HB 13C

1
A bill to be entitled
2An act relating to motor vehicle insurance; amending s.
3316.646, F.S.; requiring each person operating a motor
4vehicle to have in his or her possession proof of property
5damage liability coverage; conforming a cross-reference to
6changes made by the act; amending s. 320.02, F.S.;
7clarifying the requirements concerning insurance and
8liability coverage for certain motor vehicles registered
9in this state; amending s. 321.245, F.S., relating to the
10disposition of certain funds in the Highway Safety
11Operating Trust Fund; conforming a cross-reference;
12amending s. 324.022, F.S.; revising provisions requiring
13the owner or operator of a motor vehicle to maintain
14property damage liability coverage; specifying the
15requirements that apply to such a policy; providing
16definitions; requiring that a nonresident owner or
17registrant of a motor vehicle maintain property damage
18liability coverage if the motor vehicle is in the state
19longer than a specified period; providing an exception for
20a member of the United States Armed Forces who is on
21active duty outside the United States; creating s.
22324.0221, F.S.; requiring insurers to report to the
23Department of Highway Safety and Motor Vehicles the
24renewal, cancellation, or nonrenewal of a policy providing
25personal injury protection coverage or motor vehicle
26property damage liability coverage; authorizing the
27department to adopt rules for the reports; providing that
28failure to report as required is a violation of the
29Florida Insurance Code; requiring that an insurer notify
30the named insured that a cancelled or nonrenewed policy
31will be reported to the department; requiring that the
32department suspend the registration and driver's license
33of an owner or registrant of a motor vehicle who fails to
34maintain the required liability coverage; providing for
35the reinstatement of a registration or driver's license
36upon payment of certain fees; requiring that a person
37obtain noncancelable coverage following such
38reinstatement; providing for the deposit and use of
39reinstatement fees; amending ss. 627.7275 and 627.7295,
40F.S., relating to motor vehicle insurance policies and
41contracts; conforming provisions to changes made by the
42act; reviving and reenacting ss. 627.730, 627.731,
43627.732, 627.734, 627.737, 627.739, 627.7401, 627.7403,
44and 627.7405, F.S., and reviving, reenacting, and amending
45ss. 627.733 and 627.736, the Florida Motor Vehicle No-
46Fault Law, notwithstanding the repeal of such law provided
47in s. 19, chapter 2003-411, Laws of Florida; deleting
48certain provisions relating to the suspension and
49reinstatement of a driver's license and registration and
50notice to the Department of Highway Safety and Motor
51Vehicles; conforming provisions to changes made by the
52act; providing legislative intent with respect to the
53reenactment and codification of the Florida Motor Vehicle
54No-Fault Law, notwithstanding its prior repeal; amending
55s. 627.736, F.S., as reenacted and amended; revising
56provisions governing the medical benefits provided as
57required personal injury protection benefits; providing
58medical benefits for services and care ordered or
59prescribed by a physician or provided by certain persons
60or entities that meet certain requirements; requiring the
61Financial services Commission to adopt rules; revising a
62limitation on the amount of death benefits payable;
63requiring personal injury protection insurers to reserve
64benefits for certain providers for a specified period;
65tolling the time period for the insurer to pay claims from
66other providers; authorizing an insurer to limit
67reimbursement for personal injury protection benefits to a
68specified percentage of a schedule of maximum charges;
69prohibiting provider from billing or attempting to collect
70amounts in excess of such limits, except for amounts that
71are not covered by personal injury protection coverage;
72deleting provisions specifying allowable amounts for
73certain tests and services; providing for electronic
74transmission of certain statements; extending the period
75during which an insurer may pay an overdue claim following
76receipt of a demand letter without incurring a penalty;
77providing for penalties to be imposed against certain
78insurers for failing to pay claims for personal injury
79protection; authorizing the Department of Legal Affairs to
80investigate violations and initiate enforcement action;
81requiring that all claims related to the same health care
82provider for the same injured person be brought in one act
83unless good cause is shown; requiring that the
84transmission of electronic notices and communications
85required or authorized under the Florida Motor Vehicle No-
86Fault Law be consistent with state and federal privacy and
87security laws; amending s. 627.739, F.S., as reenacted;
88deleting provisions authorizing an insurer to offer
89certain deductibles with respect to a policy of personal
90injury protection; providing legislative intent concerning
91the application of the act; requiring insurers to deliver
92revised notices of premium and policy changes to certain
93policyholders; requiring an insurer to cancel the policy
94and return any unearned premium if the insured fails to
95timely respond to the notice; providing for calculating
96the amount of unearned premium; requiring that insurers
97continue to use certain forms and rates until a specified
98date unless the Office of Insurance Regulation approves
99new forms or rates or are otherwise legally allowed;
100providing that a person purchasing a motor vehicle
101insurance policy without personal injury protection
102coverage is exempt from the requirement for such coverage
103and is not subject to certain liability provisions for a
104specified period; requiring that insurers provide notice
105of the requirement for personal injury protection coverage
106or add an endorsement to the policy providing such
107coverage; providing effective dates.
