Senate Bill sb2626
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Florida Senate - 2007 SB 2626
By Senator Alexander
17-1308A-07
1 A bill to be entitled
2 An act relating to motor vehicle liability
3 insurance; amending s. 320.02, F.S.; providing
4 for proof of purchase of medical payments
5 coverage when registering a motor vehicle;
6 conforming a cross-reference; amending ss.
7 324.021 and 324.022, F.S., relating to
8 financial security requirements for operating a
9 motor vehicle; conforming cross-references;
10 amending s. 627.7275, F.S.; providing that a
11 motor vehicle insurance policy that provides
12 medical payments coverage may not be issued or
13 delivered in this state unless the policy
14 contains specified minimum amounts of coverage
15 for property damage liability arising from a
16 single accident or combined property damage
17 liability and bodily injury liability in any
18 one accident; amending s. 627.7295, F.S.;
19 redefining the term "policy"; authorizing a
20 licensed general lines agent to charge a fee to
21 cover certain administrative costs under
22 certain circumstances; providing an exemption
23 from certain provisions regarding the initial
24 issuance or cancellation of policies containing
25 medical payments coverage and certain other
26 types of liability coverage; conforming a
27 cross-reference; amending s. 627.733, F.S.;
28 deleting a provision requiring the owner or
29 registrant of a taxicab to maintain certain
30 personal injury protection coverage; conforming
31 cross-references; amending s. 627.734, F.S.;
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1 conforming cross-references; amending s.
2 627.736, F.S.; requiring every insurance policy
3 complying with the security requirements of
4 state law to provide medical payments coverage;
5 identifying types of medical expenses covered
6 by medical payments coverage; limiting coverage
7 for certain medical expenses up to specified
8 amounts per person and per accident; requiring
9 all bills submitted by hospitals and physicians
10 to appear on certain forms; providing for
11 charges and payment for medical services for
12 covered persons; providing definitions;
13 authorizing insurers to negotiate and enter
14 into contracts with preferred providers;
15 providing that only insurers writing motor
16 vehicle liability insurance in this state may
17 provide medical payments coverage benefits;
18 prohibiting an insurer from requiring the
19 purchase of coverage other than property damage
20 liability coverage as a condition for providing
21 such benefits; requiring insurers to make such
22 coverage available through normal marketing
23 channels; providing that failure to make
24 medical payments coverage and property damages
25 liability coverage available through normal
26 marketing channels is a violation of the
27 insurance code; providing penalties; providing
28 for payments of benefits; providing that
29 medical payments coverage benefits are subject
30 to the provisions of the Medicaid program in
31 certain circumstances; requiring each insurer
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1 that has issued a policy providing medical
2 payments coverage to report the renewal,
3 cancellation, or nonrenewal of each policy to
4 the Department of Highway Safety and Motor
5 Vehicles within a specified period after the
6 effective date of each renewal, cancellation,
7 or nonrenewal; requiring each insurer that
8 issues a new policy providing medical payments
9 coverage to report such issuance to the
10 department within a specified period after
11 issuance; providing for the form and contents
12 of such reports; providing that such reports
13 are confidential; limiting the department's use
14 of such reports; providing for the release of
15 certain information regarding insurance
16 coverage upon the written request of specified
17 parties in the event of an automobile accident;
18 requiring a written request for release of
19 information to include a copy of the
20 appropriate accident form; requiring insurers
21 to notify the named insured in writing that any
22 cancellation or nonrenewal of the policy will
23 be reported to the department; requiring that
24 the notice include certain additional
25 information; providing that there is no civil
26 liability due to the insurer's failure to
27 provide such notice; deleting provisions
28 regarding payment of benefits, rights of an
29 insured, charges for treatment of injured
30 persons, billing requirements, disputes, mental
31 and physical examinations of injured persons,
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1 attorney's fees, demand letters, actions for
2 fraud, minimum benefit coverage, and fraud
3 advisory notice; providing an effective date.
4
5 Be It Enacted by the Legislature of the State of Florida:
6
7 Section 1. Paragraphs (a) and (d) of subsection (5) of
8 section 320.02, Florida Statutes, are amended to read:
9 320.02 Registration required; application for
10 registration; forms.--
11 (5)(a) Proof that medical payments coverage personal
12 injury protection benefits have been purchased when required
13 under s. 627.733, that property damage liability coverage has
14 been purchased as required under s. 324.022, and that combined
15 bodily liability insurance and property damage liability
16 insurance have been purchased when required under s. 627.7415
17 shall be provided in the manner prescribed by law by the
18 applicant at the time of application for registration of any
19 motor vehicle owned as defined in s. 627.736(3) s. 627.732.
20 The issuing agent shall refuse to issue registration if such
21 proof of purchase is not provided. Insurers shall furnish
22 uniform proof-of-purchase cards in a form prescribed by the
23 department and shall include the name of the insured's
24 insurance company, the coverage identification number, the
25 make, year, and vehicle identification number of the vehicle
26 insured. The card shall contain a statement notifying the
27 applicant of the penalty specified in s. 316.646(4). The card
28 or insurance policy, insurance policy binder, or certificate
29 of insurance or a photocopy of any of these; an affidavit
30 containing the name of the insured's insurance company, the
31 insured's policy number, and the make and year of the vehicle
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1 insured; or such other proof as may be prescribed by the
2 department shall constitute sufficient proof of purchase. If
3 an affidavit is provided as proof, it shall be in
4 substantially the following form:
5
6 Under penalty of perjury, I (Name of insured) do hereby
7 certify that I have (Medical Payments Coverage Personal Injury
8 Protection, Property Damage Liability, and, when required,
9 Bodily Injury Liability) Insurance currently in effect with
10 (Name of insurance company) under (policy number) covering
11 (make, year, and vehicle identification number of vehicle).
12 (Signature of Insured)
13
14 Such affidavit shall include the following warning:
15
16 WARNING: GIVING FALSE INFORMATION IN ORDER TO OBTAIN A VEHICLE
17 REGISTRATION CERTIFICATE IS A CRIMINAL OFFENSE UNDER FLORIDA
18 LAW. ANYONE GIVING FALSE INFORMATION ON THIS AFFIDAVIT IS
19 SUBJECT TO PROSECUTION.
20
21 When an application is made through a licensed motor vehicle
22 dealer as required in s. 319.23, the original or a photostatic
23 copy of such card, insurance policy, insurance policy binder,
24 or certificate of insurance or the original affidavit from the
25 insured shall be forwarded by the dealer to the tax collector
26 of the county or the Department of Highway Safety and Motor
27 Vehicles for processing. By executing the aforesaid
28 affidavit, no licensed motor vehicle dealer will be liable in
29 damages for any inadequacy, insufficiency, or falsification of
30 any statement contained therein. A card shall also indicate
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1 the existence of any bodily injury liability insurance
2 voluntarily purchased.
3 (d) The verifying of proof of medical payments
4 coverage personal injury protection insurance, proof of
5 combined bodily liability insurance and property damage
6 liability insurance, or proof of financial responsibility
7 insurance and the issuance or failure to issue the motor
8 vehicle registration under the provisions of this chapter may
9 not be construed in any court as a warranty of the reliability
10 or accuracy of the evidence of such proof. Neither the
11 department nor any tax collector is liable in damages for any
12 inadequacy, insufficiency, falsification, or unauthorized
13 modification of any item of the proof of medical payments
14 coverage personal injury protection insurance, proof of
15 combined bodily liability insurance and property damage
16 liability insurance, or proof of financial responsibility
17 insurance either prior to, during, or subsequent to the
18 verification of the proof. The issuance of a motor vehicle
19 registration does not constitute prima facie evidence or a
20 presumption of insurance coverage.
21 Section 2. Subsection (1) of section 324.021, Florida
22 Statutes, is amended to read:
23 324.021 Definitions; minimum insurance required.--The
24 following words and phrases when used in this chapter shall,
25 for the purpose of this chapter, have the meanings
26 respectively ascribed to them in this section, except in those
27 instances where the context clearly indicates a different
28 meaning:
29 (1) MOTOR VEHICLE.--Every self-propelled vehicle which
30 is designed and required to be licensed for use upon a
31 highway, including trailers and semitrailers designed for use
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1 with such vehicles, except traction engines, road rollers,
2 farm tractors, power shovels, and well drillers, and every
3 vehicle which is propelled by electric power obtained from
4 overhead wires but not operated upon rails, but not including
5 any bicycle or moped. However, the term "motor vehicle" shall
6 not include any motor vehicle as defined in s. 627.736(3) s.
