reports of consultations and
599	hospitalizations, along with other similar or pertinent
600	information, for at least 5 years from the last patient contact.
601	5.  A health care provider or service provider, a clinic's
602	medical director and clinical director, have a duty to the
603	insurer to make certain each claim submitted is true and
604	accurate and is for goods or services rendered.
605	(d)  Nonemergency services.--With respect to any treatment
606	or service, other than medical services billed by a hospital or
607	other provider for treatment of emergency services and care as
608	defined in s. 395.002(10) or inpatient services rendered at a
609	hospital-owned facility, the statement of charges must be
610	furnished to the insurer by the provider and may not include,
611	and the insurer is not required to pay, charges for treatment or
612	services rendered more than 35 days before the postmark date of
613	the statement, except for the following:
614	1.  Past due amounts previously billed on a timely basis
615	under this subsection.
616	2.  If the insured fails to furnish the provider with the
617	correct name and address of the insured's personal injury
618	protection insurer, the provider has 35 days from the date the
619	provider obtains the correct information to furnish the insurer
620	with a statement of the charges. The insurer is not required to
621	pay for such charges unless the provider includes with the
622	statement documentary evidence that was provided by the insured
623	during the 35-day period demonstrating that the provider
624	reasonably relied on erroneous information from the insured and
625	either:
626	a.  A denial letter from the incorrect insurer; or
627	b.  Proof of mailing, which may include an affidavit under
628	penalty of perjury, reflecting timely mailing to the incorrect
629	address or insurer.
630	(e)  Emergency services.--
631	1.  For emergency services and care as defined in s.
632	395.002(10) rendered by a physician in a hospital emergency
633	department, by a physician in a hospital emergency department,
634	or for transport and treatment rendered by an ambulance provider
635	licensed pursuant to part III of chapter 401, the provider shall
636	submit a statement of charges within 75 days after the date of
637	treatment or discharge, whichever is applicable. The insurer
638	shall not be considered to have been furnished with notice of
639	the amount of a covered loss for purposes of subsection (9)
640	until the insurer receives a statement complying with subsection
641	(7), or a copy thereof, which specifically identifies the place
642	of service to be a hospital emergency department or an
643	ambulance.
644	2.  The injured person is not liable for, and the provider
645	shall not bill the injured person for, charges that are unpaid
646	because of the provider's failure to comply with this paragraph.
647	Any agreement requiring the injured person or insured to pay for
648	such charges is unenforceable.
649	3.  For emergency services and care as defined in s.
650	395.002 (10) rendered in a hospital, the health care provider is
651	not required to comply with ss. (8)(c)2. and (9) of this
652	section.
653	4.  In determining whether claims forms have been submitted
654	as required by this paragraph, a claim is considered submitted
655	on the date placed in the United States mail in a properly
656	addressed, postpaid envelope or, if not so posted by mail, on
657	the date of delivery to the insurer.
658	(f)  Billing notice and disclosures.--Each notice of
659	insured's rights under s. 627.7401 must include the following
660	statement in type no smaller than 12-point font:
661	BILLING REQUIREMENTS.--Florida Statutes provide that with
662	respect to any treatment or services, other than certain
663	hospital and emergency services, the statement of charges
664	furnished to the insurer by the provider may not include, and
665	the insurer and the injured person are not required to pay,
666	charges for treatment or services rendered more than 35 days
667	before the postmark date of the statement, except for past due
668	amounts previously billed on a timely basis.
669	(9)  ASSIGNMENT OF BENEFITS.--
670	(a)  Personal injury protection benefits are not
671	assignable, except that the insured may assign the after-loss
672	personal injury protection benefits to any health care provider
673	sufficient to cover any cost or expense associated with the
674	provision of health care. Any such assignment of benefits covers
675	the provider's present and future medical expenses.
676	(b) An insured may execute an assignment of benefits to
677	different health care providers. All such assignments of
678	benefits are irrevocable. The insurer shall pay the claims when
679	the insurer obtains sufficient information to determine that the
680	claims are properly payable. The insurer is not required to
681	reserve personal injury protection benefits for any provider
682	during the investigation of its bills.
683	(c)  An assignment of personal injury protection benefits
684	to the provider shall be deemed a novation. The insured is
685	relieved of all obligations for the medical bills once an
686	assignment of benefits is executed. Any agreement requiring the
687	injured person or insured to pay for charges is unenforceable.
688	Notwithstanding such assignment of benefits, the insured shall
689	be responsible for the provider's properly payable bills once
690	the personal injury protection benefits have been exhausted.
691	(d)  A provider's attorney's fees shall not be recoverable
692	pursuant to s. 627.428 if the provider did not accept a valid
693	assignment of benefits. A valid assignment of benefits must
694	contain the words: "I irrevocably assign my benefits to..." and
695	does not create any personal liability for the insured to the
696	extent personal injury protection benefits are available and
697	properly payable.
698	(e)  If the insured's actions result in no coverage for the
699	loss, or if the insured notifies the insurer in writing of his
700	or her election to use all personal injury protection benefits
701	for disability benefits, the assignment of benefits received
702	before or after such notice shall be deemed void as a matter of
703	law.
704	(f) To the extent that the insured's obligations in a
705	direction to pay or a letter of protection conflict with the
706	insurer's obligation pursuant to the assignment of benefits, the
707	assignment of benefits shall void the terms of the direction to
708	pay and letter of protection that contradict any provision of
709	the assignment of benefits.
710	(g)  For the purposes of this subsection, the term:
711	1.  "Letter of protection" means an agreement between a
712	health care provider and an insured in which the health care
713	provider agrees to postpone its right to immediate payment in
714	exchange for the insured's agreeing to pay the health care
715	provider out of the proceeds of any settlement or judgment
716	resulting from a bodily injury or uninsured motorist claim.