108
109Be It Enacted by the Legislature of the State of Florida:
110
111     Section 1.  Subsections (1) and (3) of section 316.646,
112Florida Statutes, are amended to read:
113     316.646  Security required; proof of security and display
114thereof; dismissal of cases.--
115     (1)  Any person required by s. 324.022 to maintain property
116damage liability security, required by s. 324.023 to maintain
117liability security for bodily injury or death, or any person
118required by s. 627.733 to maintain personal injury protection
119security on a motor vehicle shall have in his or her immediate
120possession at all times while operating such motor vehicle
121proper proof of maintenance of the required security. Such proof
122shall be either a uniform proof-of-insurance card in a form
123prescribed by the department, a valid insurance policy, an
124insurance policy binder, a certificate of insurance, or such
125other proof as may be prescribed by the department.
126     (3)  Any person who violates this section commits a
127nonmoving traffic infraction subject to the penalty provided in
128chapter 318 and shall be required to furnish proof of security
129as provided in this section. If any person charged with a
130violation of this section fails to furnish proof, at or before
131the scheduled court appearance date, that security was in effect
132at the time of the violation, the court may immediately suspend
133the registration and driver's license of such person. Such
134license and registration may only be reinstated only as provided
135in s. 324.0221 627.733.
136     Section 2.  Paragraphs (a) and (d) of subsection (5) of
137section 320.02, Florida Statutes, are amended to read:
138     320.02  Registration required; application for
139registration; forms.--
140     (5)(a)  Proof that personal injury protection benefits have
141been purchased when required under s. 627.733, that property
142damage liability coverage has been purchased as required under
143s. 324.022, that bodily injury or death coverage has been
144purchased if required under s. 324.023, and that combined bodily
145liability insurance and property damage liability insurance have
146been purchased when required under s. 627.7415 shall be provided
147in the manner prescribed by law by the applicant at the time of
148application for registration of any motor vehicle that is
149subject to such requirements owned as defined in s. 627.732. The
150issuing agent shall refuse to issue registration if such proof
151of purchase is not provided. Insurers shall furnish uniform
152proof-of-purchase cards in a form prescribed by the department
153and shall include the name of the insured's insurance company,
154the coverage identification number, and the make, year, and
155vehicle identification number of the vehicle insured. The card
156shall contain a statement notifying the applicant of the penalty
157specified in s. 316.646(4). The card or insurance policy,
158insurance policy binder, or certificate of insurance or a
159photocopy of any of these; an affidavit containing the name of
160the insured's insurance company, the insured's policy number,
161and the make and year of the vehicle insured; or such other
162proof as may be prescribed by the department shall constitute
163sufficient proof of purchase. If an affidavit is provided as
164proof, it shall be in substantially the following form:
165
166Under penalty of perjury, I   (Name of insured)   do hereby
167certify that I have   (Personal Injury Protection, Property
168Damage Liability, and, when required, Bodily Injury Liability)  
169Insurance currently in effect with   (Name of insurance company)  
170under   (policy number)   covering   (make, year, and vehicle
171identification number of vehicle)  .   (Signature of Insured)  
172
173Such affidavit shall include the following warning:
174
175WARNING: GIVING FALSE INFORMATION IN ORDER TO OBTAIN A VEHICLE
176REGISTRATION CERTIFICATE IS A CRIMINAL OFFENSE UNDER FLORIDA
177LAW. ANYONE GIVING FALSE INFORMATION ON THIS AFFIDAVIT IS
178SUBJECT TO PROSECUTION.
179
180When an application is made through a licensed motor vehicle
181dealer as required in s. 319.23, the original or a photostatic
182copy of such card, insurance policy, insurance policy binder, or
183certificate of insurance or the original affidavit from the
184insured shall be forwarded by the dealer to the tax collector of
185the county or the Department of Highway Safety and Motor
186Vehicles for processing. By executing the aforesaid affidavit,
187no licensed motor vehicle dealer will be liable in damages for
188any inadequacy, insufficiency, or falsification of any statement
189contained therein. A card shall also indicate the existence of
190any bodily injury liability insurance voluntarily purchased.
191     (d)  The verifying of proof of personal injury protection
192insurance, proof of property damage liability insurance, proof
193of combined bodily liability insurance and property damage
194liability insurance, or proof of financial responsibility
195insurance and the issuance or failure to issue the motor vehicle
196registration under the provisions of this chapter may not be
197construed in any court as a warranty of the reliability or
198accuracy of the evidence of such proof. Neither the department
199nor any tax collector is liable in damages for any inadequacy,
200insufficiency, falsification, or unauthorized modification of
201any item of the proof of personal injury protection insurance,
202proof of property damage liability insurance, proof of combined
203bodily liability insurance and property damage liability
204insurance, or proof of financial responsibility insurance either
205prior to, during, or subsequent to the verification of the
206proof. The issuance of a motor vehicle registration does not
207constitute prima facie evidence or a presumption of insurance
208coverage.