7 627.732(3) when the owner of such vehicle has complied with
8 the requirements of s. 627.736 ss. 627.730-627.7405,
9 inclusive, unless the provisions of s. 324.051 apply; and, in
10 such case, the applicable proof of insurance provisions of s.
11 320.02 apply.
12 Section 3. Section 324.022, Florida Statutes, is
13 amended to read:
14 324.022 Financial responsibility for property
15 damage.--Every owner or operator of a motor vehicle, which
16 motor vehicle is subject to the requirements of s. 627.736 ss.
17 627.730-627.7405 and required to be registered in this state,
18 shall, by one of the methods established in s. 324.031 or by
19 having a policy that complies with s. 627.7275, establish and
20 maintain the ability to respond in damages for liability on
21 account of accidents arising out of the use of the motor
22 vehicle in the amount of $10,000 because of damage to, or
23 destruction of, property of others in any one crash. The
24 requirements of this section may also be met by having a
25 policy which provides coverage in the amount of at least
26 $30,000 for combined property damage liability and bodily
27 injury liability for any one crash arising out of the use of
28 the motor vehicle. No insurer shall have any duty to defend
29 uncovered claims irrespective of their joinder with covered
30 claims.
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1 Section 4. Subsection (1) of section 627.7275, Florida
2 Statutes, is amended to read:
3 627.7275 Motor vehicle liability.--
4 (1) A motor vehicle insurance policy providing medical
5 payments coverage personal injury protection as set forth in
6 s. 627.736 may not be delivered or issued for delivery in this
7 state with respect to any specifically insured or identified
8 motor vehicle registered or principally garaged in this state
9 unless the policy also provides coverage for property damage
10 liability in the amount of at least $10,000 because of damage
11 to, or destruction of, property of others in any one accident
12 arising out of the use of the motor vehicle or unless the
13 policy provides coverage in the amount of at least $30,000 for
14 combined property damage liability and bodily injury liability
15 in any one accident arising out of the use of the motor
16 vehicle. The policy, as to coverage of property damage
17 liability, must meet the applicable requirements of s.
18 324.151, subject to the usual policy exclusions that have been
19 approved in policy forms by the office.
20 Section 5. Paragraph (a) of subsection (1), paragraph
21 (a) of subsection (5), and subsection (7) of section 627.7295,
22 Florida Statutes, are amended to read:
23 627.7295 Motor vehicle insurance contracts.--
24 (1) As used in this section, the term:
25 (a) "Policy" means a motor vehicle insurance policy
26 that provides medical payments coverage personal injury
27 protection and property damage liability coverage.
28 (5)(a) A licensed general lines agent may charge a
29 per-policy fee not to exceed $10 to cover the administrative
30 costs of the agent associated with selling the motor vehicle
31 insurance policy if the policy covers only medical payments
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1 personal injury protection coverage as provided by s. 627.736
2 and property damage liability coverage as provided by s.
3 627.7275 and if no other insurance is sold or issued in
4 conjunction with or collateral to the policy. The fee is not
5 considered part of the premium.
6 (7) A policy of private passenger motor vehicle
7 insurance or a binder for such a policy may be initially
8 issued in this state only if the insurer or agent has
9 collected from the insured an amount equal to 2 months'
10 premium. An insurer, agent, or premium finance company may
11 not directly or indirectly take any action resulting in the
12 insured having paid from the insured's own funds an amount
13 less than the 2 months' premium required by this subsection.
14 This subsection applies without regard to whether the premium
15 is financed by a premium finance company or is paid pursuant
16 to a periodic payment plan of an insurer or an insurance
17 agent. This subsection does not apply if an insured or member
18 of the insured's family is renewing or replacing a policy or a
19 binder for such policy written by the same insurer or a member
20 of the same insurer group. This subsection does not apply to
21 an insurer that issues private passenger motor vehicle
22 coverage primarily to active duty or former military personnel
23 or their dependents. This subsection does not apply if all
24 policy payments are paid pursuant to a payroll deduction plan
25 or an automatic electronic funds transfer payment plan from
26 the policyholder, provided that the first policy payment is
27 made by cash, cashier's check, check, or a money order. This
28 subsection and subsection (4) do not apply if all policy
29 payments to an insurer are paid pursuant to an automatic
30 electronic funds transfer payment plan from an agent or a
31 managing general agent and if the policy includes, at a
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1 minimum, medical payments coverage personal injury protection
2 pursuant to s. 627.736 ss. 627.730-627.7405; motor vehicle
3 property damage liability pursuant to s. 627.7275; and bodily
4 injury liability in at least the amount of $10,000 because of
5 bodily injury to, or death of, one person in any one accident
6 and in the amount of $20,000 because of bodily injury to, or
7 death of, two or more persons in any one accident. This
8 subsection and subsection (4) do not apply if an insured has
9 had a policy in effect for at least 6 months, the insured's
10 agent is terminated by the insurer that issued the policy, and
11 the insured obtains coverage on the policy's renewal date with
12 a new company through the terminated agent.
13 Section 6. Paragraph (b) of subsection (1) and
14 subsections (3) and (4) of section 627.733, Florida Statutes,
15 are amended to read:
16 627.733 Required security.--
17 (1)
18 (b) Every owner or registrant of a motor vehicle used
19 as a taxicab shall not be governed by paragraph (1)(a) but
20 shall maintain security as required under s. 324.032(1), and
21 s. 627.737 shall not apply to any motor vehicle used as a
22 taxicab.
23 (3) Such security shall be provided:
24 (a) By an insurance policy delivered or issued for
25 delivery in this state by an authorized or eligible motor
26 vehicle liability insurer which provides the benefits and
27 exemptions contained in s. 627.736 ss. 627.730-627.7405. Any
28 policy of insurance represented or sold as providing the
29 security required hereunder shall be deemed to provide
30 insurance for the payment of the required benefits; or
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1 (b) By any other method authorized by s. 324.031(2),
2 (3), or (4) and approved by the Department of Highway Safety
3 and Motor Vehicles as affording security equivalent to that
4 afforded by a policy of insurance or by self-insuring as
5 authorized by s. 768.28(16). The person filing such security
6 shall have all of the obligations and rights of an insurer
7 under s. 627.736 ss. 627.730-627.7405.
8 (4) An owner of a motor vehicle with respect to which
9 security is required by this section who fails to have such
10 security in effect at the time of an accident shall have no
11 immunity from tort liability, but shall be personally liable
12 for the payment of benefits under s. 627.736. With respect to
13 such benefits, such an owner shall have all of the rights and
14 obligations of an insurer under s. 627.736 ss.
15 627.730-627.7405.
16 Section 7. Section 627.734, Florida Statutes, is
17 amended to read:
18 627.734 Proof of security; security requirements;
19 penalties.--
20 (1) The provisions of chapter 324 which pertain to the
21 method of giving and maintaining proof of financial
22 responsibility and which govern and define a motor vehicle
23 liability policy shall apply to filing and maintaining proof
24 of security required by s. 627.736 ss. 627.730-627.7405.
25 (2) Any person who:
26 (a) Gives information required in a report or
27 otherwise as provided for in s. 627.736 ss. 627.730-627.7405,
28 knowing or having reason to believe that such information is
29 false;
30 (b) Forges or, without authority, signs any evidence
31 of proof of security; or
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1 (c) Files, or offers for filing, any such evidence of
2 proof, knowing or having reason to believe that it is forged
3 or signed without authority,
4
5 commits is guilty of a misdemeanor of the first degree,
6 punishable as provided in s. 775.082 or s. 775.083.
7 Section 8. Section 627.736, Florida Statutes, is
8 amended to read:
9 627.736 Required medical payments coverage personal
10 injury protection benefits; exclusions; priority; claims.--
11 (1) REQUIRED BENEFITS.--Every insurance policy
12 complying with the security requirements of s. 627.733 shall
13 provide medical payments coverage personal injury protection
14 to the named insured, relatives residing in the same
15 household, persons operating the insured motor vehicle,
16 passengers in such motor vehicle, and other persons struck by
17 such motor vehicle and suffering bodily injury while not an
18 occupant of a self-propelled vehicle, subject to the
19 provisions of subsection (2) and paragraph (4)(d), to a limit
20 of $10,000 for loss sustained by any such person as a result
21 of bodily injury, sickness, disease, or death arising out of
22 the ownership, maintenance, or use of a motor vehicle as
23 follows:
24 (1)(a) MEDICAL PAYMENTS COVERAGE benefits.--Medical
25 expenses incurred for bodily injury caused by an automobile
26 crash for the named insured or the named insured's relatives
27 residing in the same household, a pedestrian injured by any
28 self-propelled vehicle or trailer, or any other person
29 occupying a motor vehicle covered under the policy. Medical
30 expenses up to $25,000 per person or $50,000 per accident for
31 injuries resulting from being struck by an automobile,
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1 involved in an automobile crash, or struck by any other
2 self-propelled vehicle or trailer shall be limited to the
3 provision of:
4 (a) Transport and treatment rendered by an ambulance
5 provider licensed under part III of chapter 401;
6 (b) Emergency services and care as defined in s.
