1 | A bill to be entitled |
2 | An act relating to motor vehicle insurance; amending s. |
3 | 316.646, F.S.; requiring each person operating a motor |
4 | vehicle to have in his or her possession proof of property |
5 | damage liability coverage; conforming a cross-reference to |
6 | changes made by the act; amending s. 320.02, F.S.; |
7 | clarifying the requirements concerning insurance and |
8 | liability coverage for certain motor vehicles registered |
9 | in this state; amending s. 321.245, F.S., relating to the |
10 | disposition of certain funds in the Highway Safety |
11 | Operating Trust Fund; conforming a cross-reference; |
12 | amending s. 324.022, F.S.; revising provisions requiring |
13 | the owner or operator of a motor vehicle to maintain |
14 | property damage liability coverage; specifying the |
15 | requirements that apply to such a policy; providing |
16 | definitions; requiring that a nonresident owner or |
17 | registrant of a motor vehicle maintain property damage |
18 | liability coverage if the motor vehicle is in the state |
19 | longer than a specified period; providing an exception for |
20 | a member of the United States Armed Forces who is on |
21 | active duty outside the United States; creating s. |
22 | 324.0221, F.S.; requiring insurers to report to the |
23 | Department of Highway Safety and Motor Vehicles the |
24 | renewal, cancellation, or nonrenewal of a policy providing |
25 | personal injury protection coverage or motor vehicle |
26 | property damage liability coverage; authorizing the |
27 | department to adopt rules for the reports; providing that |
28 | failure to report as required is a violation of the |
29 | Florida Insurance Code; requiring that an insurer notify |
30 | the named insured that a cancelled or nonrenewed policy |
31 | will be reported to the department; requiring that the |
32 | department suspend the registration and driver's license |
33 | of an owner or registrant of a motor vehicle who fails to |
34 | maintain the required liability coverage; providing for |
35 | the reinstatement of a registration or driver's license |
36 | upon payment of certain fees; requiring that a person |
37 | obtain noncancelable coverage following such |
38 | reinstatement; providing for the deposit and use of |
39 | reinstatement fees; amending ss. 627.7275 and 627.7295, |
40 | F.S., relating to motor vehicle insurance policies and |
41 | contracts; conforming provisions to changes made by the |
42 | act; reviving and reenacting ss. 627.730, 627.731, |
43 | 627.732, 627.734, 627.737, 627.739, 627.7401, 627.7403, |
44 | and 627.7405, F.S., and reviving, reenacting, and amending |
45 | ss. 627.733 and 627.736, the Florida Motor Vehicle No- |
46 | Fault Law, notwithstanding the repeal of such law provided |
47 | in s. 19, chapter 2003-411, Laws of Florida; deleting |
48 | certain provisions relating to the suspension and |
49 | reinstatement of a driver's license and registration and |
50 | notice to the Department of Highway Safety and Motor |
51 | Vehicles; conforming provisions to changes made by the |
52 | act; providing legislative intent with respect to the |
53 | reenactment and codification of the Florida Motor Vehicle |
54 | No-Fault Law, notwithstanding its prior repeal; amending |
55 | s. 627.736, F.S., as reenacted and amended; revising |
56 | provisions governing the medical benefits provided as |
57 | required personal injury protection benefits; providing |
58 | medical benefits for services and care ordered or |
59 | prescribed by a physician or provided by certain persons |
60 | or entities that meet certain requirements; requiring the |
61 | Financial services Commission to adopt rules; revising a |
62 | limitation on the amount of death benefits payable; |
63 | requiring personal injury protection insurers to reserve |
64 | benefits for certain providers for a specified period; |
65 | tolling the time period for the insurer to pay claims from |
66 | other providers; authorizing an insurer to limit |
67 | reimbursement for personal injury protection benefits to a |
68 | specified percentage of a schedule of maximum charges; |
69 | prohibiting provider from billing or attempting to collect |
70 | amounts in excess of such limits, except for amounts that |
71 | are not covered by personal injury protection coverage; |
72 | deleting provisions specifying allowable amounts for |
73 | certain tests and services; providing for electronic |
74 | transmission of certain statements; extending the period |
75 | during which an insurer may pay an overdue claim following |
76 | receipt of a demand letter without incurring a penalty; |
77 | providing for penalties to be imposed against certain |
78 | insurers for failing to pay claims for personal injury |
79 | protection; authorizing the Department of Legal Affairs to |
80 | investigate violations and initiate enforcement action; |
81 | requiring that all claims related to the same health care |
82 | provider for the same injured person be brought in one act |
83 | unless good cause is shown; requiring that the |
84 | transmission of electronic notices and communications |
85 | required or authorized under the Florida Motor Vehicle No- |
86 | Fault Law be consistent with state and federal privacy and |
87 | security laws; amending s. 627.739, F.S., as reenacted; |
88 | deleting provisions authorizing an insurer to offer |
89 | certain deductibles with respect to a policy of personal |
90 | injury protection; providing legislative intent concerning |
91 | the application of the act; requiring insurers to deliver |
92 | revised notices of premium and policy changes to certain |
93 | policyholders; requiring an insurer to cancel the policy |
94 | and return any unearned premium if the insured fails to |
95 | timely respond to the notice; providing for calculating |
96 | the amount of unearned premium; requiring that insurers |
97 | continue to use certain forms and rates until a specified |
98 | date unless the Office of Insurance Regulation approves |
99 | new forms or rates or are otherwise legally allowed; |
100 | providing that a person purchasing a motor vehicle |
101 | insurance policy without personal injury protection |
102 | coverage is exempt from the requirement for such coverage |
103 | and is not subject to certain liability provisions for a |
104 | specified period; requiring that insurers provide notice |
105 | of the requirement for personal injury protection coverage |
106 | or add an endorsement to the policy providing such |
107 | coverage; providing effective dates. |
108 |
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109 | Be It Enacted by the Legislature of the State of Florida: |
110 |
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111 | Section 1. Subsections (1) and (3) of section 316.646, |
112 | Florida Statutes, are amended to read: |
113 | 316.646 Security required; proof of security and display |
114 | thereof; dismissal of cases.-- |
115 | (1) Any person required by s. 324.022 to maintain property |
116 | damage liability security, required by s. 324.023 to maintain |
117 | liability security for bodily injury or death, or any person |
118 | required by s. 627.733 to maintain personal injury protection |
119 | security on a motor vehicle shall have in his or her immediate |
120 | possession at all times while operating such motor vehicle |
121 | proper proof of maintenance of the required security. Such proof |
122 | shall be either a uniform proof-of-insurance card in a form |
123 | prescribed by the department, a valid insurance policy, an |
124 | insurance policy binder, a certificate of insurance, or such |
125 | other proof as may be prescribed by the department. |
126 | (3) Any person who violates this section commits a |
127 | nonmoving traffic infraction subject to the penalty provided in |
128 | chapter 318 and shall be required to furnish proof of security |
129 | as provided in this section. If any person charged with a |
130 | violation of this section fails to furnish proof, at or before |
131 | the scheduled court appearance date, that security was in effect |
132 | at the time of the violation, the court may immediately suspend |
133 | the registration and driver's license of such person. Such |
134 | license and registration may only be reinstated only as provided |
135 | in s. 324.0221 627.733. |
136 | Section 2. Paragraphs (a) and (d) of subsection (5) of |
137 | section 320.02, Florida Statutes, are amended to read: |
138 | 320.02 Registration required; application for |
139 | registration; forms.-- |
140 | (5)(a) Proof that personal injury protection benefits have |
141 | been purchased when required under s. 627.733, that property |
142 | damage liability coverage has been purchased as required under |
143 | s. 324.022, that bodily injury or death coverage has been |
144 | purchased if required under s. 324.023, and that combined bodily |
145 | liability insurance and property damage liability insurance have |
146 | been purchased when required under s. 627.7415 shall be provided |
147 | in the manner prescribed by law by the applicant at the time of |
148 | application for registration of any motor vehicle that is |
149 | subject to such requirements owned as defined in s. 627.732. The |
150 | issuing agent shall refuse to issue registration if such proof |
151 | of purchase is not provided. Insurers shall furnish uniform |
152 | proof-of-purchase cards in a form prescribed by the department |
153 | and shall include the name of the insured's insurance company, |
154 | the coverage identification number, and the make, year, and |
155 | vehicle identification number of the vehicle insured. The card |
156 | shall contain a statement notifying the applicant of the penalty |
157 | specified in s. 316.646(4). The card or insurance policy, |
158 | insurance policy binder, or certificate of insurance or a |
159 | photocopy of any of these; an affidavit containing the name of |
160 | the insured's insurance company, the insured's policy number, |
161 | and the make and year of the vehicle insured; or such other |
162 | proof as may be prescribed by the department shall constitute |
163 | sufficient proof of purchase. If an affidavit is provided as |
164 | proof, it shall be in substantially the following form: |
165 |
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166 | Under penalty of perjury, I (Name of insured) do hereby |
167 | certify that I have (Personal Injury Protection, Property |
168 | Damage Liability, and, when required, Bodily Injury Liability) |
169 | Insurance currently in effect with (Name of insurance company) |
170 | under (policy number) covering (make, year, and vehicle |
171 | identification number of vehicle) . (Signature of Insured) |
172 |
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173 | Such affidavit shall include the following warning: |
174 |
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175 | WARNING: GIVING FALSE INFORMATION IN ORDER TO OBTAIN A VEHICLE |
176 | REGISTRATION CERTIFICATE IS A CRIMINAL OFFENSE UNDER FLORIDA |
177 | LAW. ANYONE GIVING FALSE INFORMATION ON THIS AFFIDAVIT IS |
178 | SUBJECT TO PROSECUTION. |
179 |
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180 | When an application is made through a licensed motor vehicle |
181 | dealer as required in s. 319.23, the original or a photostatic |
182 | copy of such card, insurance policy, insurance policy binder, or |
183 | certificate of insurance or the original affidavit from the |
184 | insured shall be forwarded by the dealer to the tax collector of |
185 | the county or the Department of Highway Safety and Motor |
186 | Vehicles for processing. By executing the aforesaid affidavit, |
187 | no licensed motor vehicle dealer will be liable in damages for |
188 | any inadequacy, insufficiency, or falsification of any statement |
189 | contained therein. A card shall also indicate the existence of |
190 | any bodily injury liability insurance voluntarily purchased. |
191 | (d) The verifying of proof of personal injury protection |
192 | insurance, proof of property damage liability insurance, proof |
193 | of combined bodily liability insurance and property damage |
194 | liability insurance, or proof of financial responsibility |
195 | insurance and the issuance or failure to issue the motor vehicle |
196 | registration under the provisions of this chapter may not be |
197 | construed in any court as a warranty of the reliability or |
198 | accuracy of the evidence of such proof. Neither the department |
199 | nor any tax collector is liable in damages for any inadequacy, |
200 | insufficiency, falsification, or unauthorized modification of |
201 | any item of the proof of personal injury protection insurance, |
202 | proof of property damage liability insurance, proof of combined |
203 | bodily liability insurance and property damage liability |
204 | insurance, or proof of financial responsibility insurance either |
205 | prior to, during, or subsequent to the verification of the |
206 | proof. The issuance of a motor vehicle registration does not |
207 | constitute prima facie evidence or a presumption of insurance |
208 | coverage. |
209 | Section 3. Section 321.245, Florida Statutes, is amended |
210 | to read: |
211 | 321.245 Disposition of certain funds in the Highway Safety |
212 | Operating Trust Fund.--The director of the Florida Highway |
213 | Patrol, after receiving recommendations from the commander of |
214 | the auxiliary, is authorized to purchase uniforms and equipment |
215 | for auxiliary law enforcement officers as defined in s. 321.24 |
216 | from funds described in s. 324.0221(3) 627.733(7). The amounts |
217 | expended under this section shall not exceed $50,000 in any one |
218 | fiscal year. |
219 | Section 4. Section 324.022, Florida Statutes, is amended |
220 | to read: |
221 | 324.022 Financial responsibility for property damage.-- |
222 | (1) Every owner or operator of a motor vehicle, which |
223 | motor vehicle is subject to the requirements of ss. 627.730- |
224 | 627.7405 and required to be registered in this state, shall, by |
225 | one of the methods established in s. 324.031 or by having a |
226 | policy that complies with s. 627.7275, establish and maintain |
227 | the ability to respond in damages for liability on account of |
228 | accidents arising out of the use of the motor vehicle in the |
229 | amount of $10,000 because of damage to, or destruction of, |
230 | property of others in any one crash. The requirements of this |
231 | section may be met by one of the methods established in s. |
232 | 324.031; by self-insuring as authorized by s. 768.28(16); or by |
233 | maintaining an insurance policy providing coverage for property |
234 | damage liability in the amount of at least $10,000 because of |
235 | damage to, or destruction of, property of others in any one |
236 | accident arising out of the use of the motor vehicle. The |
237 | requirements of this section may also be met by having a policy |
238 | which provides coverage in the amount of at least $30,000 for |
239 | combined property damage liability and bodily injury liability |
240 | for any one crash arising out of the use of the motor vehicle. |
241 | The policy, with respect to coverage for property damage |
242 | liability, must meet the applicable requirements of s. 324.151, |
243 | subject to the usual policy exclusions that have been approved |
244 | in policy forms by the Office of Insurance Regulation. No |
245 | insurer shall have any duty to defend uncovered claims |
246 | irrespective of their joinder with covered claims. |
247 | (2) As used in this section, the term: |
248 | (a) "Motor vehicle" means any self-propelled vehicle that |
249 | has four or more wheels and that is of a type designed and |
250 | required to be licensed for use on the highways of this state, |
251 | and any trailer or semitrailer designed for use with such |
252 | vehicle. The term does not include: |
253 | 1. A mobile home. |
254 | 2. A motor vehicle that is used in mass transit and |
255 | designed to transport more than five passengers, exclusive of |
256 | the operator of the motor vehicle, and that is owned by a |
257 | municipality, transit authority, or political subdivision of the |
258 | state. |
259 | 3. A school bus as defined in s. 1006.25. |
260 | 4. A vehicle providing for-hire transportation that is |
261 | subject to the provisions of s. 324.031. A taxicab shall |
262 | maintain security as required under s. 324.032(1). |
263 | (b) "Owner" means the person who holds legal title to a |
264 | motor vehicle or the debtor or lessee who has the right to |
265 | possession of a motor vehicle that is the subject of a security |
266 | agreement or lease with an option to purchase. |
267 | (3) Each nonresident owner or registrant of a motor |
268 | vehicle that, whether operated or not, has been physically |
269 | present within this state for more than 90 days during the |
270 | preceding 365 days shall maintain security as required by |
271 | subsection (1) that is in effect continuously throughout the |
272 | period the motor vehicle remains within this state. |
273 | (4) The owner or registrant of a motor vehicle is exempt |
274 | from the requirements of this section if she or he is a member |
275 | of the United States Armed Forces and is called to or on active |
276 | duty outside the United States in an emergency situation. The |
277 | exemption provided by this subsection applies only as long as |
278 | the member of the Armed Forces is on such active duty outside |
279 | the United States and applies only while the vehicle is not |
280 | operated by any person. Upon receipt of a written request by the |
281 | insured to whom the exemption provided in this subsection |
282 | applies, the insurer shall cancel the coverages and return any |
283 | unearned premium or suspend the security required by this |
284 | section. Notwithstanding s. 324.0221(3), the department may not |
285 | suspend the registration or operator's license of any owner or |
286 | registrant of a motor vehicle during the time she or he |
287 | qualifies for an exemption under this subsection. Any owner or |
288 | registrant of a motor vehicle who qualifies for an exemption |
289 | under this subsection shall immediately notify the department |
290 | prior to and at the end of the expiration of the exemption. |
291 | Section 5. Section 324.0221, Florida Statutes, is created |
292 | to read: |
293 | 324.0221 Reports by insurers to the department; suspension |
294 | of driver's license and vehicle registrations; reinstatement.-- |
295 | (1)(a) Each insurer that has issued a policy providing |
296 | personal injury protection coverage or property damage liability |
297 | coverage shall report the renewal, cancellation, or nonrenewal |
298 | thereof to the department within 45 days after the effective |
299 | date of each renewal, cancellation, or nonrenewal. Upon the |
300 | issuance of a policy providing personal injury protection |
301 | coverage or property damage liability coverage to a named |
302 | insured not previously insured by the insurer during that |
303 | calendar year, the insurer shall report the issuance of the new |
304 | policy to the department within 30 days. The report shall be in |
305 | the form and format and contain any information required by the |
306 | department and must be provided in a format that is compatible |
307 | with the data-processing capabilities of the department. The |
308 | department may adopt rules regarding the form and documentation |
309 | required. Failure by an insurer to file proper reports with the |
310 | department as required by this subsection or rules adopted with |
311 | respect to the requirements of this subsection constitutes a |
312 | violation of the Florida Insurance Code. These records shall be |
313 | used by the department only for enforcement and regulatory |
314 | purposes, including the generation by the department of data |
315 | regarding compliance by owners of motor vehicles with the |
316 | requirements for financial responsibility coverage. |
317 | (b) With respect to an insurance policy providing personal |
318 | injury protection coverage or property damage liability |