209     Section 3.  Section 321.245, Florida Statutes, is amended
210to read:
211     321.245  Disposition of certain funds in the Highway Safety
212Operating Trust Fund.--The director of the Florida Highway
213Patrol, after receiving recommendations from the commander of
214the auxiliary, is authorized to purchase uniforms and equipment
215for auxiliary law enforcement officers as defined in s. 321.24
216from funds described in s. 324.0221(3) 627.733(7). The amounts
217expended under this section shall not exceed $50,000 in any one
218fiscal year.
219     Section 4.  Section 324.022, Florida Statutes, is amended
220to read:
221     324.022  Financial responsibility for property damage.--
222     (1)  Every owner or operator of a motor vehicle, which
223motor vehicle is subject to the requirements of ss. 627.730-
224627.7405 and required to be registered in this state, shall, by
225one of the methods established in s. 324.031 or by having a
226policy that complies with s. 627.7275, establish and maintain
227the ability to respond in damages for liability on account of
228accidents arising out of the use of the motor vehicle in the
229amount of $10,000 because of damage to, or destruction of,
230property of others in any one crash. The requirements of this
231section may be met by one of the methods established in s.
232324.031; by self-insuring as authorized by s. 768.28(16); or by
233maintaining an insurance policy providing coverage for property
234damage liability in the amount of at least $10,000 because of
235damage to, or destruction of, property of others in any one
236accident arising out of the use of the motor vehicle. The
237requirements of this section may also be met by having a policy
238which provides coverage in the amount of at least $30,000 for
239combined property damage liability and bodily injury liability
240for any one crash arising out of the use of the motor vehicle.
241The policy, with respect to coverage for property damage
242liability, must meet the applicable requirements of s. 324.151,
243subject to the usual policy exclusions that have been approved
244in policy forms by the Office of Insurance Regulation. No
245insurer shall have any duty to defend uncovered claims
246irrespective 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
249has four or more wheels and that is of a type designed and
250required to be licensed for use on the highways of this state,
251and any trailer or semitrailer designed for use with such
252vehicle. The term does not include:
253     1.  A mobile home.
254     2.  A motor vehicle that is used in mass transit and
255designed to transport more than five passengers, exclusive of
256the operator of the motor vehicle, and that is owned by a
257municipality, transit authority, or political subdivision of the
258state.
259     3.  A school bus as defined in s. 1006.25.
260     4.  A vehicle providing for-hire transportation that is
261subject to the provisions of s. 324.031. A taxicab shall
262maintain security as required under s. 324.032(1).
263     (b)  "Owner" means the person who holds legal title to a
264motor vehicle or the debtor or lessee who has the right to
265possession of a motor vehicle that is the subject of a security
266agreement or lease with an option to purchase.
267     (3)  Each nonresident owner or registrant of a motor
268vehicle that, whether operated or not, has been physically
269present within this state for more than 90 days during the
270preceding 365 days shall maintain security as required by
271subsection (1) that is in effect continuously throughout the
272period the motor vehicle remains within this state.
273     (4)  The owner or registrant of a motor vehicle is exempt
274from the requirements of this section if she or he is a member
275of the United States Armed Forces and is called to or on active
276duty outside the United States in an emergency situation. The
277exemption provided by this subsection applies only as long as
278the member of the Armed Forces is on such active duty outside
279the United States and applies only while the vehicle is not
280operated by any person. Upon receipt of a written request by the
281insured to whom the exemption provided in this subsection
282applies, the insurer shall cancel the coverages and return any
283unearned premium or suspend the security required by this
284section. Notwithstanding s. 324.0221(3), the department may not
285suspend the registration or operator's license of any owner or
286registrant of a motor vehicle during the time she or he
287qualifies for an exemption under this subsection. Any owner or
288registrant of a motor vehicle who qualifies for an exemption
289under this subsection shall immediately notify the department
290prior to and at the end of the expiration of the exemption.
291     Section 5.  Section 324.0221, Florida Statutes, is created
292to read:
293     324.0221  Reports by insurers to the department; suspension
294of driver's license and vehicle registrations; reinstatement.--
295     (1)(a)  Each insurer that has issued a policy providing
296personal injury protection coverage or property damage liability
297coverage shall report the renewal, cancellation, or nonrenewal
298thereof to the department within 45 days after the effective
299date of each renewal, cancellation, or nonrenewal. Upon the
300issuance of a policy providing personal injury protection
301coverage or property damage liability coverage to a named
302insured not previously insured by the insurer during that
303calendar year, the insurer shall report the issuance of the new
304policy to the department within 30 days. The report shall be in
305the form and format and contain any information required by the
306department and must be provided in a format that is compatible
307with the data-processing capabilities of the department. The
308department may adopt rules regarding the form and documentation
309required. Failure by an insurer to file proper reports with the
310department as required by this subsection or rules adopted with
311respect to the requirements of this subsection constitutes a
312violation of the Florida Insurance Code. These records shall be
313used by the department only for enforcement and regulatory
314purposes, including the generation by the department of data
315regarding compliance by owners of motor vehicles with the
316requirements for financial responsibility coverage.