7 395.002 rendered by physicians and hospitals in a hospital
8 emergency department, trauma center, or inpatient department
9 licensed under chapter 395; and
10 (c) Subsequent medically necessary hospital and
11 physician inpatient care resulting from a motor vehicle crash,
12 if the patient is admitted within 72 hours after the motor
13 vehicle crash. Eighty percent of all reasonable expenses for
14 medically necessary medical, surgical, X-ray, dental, and
15 rehabilitative services, including prosthetic devices, and
16 medically necessary ambulance, hospital, and nursing services.
17 Such benefits shall also include necessary remedial treatment
18 and services recognized and permitted under the laws of the
19 state for an injured person who relies upon spiritual means
20 through prayer alone for healing, in accordance with his or
21 her religious beliefs; however, this sentence does not affect
22 the determination of what other services or procedures are
23 medically necessary.
24 (2) PREFERRED PROVIDER NETWORKS.--An insurer may
25 negotiate and enter into contracts with licensed health care
26 providers for the benefits described in this section. As used
27 in this section, the term "preferred providers" shall include
28 health care providers licensed under chapter 395, chapter 401,
29 chapter 458, chapter 459, chapter 460, chapter 461, or chapter
30 463. An insurer may negotiate and enter into contracts with
31 health insurers for preferred provider networks created
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1 pursuant to s. 627.6471 or workers' compensation insurers for
2 preferred provider networks created pursuant to s. 440.134 to
3 provide the benefits required under this section. The insurer
4 shall provide each policyholder with a current roster of
5 preferred providers in the county in which the insured resides
6 at the time of purchase of such policy, and shall make such
7 list available for public inspection during regular business
8 hours at the principal office of the insurer within the state.
9 (3) DEFINITIONS.--
10 (a) "Motor vehicle" means any self-propelled vehicle
11 having four or more wheels which is of a type both designed
12 and required to be licensed for use on the highways of this
13 state and any trailer or semitrailer designed for use with
14 such vehicle.
15 (b) A "private passenger motor vehicle," means any
16 motor vehicle that is a sedan, station wagon, or jeep-type
17 vehicle, and, if not used primarily for occupational,
18 professional, or business purposes, a motor vehicle of the
19 pickup, panel, van, camper, or motor home type.
20 (c) A "commercial motor vehicle," means any motor
21 vehicle that is not a motor vehicle used to carry private
22 passengers. The term "motor vehicle" does not include a mobile
23 home or any vehicle used in mass transit other than public
24 school transportation and designed to transport more than five
25 passengers exclusive of the operator of the vehicle, and which
26 is owned by a municipality, a transit authority, or a
27 political subdivision of the state.
28 (d) "Named insured" means a person, usually the owner
29 of a vehicle, identified in a policy by name as the insured
30 under the policy.
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1 (e) "Owner" means a person who holds the legal title
2 to a motor vehicle, or the debtor or lessee who has the right
3 to possession if a motor vehicle is the subject of a security
4 agreement or lease with an option to purchase.
5 (f) "Relative residing in the same household" means a
6 relative of any degree by blood or by marriage who usually
7 makes her or his home in the same family unit, whether or not
8 temporarily living elsewhere.
9 (b) Disability benefits.--Sixty percent of any loss of
10 gross income and loss of earning capacity per individual from
11 inability to work proximately caused by the injury sustained
12 by the injured person, plus all expenses reasonably incurred
13 in obtaining from others ordinary and necessary services in
14 lieu of those that, but for the injury, the injured person
15 would have performed without income for the benefit of his or
16 her household. All disability benefits payable under this
17 provision shall be paid not less than every 2 weeks.
18 (c) Death benefits.--Death benefits of $5,000 per
19 individual. The insurer may pay such benefits to the executor
20 or administrator of the deceased, to any of the deceased's
21 relatives by blood or legal adoption or connection by
22 marriage, or to any person appearing to the insurer to be
23 equitably entitled thereto.
24 (4) LIMITATIONS.--Only insurers writing motor vehicle
25 liability insurance in this state may provide the required
26 benefits of this section, and no such insurers insurer may not
27 shall require the purchase of any other motor vehicle coverage
28 other than the purchase of property damage liability coverage
29 as required by s. 627.7275 as a condition for providing such
30 required benefits. Insurers may not require that property
31 damage liability insurance in an amount greater than $10,000
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1 be purchased in conjunction with medical payments coverage
2 personal injury protection. Such insurers shall make benefits
3 and required property damage liability insurance coverage
4 available through normal marketing channels. Any insurer
5 writing motor vehicle liability insurance in this state who
6 fails to comply with such availability requirement as a
7 general business practice violates shall be deemed to have
8 violated part IX of chapter 626, and such violation
9 constitutes shall constitute an unfair method of competition
10 or an unfair or deceptive act or practice involving the
11 business of insurance.; and Any such insurer committing such
12 violation is shall be subject to the penalties afforded in
13 such part, as well as those which may be afforded elsewhere in
14 the insurance code.
15 (5) BENEFITS.--Benefits due from an insurer pursuant
16 to this section shall be primary, except that benefits
17 received under any workers' compensation law shall be credited
18 against the benefits provided by subsection (1) and shall be
19 due and payable as loss accrues, upon receipt of reasonable
20 proof of such loss and the amount of expenses and loss
21 incurred which are covered by the policy issued under this
22 section. When the Agency for Health Care Administration
23 provides, pays, or becomes liable for medical assistance under
24 the Medicaid program related to injury, sickness, disease, or
25 death arising out of the ownership, maintenance, or use of a
26 motor vehicle, benefits under this section are subject to the
27 provisions of the Medicaid program.
28 (6) NOTICES.--
29 (a) Each insurer that has issued a policy providing
30 medical payments coverage benefits shall report the renewal,
31 cancellation, or nonrenewal thereof to the Department of
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1 Highway Safety and Motor Vehicles within 45 days after the
2 effective date of the renewal, cancellation, or nonrenewal.
3 Upon the issuance of a policy providing medical payments
4 coverage benefits to a named insured not previously insured by
5 the insurer during that calendar year, the insurer shall
6 report the issuance of the new policy to the Department of
7 Highway Safety and Motor Vehicles within 30 days. The report
8 must be in such form and format and contain such information
9 as is required by the department, and must include a format
10 compatible with the data processing capabilities of the
11 department. Failure by an insurer to file proper reports with
12 the department constitutes a violation of the Florida
13 Insurance Code. Reports of cancellations and policy renewals
14 and reports of the issuance of new policies received by the
15 department are confidential and exempt from the provisions of
16 s. 119.07(1). These records shall be used for enforcement and
17 regulatory purposes only, including the generation by the
18 department of data regarding compliance by owners of motor
19 vehicles with financial responsibility coverage requirements.
20 In addition, the department shall release, upon a written
21 request by a person involved in a motor vehicle accident, the
22 name of the person's attorney or of a representative of the
23 person's motor vehicle insurer, the name of the insurance
24 company, and the policy number for the policy covering the
25 vehicle named by the requesting party. The written request
26 must include a copy of the appropriate accident form as
27 provided in s. 316.065, s. 316.066, or s. 316.068.
28 (b) For each insurance policy providing medical
29 payments coverage benefits, the insurer shall notify the named
30 insured or, in the case of a commercial fleet policy, the
31 first named insured in writing that any cancellation or
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1 nonrenewal of the policy will be reported by the insurer to
2 the department. The notice must also inform the named insured
3 that failure to maintain medical payments coverage and
4 property damage liability insurance on a motor vehicle when
5 required by law may result in the loss of registration and
6 driving privileges in this state, and the notice must inform
7 the named insured of the amount of the reinstatement fees
8 required by s. 627.733(7). This notice is for informational
9 purposes only, and an insurer is not civilly liable for
10 failing to provide this notice.
11 (c) The department may adopt rules to administer this
12 subsection.
13 (2) AUTHORIZED EXCLUSIONS.--Any insurer may exclude
14 benefits:
15 (a) For injury sustained by the named insured and
16 relatives residing in the same household while occupying
17 another motor vehicle owned by the named insured and not
18 insured under the policy or for injury sustained by any person
19 operating the insured motor vehicle without the express or
20 implied consent of the insured.
21 (b) To any injured person, if such person's conduct
22 contributed to his or her injury under any of the following
23 circumstances:
24 1. Causing injury to himself or herself intentionally;
25 or
26 2. Being injured while committing a felony.