319 | coverage, each insurer shall notify the named insured, or the |
320 | first-named insured in the case of a commercial fleet policy, in |
321 | writing that any cancellation or nonrenewal of the policy will |
322 | be reported by the insurer to the department. The notice must |
323 | also inform the named insured that failure to maintain personal |
324 | injury protection coverage and property damage liability |
325 | coverage on a motor vehicle when required by law may result in |
326 | the loss of registration and driving privileges in this state |
327 | and inform the named insured of the amount of the reinstatement |
328 | fees required by this section. This notice is for informational |
329 | purposes only, and an insurer is not civilly liable for failing |
330 | to provide this notice. |
331 | (2) The department shall suspend, after due notice and an |
332 | opportunity to be heard, the registration and driver's license |
333 | of any owner or registrant of a motor vehicle with respect to |
334 | which security is required under ss. 324.022 and 627.733 upon: |
335 | (a) The department's records showing that the owner or |
336 | registrant of such motor vehicle did not have in full force and |
337 | effect when required security that complies with the |
338 | requirements of ss. 324.022 and 627.733; or |
339 | (b) Notification by the insurer to the department, in a |
340 | form approved by the department, of cancellation or termination |
341 | of the required security. |
342 | (3) An operator or owner whose driver's license or |
343 | registration has been suspended under this section or s. 316.646 |
344 | may effect its reinstatement upon compliance with the |
345 | requirements of this section and upon payment to the department |
346 | of a nonrefundable reinstatement fee of $150 for the first |
347 | reinstatement. The reinstatement fee is $250 for the second |
348 | reinstatement and $500 for each subsequent reinstatement during |
349 | the 3 years following the first reinstatement. A person |
350 | reinstating her or his insurance under this subsection must also |
351 | secure noncancelable coverage as described in ss. 324.021(8), |
352 | 324.023, and 627.7275(2) and present to the appropriate person |
353 | proof that the coverage is in force on a form adopted by the |
354 | department, and such proof shall be maintained for 2 years. If |
355 | the person does not have a second reinstatement within 3 years |
356 | after her or his initial reinstatement, the reinstatement fee is |
357 | $150 for the first reinstatement after that 3-year period. If a |
358 | person's license and registration are suspended under this |
359 | section or s. 316.646, only one reinstatement fee must be paid |
360 | to reinstate the license and the registration. All fees shall be |
361 | collected by the department at the time of reinstatement. The |
362 | department shall issue proper receipts for such fees and shall |
363 | promptly deposit those fees in the Highway Safety Operating |
364 | Trust Fund. One-third of the fees collected under this |
365 | subsection shall be distributed from the Highway Safety |
366 | Operating Trust Fund to the local governmental entity or state |
367 | agency that employed the law enforcement officer seizing the |
368 | license plate pursuant to s. 324.201. The funds may be used by |
369 | the local governmental entity or state agency for any authorized |
370 | purpose. |
371 | Section 6. Section 627.7275, Florida Statutes, is amended |
372 | to read: |
373 | 627.7275 Motor vehicle liability.-- |
374 | (1) A motor vehicle insurance policy providing personal |
375 | injury protection as set forth in s. 627.736 may not be |
376 | delivered or issued for delivery in this state with respect to |
377 | any specifically insured or identified motor vehicle registered |
378 | or principally garaged in this state unless the policy also |
379 | provides coverage for property damage liability as required by |
380 | s. 324.022 in the amount of at least $10,000 because of damage |
381 | to, or destruction of, property of others in any one accident |
382 | arising out of the use of the motor vehicle or unless the policy |
383 | provides coverage in the amount of at least $30,000 for combined |
384 | property damage liability and bodily injury liability in any one |
385 | accident arising out of the use of the motor vehicle. The |
386 | policy, as to coverage of property damage liability, must meet |
387 | the applicable requirements of s. 324.151, subject to the usual |
388 | policy exclusions that have been approved in policy forms by the |
389 | office. |
390 | (2)(a) Insurers writing motor vehicle insurance in this |
391 | state shall make available, subject to the insurers' usual |
392 | underwriting restrictions: |
393 | 1. Coverage under policies as described in subsection (1) |
394 | to any applicant for private passenger motor vehicle insurance |
395 | coverage who is seeking the coverage in order to reinstate the |
396 | applicant's driving privileges in this state when the driving |
397 | privileges were revoked or suspended pursuant to s. 316.646 or |
398 | s. 324.0221 627.733 due to the failure of the applicant to |
399 | maintain required security. |
400 | 2. Coverage under policies as described in subsection (1), |
401 | which also provides liability coverage for bodily injury, death, |
402 | and property damage arising out of the ownership, maintenance, |
403 | or use of the motor vehicle in an amount not less than the |
404 | limits described in s. 324.021(7) and conforms to the |
405 | requirements of s. 324.151, to any applicant for private |
406 | passenger motor vehicle insurance coverage who is seeking the |
407 | coverage in order to reinstate the applicant's driving |
408 | privileges in this state after such privileges were revoked or |
409 | suspended under s. 316.193 or s. 322.26(2) for driving under the |
410 | influence. |
411 | (b) The policies described in paragraph (a) shall be |
412 | issued for a period of at least 6 months and as to the minimum |
413 | coverages required under this section shall not be cancelable by |
414 | the insured for any reason or by the insurer after a period not |
415 | to exceed 30 days during which the insurer must complete |
416 | underwriting of the policy. After the insurer has completed |
417 | underwriting the policy within the 30-day period, the insurer |
418 | shall notify the Department of Highway Safety and Motor Vehicles |
419 | that the policy is in full force and effect and the policy shall |
420 | not be cancelable for the remainder of the policy period. A |
421 | premium shall be collected and coverage shall be in effect for |
422 | the 30-day period during which the insurer is completing the |
423 | underwriting of the policy whether or not the person's driver |
424 | license, motor vehicle tag, and motor vehicle registration are |
425 | in effect. Once the noncancelable provisions of the policy |
426 | become effective, the coverage or risk shall not be changed |
427 | during the policy period and the premium shall be nonrefundable. |
428 | If, during the pendency of the 2-year proof of insurance period |
429 | required under s. 324.0221 627.733(7) or during the 3-year proof |
430 | of financial responsibility required under s. 324.131, whichever |
431 | is applicable, the insured obtains additional coverage or |
432 | coverage for an additional risk or changes territories, the |
433 | insured must obtain a new 6-month noncancelable policy in |
434 | accordance with the provisions of this section. However, if the |
435 | insured must obtain a new 6-month policy and obtains the policy |
436 | from the same insurer, the policyholder shall receive credit on |
437 | the new policy for any premium paid on the previously issued |
438 | policy. |
439 | (c) This subsection controls to the extent of any conflict |
440 | with any other section. |
441 | (d) An insurer issuing a policy subject to this section |
442 | may cancel the policy if, during the policy term, the named |
443 | insured or any other operator, who resides in the same household |
444 | or customarily operates an automobile insured under the policy, |
445 | has his or her driver's license suspended or revoked. |
446 | (e) Nothing in this subsection requires an insurer to |
447 | offer a policy of insurance to an applicant if such offer would |
448 | be inconsistent with the insurer's underwriting guidelines and |
449 | procedures. |
450 | Section 7. Paragraph (a) of subsection (1) of section |
451 | 627.7295, Florida Statutes, is amended to read: |
452 | 627.7295 Motor vehicle insurance contracts.-- |
453 | (1) As used in this section, the term: |
454 | (a) "Policy" means a motor vehicle insurance policy that |
455 | provides personal injury protection coverage, and property |
456 | damage liability coverage, or both. |
457 | Section 8. Notwithstanding the repeal of the Florida Motor |
458 | Vehicle No-Fault Law, which occurred on October 1, 2007, section |
459 | 627.730, Florida Statutes, is revived and reenacted to read: |
460 | 627.730 Florida Motor Vehicle No-Fault Law.--Sections |
461 | 627.730-627.7405 may be cited and known as the "Florida Motor |
462 | Vehicle No-Fault Law." |
463 | Section 9. Notwithstanding the repeal of the Florida Motor |
464 | Vehicle No-Fault Law, which occurred on October 1, 2007, section |
465 | 627.731, Florida Statutes, is revived and reenacted to read: |
466 | 627.731 Purpose.--The purpose of ss. 627.730-627.7405 is |
467 | to provide for medical, surgical, funeral, and disability |
468 | insurance benefits without regard to fault, and to require motor |
469 | vehicle insurance securing such benefits, for motor vehicles |
470 | required to be registered in this state and, with respect to |
471 | motor vehicle accidents, a limitation on the right to claim |
472 | damages for pain, suffering, mental anguish, and inconvenience. |
473 | Section 10. Notwithstanding the repeal of the Florida |
474 | Motor Vehicle No-Fault Law, which occurred on October 1, 2007, |
475 | section 627.732, Florida Statutes, is revived and reenacted to |
476 | read: |
477 | 627.732 Definitions.--As used in ss. 627.730-627.7405, the |
478 | term: |
479 | (1) "Broker" means any person not possessing a license |
480 | under chapter 395, chapter 400, chapter 429, chapter 458, |
481 | chapter 459, chapter 460, chapter 461, or chapter 641 who |
482 | charges or receives compensation for any use of medical |
483 | equipment and is not the 100-percent owner or the 100-percent |
484 | lessee of such equipment. For purposes of this section, such |
485 | owner or lessee may be an individual, a corporation, a |
486 | partnership, or any other entity and any of its 100-percent- |
487 | owned affiliates and subsidiaries. For purposes of this |
488 | subsection, the term "lessee" means a long-term lessee under a |
489 | capital or operating lease, but does not include a part-time |
490 | lessee. The term "broker" does not include a hospital or |
491 | physician management company whose medical equipment is |
492 | ancillary to the practices managed, a debt collection agency, or |
493 | an entity that has contracted with the insurer to obtain a |
494 | discounted rate for such services; nor does the term include a |
495 | management company that has contracted to provide general |
496 | management services for a licensed physician or health care |
497 | facility and whose compensation is not materially affected by |
498 | the usage or frequency of usage of medical equipment or an |
499 | entity that is 100-percent owned by one or more hospitals or |
500 | physicians. The term "broker" does not include a person or |
501 | entity that certifies, upon request of an insurer, that: |
502 | (a) It is a clinic licensed under ss. 400.990-400.995; |
503 | (b) It is a 100-percent owner of medical equipment; and |
504 | (c) The owner's only part-time lease of medical equipment |
505 | for personal injury protection patients is on a temporary basis |
506 | not to exceed 30 days in a 12-month period, and such lease is |
507 | solely for the purposes of necessary repair or maintenance of |
508 | the 100-percent-owned medical equipment or pending the arrival |
509 | and installation of the newly purchased or a replacement for the |
510 | 100-percent-owned medical equipment, or for patients for whom, |
511 | because of physical size or claustrophobia, it is determined by |
512 | the medical director or clinical director to be medically |
513 | necessary that the test be performed in medical equipment that |
514 | is open-style. The leased medical equipment cannot be used by |
515 | patients who are not patients of the registered clinic for |
516 | medical treatment of services. Any person or entity making a |
517 | false certification under this subsection commits insurance |
518 | fraud as defined in s. 817.234. However, the 30-day period |
519 | provided in this paragraph may be extended for an additional 60 |
520 | days as applicable to magnetic resonance imaging equipment if |
521 | the owner certifies that the extension otherwise complies with |
522 | this paragraph. |
523 | (2) "Medically necessary" refers to a medical service or |
524 | supply that a prudent physician would provide for the purpose of |
525 | preventing, diagnosing, or treating an illness, injury, disease, |
526 | or symptom in a manner that is: |
527 | (a) In accordance with generally accepted standards of |
528 | medical practice; |
529 | (b) Clinically appropriate in terms of type, frequency, |
530 | extent, site, and duration; and |
531 | (c) Not primarily for the convenience of the patient, |
532 | physician, or other health care provider. |
533 | (3) "Motor vehicle" means any self-propelled vehicle with |
534 | four or more wheels which is of a type both designed and |
535 | required to be licensed for use on the highways of this state |
536 | and any trailer or semitrailer designed for use with such |
537 | vehicle and includes: |
538 | (a) A "private passenger motor vehicle," which is any |
539 | motor vehicle which is a sedan, station wagon, or jeep-type |
540 | vehicle and, if not used primarily for occupational, |
541 | professional, or business purposes, a motor vehicle of the |
542 | pickup, panel, van, camper, or motor home type. |
543 | (b) A "commercial motor vehicle," which is any motor |
544 | vehicle which is not a private passenger motor vehicle. |
545 |
|
546 | The term "motor vehicle" does not include a mobile home or any |
547 | motor vehicle which is used in mass transit, other than public |
548 | school transportation, and designed to transport more than five |
549 | passengers exclusive of the operator of the motor vehicle and |
550 | which is owned by a municipality, a transit authority, or a |
551 | political subdivision of the state. |
552 | (4) "Named insured" means a person, usually the owner of a |
553 | vehicle, identified in a policy by name as the insured under the |
554 | policy. |
555 | (5) "Owner" means a person who holds the legal title to a |
556 | motor vehicle; or, in the event a motor vehicle is the subject |
557 | of a security agreement or lease with an option to purchase with |
558 | the debtor or lessee having the right to possession, then the |
559 | debtor or lessee shall be deemed the owner for the purposes of |
560 | ss. 627.730-627.7405. |
561 | (6) "Relative residing in the same household" means a |
562 | relative of any degree by blood or by marriage who usually makes |
563 | her or his home in the same family unit, whether or not |
564 | temporarily living elsewhere. |
565 | (7) "Certify" means to swear or attest to being true or |
566 | represented in writing. |
567 | (8) "Immediate personal supervision," as it relates to the |
568 | performance of medical services by nonphysicians not in a |
569 | hospital, means that an individual licensed to perform the |
570 | medical service or provide the medical supplies must be present |
571 | within the confines of the physical structure where the medical |
572 | services are performed or where the medical supplies are |
573 | provided such that the licensed individual can respond |
574 | immediately to any emergencies if needed. |
575 | (9) "Incident," with respect to services considered as |
576 | incident to a physician's professional service, for a physician |
577 | licensed under chapter 458, chapter 459, chapter 460, or chapter |
578 | 461, if not furnished in a hospital, means such services must be |
579 | an integral, even if incidental, part of a covered physician's |
580 | service. |
581 | (10) "Knowingly" means that a person, with respect to |
582 | information, has actual knowledge of the information; acts in |
583 | deliberate ignorance of the truth or falsity of the information; |
584 | or acts in reckless disregard of the information, and proof of |
585 | specific intent to defraud is not required. |
586 | (11) "Lawful" or "lawfully" means in substantial |
587 | compliance with all relevant applicable criminal, civil, and |
588 | administrative requirements of state and federal law related to |
589 | the provision of medical services or treatment. |
590 | (12) "Hospital" means a facility that, at the time |
591 | services or treatment were rendered, was licensed under chapter |
592 | 395. |
593 | (13) "Properly completed" means providing truthful, |
594 | substantially complete, and substantially accurate responses as |
595 | to all material elements to each applicable request for |
596 | information or statement by a means that may lawfully be |
597 | provided and that complies with this section, or as agreed by |
598 | the parties. |
599 | (14) "Upcoding" means an action that submits a billing |
600 | code that would result in payment greater in amount than would |
601 | be paid using a billing code that accurately describes the |
602 | services performed. The term does not include an otherwise |
603 | lawful bill by a magnetic resonance imaging facility, which |
604 | globally combines both technical and professional components, if |
605 | the amount of the global bill is not more than the components if |
606 | billed separately; however, payment of such a bill constitutes |
607 | payment in full for all components of such service. |
608 | (15) "Unbundling" means an action that submits a billing |
609 | code that is properly billed under one billing code, but that |
610 | has been separated into two or more billing codes, and would |
611 | result in payment greater in amount than would be paid using one |
612 | billing code. |
613 | Section 11. Notwithstanding the repeal of the Florida |
614 | Motor Vehicle No-Fault Law, which occurred on October 1, 2007, |
615 | section 627.733, Florida Statutes, is revived, reenacted, and |
616 | amended to read: |
617 | 627.733 Required security.-- |
618 | (1)(a) Every owner or registrant of a motor vehicle, other |
619 | than a motor vehicle used as a school bus as defined in s. |
620 | 1006.25 or limousine, required to be registered and licensed in |
621 | this state shall maintain security as required by subsection (3) |
622 | in effect continuously throughout the registration or licensing |
623 | period. |
624 | (b) Every owner or registrant of a motor vehicle used as a |
625 | taxicab shall not be governed by paragraph (1)(a) but shall |
626 | maintain security as required under s. 324.032(1), and s. |
627 | 627.737 shall not apply to any motor vehicle used as a taxicab. |
628 | (2) Every nonresident owner or registrant of a motor |
629 | vehicle which, whether operated or not, has been physically |
630 | present within this state for more than 90 days during the |
631 | preceding 365 days shall thereafter maintain security as defined |
632 | by subsection (3) in effect continuously throughout the period |
633 | such motor vehicle remains within this state. |
634 | (3) Such security shall be provided: |
635 | (a) By an insurance policy delivered or issued for |
636 | delivery in this state by an authorized or eligible motor |
637 | vehicle liability insurer which provides the benefits and |
638 | exemptions contained in ss. 627.730-627.7405. Any policy of |
639 | insurance represented or sold as providing the security required |