717	2.  "Direction to pay" means a written instruction from the
718	insured to the insurer directing the insurer to pay the health
719	care provider directly.
720	(10)  OVERDUE PERSONAL INJURY PROTECTION BENEFITS.--
721	(a)  Personal injury protection insurance benefits paid
722	pursuant to this section shall be overdue if not paid within 30
723	days after the insurer is furnished written notice of the amount
724	of a covered loss, including a properly completed CMS 1500 or UB
725	92 form, medical records, assignment of benefits, or, in the
726	case of disability benefits, properly written documentation of
727	the claim. If such written notice is not furnished to the
728	insurer as to the entire claim, any partial amount supported by
729	written notice is overdue if not paid within 30 days after such
730	written notice is furnished to the insurer. Any part or all of
731	the remainder of the claim that is subsequently supported by
732	written notice is overdue if not paid within 30 days after such
733	written notice is furnished to the insurer. When an insurer pays
734	only a portion of a claim or rejects a claim, the insurer shall
735	provide at the time of the partial payment or rejection an
736	itemized specification of each item that the insurer had
737	reduced, omitted, or declined to pay and any information that
738	the insurer desires the claimant to consider related to the
739	medical necessity of the denied treatment or to explain the
740	reasonableness of the reduced charge, provided that this shall
741	not limit the introduction of evidence at trial; and the insurer
742	shall include the name and address of the person to whom the
743	claimant should respond and a claim number to be referenced in
744	future correspondence. However, notwithstanding the fact that
745	written notice has been furnished to the insurer, any payment
746	shall not be deemed overdue when the insurer has reasonable
747	proof to establish that the insurer is not responsible for the
748	payment.
749	(b)  This paragraph does not preclude or limit the ability
750	of the insurer to assert that the claim was unrelated, was for
751	services not lawfully performed, was not medically necessary, or
752	was unreasonable or that the amount of the charge was in excess
753	of that permitted under, or in violation of, this section. Such
754	assertion by the insurer may be made at any time, including
755	after payment of the claim or after the 30-day time period for
756	payment set forth in this subsection.
757	(c)  It is a violation of the insurance code for an insurer
758	to fail to timely provide benefits as required by this section
759	with such frequency as to constitute a general business
760	practice.
761	(d)  Benefits shall not be due or payable to or on the
762	behalf of an insured person if that person has committed, by a
763	material act or omission, any insurance fraud relating to
764	personal injury protection coverage under his or her policy, if
765	the fraud is admitted to in a sworn statement by the insured or
766	if it is established in a court of competent jurisdiction. Any
767	insurance fraud shall void all coverage arising from the claim
768	related to such fraud under the personal injury protection
769	coverage of the insured person who committed the fraud,
770	irrespective of whether a portion of the insured person's claim
771	may be legitimate, and any benefits paid prior to the discovery
772	of the insured person's insurance fraud shall be recoverable by
773	the insurer from the person who committed insurance fraud in
774	their entirety. The prevailing party is entitled to its costs
775	and attorney's fees in any action in which it prevails in an
776	insurer's action to enforce its right of recovery under this
777	paragraph.
778	(11)  CALCULATION OF TIME OF PAYMENT.--For the purpose of
779	calculating the extent to which any benefits are overdue,
780	payment shall be treated as being made on the date a draft or
781	other valid instrument that is equivalent to payment was placed
782	in the United States mail in a properly addressed, postpaid
783	envelope or, if not so posted, on the date of delivery.
784	(12)  INTEREST ON OVERDUE PAYMENTS.--All overdue payments
785	shall bear simple interest at the rate established under s.
786	55.03 or the rate established in the insurance contract,
787	whichever is greater, for the year in which the payment became
788	overdue, calculated from the date the insurer was furnished with
789	written notice of the amount of covered loss. In the case of
790	payment made by an insurer to the insured, or insured's
791	assignee, interest shall be due at the time payment of the
792	overdue claim is made. All amounts repayable to the insurer
793	shall bear simple interest at the rate established under s.
794	55.03 for the year in which the payment became repayable,
795	calculated from the date the insurer tendered payment.
796	(13)  CLAIMS NOT PROPERLY PAYABLE.--An insurer or insured
797	is not required to pay a claim or charges:
798	(a)  For any service or treatment that was not lawful at
799	the time rendered;
800	(b)  To any person who knowingly submits a false or
801	misleading statement relating to the claim or charges;
802	(c)  With respect to a bill or statement that does not
803	substantially meet the applicable requirements of paragraph
804	(7)(b);
805	(d)  For any treatment or service that is upcoded, or that
806	is unbundled when such treatment or services should be bundled,
807	in accordance with subsection (8). To facilitate prompt payment
808	of lawful services, an insurer may change codes that it
809	determines to have been improperly or incorrectly upcoded or
810	unbundled, and may make payment based on the changed codes,
811	without affecting the right of the provider to dispute the
812	change by the insurer, provided that before doing so, the
813	insurer must contact the health care provider and discuss the
814	reasons for the insurer's change and the health care provider's
815	reason for the coding, or make a reasonable good faith effort to
816	do so, as documented in the insurer's file; and
817	(e)  For medical services or treatment billed by a
818	physician and not provided in a hospital unless such services
819	are rendered by the physician or are incident to his or her
820	professional services and are included on the physician's bill,
821	including documentation verifying that the physician is
822	responsible for the medical services that were rendered and
823	billed.
824	(14)  VENUE.--Venue for any personal injury protection
825	claim shall be in the jurisdiction where the insured resides,
826	where the accident occurs, or, in the case of an assignment of
827	benefits, where the disputed health care services were
828	performed. Venue may be raised at any time. The cost of
829	transferring venue shall be borne by the plaintiff, and such
830	costs shall not be recoverable as plaintiff's damages.