317     (b)  With respect to an insurance policy providing personal
318injury protection coverage or property damage liability
319coverage, each insurer shall notify the named insured, or the
320first-named insured in the case of a commercial fleet policy, in
321writing that any cancellation or nonrenewal of the policy will
322be reported by the insurer to the department. The notice must
323also inform the named insured that failure to maintain personal
324injury protection coverage and property damage liability
325coverage on a motor vehicle when required by law may result in
326the loss of registration and driving privileges in this state
327and inform the named insured of the amount of the reinstatement
328fees required by this section. This notice is for informational
329purposes only, and an insurer is not civilly liable for failing
330to provide this notice.
331     (2)  The department shall suspend, after due notice and an
332opportunity to be heard, the registration and driver's license
333of any owner or registrant of a motor vehicle with respect to
334which security is required under ss. 324.022 and 627.733 upon:
335     (a)  The department's records showing that the owner or
336registrant of such motor vehicle did not have in full force and
337effect when required security that complies with the
338requirements of ss. 324.022 and 627.733; or
339     (b)  Notification by the insurer to the department, in a
340form approved by the department, of cancellation or termination
341of the required security.
342     (3)  An operator or owner whose driver's license or
343registration has been suspended under this section or s. 316.646
344may effect its reinstatement upon compliance with the
345requirements of this section and upon payment to the department
346of a nonrefundable reinstatement fee of $150 for the first
347reinstatement. The reinstatement fee is $250 for the second
348reinstatement and $500 for each subsequent reinstatement during
349the 3 years following the first reinstatement. A person
350reinstating her or his insurance under this subsection must also
351secure noncancelable coverage as described in ss. 324.021(8),
352324.023, and 627.7275(2) and present to the appropriate person
353proof that the coverage is in force on a form adopted by the
354department, and such proof shall be maintained for 2 years. If
355the person does not have a second reinstatement within 3 years
356after her or his initial reinstatement, the reinstatement fee is
357$150 for the first reinstatement after that 3-year period. If a
358person's license and registration are suspended under this
359section or s. 316.646, only one reinstatement fee must be paid
360to reinstate the license and the registration. All fees shall be
361collected by the department at the time of reinstatement. The
362department shall issue proper receipts for such fees and shall
363promptly deposit those fees in the Highway Safety Operating
364Trust Fund. One-third of the fees collected under this
365subsection shall be distributed from the Highway Safety
366Operating Trust Fund to the local governmental entity or state
367agency that employed the law enforcement officer seizing the
368license plate pursuant to s. 324.201. The funds may be used by
369the local governmental entity or state agency for any authorized
370purpose.
371     Section 6.  Section 627.7275, Florida Statutes, is amended
372to read:
373     627.7275  Motor vehicle liability.--
374     (1)  A motor vehicle insurance policy providing personal
375injury protection as set forth in s. 627.736 may not be
376delivered or issued for delivery in this state with respect to
377any specifically insured or identified motor vehicle registered
378or principally garaged in this state unless the policy also
379provides coverage for property damage liability as required by
380s. 324.022 in the amount of at least $10,000 because of damage
381to, or destruction of, property of others in any one accident
382arising out of the use of the motor vehicle or unless the policy
383provides coverage in the amount of at least $30,000 for combined
384property damage liability and bodily injury liability in any one
385accident arising out of the use of the motor vehicle. The
386policy, as to coverage of property damage liability, must meet
387the applicable requirements of s. 324.151, subject to the usual
388policy exclusions that have been approved in policy forms by the
389office.
390     (2)(a)  Insurers writing motor vehicle insurance in this
391state shall make available, subject to the insurers' usual
392underwriting restrictions:
393     1.  Coverage under policies as described in subsection (1)
394to any applicant for private passenger motor vehicle insurance
395coverage who is seeking the coverage in order to reinstate the
396applicant's driving privileges in this state when the driving
397privileges were revoked or suspended pursuant to s. 316.646 or
398s. 324.0221 627.733 due to the failure of the applicant to
399maintain required security.
400     2.  Coverage under policies as described in subsection (1),
401which also provides liability coverage for bodily injury, death,
402and property damage arising out of the ownership, maintenance,
403or use of the motor vehicle in an amount not less than the
404limits described in s. 324.021(7) and conforms to the
405requirements of s. 324.151, to any applicant for private
406passenger motor vehicle insurance coverage who is seeking the
407coverage in order to reinstate the applicant's driving
408privileges in this state after such privileges were revoked or
409suspended under s. 316.193 or s. 322.26(2) for driving under the
410influence.