640 | hereunder shall be deemed to provide insurance for the payment |
641 | of the required benefits; or |
642 | (b) By any other method authorized by s. 324.031(2), (3), |
643 | or (4) and approved by the Department of Highway Safety and |
644 | Motor Vehicles as affording security equivalent to that afforded |
645 | by a policy of insurance or by self-insuring as authorized by s. |
646 | 768.28(16). The person filing such security shall have all of |
647 | the obligations and rights of an insurer under ss. 627.730- |
648 | 627.7405. |
649 | (4) An owner of a motor vehicle with respect to which |
650 | security is required by this section who fails to have such |
651 | security in effect at the time of an accident shall have no |
652 | immunity from tort liability, but shall be personally liable for |
653 | the payment of benefits under s. 627.736. With respect to such |
654 | benefits, such an owner shall have all of the rights and |
655 | obligations of an insurer under ss. 627.730-627.7405. |
656 | (5) In addition to other persons who are not required to |
657 | provide required security as required under this section and s. |
658 | 324.022, the owner or registrant of a motor vehicle is exempt |
659 | from such requirements if she or he is a member of the United |
660 | States Armed Forces and is called to or on active duty outside |
661 | the United States in an emergency situation. The exemption |
662 | provided by this subsection applies only as long as the member |
663 | of the armed forces is on such active duty outside the United |
664 | States and applies only while the vehicle covered by the |
665 | security required by this section and s. 324.022 is not operated |
666 | by any person. Upon receipt of a written request by the insured |
667 | to whom the exemption provided in this subsection applies, the |
668 | insurer shall cancel the coverages and return any unearned |
669 | premium or suspend the security required by this section and s. |
670 | 324.022. Notwithstanding s. 324.0221(2) subsection (6), the |
671 | Department of Highway Safety and Motor Vehicles may not suspend |
672 | the registration or operator's license of any owner or |
673 | registrant of a motor vehicle during the time she or he |
674 | qualifies for an exemption under this subsection. Any owner or |
675 | registrant of a motor vehicle who qualifies for an exemption |
676 | under this subsection shall immediately notify the department |
677 | prior to and at the end of the expiration of the exemption. |
678 | (6) The Department of Highway Safety and Motor Vehicles |
679 | shall suspend, after due notice and an opportunity to be heard, |
680 | the registration and driver's license of any owner or registrant |
681 | of a motor vehicle with respect to which security is required |
682 | under this section and s. 324.022: |
683 | (a) Upon its records showing that the owner or registrant |
684 | of such motor vehicle did not have in full force and effect when |
685 | required security complying with the terms of this section; or |
686 | (b) Upon notification by the insurer to the Department of |
687 | Highway Safety and Motor Vehicles, in a form approved by the |
688 | department, of cancellation or termination of the required |
689 | security. |
690 | (7) Any operator or owner whose driver's license or |
691 | registration has been suspended pursuant to this section or s. |
692 | 316.646 may effect its reinstatement upon compliance with the |
693 | requirements of this section and upon payment to the Department |
694 | of Highway Safety and Motor Vehicles of a nonrefundable |
695 | reinstatement fee of $150 for the first reinstatement. Such |
696 | reinstatement fee shall be $250 for the second reinstatement and |
697 | $500 for each subsequent reinstatement during the 3 years |
698 | following the first reinstatement. Any person reinstating her or |
699 | his insurance under this subsection must also secure |
700 | noncancelable coverage as described in ss. 324.021(8), 324.023, |
701 | and 627.7275(2) and present to the appropriate person proof that |
702 | the coverage is in force on a form promulgated by the Department |
703 | of Highway Safety and Motor Vehicles, such proof to be |
704 | maintained for 2 years. If the person does not have a second |
705 | reinstatement within 3 years after her or his initial |
706 | reinstatement, the reinstatement fee shall be $150 for the first |
707 | reinstatement after that 3-year period. In the event that a |
708 | person's license and registration are suspended pursuant to this |
709 | section or s. 316.646, only one reinstatement fee shall be paid |
710 | to reinstate the license and the registration. All fees shall be |
711 | collected by the Department of Highway Safety and Motor Vehicles |
712 | at the time of reinstatement. The Department of Highway Safety |
713 | and Motor Vehicles shall issue proper receipts for such fees and |
714 | shall promptly deposit those fees in the Highway Safety |
715 | Operating Trust Fund. One-third of the fee collected under this |
716 | subsection shall be distributed from the Highway Safety |
717 | Operating Trust Fund to the local government entity or state |
718 | agency which employed the law enforcement officer who seizes a |
719 | license plate pursuant to s. 324.201. Such funds may be used by |
720 | the local government entity or state agency for any authorized |
721 | purpose. |
722 | Section 12. Notwithstanding the repeal of the Florida |
723 | Motor Vehicle No-Fault Law, which occurred on October 1, 2007, |
724 | section 627.734, Florida Statutes, is revived and reenacted to |
725 | read: |
726 | 627.734 Proof of security; security requirements; |
727 | penalties.-- |
728 | (1) The provisions of chapter 324 which pertain to the |
729 | method of giving and maintaining proof of financial |
730 | responsibility and which govern and define a motor vehicle |
731 | liability policy shall apply to filing and maintaining proof of |
732 | security required by ss. 627.730-627.7405. |
733 | (2) Any person who: |
734 | (a) Gives information required in a report or otherwise as |
735 | provided for in ss. 627.730-627.7405, knowing or having reason |
736 | to believe that such information is false; |
737 | (b) Forges or, without authority, signs any evidence of |
738 | proof of security; or |
739 | (c) Files, or offers for filing, any such evidence of |
740 | proof, knowing or having reason to believe that it is forged or |
741 | signed without authority, |
742 |
|
743 | is guilty of a misdemeanor of the first degree, punishable as |
744 | provided in s. 775.082 or s. 775.083. |
745 | Section 13. Notwithstanding the repeal of the Florida |
746 | Motor Vehicle No-Fault Law, which occurred on October 1, 2007, |
747 | section 627.736, Florida Statutes, is revived, reenacted, and |
748 | amended to read: |
749 | 627.736 Required personal injury protection benefits; |
750 | exclusions; priority; claims.-- |
751 | (1) REQUIRED BENEFITS.--Every insurance policy complying |
752 | with the security requirements of s. 627.733 shall provide |
753 | personal injury protection to the named insured, relatives |
754 | residing in the same household, persons operating the insured |
755 | motor vehicle, passengers in such motor vehicle, and other |
756 | persons struck by such motor vehicle and suffering bodily injury |
757 | while not an occupant of a self-propelled vehicle, subject to |
758 | the provisions of subsection (2) and paragraph (4)(d), to a |
759 | limit of $10,000 for loss sustained by any such person as a |
760 | result of bodily injury, sickness, disease, or death arising out |
761 | of the ownership, maintenance, or use of a motor vehicle as |
762 | follows: |
763 | (a) Medical benefits.--Eighty percent of all reasonable |
764 | expenses for medically necessary medical, surgical, X-ray, |
765 | dental, and rehabilitative services, including prosthetic |
766 | devices, and medically necessary ambulance, hospital, and |
767 | nursing services. Such benefits shall also include necessary |
768 | remedial treatment and services recognized and permitted under |
769 | the laws of the state for an injured person who relies upon |
770 | spiritual means through prayer alone for healing, in accordance |
771 | with his or her religious beliefs; however, this sentence does |
772 | not affect the determination of what other services or |
773 | procedures are medically necessary. |
774 | (b) Disability benefits.--Sixty percent of any loss of |
775 | gross income and loss of earning capacity per individual from |
776 | inability to work proximately caused by the injury sustained by |
777 | the injured person, plus all expenses reasonably incurred in |
778 | obtaining from others ordinary and necessary services in lieu of |
779 | those that, but for the injury, the injured person would have |
780 | performed without income for the benefit of his or her |
781 | household. All disability benefits payable under this provision |
782 | shall be paid not less than every 2 weeks. |
783 | (c) Death benefits.--Death benefits of $5,000 per |
784 | individual. The insurer may pay such benefits to the executor |
785 | or administrator of the deceased, to any of the deceased's |
786 | relatives by blood or legal adoption or connection by marriage, |
787 | or to any person appearing to the insurer to be equitably |
788 | entitled thereto. |
789 |
|
790 | Only insurers writing motor vehicle liability insurance in this |
791 | state may provide the required benefits of this section, and no |
792 | such insurer shall require the purchase of any other motor |
793 | vehicle coverage other than the purchase of property damage |
794 | liability coverage as required by s. 627.7275 as a condition for |
795 | providing such required benefits. Insurers may not require that |
796 | property damage liability insurance in an amount greater than |
797 | $10,000 be purchased in conjunction with personal injury |
798 | protection. Such insurers shall make benefits and required |
799 | property damage liability insurance coverage available through |
800 | normal marketing channels. Any insurer writing motor vehicle |
801 | liability insurance in this state who fails to comply with such |
802 | availability requirement as a general business practice shall be |
803 | deemed to have violated part IX of chapter 626, and such |
804 | violation shall constitute an unfair method of competition or an |
805 | unfair or deceptive act or practice involving the business of |
806 | insurance; and any such insurer committing such violation shall |
807 | be subject to the penalties afforded in such part, as well as |
808 | those which may be afforded elsewhere in the insurance code. |
809 | (2) AUTHORIZED EXCLUSIONS.--Any insurer may exclude |
810 | benefits: |
811 | (a) For injury sustained by the named insured and |
812 | relatives residing in the same household while occupying another |
813 | motor vehicle owned by the named insured and not insured under |
814 | the policy or for injury sustained by any person operating the |
815 | insured motor vehicle without the express or implied consent of |
816 | the insured. |
817 | (b) To any injured person, if such person's conduct |
818 | contributed to his or her injury under any of the following |
819 | circumstances: |
820 | 1. Causing injury to himself or herself intentionally; or |
821 | 2. Being injured while committing a felony. |
822 |
|
823 | Whenever an insured is charged with conduct as set forth in |
824 | subparagraph 2., the 30-day payment provision of paragraph |
825 | (4)(b) shall be held in abeyance, and the insurer shall withhold |
826 | payment of any personal injury protection benefits pending the |
827 | outcome of the case at the trial level. If the charge is nolle |
828 | prossed or dismissed or the insured is acquitted, the 30-day |
829 | payment provision shall run from the date the insurer is |
830 | notified of such action. |
831 | (3) INSURED'S RIGHTS TO RECOVERY OF SPECIAL DAMAGES IN |
832 | TORT CLAIMS.--No insurer shall have a lien on any recovery in |
833 | tort by judgment, settlement, or otherwise for personal injury |
834 | protection benefits, whether suit has been filed or settlement |
835 | has been reached without suit. An injured party who is entitled |
836 | to bring suit under the provisions of ss. 627.730-627.7405, or |
837 | his or her legal representative, shall have no right to recover |
838 | any damages for which personal injury protection benefits are |
839 | paid or payable. The plaintiff may prove all of his or her |
840 | special damages notwithstanding this limitation, but if special |
841 | damages are introduced in evidence, the trier of facts, whether |
842 | judge or jury, shall not award damages for personal injury |
843 | protection benefits paid or payable. In all cases in which a |
844 | jury is required to fix damages, the court shall instruct the |
845 | jury that the plaintiff shall not recover such special damages |
846 | for personal injury protection benefits paid or payable. |
847 | (4) BENEFITS; WHEN DUE.--Benefits due from an insurer |
848 | under ss. 627.730-627.7405 shall be primary, except that |
849 | benefits received under any workers' compensation law shall be |
850 | credited against the benefits provided by subsection (1) and |
851 | shall be due and payable as loss accrues, upon receipt of |
852 | reasonable proof of such loss and the amount of expenses and |
853 | loss incurred which are covered by the policy issued under ss. |
854 | 627.730-627.7405. When the Agency for Health Care Administration |
855 | provides, pays, or becomes liable for medical assistance under |
856 | the Medicaid program related to injury, sickness, disease, or |
857 | death arising out of the ownership, maintenance, or use of a |
858 | motor vehicle, benefits under ss. 627.730-627.7405 shall be |
859 | subject to the provisions of the Medicaid program. |
860 | (a) An insurer may require written notice to be given as |
861 | soon as practicable after an accident involving a motor vehicle |
862 | with respect to which the policy affords the security required |
863 | by ss. 627.730-627.7405. |
864 | (b) Personal injury protection insurance benefits paid |
865 | pursuant to this section shall be overdue if not paid within 30 |
866 | days after the insurer is furnished written notice of the fact |
867 | of a covered loss and of the amount of same. If such written |
868 | notice is not furnished to the insurer as to the entire claim, |
869 | any partial amount supported by written notice is overdue if not |
870 | paid within 30 days after such written notice is furnished to |
871 | the insurer. Any part or all of the remainder of the claim that |
872 | is subsequently supported by written notice is overdue if not |
873 | paid within 30 days after such written notice is furnished to |
874 | the insurer. When an insurer pays only a portion of a claim or |
875 | rejects a claim, the insurer shall provide at the time of the |
876 | partial payment or rejection an itemized specification of each |
877 | item that the insurer had reduced, omitted, or declined to pay |
878 | and any information that the insurer desires the claimant to |
879 | consider related to the medical necessity of the denied |
880 | treatment or to explain the reasonableness of the reduced |
881 | charge, provided that this shall not limit the introduction of |
882 | evidence at trial; and the insurer shall include the name and |
883 | address of the person to whom the claimant should respond and a |
884 | claim number to be referenced in future correspondence. However, |
885 | notwithstanding the fact that written notice has been furnished |
886 | to the insurer, any payment shall not be deemed overdue when the |
887 | insurer has reasonable proof to establish that the insurer is |
888 | not responsible for the payment. For the purpose of calculating |
889 | the extent to which any benefits are overdue, payment shall be |
890 | treated as being made on the date a draft or other valid |
891 | instrument which is equivalent to payment was placed in the |
892 | United States mail in a properly addressed, postpaid envelope |
893 | or, if not so posted, on the date of delivery. This paragraph |
894 | does not preclude or limit the ability of the insurer to assert |
895 | that the claim was unrelated, was not medically necessary, or |
896 | was unreasonable or that the amount of the charge was in excess |
897 | of that permitted under, or in violation of, subsection (5). |
898 | Such assertion by the insurer may be made at any time, including |
899 | after payment of the claim or after the 30-day time period for |
900 | payment set forth in this paragraph. |
901 | (c) All overdue payments shall bear simple interest at the |
902 | rate established under s. 55.03 or the rate established in the |
903 | insurance contract, whichever is greater, for the year in which |
904 | the payment became overdue, calculated from the date the insurer |
905 | was furnished with written notice of the amount of covered loss. |
906 | Interest shall be due at the time payment of the overdue claim |
907 | is made. |
908 | (d) The insurer of the owner of a motor vehicle shall pay |
909 | personal injury protection benefits for: |
910 | 1. Accidental bodily injury sustained in this state by the |
911 | owner while occupying a motor vehicle, or while not an occupant |
912 | of a self-propelled vehicle if the injury is caused by physical |
913 | contact with a motor vehicle. |
914 | 2. Accidental bodily injury sustained outside this state, |
915 | but within the United States of America or its territories or |
916 | possessions or Canada, by the owner while occupying the owner's |
917 | motor vehicle. |
918 | 3. Accidental bodily injury sustained by a relative of the |
919 | owner residing in the same household, under the circumstances |
920 | described in subparagraph 1. or subparagraph 2., provided the |
921 | relative at the time of the accident is domiciled in the owner's |
922 | household and is not himself or herself the owner of a motor |
923 | vehicle with respect to which security is required under ss. |
924 | 627.730-627.7405. |
925 | 4. Accidental bodily injury sustained in this state by any |
926 | other person while occupying the owner's motor vehicle or, if a |
927 | resident of this state, while not an occupant of a self- |
928 | propelled vehicle, if the injury is caused by physical contact |
929 | with such motor vehicle, provided the injured person is not |
930 | himself or herself: |
931 | a. The owner of a motor vehicle with respect to which |
932 | security is required under ss. 627.730-627.7405; or |
933 | b. Entitled to personal injury benefits from the insurer |
934 | of the owner or owners of such a motor vehicle. |
935 | (e) If two or more insurers are liable to pay personal |
936 | injury protection benefits for the same injury to any one |
937 | person, the maximum payable shall be as specified in subsection |
938 | (1), and any insurer paying the benefits shall be entitled to |
939 | recover from each of the other insurers an equitable pro rata |
940 | share of the benefits paid and expenses incurred in processing |
941 | the claim. |
942 | (f) It is a violation of the insurance code for an insurer |
943 | to fail to timely provide benefits as required by this section |
944 | with such frequency as to constitute a general business |
945 | practice. |
946 | (g) Benefits shall not be due or payable to or on the |
947 | behalf of an insured person if that person has committed, by a |
948 | material act or omission, any insurance fraud relating to |
949 | personal injury protection coverage under his or her policy, if |
950 | the fraud is admitted to in a sworn statement by the insured or |
951 | if it is established in a court of competent jurisdiction. Any |
952 | insurance fraud shall void all coverage arising from the claim |
953 | related to such fraud under the personal injury protection |
954 | coverage of the insured person who committed the fraud, |
955 | irrespective of whether a portion of the insured person's claim |
956 | may be legitimate, and any benefits paid prior to the discovery |