831	(15)  DEMAND LETTER.--
832	(a)  As a condition precedent to filing any action for
833	benefits under this section, the insurer must be provided with
834	written notice of an intent to initiate litigation. Such notice
835	may not be sent until the claim is overdue, including any
836	additional time the insurer has to pay the claim pursuant to
837	subsection (9).
838	(b)  The notice required shall state that it is a "demand
839	letter under s. 627.736(15)" and shall state with specificity:
840	1.  The name of the insured upon whom such benefits are
841	being sought, including a copy of the assignment giving rights
842	to the claimant if the claimant is not the insured.
843	2.  The claim number or policy number upon which such claim
844	was originally submitted to the insurer.
845	3.  To the extent applicable, the name of any medical
846	provider who rendered to an insured the treatment, services,
847	accommodations, or supplies that form the basis of such claim;
848	and an itemized statement specifying each exact amount, the date
849	of treatment, service, or accommodation, and the type of benefit
850	claimed to be due. A completed form satisfying the requirements
851	of subsection (7) or the lost-wage statement previously
852	submitted may be used as the itemized statement. To the extent
853	that the demand involves an insurer's withdrawal of payment
854	under subsection (17) for future treatment not yet rendered, the
855	claimant shall attach an itemized statement of the type,
856	frequency, and duration of future treatment claimed to be
857	reasonable and medically necessary.
858	(c)  Each notice required by this subsection must be
859	delivered to the insurer by United States certified or
860	registered mail, return receipt requested. Such postal costs
861	shall be reimbursed by the insurer if so requested by the
862	claimant in the notice, when the insurer pays the claim. Such
863	notice must be sent to the person and address specified by the
864	insurer for the purposes of receiving notices under this
865	subsection. Each licensed insurer, whether domestic, foreign, or
866	alien, shall file with the office designation of the name and
867	address of the person to whom notices pursuant to this
868	subsection shall be sent which the office shall make available
869	on its Internet website. The name and address on file with the
870	office pursuant to s. 624.422 shall be deemed the authorized
871	representative to accept notice pursuant to this subsection in
872	the event no other designation has been made.
873	(d)  If, within 21 days after receipt of notice by the
874	insurer, the overdue claim specified in the notice is paid by
875	the insurer together with applicable interest and a penalty of
876	10 percent of the overdue amount paid by the insurer, subject to
877	a maximum penalty of $350, no action may be brought against the
878	insurer. If the demand involves an insurer's withdrawal of
879	payment under subsection (17) for future treatment not yet
880	rendered, no action may be brought against the insurer if,
881	within 21 days after its receipt of the notice, the insurer
882	mails to the person filing the notice a written statement of the
883	insurer's agreement to pay for such treatment in accordance with
884	the notice and to pay a penalty of 10 percent, subject to a
885	maximum penalty of $350, when it pays for such future treatment
886	in accordance with the requirements of this section. To the
887	extent the insurer determines not to pay any amount demanded,
888	the penalty shall not be payable in any subsequent action. For
889	purposes of this subsection, payment or the insurer's agreement
890	shall be treated as being made on the date a draft or other
891	valid instrument that is equivalent to payment, or the insurer's
892	written statement of agreement, is placed in the United States
893	mail in a properly addressed, postpaid envelope, or if not so
894	posted, on the date of delivery. The insurer is not obligated to
895	pay any attorney's fees if the insurer pays the claim or mails
896	its agreement to pay for future treatment within the time
897	prescribed by this subsection.
898	(e)  The applicable statute of limitation for an action
899	under this section shall be tolled for a period of 21 business
900	days by the mailing of the notice required by this subsection.
901	(f)  Any insurer making a general business practice of not
902	paying valid claims until receipt of the notice required by this
903	subsection is engaging in an unfair trade practice under the
904	insurance code.
905	(16)  PATIENT LOG.--The provider must maintain a patient
906	log signed by the patient, in chronological order by date of
907	service, that is consistent with the services being rendered to
908	the patient as claimed. The requirements of this subsection
909	subparagraph for maintaining a patient log signed by the patient
910	may be met by a hospital that maintains medical records as
911	required by s. 395.3025 and applicable rules and makes such
912	records available to the insurer upon request.
913	(f)  Upon written notification by any person, an insurer
914	shall investigate any claim of improper billing by a physician
915	or other medical provider. The insurer shall determine if the
916	insured was properly billed for only those services and
917	treatments that the insured actually received. If the insurer
918	determines that the insured has been improperly billed, the
919	insurer shall notify the insured, the person making the written
920	notification and the provider of its findings and shall reduce
921	the amount of payment to the provider by the amount determined
922	to be improperly billed. If a reduction is made due to such
923	written notification by any person, the insurer shall pay to the
924	person 20 percent of the amount of the reduction, up to $500. If
925	the provider is arrested due to the improper billing, then the
926	insurer shall pay to the person 40 percent of the amount of the
927	reduction, up to $500.
928	(g)  An insurer may not systematically downcode with the
929	intent to deny reimbursement otherwise due. Such action
930	constitutes a material misrepresentation under s.
931	626.9541(1)(i)2.
932	(17)(6)  DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
933	DISPUTES.--
934	(a)  Every employer shall, if a request is made by an
935	insurer providing personal injury protection benefits under ss.
936	627.730-627.7405 against whom a claim has been made, furnish
937	forthwith, in a form approved by the office, a sworn statement
938	of the earnings, since the time of the bodily injury and for a
939	reasonable period before the injury, of the person upon whose
940	injury the claim is based.