27
28 Whenever an insured is charged with conduct as set forth in
29 subparagraph 2., the 30-day payment provision of paragraph
30 (4)(b) shall be held in abeyance, and the insurer shall
31 withhold payment of any personal injury protection benefits
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1 pending the outcome of the case at the trial level. If the
2 charge is nolle prossed or dismissed or the insured is
3 acquitted, the 30-day payment provision shall run from the
4 date the insurer is notified of such action.
5 (3) INSURED'S RIGHTS TO RECOVERY OF SPECIAL DAMAGES IN
6 TORT CLAIMS.--No insurer shall have a lien on any recovery in
7 tort by judgment, settlement, or otherwise for personal injury
8 protection benefits, whether suit has been filed or settlement
9 has been reached without suit. An injured party who is
10 entitled to bring suit under the provisions of ss.
11 627.730-627.7405, or his or her legal representative, shall
12 have no right to recover any damages for which personal injury
13 protection benefits are paid or payable. The plaintiff may
14 prove all of his or her special damages notwithstanding this
15 limitation, but if special damages are introduced in evidence,
16 the trier of facts, whether judge or jury, shall not award
17 damages for personal injury protection benefits paid or
18 payable. In all cases in which a jury is required to fix
19 damages, the court shall instruct the jury that the plaintiff
20 shall not recover such special damages for personal injury
21 protection benefits paid or payable.
22 (4) BENEFITS; WHEN DUE.--Benefits due from an insurer
23 under ss. 627.730-627.7405 shall be primary, except that
24 benefits received under any workers' compensation law shall be
25 credited against the benefits provided by subsection (1) and
26 shall be due and payable as loss accrues, upon receipt of
27 reasonable proof of such loss and the amount of expenses and
28 loss incurred which are covered by the policy issued under ss.
29 627.730-627.7405. When the Agency for Health Care
30 Administration provides, pays, or becomes liable for medical
31 assistance under the Medicaid program related to injury,
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1 sickness, disease, or death arising out of the ownership,
2 maintenance, or use of a motor vehicle, benefits under ss.
3 627.730-627.7405 shall be subject to the provisions of the
4 Medicaid program.
5 (a) An insurer may require written notice to be given
6 as soon as practicable after an accident involving a motor
7 vehicle with respect to which the policy affords the security
8 required by ss. 627.730-627.7405.
9 (b) Personal injury protection insurance benefits paid
10 pursuant to this section shall be overdue if not paid within
11 30 days after the insurer is furnished written notice of the
12 fact of a covered loss and of the amount of same. If such
13 written notice is not furnished to the insurer as to the
14 entire claim, any partial amount supported by written notice
15 is overdue if not paid within 30 days after such written
16 notice is furnished to the insurer. Any part or all of the
17 remainder of the claim that is subsequently supported by
18 written notice is overdue if not paid within 30 days after
19 such written notice is furnished to the insurer. When an
20 insurer pays only a portion of a claim or rejects a claim, the
21 insurer shall provide at the time of the partial payment or
22 rejection an itemized specification of each item that the
23 insurer had reduced, omitted, or declined to pay and any
24 information that the insurer desires the claimant to consider
25 related to the medical necessity of the denied treatment or to
26 explain the reasonableness of the reduced charge, provided
27 that this shall not limit the introduction of evidence at
28 trial; and the insurer shall include the name and address of
29 the person to whom the claimant should respond and a claim
30 number to be referenced in future correspondence. However,
31 notwithstanding the fact that written notice has been
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1 furnished to the insurer, any payment shall not be deemed
2 overdue when the insurer has reasonable proof to establish
3 that the insurer is not responsible for the payment. For the
4 purpose of calculating the extent to which any benefits are
5 overdue, payment shall be treated as being made on the date a
6 draft or other valid instrument which is equivalent to payment
7 was placed in the United States mail in a properly addressed,
8 postpaid envelope or, if not so posted, on the date of
9 delivery. This paragraph does not preclude or limit the
10 ability of the insurer to assert that the claim was unrelated,
11 was not medically necessary, or was unreasonable or that the
12 amount of the charge was in excess of that permitted under, or
13 in violation of, subsection (5). Such assertion by the insurer
14 may be made at any time, including after payment of the claim
15 or after the 30-day time period for payment set forth in this
16 paragraph.
17 (c) All overdue payments shall bear simple interest at
18 the rate established under s. 55.03 or the rate established in
19 the insurance contract, whichever is greater, for the year in
20 which the payment became overdue, calculated from the date the
21 insurer was furnished with written notice of the amount of
22 covered loss. Interest shall be due at the time payment of the
23 overdue claim is made.
24 (d) The insurer of the owner of a motor vehicle shall
25 pay personal injury protection benefits for:
26 1. Accidental bodily injury sustained in this state by
27 the owner while occupying a motor vehicle, or while not an
28 occupant of a self-propelled vehicle if the injury is caused
29 by physical contact with a motor vehicle.
30 2. Accidental bodily injury sustained outside this
31 state, but within the United States of America or its
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1 territories or possessions or Canada, by the owner while
2 occupying the owner's motor vehicle.
3 3. Accidental bodily injury sustained by a relative of
4 the owner residing in the same household, under the
5 circumstances described in subparagraph 1. or subparagraph 2.,
6 provided the relative at the time of the accident is domiciled
7 in the owner's household and is not himself or herself the
8 owner of a motor vehicle with respect to which security is
9 required under ss. 627.730-627.7405.
10 4. Accidental bodily injury sustained in this state by
11 any other person while occupying the owner's motor vehicle or,
12 if a resident of this state, while not an occupant of a
13 self-propelled vehicle, if the injury is caused by physical
14 contact with such motor vehicle, provided the injured person
15 is not himself or herself:
16 a. The owner of a motor vehicle with respect to which
17 security is required under ss. 627.730-627.7405; or
18 b. Entitled to personal injury benefits from the
19 insurer of the owner or owners of such a motor vehicle.
20 (e) If two or more insurers are liable to pay personal
21 injury protection benefits for the same injury to any one
22 person, the maximum payable shall be as specified in
23 subsection (1), and any insurer paying the benefits shall be
24 entitled to recover from each of the other insurers an
25 equitable pro rata share of the benefits paid and expenses
26 incurred in processing the claim.
27 (f) It is a violation of the insurance code for an
28 insurer to fail to timely provide benefits as required by this
29 section with such frequency as to constitute a general
30 business practice.
31
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1 (g) Benefits shall not be due or payable to or on the
2 behalf of an insured person if that person has committed, by a
3 material act or omission, any insurance fraud relating to
4 personal injury protection coverage under his or her policy,
5 if the fraud is admitted to in a sworn statement by the
6 insured or if it is established in a court of competent
7 jurisdiction. Any insurance fraud shall void all coverage
8 arising from the claim related to such fraud under the
9 personal injury protection coverage of the insured person who
10 committed the fraud, irrespective of whether a portion of the
11 insured person's claim may be legitimate, and any benefits
12 paid prior to the discovery of the insured person's insurance
13 fraud shall be recoverable by the insurer from the person who
14 committed insurance fraud in their entirety. The prevailing
15 party is entitled to its costs and attorney's fees in any
16 action in which it prevails in an insurer's action to enforce
17 its right of recovery under this paragraph.
18 (5) CHARGES FOR TREATMENT OF INJURED PERSONS.--
19 (a) Any physician, hospital, clinic, or other person
20 or institution lawfully rendering treatment to an injured
21 person for a bodily injury covered by personal injury
22 protection insurance may charge the insurer and injured party
23 only a reasonable amount pursuant to this section for the
24 services and supplies rendered, and the insurer providing such
25 coverage may pay for such charges directly to such person or
26 institution lawfully rendering such treatment, if the insured
27 receiving such treatment or his or her guardian has
28 countersigned the properly completed invoice, bill, or claim
29 form approved by the office upon which such charges are to be
30 paid for as having actually been rendered, to the best
31 knowledge of the insured or his or her guardian. In no event,
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1 however, may such a charge be in excess of the amount the
2 person or institution customarily charges for like services or
3 supplies. With respect to a determination of whether a charge
4 for a particular service, treatment, or otherwise is
5 reasonable, consideration may be given to evidence of usual
6 and customary charges and payments accepted by the provider
7 involved in the dispute, and reimbursement levels in the
8 community and various federal and state medical fee schedules
9 applicable to automobile and other insurance coverages, and
10 other information relevant to the reasonableness of the
11 reimbursement for the service, treatment, or supply.