957 | of the insured person's insurance fraud shall be recoverable by |
958 | the insurer from the person who committed insurance fraud in |
959 | their entirety. The prevailing party is entitled to its costs |
960 | and attorney's fees in any action in which it prevails in an |
961 | insurer's action to enforce its right of recovery under this |
962 | paragraph. |
963 | (5) CHARGES FOR TREATMENT OF INJURED PERSONS.-- |
964 | (a) Any physician, hospital, clinic, or other person or |
965 | institution lawfully rendering treatment to an injured person |
966 | for a bodily injury covered by personal injury protection |
967 | insurance may charge the insurer and injured party only a |
968 | reasonable amount pursuant to this section for the services and |
969 | supplies rendered, and the insurer providing such coverage may |
970 | pay for such charges directly to such person or institution |
971 | lawfully rendering such treatment, if the insured receiving such |
972 | treatment or his or her guardian has countersigned the properly |
973 | completed invoice, bill, or claim form approved by the office |
974 | upon which such charges are to be paid for as having actually |
975 | been rendered, to the best knowledge of the insured or his or |
976 | her guardian. In no event, however, may such a charge be in |
977 | excess of the amount the person or institution customarily |
978 | charges for like services or supplies. With respect to a |
979 | determination of whether a charge for a particular service, |
980 | treatment, or otherwise is reasonable, consideration may be |
981 | given to evidence of usual and customary charges and payments |
982 | accepted by the provider involved in the dispute, and |
983 | reimbursement levels in the community and various federal and |
984 | state medical fee schedules applicable to automobile and other |
985 | insurance coverages, and other information relevant to the |
986 | reasonableness of the reimbursement for the service, treatment, |
987 | or supply. |
988 | (b)1. An insurer or insured is not required to pay a claim |
989 | or charges: |
990 | a. Made by a broker or by a person making a claim on |
991 | behalf of a broker; |
992 | b. For any service or treatment that was not lawful at the |
993 | time rendered; |
994 | c. To any person who knowingly submits a false or |
995 | misleading statement relating to the claim or charges; |
996 | d. With respect to a bill or statement that does not |
997 | substantially meet the applicable requirements of paragraph (d); |
998 | e. For any treatment or service that is upcoded, or that |
999 | is unbundled when such treatment or services should be bundled, |
1000 | in accordance with paragraph (d). To facilitate prompt payment |
1001 | of lawful services, an insurer may change codes that it |
1002 | determines to have been improperly or incorrectly upcoded or |
1003 | unbundled, and may make payment based on the changed codes, |
1004 | without affecting the right of the provider to dispute the |
1005 | change by the insurer, provided that before doing so, the |
1006 | insurer must contact the health care provider and discuss the |
1007 | reasons for the insurer's change and the health care provider's |
1008 | reason for the coding, or make a reasonable good faith effort to |
1009 | do so, as documented in the insurer's file; and |
1010 | f. For medical services or treatment billed by a physician |
1011 | and not provided in a hospital unless such services are rendered |
1012 | by the physician or are incident to his or her professional |
1013 | services and are included on the physician's bill, including |
1014 | documentation verifying that the physician is responsible for |
1015 | the medical services that were rendered and billed. |
1016 | 2. Charges for medically necessary cephalic thermograms, |
1017 | peripheral thermograms, spinal ultrasounds, extremity |
1018 | ultrasounds, video fluoroscopy, and surface electromyography |
1019 | shall not exceed the maximum reimbursement allowance for such |
1020 | procedures as set forth in the applicable fee schedule or other |
1021 | payment methodology established pursuant to s. 440.13. |
1022 | 3. Allowable amounts that may be charged to a personal |
1023 | injury protection insurance insurer and insured for medically |
1024 | necessary nerve conduction testing when done in conjunction with |
1025 | a needle electromyography procedure and both are performed and |
1026 | billed solely by a physician licensed under chapter 458, chapter |
1027 | 459, chapter 460, or chapter 461 who is also certified by the |
1028 | American Board of Electrodiagnostic Medicine or by a board |
1029 | recognized by the American Board of Medical Specialties or the |
1030 | American Osteopathic Association or who holds diplomate status |
1031 | with the American Chiropractic Neurology Board or its |
1032 | predecessors shall not exceed 200 percent of the allowable |
1033 | amount under the participating physician fee schedule of |
1034 | Medicare Part B for year 2001, for the area in which the |
1035 | treatment was rendered, adjusted annually on August 1 to reflect |
1036 | the prior calendar year's changes in the annual Medical Care |
1037 | Item of the Consumer Price Index for All Urban Consumers in the |
1038 | South Region as determined by the Bureau of Labor Statistics of |
1039 | the United States Department of Labor. |
1040 | 4. Allowable amounts that may be charged to a personal |
1041 | injury protection insurance insurer and insured for medically |
1042 | necessary nerve conduction testing that does not meet the |
1043 | requirements of subparagraph 3. shall not exceed the applicable |
1044 | fee schedule or other payment methodology established pursuant |
1045 | to s. 440.13. |
1046 | 5. Allowable amounts that may be charged to a personal |
1047 | injury protection insurance insurer and insured for magnetic |
1048 | resonance imaging services shall not exceed 175 percent of the |
1049 | allowable amount under the participating physician fee schedule |
1050 | of Medicare Part B for year 2001, for the area in which the |
1051 | treatment was rendered, adjusted annually on August 1 to reflect |
1052 | the prior calendar year's changes in the annual Medical Care |
1053 | Item of the Consumer Price Index for All Urban Consumers in the |
1054 | South Region as determined by the Bureau of Labor Statistics of |
1055 | the United States Department of Labor for the 12-month period |
1056 | ending June 30 of that year, except that allowable amounts that |
1057 | may be charged to a personal injury protection insurance insurer |
1058 | and insured for magnetic resonance imaging services provided in |
1059 | facilities accredited by the Accreditation Association for |
1060 | Ambulatory Health Care, the American College of Radiology, or |
1061 | the Joint Commission on Accreditation of Healthcare |
1062 | Organizations shall not exceed 200 percent of the allowable |
1063 | amount under the participating physician fee schedule of |
1064 | Medicare Part B for year 2001, for the area in which the |
1065 | treatment was rendered, adjusted annually on August 1 to reflect |
1066 | the prior calendar year's changes in the annual Medical Care |
1067 | Item of the Consumer Price Index for All Urban Consumers in the |
1068 | South Region as determined by the Bureau of Labor Statistics of |
1069 | the United States Department of Labor for the 12-month period |
1070 | ending June 30 of that year. This paragraph does not apply to |
1071 | charges for magnetic resonance imaging services and nerve |
1072 | conduction testing for inpatients and emergency services and |
1073 | care as defined in chapter 395 rendered by facilities licensed |
1074 | under chapter 395. |
1075 | 6. The Department of Health, in consultation with the |
1076 | appropriate professional licensing boards, shall adopt, by rule, |
1077 | a list of diagnostic tests deemed not to be medically necessary |
1078 | for use in the treatment of persons sustaining bodily injury |
1079 | covered by personal injury protection benefits under this |
1080 | section. The initial list shall be adopted by January 1, 2004, |
1081 | and shall be revised from time to time as determined by the |
1082 | Department of Health, in consultation with the respective |
1083 | professional licensing boards. Inclusion of a test on the list |
1084 | of invalid diagnostic tests shall be based on lack of |
1085 | demonstrated medical value and a level of general acceptance by |
1086 | the relevant provider community and shall not be dependent for |
1087 | results entirely upon subjective patient response. |
1088 | Notwithstanding its inclusion on a fee schedule in this |
1089 | subsection, an insurer or insured is not required to pay any |
1090 | charges or reimburse claims for any invalid diagnostic test as |
1091 | determined by the Department of Health. |
1092 | (c)1. With respect to any treatment or service, other than |
1093 | medical services billed by a hospital or other provider for |
1094 | emergency services as defined in s. 395.002 or inpatient |
1095 | services rendered at a hospital-owned facility, the statement of |
1096 | charges must be furnished to the insurer by the provider and may |
1097 | not include, and the insurer is not required to pay, charges for |
1098 | treatment or services rendered more than 35 days before the |
1099 | postmark date of the statement, except for past due amounts |
1100 | previously billed on a timely basis under this paragraph, and |
1101 | except that, if the provider submits to the insurer a notice of |
1102 | initiation of treatment within 21 days after its first |
1103 | examination or treatment of the claimant, the statement may |
1104 | include charges for treatment or services rendered up to, but |
1105 | not more than, 75 days before the postmark date of the |
1106 | statement. The injured party is not liable for, and the provider |
1107 | shall not bill the injured party for, charges that are unpaid |
1108 | because of the provider's failure to comply with this paragraph. |
1109 | Any agreement requiring the injured person or insured to pay for |
1110 | such charges is unenforceable. |
1111 | 2. If, however, the insured fails to furnish the provider |
1112 | with the correct name and address of the insured's personal |
1113 | injury protection insurer, the provider has 35 days from the |
1114 | date the provider obtains the correct information to furnish the |
1115 | insurer with a statement of the charges. The insurer is not |
1116 | required to pay for such charges unless the provider includes |
1117 | with the statement documentary evidence that was provided by the |
1118 | insured during the 35-day period demonstrating that the provider |
1119 | reasonably relied on erroneous information from the insured and |
1120 | either: |
1121 | a. A denial letter from the incorrect insurer; or |
1122 | b. Proof of mailing, which may include an affidavit under |
1123 | penalty of perjury, reflecting timely mailing to the incorrect |
1124 | address or insurer. |
1125 | 3. For emergency services and care as defined in s. |
1126 | 395.002 rendered in a hospital emergency department or for |
1127 | transport and treatment rendered by an ambulance provider |
1128 | licensed pursuant to part III of chapter 401, the provider is |
1129 | not required to furnish the statement of charges within the time |
1130 | periods established by this paragraph; and the insurer shall not |
1131 | be considered to have been furnished with notice of the amount |
1132 | of covered loss for purposes of paragraph (4)(b) until it |
1133 | receives a statement complying with paragraph (d), or copy |
1134 | thereof, which specifically identifies the place of service to |
1135 | be a hospital emergency department or an ambulance in accordance |
1136 | with billing standards recognized by the Health Care Finance |
1137 | Administration. |
1138 | 4. Each notice of insured's rights under s. 627.7401 must |
1139 | include the following statement in type no smaller than 12 |
1140 | points: |
1141 |
|
1142 | BILLING REQUIREMENTS.--Florida Statutes provide that with |
1143 | respect to any treatment or services, other than certain |
1144 | hospital and emergency services, the statement of charges |
1145 | furnished to the insurer by the provider may not include, and |
1146 | the insurer and the injured party are not required to pay, |
1147 | charges for treatment or services rendered more than 35 days |
1148 | before the postmark date of the statement, except for past due |
1149 | amounts previously billed on a timely basis, and except that, if |
1150 | the provider submits to the insurer a notice of initiation of |
1151 | treatment within 21 days after its first examination or |
1152 | treatment of the claimant, the statement may include charges for |
1153 | treatment or services rendered up to, but not more than, 75 days |
1154 | before the postmark date of the statement. |
1155 | (d) All statements and bills for medical services rendered |
1156 | by any physician, hospital, clinic, or other person or |
1157 | institution shall be submitted to the insurer on a properly |
1158 | completed Centers for Medicare and Medicaid Services (CMS) 1500 |
1159 | form, UB 92 forms, or any other standard form approved by the |
1160 | office or adopted by the commission for purposes of this |
1161 | paragraph. All billings for such services rendered by providers |
1162 | shall, to the extent applicable, follow the Physicians' Current |
1163 | Procedural Terminology (CPT) or Healthcare Correct Procedural |
1164 | Coding System (HCPCS), or ICD-9 in effect for the year in which |
1165 | services are rendered and comply with the Centers for Medicare |
1166 | and Medicaid Services (CMS) 1500 form instructions and the |
1167 | American Medical Association Current Procedural Terminology |
1168 | (CPT) Editorial Panel and Healthcare Correct Procedural Coding |
1169 | System (HCPCS). All providers other than hospitals shall include |
1170 | on the applicable claim form the professional license number of |
1171 | the provider in the line or space provided for "Signature of |
1172 | Physician or Supplier, Including Degrees or Credentials." In |
1173 | determining compliance with applicable CPT and HCPCS coding, |
1174 | guidance shall be provided by the Physicians' Current Procedural |
1175 | Terminology (CPT) or the Healthcare Correct Procedural Coding |
1176 | System (HCPCS) in effect for the year in which services were |
1177 | rendered, the Office of the Inspector General (OIG), Physicians |
1178 | Compliance Guidelines, and other authoritative treatises |
1179 | designated by rule by the Agency for Health Care Administration. |
1180 | No statement of medical services may include charges for medical |
1181 | services of a person or entity that performed such services |
1182 | without possessing the valid licenses required to perform such |
1183 | services. For purposes of paragraph (4)(b), an insurer shall not |
1184 | be considered to have been furnished with notice of the amount |
1185 | of covered loss or medical bills due unless the statements or |
1186 | bills comply with this paragraph, and unless the statements or |
1187 | bills are properly completed in their entirety as to all |
1188 | material provisions, with all relevant information being |
1189 | provided therein. |
1190 | (e)1. At the initial treatment or service provided, each |
1191 | physician, other licensed professional, clinic, or other medical |
1192 | institution providing medical services upon which a claim for |
1193 | personal injury protection benefits is based shall require an |
1194 | insured person, or his or her guardian, to execute a disclosure |
1195 | and acknowledgment form, which reflects at a minimum that: |
1196 | a. The insured, or his or her guardian, must countersign |
1197 | the form attesting to the fact that the services set forth |
1198 | therein were actually rendered; |
1199 | b. The insured, or his or her guardian, has both the right |
1200 | and affirmative duty to confirm that the services were actually |
1201 | rendered; |
1202 | c. The insured, or his or her guardian, was not solicited |
1203 | by any person to seek any services from the medical provider; |
1204 | d. That the physician, other licensed professional, |
1205 | clinic, or other medical institution rendering services for |
1206 | which payment is being claimed explained the services to the |
1207 | insured or his or her guardian; and |
1208 | e. If the insured notifies the insurer in writing of a |
1209 | billing error, the insured may be entitled to a certain |
1210 | percentage of a reduction in the amounts paid by the insured's |
1211 | motor vehicle insurer. |
1212 | 2. The physician, other licensed professional, clinic, or |
1213 | other medical institution rendering services for which payment |
1214 | is being claimed has the affirmative duty to explain the |
1215 | services rendered to the insured, or his or her guardian, so |
1216 | that the insured, or his or her guardian, countersigns the form |
1217 | with informed consent. |
1218 | 3. Countersignature by the insured, or his or her |
1219 | guardian, is not required for the reading of diagnostic tests or |
1220 | other services that are of such a nature that they are not |
1221 | required to be performed in the presence of the insured. |
1222 | 4. The licensed medical professional rendering treatment |
1223 | for which payment is being claimed must sign, by his or her own |
1224 | hand, the form complying with this paragraph. |
1225 | 5. The original completed disclosure and acknowledgment |
1226 | form shall be furnished to the insurer pursuant to paragraph |
1227 | (4)(b) and may not be electronically furnished. |
1228 | 6. This disclosure and acknowledgment form is not required |
1229 | for services billed by a provider for emergency services as |
1230 | defined in s. 395.002, for emergency services and care as |
1231 | defined in s. 395.002 rendered in a hospital emergency |
1232 | department, or for transport and treatment rendered by an |
1233 | ambulance provider licensed pursuant to part III of chapter 401. |
1234 | 7. The Financial Services Commission shall adopt, by rule, |
1235 | a standard disclosure and acknowledgment form that shall be used |
1236 | to fulfill the requirements of this paragraph, effective 90 days |
1237 | after such form is adopted and becomes final. The commission |
1238 | shall adopt a proposed rule by October 1, 2003. Until the rule |
1239 | is final, the provider may use a form of its own which otherwise |
1240 | complies with the requirements of this paragraph. |
1241 | 8. As used in this paragraph, "countersigned" means a |
1242 | second or verifying signature, as on a previously signed |
1243 | document, and is not satisfied by the statement "signature on |
1244 | file" or any similar statement. |
1245 | 9. The requirements of this paragraph apply only with |
1246 | respect to the initial treatment or service of the insured by a |
1247 | provider. For subsequent treatments or service, the provider |
1248 | must maintain a patient log signed by the patient, in |
1249 | chronological order by date of service, that is consistent with |
1250 | the services being rendered to the patient as claimed. The |
1251 | requirements of this subparagraph for maintaining a patient log |
1252 | signed by the patient may be met by a hospital that maintains |
1253 | medical records as required by s. 395.3025 and applicable rules |
1254 | and makes such records available to the insurer upon request. |
1255 | (f) Upon written notification by any person, an insurer |
1256 | shall investigate any claim of improper billing by a physician |
1257 | or other medical provider. The insurer shall determine if the |
1258 | insured was properly billed for only those services and |
1259 | treatments that the insured actually received. If the insurer |
1260 | determines that the insured has been improperly billed, the |
1261 | insurer shall notify the insured, the person making the written |
1262 | notification and the provider of its findings and shall reduce |
1263 | the amount of payment to the provider by the amount determined |