411     (b)  The policies described in paragraph (a) shall be
412issued for a period of at least 6 months and as to the minimum
413coverages required under this section shall not be cancelable by
414the insured for any reason or by the insurer after a period not
415to exceed 30 days during which the insurer must complete
416underwriting of the policy. After the insurer has completed
417underwriting the policy within the 30-day period, the insurer
418shall notify the Department of Highway Safety and Motor Vehicles
419that the policy is in full force and effect and the policy shall
420not be cancelable for the remainder of the policy period. A
421premium shall be collected and coverage shall be in effect for
422the 30-day period during which the insurer is completing the
423underwriting of the policy whether or not the person's driver
424license, motor vehicle tag, and motor vehicle registration are
425in effect. Once the noncancelable provisions of the policy
426become effective, the coverage or risk shall not be changed
427during the policy period and the premium shall be nonrefundable.
428If, during the pendency of the 2-year proof of insurance period
429required under s. 324.0221 627.733(7) or during the 3-year proof
430of financial responsibility required under s. 324.131, whichever
431is applicable, the insured obtains additional coverage or
432coverage for an additional risk or changes territories, the
433insured must obtain a new 6-month noncancelable policy in
434accordance with the provisions of this section. However, if the
435insured must obtain a new 6-month policy and obtains the policy
436from the same insurer, the policyholder shall receive credit on
437the new policy for any premium paid on the previously issued
438policy.
439     (c)  This subsection controls to the extent of any conflict
440with any other section.
441     (d)  An insurer issuing a policy subject to this section
442may cancel the policy if, during the policy term, the named
443insured or any other operator, who resides in the same household
444or customarily operates an automobile insured under the policy,
445has his or her driver's license suspended or revoked.
446     (e)  Nothing in this subsection requires an insurer to
447offer a policy of insurance to an applicant if such offer would
448be inconsistent with the insurer's underwriting guidelines and
449procedures.
450     Section 7.  Paragraph (a) of subsection (1) of section
451627.7295, 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
455provides personal injury protection coverage, and property
456damage liability coverage, or both.
457     Section 8.  Notwithstanding the repeal of the Florida Motor
458Vehicle No-Fault Law, which occurred on October 1, 2007, section
459627.730, Florida Statutes, is revived and reenacted to read:
460     627.730  Florida Motor Vehicle No-Fault Law.--Sections
461627.730-627.7405 may be cited and known as the "Florida Motor
462Vehicle No-Fault Law."
463     Section 9.  Notwithstanding the repeal of the Florida Motor
464Vehicle No-Fault Law, which occurred on October 1, 2007, section
465627.731, Florida Statutes, is revived and reenacted to read:
466     627.731  Purpose.--The purpose of ss. 627.730-627.7405 is
467to provide for medical, surgical, funeral, and disability
468insurance benefits without regard to fault, and to require motor
469vehicle insurance securing such benefits, for motor vehicles
470required to be registered in this state and, with respect to
471motor vehicle accidents, a limitation on the right to claim
472damages for pain, suffering, mental anguish, and inconvenience.
473     Section 10.  Notwithstanding the repeal of the Florida
474Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
475section 627.732, Florida Statutes, is revived and reenacted to
476read:
477     627.732  Definitions.--As used in ss. 627.730-627.7405, the
478term:
479     (1)  "Broker" means any person not possessing a license
480under chapter 395, chapter 400, chapter 429, chapter 458,
481chapter 459, chapter 460, chapter 461, or chapter 641 who
482charges or receives compensation for any use of medical
483equipment and is not the 100-percent owner or the 100-percent
484lessee of such equipment. For purposes of this section, such
485owner or lessee may be an individual, a corporation, a
486partnership, or any other entity and any of its 100-percent-
487owned affiliates and subsidiaries. For purposes of this
488subsection, the term "lessee" means a long-term lessee under a
489capital or operating lease, but does not include a part-time
490lessee. The term "broker" does not include a hospital or
491physician management company whose medical equipment is
492ancillary to the practices managed, a debt collection agency, or
493an entity that has contracted with the insurer to obtain a
494discounted rate for such services; nor does the term include a
495management company that has contracted to provide general
496management services for a licensed physician or health care
497facility and whose compensation is not materially affected by
498the usage or frequency of usage of medical equipment or an
499entity that is 100-percent owned by one or more hospitals or
500physicians. The term "broker" does not include a person or
501entity 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
505for personal injury protection patients is on a temporary basis
506not to exceed 30 days in a 12-month period, and such lease is
507solely for the purposes of necessary repair or maintenance of
508the 100-percent-owned medical equipment or pending the arrival
509and installation of the newly purchased or a replacement for the
510100-percent-owned medical equipment, or for patients for whom,
511because of physical size or claustrophobia, it is determined by
512the medical director or clinical director to be medically
513necessary that the test be performed in medical equipment that
514is open-style. The leased medical equipment cannot be used by
515patients who are not patients of the registered clinic for
516medical treatment of services. Any person or entity making a
517false certification under this subsection commits insurance
518fraud as defined in s. 817.234. However, the 30-day period
519provided in this paragraph may be extended for an additional 60
520days as applicable to magnetic resonance imaging equipment if
521the owner certifies that the extension otherwise complies with
522this paragraph.