941	(a)(b)  Every physician, hospital, clinic, or other medical
942	institution providing, before or after bodily injury upon which
943	a claim for personal injury protection insurance benefits is
944	based, any products, services, or accommodations in relation to
945	that or any other injury, or in relation to a condition claimed
946	to be connected with that or any other injury, shall, if
947	requested to do so by the insurer against whom the claim has
948	been made:,
949	1.  Furnish forthwith a written report of the history,
950	condition, treatment, dates, and costs of such treatment of the
951	injured person and why the items identified by the insurer were
952	reasonable in amount and medically necessary lawfully rendered
953	and procedurally appropriate.,
954	2.  Provide together with a sworn statement that the
955	treatment or services rendered were reasonable and necessary
956	with respect to the bodily injury sustained.  Such sworn
957	statement shall read as follows:  "Under penalty of perjury, I
958	declare that I have read the foregoing, and the facts alleged
959	are true, to the best of my knowledge and belief."
960	3.  Identify which portion of the expenses for such
961	treatment or services was incurred as a result of such bodily
962	injury.
963	4.  Produce forthwith, and permit the inspection and
964	copying of, the records regarding such history, condition,
965	treatment, dates, and costs of treatment; provided that this
966	shall not limit the introduction of evidence at trial.
967	(b)  However, if the records are maintained at an
968	alternative location, the requested records shall be made
969	available at the principal place of business within 15 working
970	days after the request. Failure of the health care or service
971	provider to produce the requested records shall preclude the
972	health care or service provider from maintaining any action,
973	against the insured or insurer, to obtain payment of the
974	insured's bill. At the time of the records inspection, the
975	health care provider shall allow the insurer to inspect and copy
976	records and photograph the equipment and associated documents
977	associated with the insured's treatment, services, or supplies.
978	(c) The insured, the assignee of the insured, the health
979	care provider, the providers' billing and medical records
980	custodian, or any other person seeking payment under an
981	automobile policy directly, or as an assignee, must submit to
982	examination under oath by any person named by the insurer. If an
983	examination under oath is requested of a health care provider
984	licensed under chapter 457, chapter 458, chapter 459, chapter
985	460, chapter 461, chapter 462, chapter 463, chapter 466, chapter
986	467, chapter 484, chapter 486, chapter 490, or chapter 491, part
987	I, part III, part X, part XIII, or part XIV of chapter 468, or
988	s. 464.012, the insurer shall pay the person $175 per hour for
989	attendance at the examination under oath. Time spent in
990	preparation for the examination under oath is noncompensable.
991	Once requested, the examination under oath is a condition
992	precedent to filing suit. The insurer may request one
993	examination under oath of the medical records or billing
994	custodian and one examination under oath of the health care
995	provider, per claim, to be conducted at a time, within 30 days
996	of the insurer's request, and location reasonably convenient to
997	the health care provider.
998	(d)  A cause of action for violation of the physician-
999	patient privilege or invasion of the right of privacy is not
1000	permitted against any physician, hospital, clinic, or other
1001	medical institution complying with this section.
1002	(e)  The person requesting such records and such sworn
1003	statement shall pay all reasonable costs connected therewith.
1004	(f)  If an insurer makes a written request for
1005	documentation or information under this paragraph within 30 days
1006	after having received notice of the amount of a covered loss
1007	under subsection (7), the amount or the partial amount that is
1008	the subject of the insurer's inquiry shall become overdue if the
1009	insurer does not pay in accordance with subsection (9) or within
1010	15 days after the insurer's receipt of the requested
1011	documentation or information, whichever occurs later. For
1012	purposes of this paragraph, the term "receipt" includes, but is
1013	not limited to, inspection and copying pursuant to this
1014	subsection.
1015	(g)  Any insurer that requests documentation or information
1016	pertaining to reasonableness of charges or medical necessity
1017	under this subsection without a reasonable basis for such
1018	requests as a general business practice is engaging in an unfair
1019	trade practice under the insurance code.
1020	(h)  In the event of any dispute regarding an insurer's
1021	right to discovery of facts under this section, the insurer may
1022	petition a court of competent jurisdiction to enter an order
1023	permitting such discovery. The order may be made only on motion
1024	for good cause shown and upon notice to all persons having an
1025	interest, and it shall specify the time, place, manner,
1026	conditions, and scope of the discovery. Such court may, in order
1027	to protect against annoyance, embarrassment, or oppression, as
1028	justice requires, enter an order refusing discovery or
1029	specifying conditions of discovery and may order payments of
1030	costs and expenses of the proceeding, including reasonable fees
1031	for the appearance of attorneys at the proceedings, as justice
1032	requires.
1033	(i)  The injured person shall be furnished, upon request, a
1034	copy of all information obtained by the insurer under the
1035	provisions of this section, and shall pay a reasonable charge,
1036	if required by the insurer.
1037	(j)  Notice to an insurer of the existence of a claim shall
1038	not be unreasonably withheld by an insured.  In no event may
1039	this notice be later than 1 year after the occurrence.
1040	(18)  INDEPENDENT MEDICAL EXAMINATIONS.--
1041	(a)  Whenever the mental or physical condition of an
1042	injured person covered by personal injury protection is material
1043	to any claim that has been or may be made for past or future
1044	personal injury protection insurance benefits, such person
1045	shall, upon the request of an insurer, submit to mental or
1046	physical examination by a physician or physicians.
1047	(b)  The costs of any examinations requested by an insurer
1048	shall be borne entirely by the insurer, except that, if the
1049	insured has unreasonably failed to appear for the examinations,
1050	the cost for nonappearance, if any, shall be paid by the insurer
1051	from the insured's available personal injury protection
1052	benefits.