1264 | to be improperly billed. If a reduction is made due to such |
1265 | written notification by any person, the insurer shall pay to the |
1266 | person 20 percent of the amount of the reduction, up to $500. If |
1267 | the provider is arrested due to the improper billing, then the |
1268 | insurer shall pay to the person 40 percent of the amount of the |
1269 | reduction, up to $500. |
1270 | (g) An insurer may not systematically downcode with the |
1271 | intent to deny reimbursement otherwise due. Such action |
1272 | constitutes a material misrepresentation under s. |
1273 | 626.9541(1)(i)2. |
1274 | (6) DISCOVERY OF FACTS ABOUT AN INJURED PERSON; |
1275 | DISPUTES.-- |
1276 | (a) Every employer shall, if a request is made by an |
1277 | insurer providing personal injury protection benefits under ss. |
1278 | 627.730-627.7405 against whom a claim has been made, furnish |
1279 | forthwith, in a form approved by the office, a sworn statement |
1280 | of the earnings, since the time of the bodily injury and for a |
1281 | reasonable period before the injury, of the person upon whose |
1282 | injury the claim is based. |
1283 | (b) Every physician, hospital, clinic, or other medical |
1284 | institution providing, before or after bodily injury upon which |
1285 | a claim for personal injury protection insurance benefits is |
1286 | based, any products, services, or accommodations in relation to |
1287 | that or any other injury, or in relation to a condition claimed |
1288 | to be connected with that or any other injury, shall, if |
1289 | requested to do so by the insurer against whom the claim has |
1290 | been made, furnish forthwith a written report of the history, |
1291 | condition, treatment, dates, and costs of such treatment of the |
1292 | injured person and why the items identified by the insurer were |
1293 | reasonable in amount and medically necessary, together with a |
1294 | sworn statement that the treatment or services rendered were |
1295 | reasonable and necessary with respect to the bodily injury |
1296 | sustained and identifying which portion of the expenses for such |
1297 | treatment or services was incurred as a result of such bodily |
1298 | injury, and produce forthwith, and permit the inspection and |
1299 | copying of, his or her or its records regarding such history, |
1300 | condition, treatment, dates, and costs of treatment; provided |
1301 | that this shall not limit the introduction of evidence at trial. |
1302 | Such sworn statement shall read as follows: "Under penalty of |
1303 | perjury, I declare that I have read the foregoing, and the facts |
1304 | alleged are true, to the best of my knowledge and belief." No |
1305 | cause of action for violation of the physician-patient privilege |
1306 | or invasion of the right of privacy shall be permitted against |
1307 | any physician, hospital, clinic, or other medical institution |
1308 | complying with the provisions of this section. The person |
1309 | requesting such records and such sworn statement shall pay all |
1310 | reasonable costs connected therewith. If an insurer makes a |
1311 | written request for documentation or information under this |
1312 | paragraph within 30 days after having received notice of the |
1313 | amount of a covered loss under paragraph (4)(a), the amount or |
1314 | the partial amount which is the subject of the insurer's inquiry |
1315 | shall become overdue if the insurer does not pay in accordance |
1316 | with paragraph (4)(b) or within 10 days after the insurer's |
1317 | receipt of the requested documentation or information, whichever |
1318 | occurs later. For purposes of this paragraph, the term "receipt" |
1319 | includes, but is not limited to, inspection and copying pursuant |
1320 | to this paragraph. Any insurer that requests documentation or |
1321 | information pertaining to reasonableness of charges or medical |
1322 | necessity under this paragraph without a reasonable basis for |
1323 | such requests as a general business practice is engaging in an |
1324 | unfair trade practice under the insurance code. |
1325 | (c) In the event of any dispute regarding an insurer's |
1326 | right to discovery of facts under this section, the insurer may |
1327 | petition a court of competent jurisdiction to enter an order |
1328 | permitting such discovery. The order may be made only on motion |
1329 | for good cause shown and upon notice to all persons having an |
1330 | interest, and it shall specify the time, place, manner, |
1331 | conditions, and scope of the discovery. Such court may, in order |
1332 | to protect against annoyance, embarrassment, or oppression, as |
1333 | justice requires, enter an order refusing discovery or |
1334 | specifying conditions of discovery and may order payments of |
1335 | costs and expenses of the proceeding, including reasonable fees |
1336 | for the appearance of attorneys at the proceedings, as justice |
1337 | requires. |
1338 | (d) The injured person shall be furnished, upon request, a |
1339 | copy of all information obtained by the insurer under the |
1340 | provisions of this section, and shall pay a reasonable charge, |
1341 | if required by the insurer. |
1342 | (e) Notice to an insurer of the existence of a claim shall |
1343 | not be unreasonably withheld by an insured. |
1344 | (7) MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON; |
1345 | REPORTS.-- |
1346 | (a) Whenever the mental or physical condition of an |
1347 | injured person covered by personal injury protection is material |
1348 | to any claim that has been or may be made for past or future |
1349 | personal injury protection insurance benefits, such person |
1350 | shall, upon the request of an insurer, submit to mental or |
1351 | physical examination by a physician or physicians. The costs of |
1352 | any examinations requested by an insurer shall be borne entirely |
1353 | by the insurer. Such examination shall be conducted within the |
1354 | municipality where the insured is receiving treatment, or in a |
1355 | location reasonably accessible to the insured, which, for |
1356 | purposes of this paragraph, means any location within the |
1357 | municipality in which the insured resides, or any location |
1358 | within 10 miles by road of the insured's residence, provided |
1359 | such location is within the county in which the insured resides. |
1360 | If the examination is to be conducted in a location reasonably |
1361 | accessible to the insured, and if there is no qualified |
1362 | physician to conduct the examination in a location reasonably |
1363 | accessible to the insured, then such examination shall be |
1364 | conducted in an area of the closest proximity to the insured's |
1365 | residence. Personal protection insurers are authorized to |
1366 | include reasonable provisions in personal injury protection |
1367 | insurance policies for mental and physical examination of those |
1368 | claiming personal injury protection insurance benefits. An |
1369 | insurer may not withdraw payment of a treating physician without |
1370 | the consent of the injured person covered by the personal injury |
1371 | protection, unless the insurer first obtains a valid report by a |
1372 | Florida physician licensed under the same chapter as the |
1373 | treating physician whose treatment authorization is sought to be |
1374 | withdrawn, stating that treatment was not reasonable, related, |
1375 | or necessary. A valid report is one that is prepared and signed |
1376 | by the physician examining the injured person or reviewing the |
1377 | treatment records of the injured person and is factually |
1378 | supported by the examination and treatment records if reviewed |
1379 | and that has not been modified by anyone other than the |
1380 | physician. The physician preparing the report must be in active |
1381 | practice, unless the physician is physically disabled. Active |
1382 | practice means that during the 3 years immediately preceding the |
1383 | date of the physical examination or review of the treatment |
1384 | records the physician must have devoted professional time to the |
1385 | active clinical practice of evaluation, diagnosis, or treatment |
1386 | of medical conditions or to the instruction of students in an |
1387 | accredited health professional school or accredited residency |
1388 | program or a clinical research program that is affiliated with |
1389 | an accredited health professional school or teaching hospital or |
1390 | accredited residency program. The physician preparing a report |
1391 | at the request of an insurer and physicians rendering expert |
1392 | opinions on behalf of persons claiming medical benefits for |
1393 | personal injury protection, or on behalf of an insured through |
1394 | an attorney or another entity, shall maintain, for at least 3 |
1395 | years, copies of all examination reports as medical records and |
1396 | shall maintain, for at least 3 years, records of all payments |
1397 | for the examinations and reports. Neither an insurer nor any |
1398 | person acting at the direction of or on behalf of an insurer may |
1399 | materially change an opinion in a report prepared under this |
1400 | paragraph or direct the physician preparing the report to change |
1401 | such opinion. The denial of a payment as the result of such a |
1402 | changed opinion constitutes a material misrepresentation under |
1403 | s. 626.9541(1)(i)2.; however, this provision does not preclude |
1404 | the insurer from calling to the attention of the physician |
1405 | errors of fact in the report based upon information in the claim |
1406 | file. |
1407 | (b) If requested by the person examined, a party causing |
1408 | an examination to be made shall deliver to him or her a copy of |
1409 | every written report concerning the examination rendered by an |
1410 | examining physician, at least one of which reports must set out |
1411 | the examining physician's findings and conclusions in detail. |
1412 | After such request and delivery, the party causing the |
1413 | examination to be made is entitled, upon request, to receive |
1414 | from the person examined every written report available to him |
1415 | or her or his or her representative concerning any examination, |
1416 | previously or thereafter made, of the same mental or physical |
1417 | condition. By requesting and obtaining a report of the |
1418 | examination so ordered, or by taking the deposition of the |
1419 | examiner, the person examined waives any privilege he or she may |
1420 | have, in relation to the claim for benefits, regarding the |
1421 | testimony of every other person who has examined, or may |
1422 | thereafter examine, him or her in respect to the same mental or |
1423 | physical condition. If a person unreasonably refuses to submit |
1424 | to an examination, the personal injury protection carrier is no |
1425 | longer liable for subsequent personal injury protection |
1426 | benefits. |
1427 | (8) APPLICABILITY OF PROVISION REGULATING ATTORNEY'S |
1428 | FEES.--With respect to any dispute under the provisions of ss. |
1429 | 627.730-627.7405 between the insured and the insurer, or between |
1430 | an assignee of an insured's rights and the insurer, the |
1431 | provisions of s. 627.428 shall apply, except as provided in |
1432 | subsection (10) (11). |
1433 | (9)(a) Each insurer which has issued a policy providing |
1434 | personal injury protection benefits shall report the renewal, |
1435 | cancellation, or nonrenewal thereof to the Department of Highway |
1436 | Safety and Motor Vehicles within 45 days from the effective date |
1437 | of the renewal, cancellation, or nonrenewal. Upon the issuance |
1438 | of a policy providing personal injury protection benefits to a |
1439 | named insured not previously insured by the insurer thereof |
1440 | during that calendar year, the insurer shall report the issuance |
1441 | of the new policy to the Department of Highway Safety and Motor |
1442 | Vehicles within 30 days. The report shall be in such form and |
1443 | format and contain such information as may be required by the |
1444 | Department of Highway Safety and Motor Vehicles which shall |
1445 | include a format compatible with the data processing |
1446 | capabilities of said department, and the Department of Highway |
1447 | Safety and Motor Vehicles is authorized to adopt rules necessary |
1448 | with respect thereto. Failure by an insurer to file proper |
1449 | reports with the Department of Highway Safety and Motor Vehicles |
1450 | as required by this subsection or rules adopted with respect to |
1451 | the requirements of this subsection constitutes a violation of |
1452 | the Florida Insurance Code. Reports of cancellations and policy |
1453 | renewals and reports of the issuance of new policies received by |
1454 | the Department of Highway Safety and Motor Vehicles are |
1455 | confidential and exempt from the provisions of s. 119.07(1). |
1456 | These records are to be used for enforcement and regulatory |
1457 | purposes only, including the generation by the department of |
1458 | data regarding compliance by owners of motor vehicles with |
1459 | financial responsibility coverage requirements. In addition, the |
1460 | Department of Highway Safety and Motor Vehicles shall release, |
1461 | upon a written request by a person involved in a motor vehicle |
1462 | accident, by the person's attorney, or by a representative of |
1463 | the person's motor vehicle insurer, the name of the insurance |
1464 | company and the policy number for the policy covering the |
1465 | vehicle named by the requesting party. The written request must |
1466 | include a copy of the appropriate accident form as provided in |
1467 | s. 316.065, s. 316.066, or s. 316.068. |
1468 | (b) Every insurer with respect to each insurance policy |
1469 | providing personal injury protection benefits shall notify the |
1470 | named insured or in the case of a commercial fleet policy, the |
1471 | first named insured in writing that any cancellation or |
1472 | nonrenewal of the policy will be reported by the insurer to the |
1473 | Department of Highway Safety and Motor Vehicles. The notice |
1474 | shall also inform the named insured that failure to maintain |
1475 | personal injury protection and property damage liability |
1476 | insurance on a motor vehicle when required by law may result in |
1477 | the loss of registration and driving privileges in this state, |
1478 | and the notice shall inform the named insured of the amount of |
1479 | the reinstatement fees required by s. 627.733(7). This notice |
1480 | is for informational purposes only, and no civil liability shall |
1481 | attach to an insurer due to failure to provide this notice. |
1482 | (9)(10) An insurer may negotiate and enter into contracts |
1483 | with licensed health care providers for the benefits described |
1484 | in this section, referred to in this section as "preferred |
1485 | providers," which shall include health care providers licensed |
1486 | under chapters 458, 459, 460, 461, and 463. The insurer may |
1487 | provide an option to an insured to use a preferred provider at |
1488 | the time of purchase of the policy for personal injury |
1489 | protection benefits, if the requirements of this subsection are |
1490 | met. If the insured elects to use a provider who is not a |
1491 | preferred provider, whether the insured purchased a preferred |
1492 | provider policy or a nonpreferred provider policy, the medical |
1493 | benefits provided by the insurer shall be as required by this |
1494 | section. If the insured elects to use a provider who is a |
1495 | preferred provider, the insurer may pay medical benefits in |
1496 | excess of the benefits required by this section and may waive or |
1497 | lower the amount of any deductible that applies to such medical |
1498 | benefits. If the insurer offers a preferred provider policy to a |
1499 | policyholder or applicant, it must also offer a nonpreferred |
1500 | provider policy. The insurer shall provide each policyholder |
1501 | with a current roster of preferred providers in the county in |
1502 | which the insured resides at the time of purchase of such |
1503 | policy, and shall make such list available for public inspection |
1504 | during regular business hours at the principal office of the |
1505 | insurer within the state. |
1506 | (10)(11) DEMAND LETTER.-- |
1507 | (a) As a condition precedent to filing any action for |
1508 | benefits under this section, the insurer must be provided with |
1509 | written notice of an intent to initiate litigation. Such notice |
1510 | may not be sent until the claim is overdue, including any |
1511 | additional time the insurer has to pay the claim pursuant to |
1512 | paragraph (4)(b). |
1513 | (b) The notice required shall state that it is a "demand |
1514 | letter under s. 627.736(10)(11)" and shall state with |
1515 | specificity: |
1516 | 1. The name of the insured upon which such benefits are |
1517 | being sought, including a copy of the assignment giving rights |
1518 | to the claimant if the claimant is not the insured. |
1519 | 2. The claim number or policy number upon which such claim |
1520 | was originally submitted to the insurer. |
1521 | 3. To the extent applicable, the name of any medical |
1522 | provider who rendered to an insured the treatment, services, |
1523 | accommodations, or supplies that form the basis of such claim; |
1524 | and an itemized statement specifying each exact amount, the date |
1525 | of treatment, service, or accommodation, and the type of benefit |
1526 | claimed to be due. A completed form satisfying the requirements |
1527 | of paragraph (5)(d) or the lost-wage statement previously |
1528 | submitted may be used as the itemized statement. To the extent |
1529 | that the demand involves an insurer's withdrawal of payment |
1530 | under paragraph (7)(a) for future treatment not yet rendered, |
1531 | the claimant shall attach a copy of the insurer's notice |
1532 | withdrawing such payment and an itemized statement of the type, |
1533 | frequency, and duration of future treatment claimed to be |
1534 | reasonable and medically necessary. |
1535 | (c) Each notice required by this subsection must be |
1536 | delivered to the insurer by United States certified or |
1537 | registered mail, return receipt requested. Such postal costs |
1538 | shall be reimbursed by the insurer if so requested by the |
1539 | claimant in the notice, when the insurer pays the claim. Such |
1540 | notice must be sent to the person and address specified by the |
1541 | insurer for the purposes of receiving notices under this |
1542 | subsection. Each licensed insurer, whether domestic, foreign, or |
1543 | alien, shall file with the office designation of the name and |
1544 | address of the person to whom notices pursuant to this |
1545 | subsection shall be sent which the office shall make available |
1546 | on its Internet website. The name and address on file with the |
1547 | office pursuant to s. 624.422 shall be deemed the authorized |
1548 | representative to accept notice pursuant to this subsection in |
1549 | the event no other designation has been made. |
1550 | (d) If, within 15 days after receipt of notice by the |
1551 | insurer, the overdue claim specified in the notice is paid by |
1552 | the insurer together with applicable interest and a penalty of |
1553 | 10 percent of the overdue amount paid by the insurer, subject to |
1554 | a maximum penalty of $250, no action may be brought against the |
1555 | insurer. If the demand involves an insurer's withdrawal of |
1556 | payment under paragraph (7)(a) for future treatment not yet |
1557 | rendered, no action may be brought against the insurer if, |
1558 | within 15 days after its receipt of the notice, the insurer |
1559 | mails to the person filing the notice a written statement of the |
1560 | insurer's agreement to pay for such treatment in accordance with |
1561 | the notice and to pay a penalty of 10 percent, subject to a |
1562 | maximum penalty of $250, when it pays for such future treatment |
1563 | in accordance with the requirements of this section. To the |
1564 | extent the insurer determines not to pay any amount demanded, |