12 (b)1. An insurer or insured is not required to pay a
13 claim or charges:
14 a. Made by a broker or by a person making a claim on
15 behalf of a broker;
16 b. For any service or treatment that was not lawful at
17 the time rendered;
18 c. To any person who knowingly submits a false or
19 misleading statement relating to the claim or charges;
20 d. With respect to a bill or statement that does not
21 substantially meet the applicable requirements of paragraph
22 (d);
23 e. For any treatment or service that is upcoded, or
24 that is unbundled when such treatment or services should be
25 bundled, in accordance with paragraph (d). To facilitate
26 prompt payment of lawful services, an insurer may change codes
27 that it determines to have been improperly or incorrectly
28 upcoded or unbundled, and may make payment based on the
29 changed codes, without affecting the right of the provider to
30 dispute the change by the insurer, provided that before doing
31 so, the insurer must contact the health care provider and
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1 discuss the reasons for the insurer's change and the health
2 care provider's reason for the coding, or make a reasonable
3 good faith effort to do so, as documented in the insurer's
4 file; and
5 f. For medical services or treatment billed by a
6 physician and not provided in a hospital unless such services
7 are rendered by the physician or are incident to his or her
8 professional services and are included on the physician's
9 bill, including documentation verifying that the physician is
10 responsible for the medical services that were rendered and
11 billed.
12 2. Charges for medically necessary cephalic
13 thermograms, peripheral thermograms, spinal ultrasounds,
14 extremity ultrasounds, video fluoroscopy, and surface
15 electromyography shall not exceed the maximum reimbursement
16 allowance for such procedures as set forth in the applicable
17 fee schedule or other payment methodology established pursuant
18 to s. 440.13.
19 3. Allowable amounts that may be charged to a personal
20 injury protection insurance insurer and insured for medically
21 necessary nerve conduction testing when done in conjunction
22 with a needle electromyography procedure and both are
23 performed and billed solely by a physician licensed under
24 chapter 458, chapter 459, chapter 460, or chapter 461 who is
25 also certified by the American Board of Electrodiagnostic
26 Medicine or by a board recognized by the American Board of
27 Medical Specialties or the American Osteopathic Association or
28 who holds diplomate status with the American Chiropractic
29 Neurology Board or its predecessors shall not exceed 200
30 percent of the allowable amount under the participating
31 physician fee schedule of Medicare Part B for year 2001, for
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1 the area in which the treatment was rendered, adjusted
2 annually on August 1 to reflect the prior calendar year's
3 changes in the annual Medical Care Item of the Consumer Price
4 Index for All Urban Consumers in the South Region as
5 determined by the Bureau of Labor Statistics of the United
6 States Department of Labor.
7 4. Allowable amounts that may be charged to a personal
8 injury protection insurance insurer and insured for medically
9 necessary nerve conduction testing that does not meet the
10 requirements of subparagraph 3. shall not exceed the
11 applicable fee schedule or other payment methodology
12 established pursuant to s. 440.13.
13 5. Allowable amounts that may be charged to a personal
14 injury protection insurance insurer and insured for magnetic
15 resonance imaging services shall not exceed 175 percent of the
16 allowable amount under the participating physician fee
17 schedule of Medicare Part B for year 2001, for the area in
18 which the treatment was rendered, adjusted annually on August
19 1 to reflect the prior calendar year's changes in the annual
20 Medical Care Item of the Consumer Price Index for All Urban
21 Consumers in the South Region as determined by the Bureau of
22 Labor Statistics of the United States Department of Labor for
23 the 12-month period ending June 30 of that year, except that
24 allowable amounts that may be charged to a personal injury
25 protection insurance insurer and insured for magnetic
26 resonance imaging services provided in facilities accredited
27 by the Accreditation Association for Ambulatory Health Care,
28 the American College of Radiology, or the Joint Commission on
29 Accreditation of Healthcare Organizations shall not exceed 200
30 percent of the allowable amount under the participating
31 physician fee schedule of Medicare Part B for year 2001, for
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1 the area in which the treatment was rendered, adjusted
2 annually on August 1 to reflect the prior calendar year's
3 changes in the annual Medical Care Item of the Consumer Price
4 Index for All Urban Consumers in the South Region as
5 determined by the Bureau of Labor Statistics of the United
6 States Department of Labor for the 12-month period ending June
7 30 of that year. This paragraph does not apply to charges for
8 magnetic resonance imaging services and nerve conduction
9 testing for inpatients and emergency services and care as
10 defined in chapter 395 rendered by facilities licensed under
11 chapter 395.
12 6. The Department of Health, in consultation with the
13 appropriate professional licensing boards, shall adopt, by
14 rule, a list of diagnostic tests deemed not to be medically
15 necessary for use in the treatment of persons sustaining
16 bodily injury covered by personal injury protection benefits
17 under this section. The initial list shall be adopted by
18 January 1, 2004, and shall be revised from time to time as
19 determined by the Department of Health, in consultation with
20 the respective professional licensing boards. Inclusion of a
21 test on the list of invalid diagnostic tests shall be based on
22 lack of demonstrated medical value and a level of general
23 acceptance by the relevant provider community and shall not be
24 dependent for results entirely upon subjective patient
25 response. Notwithstanding its inclusion on a fee schedule in
26 this subsection, an insurer or insured is not required to pay
27 any charges or reimburse claims for any invalid diagnostic
28 test as determined by the Department of Health.
29 (c)1. With respect to any treatment or service, other
30 than medical services billed by a hospital or other provider
31 for emergency services as defined in s. 395.002 or inpatient
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1 services rendered at a hospital-owned facility, the statement
2 of charges must be furnished to the insurer by the provider
3 and may not include, and the insurer is not required to pay,
4 charges for treatment or services rendered more than 35 days
5 before the postmark date of the statement, except for past due
6 amounts previously billed on a timely basis under this
7 paragraph, and except that, if the provider submits to the
8 insurer a notice of initiation of treatment within 21 days
9 after its first examination or treatment of the claimant, the
10 statement may include charges for treatment or services
11 rendered up to, but not more than, 75 days before the postmark
12 date of the statement. The injured party is not liable for,
13 and the provider shall not bill the injured party for, charges
14 that are unpaid because of the provider's failure to comply
15 with this paragraph. Any agreement requiring the injured
16 person or insured to pay for such charges is unenforceable.
17 2. If, however, the insured fails to furnish the
18 provider with the correct name and address of the insured's
19 personal injury protection insurer, the provider has 35 days
20 from the date the provider obtains the correct information to
21 furnish the insurer with a statement of the charges. The
22 insurer is not required to pay for such charges unless the
23 provider includes with the statement documentary evidence that
24 was provided by the insured during the 35-day period
25 demonstrating that the provider reasonably relied on erroneous
26 information from the insured and either:
27 a. A denial letter from the incorrect insurer; or
28 b. Proof of mailing, which may include an affidavit
29 under penalty of perjury, reflecting timely mailing to the
30 incorrect address or insurer.
31
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1 3. For emergency services and care as defined in s.
2 395.002 rendered in a hospital emergency department or for
3 transport and treatment rendered by an ambulance provider
4 licensed pursuant to part III of chapter 401, the provider is
5 not required to furnish the statement of charges within the
6 time periods established by this paragraph; and the insurer
7 shall not be considered to have been furnished with notice of
8 the amount of covered loss for purposes of paragraph (4)(b)
9 until it receives a statement complying with paragraph (d), or
10 copy thereof, which specifically identifies the place of
11 service to be a hospital emergency department or an ambulance
12 in accordance with billing standards recognized by the Health
13 Care Finance Administration.
14 4. Each notice of insured's rights under s. 627.7401
15 must include the following statement in type no smaller than
16 12 points:
17
18 BILLING REQUIREMENTS.--Florida Statutes provide
19 that with respect to any treatment or services,
20 other than certain hospital and emergency
21 services, the statement of charges furnished to
22 the insurer by the provider may not include,
23 and the insurer and the injured party are not
24 required to pay, charges for treatment or
25 services rendered more than 35 days before the
26 postmark date of the statement, except for past
27 due amounts previously billed on a timely
28 basis, and except that, if the provider submits
29 to the insurer a notice of initiation of
30 treatment within 21 days after its first
31 examination or treatment of the claimant, the
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1 statement may include charges for treatment or
2 services rendered up to, but not more than, 75
3 days before the postmark date of the statement.