1053	(c)  Such examination shall be conducted within the
1054	municipality where the insured is receiving treatment, or in a
1055	location reasonably accessible to the insured, which, for
1056	purposes of this paragraph, means any location within the
1057	municipality in which the insured resides, or any location
1058	within 10 miles by road of the insured's residence, provided
1059	such location is within the county in which the insured resides.
1060	(d)  If the examination is to be conducted in a location
1061	reasonably accessible to the insured, and if there is no
1062	qualified physician to conduct the examination in a location
1063	reasonably accessible to the insured, then such examination
1064	shall be conducted in an area of the closest proximity to the
1065	insured's residence.  The insurer shall pay, to the extent
1066	personal injury protection benefits are available, lost wages
1067	for time missed from work as a result of attending any such
1068	examination.
1069	(e)  Insurers are authorized to include reasonable
1070	provisions in personal injury protection insurance policies for
1071	mental and physical examination of those claiming personal
1072	injury protection insurance benefits.
1073	(f)  An insurer may not withdraw payment of a treating
1074	physician without the consent of the injured person covered by
1075	the personal injury protection, unless the insurer first obtains
1076	a valid report by a Florida physician licensed under the same
1077	chapter as the treating physician whose treatment authorization
1078	is sought to be withdrawn, stating that treatment was not
1079	reasonable, related, or necessary.
1080	(g)  A valid report is one that is prepared and signed by
1081	the physician examining the injured person or reviewing the
1082	treatment records of the injured person, or other relevant
1083	information if reviewed and that has not been modified by anyone
1084	other than the physician.  Such a report may be written by a
1085	physician who has reviewed the medical records of the insured,
1086	even if the physician has not physically examined the insured.
1087	(h)  The physician preparing the report must be in active
1088	practice, unless the physician is physically disabled. Active
1089	practice means that during the 3 years immediately preceding the
1090	date of the physical examination or review of the treatment
1091	records the physician must have devoted professional time to the
1092	active clinical practice of evaluation, diagnosis, or treatment
1093	of medical conditions or to the instruction of students in an
1094	accredited health professional school or accredited residency
1095	program or a clinical research program that is affiliated with
1096	an accredited health professional school or teaching hospital or
1097	accredited residency program.
1098	(i)  The physician preparing a report at the request of an
1099	insurer and physicians rendering expert opinions on behalf of
1100	persons claiming medical benefits for personal injury
1101	protection, or on behalf of an insured through an attorney or
1102	another entity, shall maintain, for at least 3 years, copies of
1103	all examination reports as medical records and shall maintain,
1104	for at least 3 years, records of all payments for the
1105	examinations and reports.
1106	(j)  Neither an insurer nor any person acting at the
1107	direction of or on behalf of an insurer may materially change an
1108	opinion in a report prepared under this subsection or direct the
1109	physician preparing the report to change such opinion. The
1110	denial of a payment as the result of such a changed opinion
1111	constitutes a material misrepresentation under s.
1112	626.9541(1)(i)2.; however, this provision does not preclude the
1113	insurer from calling to the attention of the physician errors of
1114	fact in the report based upon information in the claim file or
1115	on new information that will become part of the claim file.
1116	(k)  If requested by the person examined, a party causing
1117	an examination to be made shall deliver to him or her a copy of
1118	every written report concerning the examination rendered by an
1119	examining physician, at least one of which reports must set out
1120	the examining physician's findings and conclusions in detail.
1121	After such request and delivery, the party causing the
1122	examination to be made is entitled, upon request, to receive
1123	from the person examined every written report available to him
1124	or her or his or her representative concerning any examination,
1125	previously or thereafter made, of the same mental or physical
1126	condition. By requesting and obtaining a report of the
1127	examination so ordered, or by taking the deposition of the
1128	examiner, the person examined waives any privilege he or she may
1129	have, in relation to the claim for benefits, regarding the
1130	testimony of every other person who has examined, or may
1131	thereafter examine, him or her in respect to the same mental or
1132	physical condition. If a person unreasonably fails or
1133	unreasonably refuses to submit to an examination, the personal
1134	injury protection carrier is no longer liable for subsequent
1135	personal injury protection benefits.
1136	(l)  During the independent medical examination, neither
1137	the insurer, the insured, nor the assignee of the insured may
1138	have counsel, a court reporter, or a videographer present.
1139	(m)  Nothing in this section shall be interpreted to
1140	preclude or limit the ability of the insurer to assert that the
1141	claim was unrelated, was not medically necessary, or was
1142	unreasonable, or that the amount of the charge was in excess of
1143	that permitted under, or in violation of, this section. Such
1144	assertion by the insurer may be made, through or without expert
1145	testimony, at any time, including after payment of the claim or
1146	after the 30-day time period for payment set forth in this
1147	section.
1148	(19)  CANCELLATION OR NONRENEWAL.--
1149	(a)  Each insurer that has issued a policy providing
1150	personal injury protection benefits shall report the renewal,
1151	cancellation, or nonrenewal thereof to the Department of Highway
1152	Safety and Motor Vehicles within 45 days from the effective date
1153	of the renewal, cancellation, or nonrenewal.
1154	(b)  Upon the issuance of a policy providing personal
1155	injury protection benefits to a named insured not previously
1156	insured by the insurer thereof during that calendar year, the
1157	insurer shall report the issuance of the new policy to the
1158	Department of Highway Safety and Motor Vehicles within 30 days.
1159	The report shall be in such form and format and contain such
1160	information as is required by the Department of Highway Safety
1161	and Motor Vehicles which shall include a format compatible with
1162	the data processing capabilities of such said department, and
1163	the Department of Highway Safety and Motor Vehicles is
1164	authorized to adopt rules necessary with respect thereto.