523     (2)  "Medically necessary" refers to a medical service or
524supply that a prudent physician would provide for the purpose of
525preventing, diagnosing, or treating an illness, injury, disease,
526or symptom in a manner that is:
527     (a)  In accordance with generally accepted standards of
528medical practice;
529     (b)  Clinically appropriate in terms of type, frequency,
530extent, site, and duration; and
531     (c)  Not primarily for the convenience of the patient,
532physician, or other health care provider.
533     (3)  "Motor vehicle" means any self-propelled vehicle with
534four or more wheels which is of a type both designed and
535required to be licensed for use on the highways of this state
536and any trailer or semitrailer designed for use with such
537vehicle and includes:
538     (a)  A "private passenger motor vehicle," which is any
539motor vehicle which is a sedan, station wagon, or jeep-type
540vehicle and, if not used primarily for occupational,
541professional, or business purposes, a motor vehicle of the
542pickup, panel, van, camper, or motor home type.
543     (b)  A "commercial motor vehicle," which is any motor
544vehicle which is not a private passenger motor vehicle.
545
546The term "motor vehicle" does not include a mobile home or any
547motor vehicle which is used in mass transit, other than public
548school transportation, and designed to transport more than five
549passengers exclusive of the operator of the motor vehicle and
550which is owned by a municipality, a transit authority, or a
551political subdivision of the state.
552     (4)  "Named insured" means a person, usually the owner of a
553vehicle, identified in a policy by name as the insured under the
554policy.
555     (5)  "Owner" means a person who holds the legal title to a
556motor vehicle; or, in the event a motor vehicle is the subject
557of a security agreement or lease with an option to purchase with
558the debtor or lessee having the right to possession, then the
559debtor or lessee shall be deemed the owner for the purposes of
560ss. 627.730-627.7405.
561     (6)  "Relative residing in the same household" means a
562relative of any degree by blood or by marriage who usually makes
563her or his home in the same family unit, whether or not
564temporarily living elsewhere.
565     (7)  "Certify" means to swear or attest to being true or
566represented in writing.
567     (8)  "Immediate personal supervision," as it relates to the
568performance of medical services by nonphysicians not in a
569hospital, means that an individual licensed to perform the
570medical service or provide the medical supplies must be present
571within the confines of the physical structure where the medical
572services are performed or where the medical supplies are
573provided such that the licensed individual can respond
574immediately to any emergencies if needed.
575     (9)  "Incident," with respect to services considered as
576incident to a physician's professional service, for a physician
577licensed under chapter 458, chapter 459, chapter 460, or chapter
578461, if not furnished in a hospital, means such services must be
579an integral, even if incidental, part of a covered physician's
580service.
581     (10)  "Knowingly" means that a person, with respect to
582information, has actual knowledge of the information; acts in
583deliberate ignorance of the truth or falsity of the information;
584or acts in reckless disregard of the information, and proof of
585specific intent to defraud is not required.
586     (11)  "Lawful" or "lawfully" means in substantial
587compliance with all relevant applicable criminal, civil, and
588administrative requirements of state and federal law related to
589the provision of medical services or treatment.
590     (12)  "Hospital" means a facility that, at the time
591services or treatment were rendered, was licensed under chapter
592395.
593     (13)  "Properly completed" means providing truthful,
594substantially complete, and substantially accurate responses as
595to all material elements to each applicable request for
596information or statement by a means that may lawfully be
597provided and that complies with this section, or as agreed by
598the parties.
599     (14)  "Upcoding" means an action that submits a billing
600code that would result in payment greater in amount than would
601be paid using a billing code that accurately describes the
602services performed. The term does not include an otherwise
603lawful bill by a magnetic resonance imaging facility, which
604globally combines both technical and professional components, if
605the amount of the global bill is not more than the components if
606billed separately; however, payment of such a bill constitutes
607payment in full for all components of such service.
608     (15)  "Unbundling" means an action that submits a billing
609code that is properly billed under one billing code, but that
610has been separated into two or more billing codes, and would
611result in payment greater in amount than would be paid using one
612billing code.
613     Section 11.  Notwithstanding the repeal of the Florida
614Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
615section 627.733, Florida Statutes, is revived, reenacted, and
616amended to read:
617     627.733  Required security.--
618     (1)(a)  Every owner or registrant of a motor vehicle, other
619than a motor vehicle used as a school bus as defined in s.
6201006.25 or limousine, required to be registered and licensed in
621this state shall maintain security as required by subsection (3)
622in effect continuously throughout the registration or licensing
623period.
624     (b)  Every owner or registrant of a motor vehicle used as a
625taxicab shall not be governed by paragraph (1)(a) but shall
626maintain security as required under s. 324.032(1), and s.
627627.737 shall not apply to any motor vehicle used as a taxicab.