4
5 (d) All statements and bills for medical services
6 rendered by any physician, hospital, clinic, or other person
7 or institution shall be submitted to the insurer on a properly
8 completed Centers for Medicare and Medicaid Services (CMS)
9 1500 form, UB 92 forms, or any other standard form approved by
10 the office or adopted by the commission for purposes of this
11 paragraph. All billings for such services rendered by
12 providers shall, to the extent applicable, follow the
13 Physicians' Current Procedural Terminology (CPT) or Healthcare
14 Correct Procedural Coding System (HCPCS), or ICD-9 in effect
15 for the year in which services are rendered and comply with
16 the Centers for Medicare and Medicaid Services (CMS) 1500 form
17 instructions and the American Medical Association Current
18 Procedural Terminology (CPT) Editorial Panel and Healthcare
19 Correct Procedural Coding System (HCPCS). All providers other
20 than hospitals shall include on the applicable claim form the
21 professional license number of the provider in the line or
22 space provided for "Signature of Physician or Supplier,
23 Including Degrees or Credentials." In determining compliance
24 with applicable CPT and HCPCS coding, guidance shall be
25 provided by the Physicians' Current Procedural Terminology
26 (CPT) or the Healthcare Correct Procedural Coding System
27 (HCPCS) in effect for the year in which services were
28 rendered, the Office of the Inspector General (OIG),
29 Physicians Compliance Guidelines, and other authoritative
30 treatises designated by rule by the Agency for Health Care
31 Administration. No statement of medical services may include
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1 charges for medical services of a person or entity that
2 performed such services without possessing the valid licenses
3 required to perform such services. For purposes of paragraph
4 (4)(b), an insurer shall not be considered to have been
5 furnished with notice of the amount of covered loss or medical
6 bills due unless the statements or bills comply with this
7 paragraph, and unless the statements or bills are properly
8 completed in their entirety as to all material provisions,
9 with all relevant information being provided therein.
10 (e)1. At the initial treatment or service provided,
11 each physician, other licensed professional, clinic, or other
12 medical institution providing medical services upon which a
13 claim for personal injury protection benefits is based shall
14 require an insured person, or his or her guardian, to execute
15 a disclosure and acknowledgment form, which reflects at a
16 minimum that:
17 a. The insured, or his or her guardian, must
18 countersign the form attesting to the fact that the services
19 set forth therein were actually rendered;
20 b. The insured, or his or her guardian, has both the
21 right and affirmative duty to confirm that the services were
22 actually rendered;
23 c. The insured, or his or her guardian, was not
24 solicited by any person to seek any services from the medical
25 provider;
26 d. That the physician, other licensed professional,
27 clinic, or other medical institution rendering services for
28 which payment is being claimed explained the services to the
29 insured or his or her guardian; and
30 e. If the insured notifies the insurer in writing of a
31 billing error, the insured may be entitled to a certain
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1 percentage of a reduction in the amounts paid by the insured's
2 motor vehicle insurer.
3 2. The physician, other licensed professional, clinic,
4 or other medical institution rendering services for which
5 payment is being claimed has the affirmative duty to explain
6 the services rendered to the insured, or his or her guardian,
7 so that the insured, or his or her guardian, countersigns the
8 form with informed consent.
9 3. Countersignature by the insured, or his or her
10 guardian, is not required for the reading of diagnostic tests
11 or other services that are of such a nature that they are not
12 required to be performed in the presence of the insured.
13 4. The licensed medical professional rendering
14 treatment for which payment is being claimed must sign, by his
15 or her own hand, the form complying with this paragraph.
16 5. The original completed disclosure and
17 acknowledgment form shall be furnished to the insurer pursuant
18 to paragraph (4)(b) and may not be electronically furnished.
19 6. This disclosure and acknowledgment form is not
20 required for services billed by a provider for emergency
21 services as defined in s. 395.002, for emergency services and
22 care as defined in s. 395.002 rendered in a hospital emergency
23 department, or for transport and treatment rendered by an
24 ambulance provider licensed pursuant to part III of chapter
25 401.
26 7. The Financial Services Commission shall adopt, by
27 rule, a standard disclosure and acknowledgment form that shall
28 be used to fulfill the requirements of this paragraph,
29 effective 90 days after such form is adopted and becomes
30 final. The commission shall adopt a proposed rule by October
31 1, 2003. Until the rule is final, the provider may use a form
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1 of its own which otherwise complies with the requirements of
2 this paragraph.
3 8. As used in this paragraph, "countersigned" means a
4 second or verifying signature, as on a previously signed
5 document, and is not satisfied by the statement "signature on
6 file" or any similar statement.
7 9. The requirements of this paragraph apply only with
8 respect to the initial treatment or service of the insured by
9 a provider. For subsequent treatments or service, the provider
10 must maintain a patient log signed by the patient, in
11 chronological order by date of service, that is consistent
12 with the services being rendered to the patient as claimed.
13 The requirements of this subparagraph for maintaining a
14 patient log signed by the patient may be met by a hospital
15 that maintains medical records as required by s. 395.3025 and
16 applicable rules and makes such records available to the
17 insurer upon request.
18 (f) Upon written notification by any person, an
19 insurer shall investigate any claim of improper billing by a
20 physician or other medical provider. The insurer shall
21 determine if the insured was properly billed for only those
22 services and treatments that the insured actually received. If
23 the insurer determines that the insured has been improperly
24 billed, the insurer shall notify the insured, the person
25 making the written notification and the provider of its
26 findings and shall reduce the amount of payment to the
27 provider by the amount determined to be improperly billed. If
28 a reduction is made due to such written notification by any
29 person, the insurer shall pay to the person 20 percent of the
30 amount of the reduction, up to $500. If the provider is
31 arrested due to the improper billing, then the insurer shall
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1 pay to the person 40 percent of the amount of the reduction,
2 up to $500.
3 (g) An insurer may not systematically downcode with
4 the intent to deny reimbursement otherwise due. Such action
5 constitutes a material misrepresentation under s.
6 626.9541(1)(i)2.
7 (6) DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
8 DISPUTES.--
9 (a) Every employer shall, if a request is made by an
10 insurer providing personal injury protection benefits under
11 ss. 627.730-627.7405 against whom a claim has been made,
12 furnish forthwith, in a form approved by the office, a sworn
13 statement of the earnings, since the time of the bodily injury
14 and for a reasonable period before the injury, of the person
15 upon whose injury the claim is based.
16 (b) Every physician, hospital, clinic, or other
17 medical institution providing, before or after bodily injury
18 upon which a claim for personal injury protection insurance
19 benefits is based, any products, services, or accommodations
20 in relation to that or any other injury, or in relation to a
21 condition claimed to be connected with that or any other
22 injury, shall, if requested to do so by the insurer against
23 whom the claim has been made, furnish forthwith a written
24 report of the history, condition, treatment, dates, and costs
25 of such treatment of the injured person and why the items
26 identified by the insurer were reasonable in amount and
27 medically necessary, together with a sworn statement that the
28 treatment or services rendered were reasonable and necessary
29 with respect to the bodily injury sustained and identifying
30 which portion of the expenses for such treatment or services
31 was incurred as a result of such bodily injury, and produce
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1 forthwith, and permit the inspection and copying of, his or
2 her or its records regarding such history, condition,
3 treatment, dates, and costs of treatment; provided that this
4 shall not limit the introduction of evidence at trial. Such
5 sworn statement shall read as follows: "Under penalty of
6 perjury, I declare that I have read the foregoing, and the
7 facts alleged are true, to the best of my knowledge and
8 belief." No cause of action for violation of the
9 physician-patient privilege or invasion of the right of
10 privacy shall be permitted against any physician, hospital,
11 clinic, or other medical institution complying with the
12 provisions of this section. The person requesting such records
13 and such sworn statement shall pay all reasonable costs
14 connected therewith. If an insurer makes a written request for
15 documentation or information under this paragraph within 30
16 days after having received notice of the amount of a covered
17 loss under paragraph (4)(a), the amount or the partial amount
18 which is the subject of the insurer's inquiry shall become
19 overdue if the insurer does not pay in accordance with
20 paragraph (4)(b) or within 10 days after the insurer's receipt
21 of the requested documentation or information, whichever
22 occurs later. For purposes of this paragraph, the term
23 "receipt" includes, but is not limited to, inspection and
24 copying pursuant to this paragraph. Any insurer that requests
25 documentation or information pertaining to reasonableness of
26 charges or medical necessity under this paragraph without a
27 reasonable basis for such requests as a general business
28 practice is engaging in an unfair trade practice under the
29 insurance code.
30 (c) In the event of any dispute regarding an insurer's
31 right to discovery of facts under this section, the insurer
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1 may petition a court of competent jurisdiction to enter an
2 order permitting such discovery. The order may be made only
3 on motion for good cause shown and upon notice to all persons
4 having an interest, and it shall specify the time, place,
5 manner, conditions, and scope of the discovery. Such court
6 may, in order to protect against annoyance, embarrassment, or
7 oppression, as justice requires, enter an order refusing
8 discovery or specifying conditions of discovery and may order
9 payments of costs and expenses of the proceeding, including
10 reasonable fees for the appearance of attorneys at the
11 proceedings, as justice requires.