1165	Failure by an insurer to file proper reports with the Department
1166	of Highway Safety and Motor Vehicles as required by this
1167	subsection or rules adopted with respect to the requirements of
1168	this subsection constitutes a violation of the Florida Insurance
1169	Code.
1170	(c)  Reports of cancellations and policy renewals and
1171	reports of the issuance of new policies received by the
1172	Department of Highway Safety and Motor Vehicles are confidential
1173	and exempt from the provisions of s. 119.07(1).
1174	(d)  These records are to be used for enforcement and
1175	regulatory purposes only, including the generation by the
1176	department of data regarding compliance by owners of motor
1177	vehicles with financial responsibility coverage requirements. In
1178	addition, the Department of Highway Safety and Motor Vehicles
1179	shall release, upon a written request by a person involved in a
1180	motor vehicle accident, by the person's attorney, or by a
1181	representative of the person's motor vehicle insurer, the name
1182	of the insurance company and the policy number for the policy
1183	covering the vehicle named by the requesting party. The written
1184	request must include a copy of the appropriate accident form as
1185	provided in s. 316.065, s. 316.066, or s. 316.068.
1186	(e)  Every insurer with respect to each insurance policy
1187	providing personal injury protection benefits shall notify the
1188	named insured or in the case of a commercial fleet policy, the
1189	first named insured in writing that any cancellation or
1190	nonrenewal of the policy will be reported by the insurer to the
1191	Department of Highway Safety and Motor Vehicles. The notice
1192	shall also inform the named insured that failure to maintain
1193	personal injury protection and property damage liability
1194	insurance on a motor vehicle when required by law may result in
1195	the loss of registration and driving privileges in this state,
1196	and the notice shall inform the named insured of the amount of
1197	the reinstatement fees required by s. 627.733(7). This notice is
1198	for informational purposes only, and no civil liability shall
1199	attach to an insurer due to failure to provide this notice.
1200	(20)  ATTORNEY'S FEES.-- With respect to any dispute under
1201	ss. 627.730-627.7405 between the insured and the insurer, or
1202	between an assignee of an insured and the insurer:
1203	(a)  Section 768.79 shall apply; and
1204	(b)  A contingency risk multiplier shall not be applied.
1205	(21)  CIVIL ACTION FOR INSURANCE FRAUD.--An insurer shall
1206	have a cause of action against any person convicted of, or who,
1207	regardless of adjudication of guilt, pleads guilty or nolo
1208	contendere to insurance fraud under s. 817.234, patient
1209	brokering under s. 817.505, or kickbacks under s. 456.054,
1210	associated with a claim for personal injury protection benefits
1211	in accordance with this section. An insurer prevailing in an
1212	action brought under this subsection may recover compensatory,
1213	consequential, and punitive damages subject to the requirements
1214	and limitations of part II of chapter 768, and attorney's fees
1215	and costs incurred in litigating a cause of action against any
1216	person convicted of, or who, regardless of adjudication of
1217	guilt, pleads guilty or nolo contendere to insurance fraud under
1218	s. 817.234, patient brokering under s. 817.505, or kickbacks
1219	under s. 456.054, associated with a claim for personal injury
1220	protection benefits in accordance with this section.
1221	(22)  PILOT PROGRAM.--A 6-year pilot program effective
1222	October 1 of 2006, shall be created for the delivery of magnetic
1223	resonance imaging (MRI), static radiographs (static x ray),
1224	computed tomography, position emission tomography and approved
1225	diagnostic procedures at Hospitals as defined in s. 395.002(13)
1226	, physician-owned centers as defined in s. 456.001(4) and
1227	Florida Diagnostic Testing Facilities as defined in s.
1228	627.732(13) in Miami-Dade, Broward and Palm Beach counties.
1229	participation in the pilot program by Hospitals as defined in s.
1230	395.002(13), physician-owned centers as defined in s. 456.001(4)
1231	and Florida Diagnostic Testing Facilities as defined in s.
1232	627.732 shall be required for reimbursement under a personal
1233	injury protection insurance policy of any magnetic resonance
1234	imaging, static radiographs (static x ray), computed tomography,
1235	position emission tomography, and approved diagnostic procedures
1236	conducted in Miami-Dade, Broward and Palm Beach. The pilot
1237	program shall focus on the elimination of fraud and the
1238	development of a more efficient personal injury protection
1239	delivery system that shall include:
1240	(a)  The formulation of a cost-effective electronic billing
1241	system using approved health care billing standards;
1242	(b)  The development of patient care standards; and
1243	(c)  The monitoring of fraudulent activity.
1244
1245	The percentage of scans billed to all personal injury protection
1246	insurance carriers in the pilot program shall not be used for
1247	the calculation in s. 400.9935(1)(g). The Office of the Chief
1248	Financial Officer shall report these outcomes to the legislature
1249	in January of 2012.
1250	(23)  NONPREEMPTION.-This section shall not be deemed to
1251	preempt or supersede any cause of action that may otherwise be
1252	available to the insurer.
1253	Section 5.  Subsections (1) and (2) of section 627.737,
1254	Florida Statutes, are amended to read:
1255	627.737  Tort exemption; limitation on right to damages;
1256	punitive damages.--
1257	(1)  Every owner, registrant, operator, or occupant of a
1258	motor vehicle with respect to which security has been provided
1259	as required by ss. 627.730-627.7405, and every person or
1260	organization legally responsible for her or his acts or
1261	omissions, is hereby exempted from tort liability for damages
1262	arising from because of bodily injury, sickness, or disease
1263	arising out of the ownership, operation, maintenance, or use of
1264	such motor vehicle in this state to the extent that the benefits
1265	described in s. 627.736(1) are payable for such injury, or would
1266	be payable but for any exclusion authorized by ss. 627.730-
1267	627.7405, under any insurance policy or other method of security
1268	complying with the requirements of s. 627.733, or by an owner
1269	personally liable under s. 627.733 for the payment of such
1270	benefits, unless a person is entitled to maintain an action to
1271	recover non-economic or general damages including damages for
1272	pain, suffering, mental anguish, physical impairment, loss of
1273	capacity to enjoy life, and inconvenience for such injury under
1274	the provisions of subsection (2).