628     (2)  Every nonresident owner or registrant of a motor
629vehicle which, whether operated or not, has been physically
630present within this state for more than 90 days during the
631preceding 365 days shall thereafter maintain security as defined
632by subsection (3) in effect continuously throughout the period
633such motor vehicle remains within this state.
634     (3)  Such security shall be provided:
635     (a)  By an insurance policy delivered or issued for
636delivery in this state by an authorized or eligible motor
637vehicle liability insurer which provides the benefits and
638exemptions contained in ss. 627.730-627.7405. Any policy of
639insurance represented or sold as providing the security required
640hereunder shall be deemed to provide insurance for the payment
641of the required benefits; or
642     (b)  By any other method authorized by s. 324.031(2), (3),
643or (4) and approved by the Department of Highway Safety and
644Motor Vehicles as affording security equivalent to that afforded
645by a policy of insurance or by self-insuring as authorized by s.
646768.28(16). The person filing such security shall have all of
647the obligations and rights of an insurer under ss. 627.730-
648627.7405.
649     (4)  An owner of a motor vehicle with respect to which
650security is required by this section who fails to have such
651security in effect at the time of an accident shall have no
652immunity from tort liability, but shall be personally liable for
653the payment of benefits under s. 627.736. With respect to such
654benefits, such an owner shall have all of the rights and
655obligations of an insurer under ss. 627.730-627.7405.
656     (5)  In addition to other persons who are not required to
657provide required security as required under this section and s.
658324.022, the owner or registrant of a motor vehicle is exempt
659from such requirements if she or he is a member of the United
660States Armed Forces and is called to or on active duty outside
661the United States in an emergency situation. The exemption
662provided by this subsection applies only as long as the member
663of the armed forces is on such active duty outside the United
664States and applies only while the vehicle covered by the
665security required by this section and s. 324.022 is not operated
666by any person. Upon receipt of a written request by the insured
667to whom the exemption provided in this subsection applies, the
668insurer shall cancel the coverages and return any unearned
669premium or suspend the security required by this section and s.
670324.022. Notwithstanding s. 324.0221(2) subsection (6), the
671Department of Highway Safety and Motor Vehicles may not suspend
672the registration or operator's license of any owner or
673registrant of a motor vehicle during the time she or he
674qualifies for an exemption under this subsection. Any owner or
675registrant of a motor vehicle who qualifies for an exemption
676under this subsection shall immediately notify the department
677prior to and at the end of the expiration of the exemption.
678     (6)  The Department of Highway Safety and Motor Vehicles
679shall suspend, after due notice and an opportunity to be heard,
680the registration and driver's license of any owner or registrant
681of a motor vehicle with respect to which security is required
682under this section and s. 324.022:
683     (a)  Upon its records showing that the owner or registrant
684of such motor vehicle did not have in full force and effect when
685required security complying with the terms of this section; or
686     (b)  Upon notification by the insurer to the Department of
687Highway Safety and Motor Vehicles, in a form approved by the
688department, of cancellation or termination of the required
689security.
690     (7)  Any operator or owner whose driver's license or
691registration has been suspended pursuant to this section or s.
692316.646 may effect its reinstatement upon compliance with the
693requirements of this section and upon payment to the Department
694of Highway Safety and Motor Vehicles of a nonrefundable
695reinstatement fee of $150 for the first reinstatement.  Such
696reinstatement fee shall be $250 for the second reinstatement and
697$500 for each subsequent reinstatement during the 3 years
698following the first reinstatement. Any person reinstating her or
699his insurance under this subsection must also secure
700noncancelable coverage as described in ss. 324.021(8), 324.023,
701and 627.7275(2) and present to the appropriate person proof that
702the coverage is in force on a form promulgated by the Department
703of Highway Safety and Motor Vehicles, such proof to be
704maintained for 2 years.  If the person does not have a second
705reinstatement within 3 years after her or his initial
706reinstatement, the reinstatement fee shall be $150 for the first
707reinstatement after that 3-year period. In the event that a
708person's license and registration are suspended pursuant to this
709section or s. 316.646, only one reinstatement fee shall be paid
710to reinstate the license and the registration. All fees shall be
711collected by the Department of Highway Safety and Motor Vehicles
712at the time of reinstatement. The Department of Highway Safety
713and Motor Vehicles shall issue proper receipts for such fees and
714shall promptly deposit those fees in the Highway Safety
715Operating Trust Fund. One-third of the fee collected under this
716subsection shall be distributed from the Highway Safety
717Operating Trust Fund to the local government entity or state
718agency which employed the law enforcement officer who seizes a
719license plate pursuant to s. 324.201. Such funds may be used by
720the local government entity or state agency for any authorized
721purpose.
722     Section 12.  Notwithstanding the repeal of the Florida
723Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
724section 627.734, Florida Statutes, is revived and reenacted to
725read:
726     627.734  Proof of security; security requirements;
727penalties.--
728     (1)  The provisions of chapter 324 which pertain to the
729method of giving and maintaining proof of financial
730responsibility and which govern and define a motor vehicle
731liability policy shall apply to filing and maintaining proof of
732security required by ss. 627.730-627.7405.