1565 | the penalty shall not be payable in any subsequent action. For |
1566 | purposes of this subsection, payment or the insurer's agreement |
1567 | shall be treated as being made on the date a draft or other |
1568 | valid instrument that is equivalent to payment, or the insurer's |
1569 | written statement of agreement, is placed in the United States |
1570 | mail in a properly addressed, postpaid envelope, or if not so |
1571 | posted, on the date of delivery. The insurer shall not be |
1572 | obligated to pay any attorney's fees if the insurer pays the |
1573 | claim or mails its agreement to pay for future treatment within |
1574 | the time prescribed by this subsection. |
1575 | (e) The applicable statute of limitation for an action |
1576 | under this section shall be tolled for a period of 15 business |
1577 | days by the mailing of the notice required by this subsection. |
1578 | (f) Any insurer making a general business practice of not |
1579 | paying valid claims until receipt of the notice required by this |
1580 | subsection is engaging in an unfair trade practice under the |
1581 | insurance code. |
1582 | (11)(12) CIVIL ACTION FOR INSURANCE FRAUD.--An insurer |
1583 | shall have a cause of action against any person convicted of, or |
1584 | who, regardless of adjudication of guilt, pleads guilty or nolo |
1585 | contendere to insurance fraud under s. 817.234, patient |
1586 | brokering under s. 817.505, or kickbacks under s. 456.054, |
1587 | associated with a claim for personal injury protection benefits |
1588 | in accordance with this section. An insurer prevailing in an |
1589 | action brought under this subsection may recover compensatory, |
1590 | consequential, and punitive damages subject to the requirements |
1591 | and limitations of part II of chapter 768, and attorney's fees |
1592 | and costs incurred in litigating a cause of action against any |
1593 | person convicted of, or who, regardless of adjudication of |
1594 | guilt, pleads guilty or nolo contendere to insurance fraud under |
1595 | s. 817.234, patient brokering under s. 817.505, or kickbacks |
1596 | under s. 456.054, associated with a claim for personal injury |
1597 | protection benefits in accordance with this section. |
1598 | (12)(13) MINIMUM BENEFIT COVERAGE.--If the Financial |
1599 | Services Commission determines that the cost savings under |
1600 | personal injury protection insurance benefits paid by insurers |
1601 | have been realized due to the provisions of this act, prior |
1602 | legislative reforms, or other factors, the commission may |
1603 | increase the minimum $10,000 benefit coverage requirement. In |
1604 | establishing the amount of such increase, the commission must |
1605 | determine that the additional premium for such coverage is |
1606 | approximately equal to the premium cost savings that have been |
1607 | realized for the personal injury protection coverage with limits |
1608 | of $10,000. |
1609 | (13)(14) FRAUD ADVISORY NOTICE.--Upon receiving notice of |
1610 | a claim under this section, an insurer shall provide a notice to |
1611 | the insured or to a person for whom a claim for reimbursement |
1612 | for diagnosis or treatment of injuries has been filed, advising |
1613 | that: |
1614 | (a) Pursuant to s. 626.9892, the Department of Financial |
1615 | Services may pay rewards of up to $25,000 to persons providing |
1616 | information leading to the arrest and conviction of persons |
1617 | committing crimes investigated by the Division of Insurance |
1618 | Fraud arising from violations of s. 440.105, s. 624.15, s. |
1619 | 626.9541, s. 626.989, or s. 817.234. |
1620 | (b) Solicitation of a person injured in a motor vehicle |
1621 | crash for purposes of filing personal injury protection or tort |
1622 | claims could be a violation of s. 817.234, s. 817.505, or the |
1623 | rules regulating The Florida Bar and should be immediately |
1624 | reported to the Division of Insurance Fraud if such conduct has |
1625 | taken place. |
1626 | Section 14. Notwithstanding the repeal of the Florida |
1627 | Motor Vehicle No-Fault Law, which occurred on October 1, 2007, |
1628 | section 627.737, Florida Statutes, is revived and reenacted to |
1629 | read: |
1630 | 627.737 Tort exemption; limitation on right to damages; |
1631 | punitive damages.-- |
1632 | (1) Every owner, registrant, operator, or occupant of a |
1633 | motor vehicle with respect to which security has been provided |
1634 | as required by ss. 627.730-627.7405, and every person or |
1635 | organization legally responsible for her or his acts or |
1636 | omissions, is hereby exempted from tort liability for damages |
1637 | because of bodily injury, sickness, or disease arising out of |
1638 | the ownership, operation, maintenance, or use of such motor |
1639 | vehicle in this state to the extent that the benefits described |
1640 | in s. 627.736(1) are payable for such injury, or would be |
1641 | payable but for any exclusion authorized by ss. 627.730- |
1642 | 627.7405, under any insurance policy or other method of security |
1643 | complying with the requirements of s. 627.733, or by an owner |
1644 | personally liable under s. 627.733 for the payment of such |
1645 | benefits, unless a person is entitled to maintain an action for |
1646 | pain, suffering, mental anguish, and inconvenience for such |
1647 | injury under the provisions of subsection (2). |
1648 | (2) In any action of tort brought against the owner, |
1649 | registrant, operator, or occupant of a motor vehicle with |
1650 | respect to which security has been provided as required by ss. |
1651 | 627.730-627.7405, or against any person or organization legally |
1652 | responsible for her or his acts or omissions, a plaintiff may |
1653 | recover damages in tort for pain, suffering, mental anguish, and |
1654 | inconvenience because of bodily injury, sickness, or disease |
1655 | arising out of the ownership, maintenance, operation, or use of |
1656 | such motor vehicle only in the event that the injury or disease |
1657 | consists in whole or in part of: |
1658 | (a) Significant and permanent loss of an important bodily |
1659 | function. |
1660 | (b) Permanent injury within a reasonable degree of medical |
1661 | probability, other than scarring or disfigurement. |
1662 | (c) Significant and permanent scarring or disfigurement. |
1663 | (d) Death. |
1664 | (3) When a defendant, in a proceeding brought pursuant to |
1665 | ss. 627.730-627.7405, questions whether the plaintiff has met |
1666 | the requirements of subsection (2), then the defendant may file |
1667 | an appropriate motion with the court, and the court shall, on a |
1668 | one-time basis only, 30 days before the date set for the trial |
1669 | or the pretrial hearing, whichever is first, by examining the |
1670 | pleadings and the evidence before it, ascertain whether the |
1671 | plaintiff will be able to submit some evidence that the |
1672 | plaintiff will meet the requirements of subsection (2). If the |
1673 | court finds that the plaintiff will not be able to submit such |
1674 | evidence, then the court shall dismiss the plaintiff's claim |
1675 | without prejudice. |
1676 | (4) In any action brought against an automobile liability |
1677 | insurer for damages in excess of its policy limits, no claim for |
1678 | punitive damages shall be allowed. |
1679 | Section 15. Notwithstanding the repeal of the Florida |
1680 | Motor Vehicle No-Fault Law, which occurred on October 1, 2007, |
1681 | section 627.739, Florida Statutes, is revived and reenacted to |
1682 | read: |
1683 | 627.739 Personal injury protection; optional limitations; |
1684 | deductibles.-- |
1685 | (1) The named insured may elect a deductible or modified |
1686 | coverage or combination thereof to apply to the named insured |
1687 | alone or to the named insured and dependent relatives residing |
1688 | in the same household, but may not elect a deductible or |
1689 | modified coverage to apply to any other person covered under the |
1690 | policy. |
1691 | (2) Insurers shall offer to each applicant and to each |
1692 | policyholder, upon the renewal of an existing policy, |
1693 | deductibles, in amounts of $250, $500, and $1,000. The |
1694 | deductible amount must be applied to 100 percent of the expenses |
1695 | and losses described in s. 627.736. After the deductible is met, |
1696 | each insured is eligible to receive up to $10,000 in total |
1697 | benefits described in s. 627.736(1). However, this subsection |
1698 | shall not be applied to reduce the amount of any benefits |
1699 | received in accordance with s. 627.736(1)(c). |
1700 | (3) Insurers shall offer coverage wherein, at the election |
1701 | of the named insured, the benefits for loss of gross income and |
1702 | loss of earning capacity described in s. 627.736(1)(b) shall be |
1703 | excluded. |
1704 | (4) The named insured shall not be prevented from electing |
1705 | a deductible under subsection (2) and modified coverage under |
1706 | subsection (3). Each election made by the named insured under |
1707 | this section shall result in an appropriate reduction of premium |
1708 | associated with that election. |
1709 | (5) All such offers shall be made in clear and unambiguous |
1710 | language at the time the initial application is taken and prior |
1711 | to each annual renewal and shall indicate that a premium |
1712 | reduction will result from each election. At the option of the |
1713 | insurer, the requirements of the preceding sentence are met by |
1714 | using forms of notice approved by the office, or by providing |
1715 | the following notice in 10-point type in the insurer's |
1716 | application for initial issuance of a policy of motor vehicle |
1717 | insurance and the insurer's annual notice of renewal premium: |
1718 | For personal injury protection insurance, the named insured may |
1719 | elect a deductible and to exclude coverage for loss of gross |
1720 | income and loss of earning capacity ("lost wages"). These |
1721 | elections apply to the named insured alone, or to the named |
1722 | insured and all dependent resident relatives. A premium |
1723 | reduction will result from these elections. The named insured is |
1724 | hereby advised not to elect the lost wage exclusion if the named |
1725 | insured or dependent resident relatives are employed, since lost |
1726 | wages will not be payable in the event of an accident. |
1727 | Section 16. Notwithstanding the repeal of the Florida |
1728 | Motor Vehicle No-Fault Law, which occurred on October 1, 2007, |
1729 | section 627.7401, Florida Statutes, is revived and reenacted to |
1730 | read: |
1731 | 627.7401 Notification of insured's rights.-- |
1732 | (1) The commission, by rule, shall adopt a form for the |
1733 | notification of insureds of their right to receive personal |
1734 | injury protection benefits under the Florida Motor Vehicle No- |
1735 | Fault Law. Such notice shall include: |
1736 | (a) A description of the benefits provided by personal |
1737 | injury protection, including, but not limited to, the specific |
1738 | types of services for which medical benefits are paid, |
1739 | disability benefits, death benefits, significant exclusions from |
1740 | and limitations on personal injury protection benefits, when |
1741 | payments are due, how benefits are coordinated with other |
1742 | insurance benefits that the insured may have, penalties and |
1743 | interest that may be imposed on insurers for failure to make |
1744 | timely payments of benefits, and rights of parties regarding |
1745 | disputes as to benefits. |
1746 | (b) An advisory informing insureds that: |
1747 | 1. Pursuant to s. 626.9892, the Department of Financial |
1748 | Services may pay rewards of up to $25,000 to persons providing |
1749 | information leading to the arrest and conviction of persons |
1750 | committing crimes investigated by the Division of Insurance |
1751 | Fraud arising from violations of s. 440.105, s. 624.15, s. |
1752 | 626.9541, s. 626.989, or s. 817.234. |
1753 | 2. Pursuant to s. 627.736(5)(e)1., if the insured notifies |
1754 | the insurer of a billing error, the insured may be entitled to a |
1755 | certain percentage of a reduction in the amount paid by the |
1756 | insured's motor vehicle insurer. |
1757 | (c) A notice that solicitation of a person injured in a |
1758 | motor vehicle crash for purposes of filing personal injury |
1759 | protection or tort claims could be a violation of s. 817.234, s |
1760 | 817.505, or the rules regulating The Florida Bar and should be |
1761 | immediately reported to the Division of Insurance Fraud if such |
1762 | conduct has taken place. |
1763 | (2) Each insurer issuing a policy in this state providing |
1764 | personal injury protection benefits must mail or deliver the |
1765 | notice as specified in subsection (1) to an insured within 21 |
1766 | days after receiving from the insured notice of an automobile |
1767 | accident or claim involving personal injury to an insured who is |
1768 | covered under the policy. The office may allow an insurer |
1769 | additional time to provide the notice specified in subsection |
1770 | (1) not to exceed 30 days, upon a showing by the insurer that an |
1771 | emergency justifies an extension of time. |
1772 | (3) The notice required by this section does not alter or |
1773 | modify the terms of the insurance contract or other requirements |
1774 | of this act. |
1775 | Section 17. Notwithstanding the repeal of the Florida |
1776 | Motor Vehicle No-Fault Law, which occurred on October 1, 2007, |
1777 | section 627.7403, Florida Statutes, is revived and reenacted to |
1778 | read: |
1779 | 627.7403 Mandatory joinder of derivative claim.--In any |
1780 | action brought pursuant to the provisions of s. 627.737 claiming |
1781 | personal injuries, all claims arising out of the plaintiff's |
1782 | injuries, including all derivative claims, shall be brought |
1783 | together, unless good cause is shown why such claims should be |
1784 | brought separately. |
1785 | Section 18. Notwithstanding the repeal of the Florida |
1786 | Motor Vehicle No-Fault Law, which occurred on October 1, 2007, |
1787 | section 627.7405, Florida Statutes, is revived and reenacted to |
1788 | read: |
1789 | 627.7405 Insurers' right of |
1790 | reimbursement.--Notwithstanding any other provisions of ss. |
1791 | 627.730-627.7405, any insurer providing personal injury |
1792 | protection benefits on a private passenger motor vehicle shall |
1793 | have, to the extent of any personal injury protection benefits |
1794 | paid to any person as a benefit arising out of such private |
1795 | passenger motor vehicle insurance, a right of reimbursement |
1796 | against the owner or the insurer of the owner of a commercial |
1797 | motor vehicle, if the benefits paid result from such person |
1798 | having been an occupant of the commercial motor vehicle or |
1799 | having been struck by the commercial motor vehicle while not an |
1800 | occupant of any self-propelled vehicle. |
1801 | Section 19. This act revives and reenacts, with |
1802 | amendments, the Florida Motor Vehicle No-Fault Law, which |
1803 | expired by operation of law on October 1, 2007. This act is |
1804 | intended to be remedial and curative in nature and to minimize |
1805 | confusion concerning the changes made by this act to ss. |
1806 | 627.730-627.7405, Florida Statutes. Therefore, the Florida Motor |
1807 | Vehicle No-Fault Law shall continue to be codified as ss. |
1808 | 627.730-627.7405, Florida Statutes, notwithstanding the repeal |
1809 | of those sections contained in s. 19, chapter 2003-411, Laws of |
1810 | Florida. |
1811 | Section 20. Effective January 15, 2008, and applicable to |
1812 | policies issued or renewed on or after that date, subsections |
1813 | (1) and (4), paragraphs (a), (b), and (c) of subsection (5), |
1814 | subsection (8), and paragraphs (d) and (e) of subsection (10) of |
1815 | section 627.736, Florida Statutes, as reenacted and amended by |
1816 | this act, are amended, subsections (11), (12), and (13) of that |
1817 | section, as reenacted and amended by this act, are renumbered as |
1818 | subsections (12), (13), and (14), respectively, and a new |
1819 | subsection (11) and subsections (15) and (16) are added to that |
1820 | section, to read: |
1821 | 627.736 Required personal injury protection benefits; |
1822 | exclusions; priority; claims.-- |
1823 | (1) REQUIRED BENEFITS.--Every insurance policy complying |
1824 | with the security requirements of s. 627.733 shall provide |
1825 | personal injury protection to the named insured, relatives |
1826 | residing in the same household, persons operating the insured |
1827 | motor vehicle, passengers in such motor vehicle, and other |
1828 | persons struck by such motor vehicle and suffering bodily injury |
1829 | while not an occupant of a self-propelled vehicle, subject to |
1830 | the provisions of subsection (2) and paragraph (4)(e)(d), to a |
1831 | limit of $10,000 for loss sustained by any such person as a |
1832 | result of bodily injury, sickness, disease, or death arising out |
1833 | of the ownership, maintenance, or use of a motor vehicle as |
1834 | follows: |
1835 | (a) Medical benefits.--Eighty percent of all reasonable |
1836 | expenses for medically necessary medical, surgical, X-ray, |
1837 | dental, and rehabilitative services, including prosthetic |
1838 | devices, and medically necessary ambulance, hospital, and |
1839 | nursing services. However, the medical benefits shall provide |
1840 | reimbursement only for such services and care that are provided, |
1841 | ordered, or prescribed by a physician licensed under chapter 458 |
1842 | or chapter 459 or a dentist licensed under chapter 466 or that |
1843 | are provided by any of the following persons or entities: |
1844 | 1. A chiropractic physician licensed under chapter 460. |
1845 | 2. A hospital or ambulatory surgical center licensed under |
1846 | chapter 395. |
1847 | 3. A person or entity licensed under ss. 401.2101-401.45 |
1848 | that provides emergency transportation and treatment. |
1849 | 4. An entity wholly owned by one or more physicians |
1850 | licensed under chapter 458 or chapter 459, chiropractic |
1851 | physicians licensed under chapter 460, or dentists licensed |
1852 | under chapter 466 or by such practitioner or practitioners and |
1853 | the spouse, parent, child, or sibling of that practitioner or |
1854 | those practitioners. |
1855 | 5. An entity wholly owned, directly or indirectly, by a |
1856 | hospital or hospitals. |
1857 | 6. A health care clinic licensed under ss. 400.990-400.995 |
1858 | that is: |
1859 | a. Accredited by the Joint Commission on Accreditation of |
1860 | Healthcare Organizations, the American Osteopathic Association, |
1861 | the Commission on Accreditation of Rehabilitation Facilities, or |
1862 | the Accreditation Association for Ambulatory Health Care, Inc.; |
1863 | or |
1864 | b. A health care clinic that: |
1865 | (I) Has a medical director licensed under chapter 458, |
1866 | chapter 459, or chapter 460; |
1867 | (II) Has been continuously licensed for more than 3 years |
1868 | or is a publicly traded corporation that issues securities |
1869 | traded on an exchange registered with the United States |
1870 | Securities and Exchange Commission as a national securities |
1871 | exchange; and |
1872 | (III) Provides at least four of the following medical |
1873 | specialties: |
1874 | (A) General medicine. |
1875 | (B) Radiography. |
1876 | (C) Orthopedic medicine. |
1877 | (D) Physical medicine. |
1878 | (E) Physical therapy. |
1879 | (F) Physical rehabilitation. |
1880 | (G) Prescribing or dispensing outpatient prescription |
1881 | medication. |
1882 | (H) Laboratory services. |
1883 |
|
1884 | The Financial Services Commission shall adopt by rule the form |
1885 | that must be used by an insurer and a health care provider |
1886 | specified in subparagraph 4., subparagraph 5., or subparagraph |
1887 | 6. to document that the health care provider meets the criteria |
1888 | of this paragraph, which rule must include a requirement for a |
1889 | sworn statement or affidavit Such benefits shall also include |