12 (d) The injured person shall be furnished, upon
13 request, a copy of all information obtained by the insurer
14 under the provisions of this section, and shall pay a
15 reasonable charge, if required by the insurer.
16 (e) Notice to an insurer of the existence of a claim
17 shall not be unreasonably withheld by an insured.
18 (7) MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON;
19 REPORTS.--
20 (a) Whenever the mental or physical condition of an
21 injured person covered by personal injury protection is
22 material to any claim that has been or may be made for past or
23 future personal injury protection insurance benefits, such
24 person shall, upon the request of an insurer, submit to mental
25 or physical examination by a physician or physicians. The
26 costs of any examinations requested by an insurer shall be
27 borne entirely by the insurer. Such examination shall be
28 conducted within the municipality where the insured is
29 receiving treatment, or in a location reasonably accessible to
30 the insured, which, for purposes of this paragraph, means any
31 location within the municipality in which the insured resides,
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1 or any location within 10 miles by road of the insured's
2 residence, provided such location is within the county in
3 which the insured resides. If the examination is to be
4 conducted in a location reasonably accessible to the insured,
5 and if there is no qualified physician to conduct the
6 examination in a location reasonably accessible to the
7 insured, then such examination shall be conducted in an area
8 of the closest proximity to the insured's residence. Personal
9 protection insurers are authorized to include reasonable
10 provisions in personal injury protection insurance policies
11 for mental and physical examination of those claiming personal
12 injury protection insurance benefits. An insurer may not
13 withdraw payment of a treating physician without the consent
14 of the injured person covered by the personal injury
15 protection, unless the insurer first obtains a valid report by
16 a Florida physician licensed under the same chapter as the
17 treating physician whose treatment authorization is sought to
18 be withdrawn, stating that treatment was not reasonable,
19 related, or necessary. A valid report is one that is prepared
20 and signed by the physician examining the injured person or
21 reviewing the treatment records of the injured person and is
22 factually supported by the examination and treatment records
23 if reviewed and that has not been modified by anyone other
24 than the physician. The physician preparing the report must be
25 in active practice, unless the physician is physically
26 disabled. Active practice means that during the 3 years
27 immediately preceding the date of the physical examination or
28 review of the treatment records the physician must have
29 devoted professional time to the active clinical practice of
30 evaluation, diagnosis, or treatment of medical conditions or
31 to the instruction of students in an accredited health
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1 professional school or accredited residency program or a
2 clinical research program that is affiliated with an
3 accredited health professional school or teaching hospital or
4 accredited residency program. The physician preparing a report
5 at the request of an insurer and physicians rendering expert
6 opinions on behalf of persons claiming medical benefits for
7 personal injury protection, or on behalf of an insured through
8 an attorney or another entity, shall maintain, for at least 3
9 years, copies of all examination reports as medical records
10 and shall maintain, for at least 3 years, records of all
11 payments for the examinations and reports. Neither an insurer
12 nor any person acting at the direction of or on behalf of an
13 insurer may materially change an opinion in a report prepared
14 under this paragraph or direct the physician preparing the
15 report to change such opinion. The denial of a payment as the
16 result of such a changed opinion constitutes a material
17 misrepresentation under s. 626.9541(1)(i)2.; however, this
18 provision does not preclude the insurer from calling to the
19 attention of the physician errors of fact in the report based
20 upon information in the claim file.
21 (b) If requested by the person examined, a party
22 causing an examination to be made shall deliver to him or her
23 a copy of every written report concerning the examination
24 rendered by an examining physician, at least one of which
25 reports must set out the examining physician's findings and
26 conclusions in detail. After such request and delivery, the
27 party causing the examination to be made is entitled, upon
28 request, to receive from the person examined every written
29 report available to him or her or his or her representative
30 concerning any examination, previously or thereafter made, of
31 the same mental or physical condition. By requesting and
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1 obtaining a report of the examination so ordered, or by taking
2 the deposition of the examiner, the person examined waives any
3 privilege he or she may have, in relation to the claim for
4 benefits, regarding the testimony of every other person who
5 has examined, or may thereafter examine, him or her in respect
6 to the same mental or physical condition. If a person
7 unreasonably refuses to submit to an examination, the personal
8 injury protection carrier is no longer liable for subsequent
9 personal injury protection benefits.
10 (8) APPLICABILITY OF PROVISION REGULATING ATTORNEY'S
11 FEES.--With respect to any dispute under the provisions of ss.
12 627.730-627.7405 between the insured and the insurer, or
13 between an assignee of an insured's rights and the insurer,
14 the provisions of s. 627.428 shall apply, except as provided
15 in subsection (11).
16 (9)(a) Each insurer which has issued a policy
17 providing personal injury protection benefits shall report the
18 renewal, cancellation, or nonrenewal thereof to the Department
19 of Highway Safety and Motor Vehicles within 45 days from the
20 effective date of the renewal, cancellation, or nonrenewal.
21 Upon the issuance of a policy providing personal injury
22 protection benefits to a named insured not previously insured
23 by the insurer thereof during that calendar year, the insurer
24 shall report the issuance of the new policy to the Department
25 of Highway Safety and Motor Vehicles within 30 days. The
26 report shall be in such form and format and contain such
27 information as may be required by the Department of Highway
28 Safety and Motor Vehicles which shall include a format
29 compatible with the data processing capabilities of said
30 department, and the Department of Highway Safety and Motor
31 Vehicles is authorized to adopt rules necessary with respect
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1 thereto. Failure by an insurer to file proper reports with the
2 Department of Highway Safety and Motor Vehicles as required by
3 this subsection or rules adopted with respect to the
4 requirements of this subsection constitutes a violation of the
5 Florida Insurance Code. Reports of cancellations and policy
6 renewals and reports of the issuance of new policies received
7 by the Department of Highway Safety and Motor Vehicles are
8 confidential and exempt from the provisions of s. 119.07(1).
9 These records are to be used for enforcement and regulatory
10 purposes only, including the generation by the department of
11 data regarding compliance by owners of motor vehicles with
12 financial responsibility coverage requirements. In addition,
13 the Department of Highway Safety and Motor Vehicles shall
14 release, upon a written request by a person involved in a
15 motor vehicle accident, by the person's attorney, or by a
16 representative of the person's motor vehicle insurer, the name
17 of the insurance company and the policy number for the policy
18 covering the vehicle named by the requesting party. The
19 written request must include a copy of the appropriate
20 accident form as provided in s. 316.065, s. 316.066, or s.
21 316.068.
22 (b) Every insurer with respect to each insurance
23 policy providing personal injury protection benefits shall
24 notify the named insured or in the case of a commercial fleet
25 policy, the first named insured in writing that any
26 cancellation or nonrenewal of the policy will be reported by
27 the insurer to the Department of Highway Safety and Motor
28 Vehicles. The notice shall also inform the named insured that
29 failure to maintain personal injury protection and property
30 damage liability insurance on a motor vehicle when required by
31 law may result in the loss of registration and driving
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1 privileges in this state, and the notice shall inform the
2 named insured of the amount of the reinstatement fees required
3 by s. 627.733(7). This notice is for informational purposes
4 only, and no civil liability shall attach to an insurer due to
5 failure to provide this notice.
6 (10) An insurer may negotiate and enter into contracts
7 with licensed health care providers for the benefits described
8 in this section, referred to in this section as "preferred
9 providers," which shall include health care providers licensed
10 under chapters 458, 459, 460, 461, and 463. The insurer may
11 provide an option to an insured to use a preferred provider at
12 the time of purchase of the policy for personal injury
13 protection benefits, if the requirements of this subsection
14 are met. If the insured elects to use a provider who is not a
15 preferred provider, whether the insured purchased a preferred
16 provider policy or a nonpreferred provider policy, the medical
17 benefits provided by the insurer shall be as required by this
18 section. If the insured elects to use a provider who is a
19 preferred provider, the insurer may pay medical benefits in
20 excess of the benefits required by this section and may waive
21 or lower the amount of any deductible that applies to such
22 medical benefits. If the insurer offers a preferred provider
23 policy to a policyholder or applicant, it must also offer a
24 nonpreferred provider policy. The insurer shall provide each
25 policyholder with a current roster of preferred providers in
26 the county in which the insured resides at the time of
27 purchase of such policy, and shall make such list available
28 for public inspection during regular business hours at the
29 principal office of the insurer within the state.