1275	(2)  In any action of tort brought against the owner,
1276	registrant, operator, or occupant of a motor vehicle with
1277	respect to which security has been provided as required by ss.
1278	627.730-627.7405, or against any person or organization legally
1279	responsible for her or his acts or omissions, a plaintiff may
1280	recover non-economic or general damages in tort including for
1281	pain, suffering, mental anguish, physical impairment, loss of
1282	capacity to enjoy life, and inconvenience arising from because
1283	of bodily injury, sickness, or disease arising out of the
1284	ownership, maintenance, operation, or use of such motor vehicle
1285	only in the event that the injury or disease consists in whole
1286	or in part of:
1287	(a)  Significant and permanent loss of an important bodily
1288	function.
1289	(a)(b)  Significant permanent injury resulting in loss of
1290	an important bodily function within a reasonable degree of
1291	medical probability, other than scarring or disfigurement, that
1292	has a substantial and permanent impact on the plaintiff's
1293	general ability to perform in activities associated with a
1294	reasonably normal lifestyle.
1295	(b)(c)  Significant and permanent scarring or
1296	disfigurement.
1297	(c)(d)  Death.
1298	Section 6.  Effective October 1 2006, subsection (1) of
1299	section 627.7401, Florida Statutes, is amended to read:
1300	627.7401  Notification of insured's rights.--
1301	(1)  The commission, by rule, shall adopt a form for the
1302	notification of insureds of their right to receive personal
1303	injury protection benefits under the Florida Motor Vehicle No-
1304	Fault Law. Such notice shall include:
1305	(a)  A description of the benefits provided by personal
1306	injury protection, including, but not limited to, the specific
1307	types of services for which medical benefits are paid,
1308	disability benefits, death benefits, significant exclusions from
1309	and limitations on personal injury protection benefits, when
1310	payments are due, how benefits are coordinated with other
1311	insurance benefits that the insured may have, penalties and
1312	interest that may be imposed on insurers for failure to make
1313	timely payments of benefits, and rights of parties regarding
1314	disputes as to benefits; and.
1315	(b)  Notify the insured that:
1316	1. Pursuant to s. 626.9892, the Department of Financial
1317	Services may pay rewards of up to $25,000 to persons providing
1318	information leading to the arrest and conviction of persons
1319	committing crimes investigated by the Division of Insurance
1320	Fraud arising from violations of s. 440.105, s. 624.15, s.
1321	626.9541, s. 626.989, or s. 817.234; and
1322	2. Solicitation of a person injured in a motor vehicle
1323	crash for purposes of filing personal injury protection or tort
1324	claims could be a violation of s. 817.234, s. 817.505, or the
1325	rules regulating The Florida Bar and should be immediately
1326	reported to the Division of Insurance Fraud if such conduct has
1327	taken place.
1328	Section 7.  Section 627.7403, Florida Statutes, is amended
1329	to read:
1330	627.7403  Mandatory joinder of derivative claim.--
1331	(1)  In any action brought pursuant to the provisions of s.
1332	627.737 claiming personal injuries, all claims arising out of
1333	the plaintiff's injuries, including all derivative claims, shall
1334	be brought together, unless good cause is shown why such claims
1335	should be brought separately.
1336	(b)  In any action brought pursuant to the provisions of s.
1337	627.736 claiming personal injury protection benefits, all claims
1338	arising out of the claimant's injuries, including all claims
1339	resulting from a valid assignment of benefits that are, or with
1340	due diligence could have been identified, must be brought at the
1341	same time and consolidated into one cause of action or shall be
1342	deemed waived.
1343	Section 8.  Section 627.7404, Florida Statutes, is created
1344	to read:
1345	627.7404  Interpleader.--An action for interpleader or in
1346	the nature of interpleader may be brought against two or more
1347	adverse claimants who claim or may claim entitlement to benefits
1348	that may be available pursuant to a policy of motor vehicle
1349	insurance.  The claims of the several defendants need not have a
1350	common origin or be identical but may be adverse to and
1351	independent of each other.  The plaintiff may deny liability in
1352	whole or in part to any or all of the defendants.  A defendant
1353	may likewise obtain interpleader by way of counterclaim or
1354	cross-claim.  The complaint for interpleader shall specify the
1355	nature and value of the benefits and must be accompanied by
1356	payment or tender into court of the benefits available.  The
1357	complaint may request, and the court may grant prior to the
1358	entry of an order of interpleader, appropriate ancillary relief,
1359	including, but not limited to, preliminary injunctive relief.
1360	Interpleading of policy limits shall be prima facia evidence of
1361	good faith on the part of the insurance company.  No part of
1362	this section shall limit in any way the joinder of parties
1363	otherwise required or permitted by Florida law.
1364	Section 9.  Subsection (2) of section 316.068, Florida
1365	Statutes, is amended to read:
1366	316.068  Crash report forms.--
1367	(2)  Every crash report required to be made in writing must
1368	be made on the appropriate form approved by the department and
1369	must contain all the information required therein to include:
1370	(a) The date, time, and location of the crash;
1371	(b) A description of the vehicles involved;
1372	(c) The names and addresses of the parties involved;
1373	(d) The names and addresses of all drivers and passengers
1374	in the vehicles involved;
1375	(e) The names and addresses of witnesses;
1376	(f) The name, badge number, and law enforcement agency of
1377	the officer investigating the crash; and
1378	(g)  The names of the insurance companies for the
1379	respective parties involved in the crash unless not available.