1890 | necessary remedial treatment and services recognized and |
1891 | permitted under the laws of the state for an injured person who |
1892 | relies upon spiritual means through prayer alone for healing, in |
1893 | accordance with his or her religious beliefs; however, this |
1894 | sentence does not affect the determination of what other |
1895 | services or procedures are medically necessary. |
1896 | (b) Disability benefits.--Sixty percent of any loss of |
1897 | gross income and loss of earning capacity per individual from |
1898 | inability to work proximately caused by the injury sustained by |
1899 | the injured person, plus all expenses reasonably incurred in |
1900 | obtaining from others ordinary and necessary services in lieu of |
1901 | those that, but for the injury, the injured person would have |
1902 | performed without income for the benefit of his or her |
1903 | household. All disability benefits payable under this provision |
1904 | shall be paid not less than every 2 weeks. |
1905 | (c) Death benefits.--Death benefits equal to the lesser of |
1906 | $5,000 or the remainder of unused personal injury protection |
1907 | benefits per individual. The insurer may pay such benefits to |
1908 | the executor or administrator of the deceased, to any of the |
1909 | deceased's relatives by blood or legal adoption or connection by |
1910 | marriage, or to any person appearing to the insurer to be |
1911 | equitably entitled thereto. |
1912 |
|
1913 | Only insurers writing motor vehicle liability insurance in this |
1914 | state may provide the required benefits of this section, and no |
1915 | such insurer shall require the purchase of any other motor |
1916 | vehicle coverage other than the purchase of property damage |
1917 | liability coverage as required by s. 627.7275 as a condition for |
1918 | providing such required benefits. Insurers may not require that |
1919 | property damage liability insurance in an amount greater than |
1920 | $10,000 be purchased in conjunction with personal injury |
1921 | protection. Such insurers shall make benefits and required |
1922 | property damage liability insurance coverage available through |
1923 | normal marketing channels. Any insurer writing motor vehicle |
1924 | liability insurance in this state who fails to comply with such |
1925 | availability requirement as a general business practice shall be |
1926 | deemed to have violated part IX of chapter 626, and such |
1927 | violation shall constitute an unfair method of competition or an |
1928 | unfair or deceptive act or practice involving the business of |
1929 | insurance; and any such insurer committing such violation shall |
1930 | be subject to the penalties afforded in such part, as well as |
1931 | those which may be afforded elsewhere in the insurance code. |
1932 | (4) BENEFITS; WHEN DUE.--Benefits due from an insurer |
1933 | under ss. 627.730-627.7405 shall be primary, except that |
1934 | benefits received under any workers' compensation law shall be |
1935 | credited against the benefits provided by subsection (1) and |
1936 | shall be due and payable as loss accrues, upon receipt of |
1937 | reasonable proof of such loss and the amount of expenses and |
1938 | loss incurred which are covered by the policy issued under ss. |
1939 | 627.730-627.7405. When the Agency for Health Care Administration |
1940 | provides, pays, or becomes liable for medical assistance under |
1941 | the Medicaid program related to injury, sickness, disease, or |
1942 | death arising out of the ownership, maintenance, or use of a |
1943 | motor vehicle, benefits under ss. 627.730-627.7405 shall be |
1944 | subject to the provisions of the Medicaid program. |
1945 | (a) An insurer may require written notice to be given as |
1946 | soon as practicable after an accident involving a motor vehicle |
1947 | with respect to which the policy affords the security required |
1948 | by ss. 627.730-627.7405. |
1949 | (b) Personal injury protection insurance benefits paid |
1950 | pursuant to this section shall be overdue if not paid within 30 |
1951 | days after the insurer is furnished written notice of the fact |
1952 | of a covered loss and of the amount of same. If such written |
1953 | notice is not furnished to the insurer as to the entire claim, |
1954 | any partial amount supported by written notice is overdue if not |
1955 | paid within 30 days after such written notice is furnished to |
1956 | the insurer. Any part or all of the remainder of the claim that |
1957 | is subsequently supported by written notice is overdue if not |
1958 | paid within 30 days after such written notice is furnished to |
1959 | the insurer. When an insurer pays only a portion of a claim or |
1960 | rejects a claim, the insurer shall provide at the time of the |
1961 | partial payment or rejection an itemized specification of each |
1962 | item that the insurer had reduced, omitted, or declined to pay |
1963 | and any information that the insurer desires the claimant to |
1964 | consider related to the medical necessity of the denied |
1965 | treatment or to explain the reasonableness of the reduced |
1966 | charge, provided that this shall not limit the introduction of |
1967 | evidence at trial; and the insurer shall include the name and |
1968 | address of the person to whom the claimant should respond and a |
1969 | claim number to be referenced in future correspondence. However, |
1970 | notwithstanding the fact that written notice has been furnished |
1971 | to the insurer, any payment shall not be deemed overdue when the |
1972 | insurer has reasonable proof to establish that the insurer is |
1973 | not responsible for the payment. For the purpose of calculating |
1974 | the extent to which any benefits are overdue, payment shall be |
1975 | treated as being made on the date a draft or other valid |
1976 | instrument which is equivalent to payment was placed in the |
1977 | United States mail in a properly addressed, postpaid envelope |
1978 | or, if not so posted, on the date of delivery. This paragraph |
1979 | does not preclude or limit the ability of the insurer to assert |
1980 | that the claim was unrelated, was not medically necessary, or |
1981 | was unreasonable or that the amount of the charge was in excess |
1982 | of that permitted under, or in violation of, subsection (5). |
1983 | Such assertion by the insurer may be made at any time, including |
1984 | after payment of the claim or after the 30-day time period for |
1985 | payment set forth in this paragraph. |
1986 | (c) Upon receiving notice of an accident that is |
1987 | potentially covered by personal injury protection benefits, the |
1988 | insurer must reserve $5,000 of personal injury protection |
1989 | benefits for payment to physicians licensed under chapter 458 or |
1990 | chapter 459 who provide emergency services and care, as defined |
1991 | in s. 395.002(9), or who provide hospital inpatient care. The |
1992 | amount required to be held in reserve may be used only to pay |
1993 | claims from such physicians until 30 days after the date the |
1994 | insurer receives notice of the accident. After the 30-day |
1995 | period, any amount of the reserve for which the insurer has not |
1996 | received notice of a claim from a physician who provided |
1997 | emergency services and care or who provided hospital inpatient |
1998 | care may then be used by the insurer to pay other claims. The |
1999 | time periods specified in paragraph (b) for required payment of |
2000 | personal injury protection benefits shall be tolled for the |
2001 | period of time that an insurer is required by this paragraph to |
2002 | hold payment of a claim that is not from a physician who |
2003 | provided emergency services and care or who provided hospital |
2004 | inpatient care. |
2005 | (d)(c) All overdue payments shall bear simple interest at |
2006 | the rate established under s. 55.03 or the rate established in |
2007 | the insurance contract, whichever is greater, for the year in |
2008 | which the payment became overdue, calculated from the date the |
2009 | insurer was furnished with written notice of the amount of |
2010 | covered loss. Interest shall be due at the time payment of the |
2011 | overdue claim is made. |
2012 | (e)(d) The insurer of the owner of a motor vehicle shall |
2013 | pay personal injury protection benefits for: |
2014 | 1. Accidental bodily injury sustained in this state by the |
2015 | owner while occupying a motor vehicle, or while not an occupant |
2016 | of a self-propelled vehicle if the injury is caused by physical |
2017 | contact with a motor vehicle. |
2018 | 2. Accidental bodily injury sustained outside this state, |
2019 | but within the United States of America or its territories or |
2020 | possessions or Canada, by the owner while occupying the owner's |
2021 | motor vehicle. |
2022 | 3. Accidental bodily injury sustained by a relative of the |
2023 | owner residing in the same household, under the circumstances |
2024 | described in subparagraph 1. or subparagraph 2., provided the |
2025 | relative at the time of the accident is domiciled in the owner's |
2026 | household and is not himself or herself the owner of a motor |
2027 | vehicle with respect to which security is required under ss. |
2028 | 627.730-627.7405. |
2029 | 4. Accidental bodily injury sustained in this state by any |
2030 | other person while occupying the owner's motor vehicle or, if a |
2031 | resident of this state, while not an occupant of a self- |
2032 | propelled vehicle, if the injury is caused by physical contact |
2033 | with such motor vehicle, provided the injured person is not |
2034 | himself or herself: |
2035 | a. The owner of a motor vehicle with respect to which |
2036 | security is required under ss. 627.730-627.7405; or |
2037 | b. Entitled to personal injury benefits from the insurer |
2038 | of the owner or owners of such a motor vehicle. |
2039 | (f)(e) If two or more insurers are liable to pay personal |
2040 | injury protection benefits for the same injury to any one |
2041 | person, the maximum payable shall be as specified in subsection |
2042 | (1), and any insurer paying the benefits shall be entitled to |
2043 | recover from each of the other insurers an equitable pro rata |
2044 | share of the benefits paid and expenses incurred in processing |
2045 | the claim. |
2046 | (g)(f) It is a violation of the insurance code for an |
2047 | insurer to fail to timely provide benefits as required by this |
2048 | section with such frequency as to constitute a general business |
2049 | practice. |
2050 | (h)(g) Benefits shall not be due or payable to or on the |
2051 | behalf of an insured person if that person has committed, by a |
2052 | material act or omission, any insurance fraud relating to |
2053 | personal injury protection coverage under his or her policy, if |
2054 | the fraud is admitted to in a sworn statement by the insured or |
2055 | if it is established in a court of competent jurisdiction. Any |
2056 | insurance fraud shall void all coverage arising from the claim |
2057 | related to such fraud under the personal injury protection |
2058 | coverage of the insured person who committed the fraud, |
2059 | irrespective of whether a portion of the insured person's claim |
2060 | may be legitimate, and any benefits paid prior to the discovery |
2061 | of the insured person's insurance fraud shall be recoverable by |
2062 | the insurer from the person who committed insurance fraud in |
2063 | their entirety. The prevailing party is entitled to its costs |
2064 | and attorney's fees in any action in which it prevails in an |
2065 | insurer's action to enforce its right of recovery under this |
2066 | paragraph. |
2067 | (5) CHARGES FOR TREATMENT OF INJURED PERSONS.-- |
2068 | (a)1. Any physician, hospital, clinic, or other person or |
2069 | institution lawfully rendering treatment to an injured person |
2070 | for a bodily injury covered by personal injury protection |
2071 | insurance may charge the insurer and injured party only a |
2072 | reasonable amount pursuant to this section for the services and |
2073 | supplies rendered, and the insurer providing such coverage may |
2074 | pay for such charges directly to such person or institution |
2075 | lawfully rendering such treatment, if the insured receiving such |
2076 | treatment or his or her guardian has countersigned the properly |
2077 | completed invoice, bill, or claim form approved by the office |
2078 | upon which such charges are to be paid for as having actually |
2079 | been rendered, to the best knowledge of the insured or his or |
2080 | her guardian. In no event, however, may such a charge be in |
2081 | excess of the amount the person or institution customarily |
2082 | charges for like services or supplies. With respect to a |
2083 | determination of whether a charge for a particular service, |
2084 | treatment, or otherwise is reasonable, consideration may be |
2085 | given to evidence of usual and customary charges and payments |
2086 | accepted by the provider involved in the dispute, and |
2087 | reimbursement levels in the community and various federal and |
2088 | state medical fee schedules applicable to automobile and other |
2089 | insurance coverages, and other information relevant to the |
2090 | reasonableness of the reimbursement for the service, treatment, |
2091 | or supply. |
2092 | 2. The insurer may limit reimbursement to 80 percent of |
2093 | the following schedule of maximum charges: |
2094 | a. For emergency transport and treatment by providers |
2095 | licensed under chapter 401, 200 percent of Medicare. |
2096 | b. For emergency services and care provided by a hospital |
2097 | licensed under chapter 395, 75 percent of the hospital's usual |
2098 | and customary charges. |
2099 | c. For emergency services and care rendered by a physician |
2100 | and related hospital inpatient services rendered by a physician, |
2101 | the usual and customary charges in the community. |
2102 | d. For hospital inpatient services, other than emergency |
2103 | services and care, 200 percent of the Medicare Part A |
2104 | prospective payment applicable to the specific hospital |
2105 | providing the inpatient services. |
2106 | e. For hospital outpatient services, other than emergency |
2107 | services and care, 200 percent of the Medicare Part A Ambulatory |
2108 | Payment Classification for the specific hospital providing the |
2109 | outpatient services. |
2110 | f. For all other medical services, supplies, and care, 200 |
2111 | percent of the applicable Medicare Part B fee schedule. However, |
2112 | if such services, supplies, or care are not reimbursable under |
2113 | Medicare Part B, the insurer may limit reimbursement to 80 |
2114 | percent of the maximum reimbursable allowance under workers' |
2115 | compensation, as determined under s. 440.13 and rules adopted |
2116 | thereunder which are in effect at the time such services, |
2117 | supplies, or care are provided. Services, supplies, or care that |
2118 | are not reimbursable under Medicare or workers' compensation are |
2119 | not required to be reimbursed by the insurer. |
2120 | 3. For purposes of subparagraph 2., the applicable fee |
2121 | schedule or payment limitation under Medicare is the fee |
2122 | schedule or payment limitation in effect at the time the |
2123 | services, supplies, or care were rendered and for the area in |
2124 | which such services were rendered. |
2125 | 4. Subparagraph 2. does not allow the insurer to apply any |
2126 | limitation on the number of treatments or other utilization |
2127 | limits that apply under Medicare or workers' compensation. An |
2128 | insurer that applies the allowable payment limitations of |
2129 | subparagraph 2. must reimburse a provider who lawfully provided |
2130 | care or treatment under the scope of his or her license, |
2131 | regardless of whether such provider would be entitled to |
2132 | reimbursement under Medicare due to restrictions or limitations |
2133 | on the types or discipline of health care providers who may be |
2134 | reimbursed for particular procedures or procedure codes. |
2135 | 5. If an insurer limits payment as authorized by |
2136 | subparagraph 2., the person providing such services, supplies, |
2137 | or care may not bill or attempt to collect from the insured any |
2138 | amount in excess of such limits, except for amounts that are not |
2139 | covered by the insured's personal injury protection coverage due |
2140 | to the coinsurance amount or maximum policy limits. |
2141 | (b)1. An insurer or insured is not required to pay a claim |
2142 | or charges: |
2143 | a. Made by a broker or by a person making a claim on |
2144 | behalf of a broker; |
2145 | b. For any service or treatment that was not lawful at the |
2146 | time rendered; |
2147 | c. To any person who knowingly submits a false or |
2148 | misleading statement relating to the claim or charges; |
2149 | d. With respect to a bill or statement that does not |
2150 | substantially meet the applicable requirements of paragraph (d); |
2151 | e. For any treatment or service that is upcoded, or that |
2152 | is unbundled when such treatment or services should be bundled, |
2153 | in accordance with paragraph (d). To facilitate prompt payment |
2154 | of lawful services, an insurer may change codes that it |
2155 | determines to have been improperly or incorrectly upcoded or |
2156 | unbundled, and may make payment based on the changed codes, |
2157 | without affecting the right of the provider to dispute the |
2158 | change by the insurer, provided that before doing so, the |
2159 | insurer must contact the health care provider and discuss the |
2160 | reasons for the insurer's change and the health care provider's |
2161 | reason for the coding, or make a reasonable good faith effort to |
2162 | do so, as documented in the insurer's file; and |
2163 | f. For medical services or treatment billed by a physician |
2164 | and not provided in a hospital unless such services are rendered |
2165 | by the physician or are incident to his or her professional |
2166 | services and are included on the physician's bill, including |
2167 | documentation verifying that the physician is responsible for |
2168 | the medical services that were rendered and billed. |
2169 | 2. Charges for medically necessary cephalic thermograms, |
2170 | peripheral thermograms, spinal ultrasounds, extremity |
2171 | ultrasounds, video fluoroscopy, and surface electromyography |
2172 | shall not exceed the maximum reimbursement allowance for such |
2173 | procedures as set forth in the applicable fee schedule or other |
2174 | payment methodology established pursuant to s. 440.13. |
2175 | 3. Allowable amounts that may be charged to a personal |
2176 | injury protection insurance insurer and insured for medically |
2177 | necessary nerve conduction testing when done in conjunction with |
2178 | a needle electromyography procedure and both are performed and |
2179 | billed solely by a physician licensed under chapter 458, chapter |
2180 | 459, chapter 460, or chapter 461 who is also certified by the |
2181 | American Board of Electrodiagnostic Medicine or by a board |
2182 | recognized by the American Board of Medical Specialties or the |
2183 | American Osteopathic Association or who holds diplomate status |
2184 | with the American Chiropractic Neurology Board or its |
2185 | predecessors shall not exceed 200 percent of the allowable |
2186 | amount under the participating physician fee schedule of |
2187 | Medicare Part B for year 2001, for the area in which the |
2188 | treatment was rendered, adjusted annually on August 1 to reflect |
2189 | the prior calendar year's changes in the annual Medical Care |
2190 | Item of the Consumer Price Index for All Urban Consumers in the |
2191 | South Region as determined by the Bureau of Labor Statistics of |
2192 | the United States Department of Labor. |
2193 | 4. Allowable amounts that may be charged to a personal |
2194 | injury protection insurance insurer and insured for medically |
2195 | necessary nerve conduction testing that does not meet the |