30 (11) DEMAND LETTER.--
31
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1 (a) As a condition precedent to filing any action for
2 benefits under this section, the insurer must be provided with
3 written notice of an intent to initiate litigation. Such
4 notice may not be sent until the claim is overdue, including
5 any additional time the insurer has to pay the claim pursuant
6 to paragraph (4)(b).
7 (b) The notice required shall state that it is a
8 "demand letter under s. 627.736(11)" and shall state with
9 specificity:
10 1. The name of the insured upon which such benefits
11 are being sought, including a copy of the assignment giving
12 rights to the claimant if the claimant is not the insured.
13 2. The claim number or policy number upon which such
14 claim was originally submitted to the insurer.
15 3. To the extent applicable, the name of any medical
16 provider who rendered to an insured the treatment, services,
17 accommodations, or supplies that form the basis of such claim;
18 and an itemized statement specifying each exact amount, the
19 date of treatment, service, or accommodation, and the type of
20 benefit claimed to be due. A completed form satisfying the
21 requirements of paragraph (5)(d) or the lost-wage statement
22 previously submitted may be used as the itemized statement. To
23 the extent that the demand involves an insurer's withdrawal of
24 payment under paragraph (7)(a) for future treatment not yet
25 rendered, the claimant shall attach a copy of the insurer's
26 notice withdrawing such payment and an itemized statement of
27 the type, frequency, and duration of future treatment claimed
28 to be reasonable and medically necessary.
29 (c) Each notice required by this subsection must be
30 delivered to the insurer by United States certified or
31 registered mail, return receipt requested. Such postal costs
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1 shall be reimbursed by the insurer if so requested by the
2 claimant in the notice, when the insurer pays the claim. Such
3 notice must be sent to the person and address specified by the
4 insurer for the purposes of receiving notices under this
5 subsection. Each licensed insurer, whether domestic, foreign,
6 or alien, shall file with the office designation of the name
7 and address of the person to whom notices pursuant to this
8 subsection shall be sent which the office shall make available
9 on its Internet website. The name and address on file with the
10 office pursuant to s. 624.422 shall be deemed the authorized
11 representative to accept notice pursuant to this subsection in
12 the event no other designation has been made.
13 (d) If, within 15 days after receipt of notice by the
14 insurer, the overdue claim specified in the notice is paid by
15 the insurer together with applicable interest and a penalty of
16 10 percent of the overdue amount paid by the insurer, subject
17 to a maximum penalty of $250, no action may be brought against
18 the insurer. If the demand involves an insurer's withdrawal of
19 payment under paragraph (7)(a) for future treatment not yet
20 rendered, no action may be brought against the insurer if,
21 within 15 days after its receipt of the notice, the insurer
22 mails to the person filing the notice a written statement of
23 the insurer's agreement to pay for such treatment in
24 accordance with the notice and to pay a penalty of 10 percent,
25 subject to a maximum penalty of $250, when it pays for such
26 future treatment in accordance with the requirements of this
27 section. To the extent the insurer determines not to pay any
28 amount demanded, the penalty shall not be payable in any
29 subsequent action. For purposes of this subsection, payment or
30 the insurer's agreement shall be treated as being made on the
31 date a draft or other valid instrument that is equivalent to
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1 payment, or the insurer's written statement of agreement, is
2 placed in the United States mail in a properly addressed,
3 postpaid envelope, or if not so posted, on the date of
4 delivery. The insurer shall not be obligated to pay any
5 attorney's fees if the insurer pays the claim or mails its
6 agreement to pay for future treatment within the time
7 prescribed by this subsection.
8 (e) The applicable statute of limitation for an action
9 under this section shall be tolled for a period of 15 business
10 days by the mailing of the notice required by this subsection.
11 (f) Any insurer making a general business practice of
12 not paying valid claims until receipt of the notice required
13 by this subsection is engaging in an unfair trade practice
14 under the insurance code.
15 (12) CIVIL ACTION FOR INSURANCE FRAUD.--An insurer
16 shall have a cause of action against any person convicted of,
17 or who, regardless of adjudication of guilt, pleads guilty or
18 nolo contendere to insurance fraud under s. 817.234, patient
19 brokering under s. 817.505, or kickbacks under s. 456.054,
20 associated with a claim for personal injury protection
21 benefits in accordance with this section. An insurer
22 prevailing in an action brought under this subsection may
23 recover compensatory, consequential, and punitive damages
24 subject to the requirements and limitations of part II of
25 chapter 768, and attorney's fees and costs incurred in
26 litigating a cause of action against any person convicted of,
27 or who, regardless of adjudication of guilt, pleads guilty or
28 nolo contendere to insurance fraud under s. 817.234, patient
29 brokering under s. 817.505, or kickbacks under s. 456.054,
30 associated with a claim for personal injury protection
31 benefits in accordance with this section.
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1 (13) MINIMUM BENEFIT COVERAGE.--If the Financial
2 Services Commission determines that the cost savings under
3 personal injury protection insurance benefits paid by insurers
4 have been realized due to the provisions of this act, prior
5 legislative reforms, or other factors, the commission may
6 increase the minimum $10,000 benefit coverage requirement. In
7 establishing the amount of such increase, the commission must
8 determine that the additional premium for such coverage is
9 approximately equal to the premium cost savings that have been
10 realized for the personal injury protection coverage with
11 limits of $10,000.
12 (14) FRAUD ADVISORY NOTICE.--Upon receiving notice of
13 a claim under this section, an insurer shall provide a notice
14 to the insured or to a person for whom a claim for
15 reimbursement for diagnosis or treatment of injuries has been
16 filed, advising that:
17 (a) Pursuant to s. 626.9892, the Department of
18 Financial Services may pay rewards of up to $25,000 to persons
19 providing information leading to the arrest and conviction of
20 persons committing crimes investigated by the Division of
21 Insurance Fraud arising from violations of s. 440.105, s.
22 624.15, s. 626.9541, s. 626.989, or s. 817.234.
23 (b) Solicitation of a person injured in a motor
24 vehicle crash for purposes of filing personal injury
25 protection or tort claims could be a violation of s. 817.234,
26 s. 817.505, or the rules regulating The Florida Bar and should
27 be immediately reported to the Division of Insurance Fraud if
28 such conduct has taken place.
29 Section 9. This act shall take effect July 1, 2007.
30
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1 *****************************************
2 SENATE SUMMARY
3 Provides for the proof of purchase of medical payments
coverage. Provides that a motor vehicle insurance policy
4 providing medical payments coverage may not be issued or
delivered in this state unless the policy contains
5 specified minimum amounts of certain types of liability
coverage. Authorizes a licensed general lines agent to
6 charge a fee not to exceed $10 to cover certain
administrative costs under certain circumstances.
7 Provides an exemption to certain provisions regarding the
initial issuance or cancellation of policies containing
8 medical payments coverage and certain other types of
liability coverage. Requires every insurance policy
9 complying with the security requirements of state law to
provide medical payments coverage. Identifies types of
10 medical expenses covered by medical payments coverage.
Limits coverage for certain medical expenses up to
11 specified amounts per person and per accident. Requires
all bills submitted by hospitals and physicians to appear
12 on certain forms. Provides for charges and payment for
medical services for covered persons. Authorizes insurers
13 to negotiate and enter into contracts with preferred
providers. Provides that only insurers writing motor
14 vehicle liability insurance in this state may provide
medical payments coverage benefits. Prohibits an insurer
15 from requiring the purchase of coverage other than
property damage liability coverage as a condition for
16 providing such benefits. Requires insurers to make such
coverage available through normal marketing channels.
17 Provides that failure to make medical payments coverage
and property damages liability coverage available through
18 normal marketing channels is a violation of the insurance
code. Provides penalties. Provides for payments of
19 benefits. Provides that medical payments coverage
benefits are subject to the provisions of the Medicaid
20 program in certain circumstances. Requires each insurer
that has issued a policy providing medical payments
21 coverage to report the renewal, cancellation, or
nonrenewal of each policy to the Department of Highway
22 Safety and Motor Vehicles within a specified period after
the effective date of each renewal, cancellation, or
23 nonrenewal. Requires each insurer that issues a new
policy providing medical payments coverage to report such
24 issuance to the department within a specified period
after issuance. Provides for the form and contents of
25 such reports. Provides that such reports are
confidential. Limits the department's use of such
26 reports. Provides for the release of certain information
regarding insurance coverage upon the written request of
27 specified parties in the event of an automobile accident.
Requires a written request for release of information to
28 include a copy of the appropriate accident form. Requires
insurers to notify the named insured in writing that any
29 cancellation or nonrenewal of the policy will be reported
to the department. Requires that the notice include
30 certain additional information. Provides that no civil
liability attaches due to the insurer's failure to
31 provide such notice.
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