1380	The absence of information in such written crash reports
1381	regarding the existence of passengers in the vehicles involved
1382	in the crash constitutes a rebuttable presumption that no such
1383	passengers were involved in the reported crash.
1384	Notwithstanding any other provisions of this section, a crash
1385	report produced electronically by a law enforcement officer
1386	must, at a minimum, contain the same information as is called
1387	for on those forms approved by the department.
1388	Section 10.  Subsection (9) is added to section 322.26,
1389	Florida Statutes, to read:
1390	322.26  Mandatory revocation of license by department.--The
1391	department shall forthwith revoke the license or driving
1392	privilege of any person upon receiving a record of such person's
1393	conviction of any of the following offenses:
1394	(9)  Conviction in any court having jurisdiction over
1395	offenses committed under s. 817.234(8) or (9).
1396	Section 11.  Subsection (9) of section 817.234, Florida
1397	Statutes, is amended to read:
1398	817.234  False and fraudulent insurance claims.--
1399	(9)  A person may not organize, plan, or knowingly
1400	participate in an intentional motor vehicle crash or a scheme to
1401	create documentation of a motor vehicle crash that did not occur
1402	for the purpose of making motor vehicle tort claims or claims
1403	for personal injury protection benefits as required by s.
1404	627.736. Any person who violates this subsection commits a
1405	felony of the second degree, punishable as provided in s.
1406	775.082, s. 775.083, or s. 775.084. A person who is convicted of
1407	a violation of this subsection shall be sentenced to a minimum
1408	term of imprisonment of 2 years.
1409	Section 12.  Section 817.2361, Florida Statutes, is amended
1410	to read:
1411	817.2361  False or fraudulent proof of motor vehicle
1412	insurance card.--Any person who, with intent to deceive any
1413	other person, creates, markets, or presents a false or
1414	fraudulent proof of motor vehicle insurance card commits a
1415	felony of the third degree, punishable as provided in s.
1416	775.082, s. 775.083, or s. 775.084.
1417	Section 13.  Section 19 of chapter 2003-411, Laws of
1418	Florida, is repealed.
1419	Section 14.  Unless otherwise provided herein, this act
1420	shall take effect upon becoming law.
1421
1422
1423	======= T I T L E  A M E N D M E N T ==========
1424	Remove the entire title and insert:
1425	A bill to be entitled
1426	An act relating to motor vehicle insurance; amending s.
1427	624.155, F.S.; providing notice requirements for causes of
1428	action against motor vehicle insurers; amending s.
1429	627.731, F.S.; revising purposes; amending s. 627.732,
1430	F.S.; revising definition; providing additional
1431	definitions; amending s. 627.736, F.S.; providing that a
1432	self-employed injured person or an injured person owning
1433	25 percent or more interest in an employer offer proof of
1434	income and lost wages to insurers as a condition precedent
1435	for payment; providing for a statement of earnings;
1436	requiring an insured to notify an insurer in writing of
1437	election to reserve benefits for lost wages; specifying
1438	that such notification takes priority over other claims,
1439	except specified hospital liens; providing for Medicaid
1440	benefits; requiring the Department of Health to determine
1441	by rule tests deemed not to be medically necessary;
1442	providing guidance as to criteria to be considered;
1443	providing for required payment of benefits; authorizing a
1444	parent or legal guardian of an injured minor to complete
1445	application for personal injury protection benefits;
1446	providing for changes for treatment of injured persons;
1447	providing requirements for compliance with billing
1448	procedures; specifying the time period within which a
1449	health care provider or other specified provider must
1450	submit a statement of charges; prohibiting providers from
1451	billing an injured person under specified conditions for
1452	emergency services and care; requiring insurers to provide
1453	specified documents to insureds; requiring that amounts
1454	repayable to an insurer include the statutory interest
1455	penalty; increasing the time period for an insurer to
1456	respond to a demand letter; providing requirements for the
1457	production and inspection of an injured person's medical
1458	records from a provider; providing a right of compensation
1459	to health care providers for responding to requests for
1460	information by insurers; providing for application of
1461	attorney's fees; providing that persons notifying insurers
1462	of improper billing may obtain a reward; restricting venue
1463	for any personal injury protection claim to specified
1464	jurisdictions and providing for costs of transferring
1465	venue; amending s. 627.737, F.S.; revising a tort
1466	exemption provision; revising certain limitations on
1467	rights to damages; amending s. 627.7401, F.S.; specifying
1468	additional information requirements for notification of an
1469	insured's right to receive personal injury protection
1470	benefits under the Florida Motor Vehicle No-Fault Law
1471	relating to anti-fraud rewards; amending s. 627.7403,
1472	F.S.; revising provisions relating to mandatory joinder of
1473	derivative claims; creating s. 627.404, F.S.; providing
1474	procedures, requirements, and limitations on actions for
1475	interpleader; amending s. 316.068, F.S.; specifying
1476	additional information to be included in a crash report;
1477	creating a rebuttable presumption relating to the
1478	existence of passengers in vehicles involved in a crash;
1479	amending s. 322.26, F.S.; providing an additional
1480	circumstance relating to insurance crimes for mandatory
1481	revocation of a person's driver's license; amending s.
1482	817.234, F.S.; prohibiting scheming to create
1483	documentation of a motor vehicle crash that did not occur;
1484	providing a criminal penalty; amending s. 817.2361, F.S.;
1485	providing that creating, marketing, or presenting
1486	fraudulent proof of motor vehicle insurance is a felony of
1487	the third degree; repealing section 19, ch. 2003, Laws of
1488	Florida, relating to the repeal of the Florida Motor
1489	Vehicle No-Fault Law; providing an effective date.

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