2196 | requirements of subparagraph 3. shall not exceed the applicable |
2197 | fee schedule or other payment methodology established pursuant |
2198 | to s. 440.13. |
2199 | 5. Allowable amounts that may be charged to a personal |
2200 | injury protection insurance insurer and insured for magnetic |
2201 | resonance imaging services shall not exceed 175 percent of the |
2202 | allowable amount under the participating physician fee schedule |
2203 | of Medicare Part B for year 2001, for the area in which the |
2204 | treatment was rendered, adjusted annually on August 1 to reflect |
2205 | the prior calendar year's changes in the annual Medical Care |
2206 | Item of the Consumer Price Index for All Urban Consumers in the |
2207 | South Region as determined by the Bureau of Labor Statistics of |
2208 | the United States Department of Labor for the 12-month period |
2209 | ending June 30 of that year, except that allowable amounts that |
2210 | may be charged to a personal injury protection insurance insurer |
2211 | and insured for magnetic resonance imaging services provided in |
2212 | facilities accredited by the Accreditation Association for |
2213 | Ambulatory Health Care, the American College of Radiology, or |
2214 | the Joint Commission on Accreditation of Healthcare |
2215 | Organizations shall not exceed 200 percent of the allowable |
2216 | amount under the participating physician fee schedule of |
2217 | Medicare Part B for year 2001, for the area in which the |
2218 | treatment was rendered, adjusted annually on August 1 to reflect |
2219 | the prior calendar year's changes in the annual Medical Care |
2220 | Item of the Consumer Price Index for All Urban Consumers in the |
2221 | South Region as determined by the Bureau of Labor Statistics of |
2222 | the United States Department of Labor for the 12-month period |
2223 | ending June 30 of that year. This paragraph does not apply to |
2224 | charges for magnetic resonance imaging services and nerve |
2225 | conduction testing for inpatients and emergency services and |
2226 | care as defined in chapter 395 rendered by facilities licensed |
2227 | under chapter 395. |
2228 | 2.6. The Department of Health, in consultation with the |
2229 | appropriate professional licensing boards, shall adopt, by rule, |
2230 | a list of diagnostic tests deemed not to be medically necessary |
2231 | for use in the treatment of persons sustaining bodily injury |
2232 | covered by personal injury protection benefits under this |
2233 | section. The initial list shall be adopted by January 1, 2004, |
2234 | and shall be revised from time to time as determined by the |
2235 | Department of Health, in consultation with the respective |
2236 | professional licensing boards. Inclusion of a test on the list |
2237 | of invalid diagnostic tests shall be based on lack of |
2238 | demonstrated medical value and a level of general acceptance by |
2239 | the relevant provider community and shall not be dependent for |
2240 | results entirely upon subjective patient response. |
2241 | Notwithstanding its inclusion on a fee schedule in this |
2242 | subsection, an insurer or insured is not required to pay any |
2243 | charges or reimburse claims for any invalid diagnostic test as |
2244 | determined by the Department of Health. |
2245 | (c)1. With respect to any treatment or service, other than |
2246 | medical services billed by a hospital or other provider for |
2247 | emergency services as defined in s. 395.002 or inpatient |
2248 | services rendered at a hospital-owned facility, the statement of |
2249 | charges must be furnished to the insurer by the provider and may |
2250 | not include, and the insurer is not required to pay, charges for |
2251 | treatment or services rendered more than 35 days before the |
2252 | postmark date or electronic transmission date of the statement, |
2253 | except for past due amounts previously billed on a timely basis |
2254 | under this paragraph, and except that, if the provider submits |
2255 | to the insurer a notice of initiation of treatment within 21 |
2256 | days after its first examination or treatment of the claimant, |
2257 | the statement may include charges for treatment or services |
2258 | rendered up to, but not more than, 75 days before the postmark |
2259 | date of the statement. The injured party is not liable for, and |
2260 | the provider shall not bill the injured party for, charges that |
2261 | are unpaid because of the provider's failure to comply with this |
2262 | paragraph. Any agreement requiring the injured person or insured |
2263 | to pay for such charges is unenforceable. |
2264 | 2. If, however, the insured fails to furnish the provider |
2265 | with the correct name and address of the insured's personal |
2266 | injury protection insurer, the provider has 35 days from the |
2267 | date the provider obtains the correct information to furnish the |
2268 | insurer with a statement of the charges. The insurer is not |
2269 | required to pay for such charges unless the provider includes |
2270 | with the statement documentary evidence that was provided by the |
2271 | insured during the 35-day period demonstrating that the provider |
2272 | reasonably relied on erroneous information from the insured and |
2273 | either: |
2274 | a. A denial letter from the incorrect insurer; or |
2275 | b. Proof of mailing, which may include an affidavit under |
2276 | penalty of perjury, reflecting timely mailing to the incorrect |
2277 | address or insurer. |
2278 | 3. For emergency services and care as defined in s. |
2279 | 395.002 rendered in a hospital emergency department or for |
2280 | transport and treatment rendered by an ambulance provider |
2281 | licensed pursuant to part III of chapter 401, the provider is |
2282 | not required to furnish the statement of charges within the time |
2283 | periods established by this paragraph; and the insurer shall not |
2284 | be considered to have been furnished with notice of the amount |
2285 | of covered loss for purposes of paragraph (4)(b) until it |
2286 | receives a statement complying with paragraph (d), or copy |
2287 | thereof, which specifically identifies the place of service to |
2288 | be a hospital emergency department or an ambulance in accordance |
2289 | with billing standards recognized by the Health Care Finance |
2290 | Administration. |
2291 | 4. Each notice of insured's rights under s. 627.7401 must |
2292 | include the following statement in type no smaller than 12 |
2293 | points: |
2294 |
|
2295 | BILLING REQUIREMENTS.--Florida Statutes provide that with |
2296 | respect to any treatment or services, other than certain |
2297 | hospital and emergency services, the statement of charges |
2298 | furnished to the insurer by the provider may not include, and |
2299 | the insurer and the injured party are not required to pay, |
2300 | charges for treatment or services rendered more than 35 days |
2301 | before the postmark date of the statement, except for past due |
2302 | amounts previously billed on a timely basis, and except that, if |
2303 | the provider submits to the insurer a notice of initiation of |
2304 | treatment within 21 days after its first examination or |
2305 | treatment of the claimant, the statement may include charges for |
2306 | treatment or services rendered up to, but not more than, 75 days |
2307 | before the postmark date of the statement. |
2308 | (8) APPLICABILITY OF PROVISION REGULATING ATTORNEY'S |
2309 | FEES.--With respect to any dispute under the provisions of ss. |
2310 | 627.730-627.7405 between the insured and the insurer, or between |
2311 | an assignee of an insured's rights and the insurer, the |
2312 | provisions of s. 627.428 shall apply, except as provided in |
2313 | subsections subsection (10) and (15). |
2314 | (10) DEMAND LETTER.-- |
2315 | (d) If, within 30 15 days after receipt of notice by the |
2316 | insurer, the overdue claim specified in the notice is paid by |
2317 | the insurer together with applicable interest and a penalty of |
2318 | 10 percent of the overdue amount paid by the insurer, subject to |
2319 | a maximum penalty of $250, no action may be brought against the |
2320 | insurer. If the demand involves an insurer's withdrawal of |
2321 | payment under paragraph (7)(a) for future treatment not yet |
2322 | rendered, no action may be brought against the insurer if, |
2323 | within 30 15 days after its receipt of the notice, the insurer |
2324 | mails to the person filing the notice a written statement of the |
2325 | insurer's agreement to pay for such treatment in accordance with |
2326 | the notice and to pay a penalty of 10 percent, subject to a |
2327 | maximum penalty of $250, when it pays for such future treatment |
2328 | in accordance with the requirements of this section. To the |
2329 | extent the insurer determines not to pay any amount demanded, |
2330 | the penalty shall not be payable in any subsequent action. For |
2331 | purposes of this subsection, payment or the insurer's agreement |
2332 | shall be treated as being made on the date a draft or other |
2333 | valid instrument that is equivalent to payment, or the insurer's |
2334 | written statement of agreement, is placed in the United States |
2335 | mail in a properly addressed, postpaid envelope, or if not so |
2336 | posted, on the date of delivery. The insurer is shall not be |
2337 | obligated to pay any attorney's fees if the insurer pays the |
2338 | claim or mails its agreement to pay for future treatment within |
2339 | the time prescribed by this subsection. |
2340 | (e) The applicable statute of limitation for an action |
2341 | under this section shall be tolled for a period of 30 15 |
2342 | business days by the mailing of the notice required by this |
2343 | subsection. |
2344 | (11) FAILURE TO PAY VALID CLAIMS; UNFAIR OR DECEPTIVE |
2345 | PRACTICE.-- |
2346 | (a) If an insurer fails to pay valid claims for personal |
2347 | injury protection with such frequency so as to indicate a |
2348 | general business practice, the insurer is engaging in a |
2349 | prohibited unfair or deceptive practice that is subject to the |
2350 | penalties provided in s. 626.9521 and the office has the powers |
2351 | and duties specified in ss. 626.9561-626.9601 with respect |
2352 | thereto. |
2353 | (b) Notwithstanding s. 501.212, the Department of Legal |
2354 | Affairs may investigate and initiate actions for a violation of |
2355 | this subsection, including, but not limited to, the powers and |
2356 | duties specified in part II of chapter 501. |
2357 | (15) ALL CLAIMS BROUGHT IN A SINGLE ACTION.--In any civil |
2358 | action to recover personal injury protection benefits brought by |
2359 | a claimant pursuant to this section against an insurer, all |
2360 | claims related to the same health care provider for the same |
2361 | injured person shall be brought in one action, unless good cause |
2362 | is shown why such claims should be brought separately. If the |
2363 | court determines that a civil action is filed for a claim that |
2364 | should have been brought in a prior civil action, the court may |
2365 | not award attorney's fees to the claimant. |
2366 | (16) SECURE ELECTRONIC DATA TRANSFER.--An electronic |
2367 | notice, documentation, transmission, or communication of any |
2368 | kind required or authorized under ss. 627.730-627.7405 must be |
2369 | transmitted by secure electronic data transfer that is |
2370 | consistent with state and federal privacy and security laws. |
2371 | Section 21. Effective January 15, 2008, and applicable to |
2372 | policies issued or renewed on or after that date, section |
2373 | 627.739, Florida Statutes, as reenacted by this act, is amended |
2374 | to read: |
2375 | 627.739 Personal injury protection; optional limitations; |
2376 | deductibles.-- |
2377 | (1) The named insured may elect a deductible or modified |
2378 | coverage as specified in subsection (2) or combination thereof |
2379 | to apply to the named insured alone or to the named insured and |
2380 | dependent relatives residing in the same household, but may not |
2381 | elect a deductible or modified coverage to apply to any other |
2382 | person covered under the policy. |
2383 | (2) Insurers shall offer to each applicant and to each |
2384 | policyholder, upon the renewal of an existing policy, |
2385 | deductibles, in amounts of $250, $500, and $1,000. The |
2386 | deductible amount must be applied to 100 percent of the expenses |
2387 | and losses described in s. 627.736. After the deductible is met, |
2388 | each insured is eligible to receive up to $10,000 in total |
2389 | benefits described in s. 627.736(1). However, this subsection |
2390 | shall not be applied to reduce the amount of any benefits |
2391 | received in accordance with s. 627.736(1)(c). |
2392 | (2)(3) Insurers shall offer coverage wherein, at the |
2393 | election of the named insured, the benefits for loss of gross |
2394 | income and loss of earning capacity described in s. |
2395 | 627.736(1)(b) shall be excluded. |
2396 | (3)(4) The named insured shall not be prevented from |
2397 | electing a deductible under subsection (2) and modified coverage |
2398 | under subsection (2) (3). Each election made by the named |
2399 | insured under this section shall result in an appropriate |
2400 | reduction of premium associated with that election. |
2401 | (4)(5) All Such offer offers shall be made in clear and |
2402 | unambiguous language at the time the initial application is |
2403 | taken and prior to each annual renewal and shall indicate that a |
2404 | premium reduction will result from such each election. At the |
2405 | option of the insurer, the requirements of the preceding |
2406 | sentence are met by using forms of notice approved by the |
2407 | office, or by providing the following notice in 10-point type in |
2408 | the insurer's application for initial issuance of a policy of |
2409 | motor vehicle insurance and the insurer's annual notice of |
2410 | renewal premium: |
2411 |
|
2412 | For personal injury protection insurance, the named insured may |
2413 | elect a deductible and to exclude coverage for loss of gross |
2414 | income and loss of earning capacity ("lost wages"). This |
2415 | election applies These elections apply to the named insured |
2416 | alone, or to the named insured and all dependent resident |
2417 | relatives. A premium reduction will result from this election |
2418 | these elections. The named insured is hereby advised not to |
2419 | elect the lost wage exclusion if the named insured or dependent |
2420 | resident relatives are employed, since lost wages will not be |
2421 | payable in the event of an accident. |
2422 | Section 22. (1) The Legislature intends that the |
2423 | provisions of this act reviving and reenacting the Florida Motor |
2424 | Vehicle No-Fault Law apply to policies issued on or after the |
2425 | effective date of this act. |
2426 | (2) Each insurer that issued coverage for a motor vehicle |
2427 | that is subject to the Florida Motor Vehicle No-Fault Law shall, |
2428 | within 30 days after the effective date of this act, mail or |
2429 | deliver a revised notice of the premium and policy changes to |
2430 | each policyholder whose policy has an effective date on or after |
2431 | the effective date of this act and who was previously issued a |
2432 | motor vehicle insurance policy or sent a renewal notice based on |
2433 | the assumption that the Florida Motor Vehicle No-Fault Law would |
2434 | be repealed on October 1, 2007. For a renewal policy, the |
2435 | coverage must provide the same limits of personal injury |
2436 | protection coverage, the same deductible from personal injury |
2437 | protection coverage, and the same limits of medical payments |
2438 | coverage as provided in the prior policy, unless the |
2439 | policyholder elects different limits that are available. The |
2440 | effective date of the revised policy or renewal shall be the |
2441 | same as the effective date specified in the prior notice. The |
2442 | revised notice of premium and coverage changes is exempt from |
2443 | the requirements of ss. 627.7277, 627.728, and 627.7282, Florida |
2444 | Statutes. The policyholder has a period of 30 days, or a longer |
2445 | period if specified by the insurer, following receipt of the |
2446 | revised notice within which to pay any additional amount of |
2447 | premium due and thereby maintain the policy in force as |
2448 | specified in this section. Alternatively, the policyholder may |
2449 | cancel the policy within this time period and obtain a refund of |
2450 | the unearned premium. If the policyholder fails to timely |
2451 | respond to the notice, the insurer must cancel the policy and |
2452 | return any unearned premium to the insured. The date on which |
2453 | the policy will be canceled shall be stated in the notice and |
2454 | may not be less than 35 days after the date of the notice. The |
2455 | amount of unearned premium due to the policyholder shall be |
2456 | calculated on a pro rata basis. The failure of an insurer to |
2457 | timely mail or deliver a revised notice as required by this |
2458 | subsection does not affect the other requirements of this |
2459 | section. |
2460 | (3) With respect to a policy providing personal injury |
2461 | protection coverage having an effective date between the |
2462 | effective date of this act and January 14, 2008, inclusive, the |
2463 | insurer shall use the forms and rates it had in effect on |
2464 | September 30, 2007, for all coverages in that policy unless the |
2465 | insurer makes a new rate or form filing that is approved by the |
2466 | Office of Insurance Regulation or otherwise legally allowed. |
2467 | (4) The Legislature recognizes that some persons have been |
2468 | issued a motor vehicle insurance policy effective on or after |
2469 | October 1, 2007, and before the effective date of this act, |
2470 | which does not include personal injury protection, based upon |
2471 | the expected repeal of the Florida Motor Vehicle No-Fault Law on |
2472 | October 1, 2007, pursuant to s. 19, chapter 2003-411, Laws of |
2473 | Florida. Any such person: |
2474 | (a) May continue to own and operate a motor vehicle in |
2475 | this state without being subject to any sanction for failing to |
2476 | maintain personal injury protection coverage if that person |
2477 | continues to meet statutory requirements relating to property |
2478 | damage liability coverage and obtains personal injury protection |
2479 | coverage that takes effect no later than December 1, 2007. |
2480 | (b) Is not subject to the provisions of s. 627.737, |
2481 | Florida Statutes, relating to the exemption from tort liability |
2482 | with respect to injuries sustained by the person in a motor |
2483 | vehicle crash occurring while the policy without personal injury |
2484 | protection coverage is in effect but not later than November 30, |
2485 | 2007. This paragraph also applies during such period to any |
2486 | person who would have been covered under a personal injury |
2487 | protection policy if such a policy had been maintained on such |
2488 | motor vehicle. |
2489 | (5) Each insurer shall, by October 31, 2007, provide |
2490 | written notification to each insured referred to in subsection |
2491 | (4) informing the insured that he or she must obtain personal |
2492 | injury protection coverage that takes effect no later than |
2493 | December 1, 2007. Such notice must include the premium for such |
2494 | coverage and the premium credit, if any, which will be provided |
2495 | for other coverage, such as bodily injury liability coverage or |
2496 | uninsured motorist coverage, as required by subsection (4). |
2497 | Alternatively, the insurer may add an endorsement to the policy |
2498 | to provide personal injury protection coverage as required by |
2499 | law, effective no later than December 1, 2007, without requiring |
2500 | any additional payment from the insured, and shall provide |
2501 | written notification to the insured of such endorsement by |
2502 | October 31, 2007. |
2503 | Section 23. Except as otherwise expressly provided in this |
2504 | act, this act shall take effect upon becoming a law. |