733     (2)  Any person who:
734     (a)  Gives information required in a report or otherwise as
735provided for in ss. 627.730-627.7405, knowing or having reason
736to believe that such information is false;
737     (b)  Forges or, without authority, signs any evidence of
738proof of security; or
739     (c)  Files, or offers for filing, any such evidence of
740proof, knowing or having reason to believe that it is forged or
741signed without authority,
742
743is guilty of a misdemeanor of the first degree, punishable as
744provided in s. 775.082 or s. 775.083.
745     Section 13.  Notwithstanding the repeal of the Florida
746Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
747section 627.736, Florida Statutes, is revived, reenacted, and
748amended to read:
749     627.736  Required personal injury protection benefits;
750exclusions; priority; claims.--
751     (1)  REQUIRED BENEFITS.--Every insurance policy complying
752with the security requirements of s. 627.733 shall provide
753personal injury protection to the named insured, relatives
754residing in the same household, persons operating the insured
755motor vehicle, passengers in such motor vehicle, and other
756persons struck by such motor vehicle and suffering bodily injury
757while not an occupant of a self-propelled vehicle, subject to
758the provisions of subsection (2) and paragraph (4)(d), to a
759limit of $10,000 for loss sustained by any such person as a
760result of bodily injury, sickness, disease, or death arising out
761of the ownership, maintenance, or use of a motor vehicle as
762follows:
763     (a)  Medical benefits.--Eighty percent of all reasonable
764expenses for medically necessary medical, surgical, X-ray,
765dental, and rehabilitative services, including prosthetic
766devices, and medically necessary ambulance, hospital, and
767nursing services. Such benefits shall also include necessary
768remedial treatment and services recognized and permitted under
769the laws of the state for an injured person who relies upon
770spiritual means through prayer alone for healing, in accordance
771with his or her religious beliefs; however, this sentence does
772not affect the determination of what other services or
773procedures are medically necessary.
774     (b)  Disability benefits.--Sixty percent of any loss of
775gross income and loss of earning capacity per individual from
776inability to work proximately caused by the injury sustained by
777the injured person, plus all expenses reasonably incurred in
778obtaining from others ordinary and necessary services in lieu of
779those that, but for the injury, the injured person would have
780performed without income for the benefit of his or her
781household. All disability benefits payable under this provision
782shall be paid not less than every 2 weeks.
783     (c)  Death benefits.--Death benefits of $5,000 per
784individual.  The insurer may pay such benefits to the executor
785or administrator of the deceased, to any of the deceased's
786relatives by blood or legal adoption or connection by marriage,
787or to any person appearing to the insurer to be equitably
788entitled thereto.
789
790Only insurers writing motor vehicle liability insurance in this
791state may provide the required benefits of this section, and no
792such insurer shall require the purchase of any other motor
793vehicle coverage other than the purchase of property damage
794liability coverage as required by s. 627.7275 as a condition for
795providing such required benefits. Insurers may not require that
796property damage liability insurance in an amount greater than
797$10,000 be purchased in conjunction with personal injury
798protection.  Such insurers shall make benefits and required
799property damage liability insurance coverage available through
800normal marketing channels. Any insurer writing motor vehicle
801liability insurance in this state who fails to comply with such
802availability requirement as a general business practice shall be
803deemed to have violated part IX of chapter 626, and such
804violation shall constitute an unfair method of competition or an
805unfair or deceptive act or practice involving the business of
806insurance; and any such insurer committing such violation shall
807be subject to the penalties afforded in such part, as well as
808those which may be afforded elsewhere in the insurance code.
809     (2)  AUTHORIZED EXCLUSIONS.--Any insurer may exclude
810benefits:
811     (a)  For injury sustained by the named insured and
812relatives residing in the same household while occupying another
813motor vehicle owned by the named insured and not insured under
814the policy or for injury sustained by any person operating the
815insured motor vehicle without the express or implied consent of
816the insured.
817     (b)  To any injured person, if such person's conduct
818contributed to his or her injury under any of the following
819circumstances:
820     1.  Causing injury to himself or herself intentionally; or
821     2.  Being injured while committing a felony.
822
823Whenever an insured is charged with conduct as set forth in
824subparagraph 2., the 30-day payment provision of paragraph
825(4)(b) shall be held in abeyance, and the insurer shall withhold
826payment of any personal injury protection benefits pending the
827outcome of the case at the trial level.  If the charge is nolle
828prossed or dismissed or the insured is acquitted, the 30-day
829payment provision shall run from the date the insurer is
830notified of such action.
831     (3)  INSURED'S RIGHTS TO RECOVERY OF SPECIAL DAMAGES IN
832TORT CLAIMS.--No insurer shall have a lien on any recovery in
833tort by judgment, settlement, or otherwise for personal injury
834protection benefits, whether suit has been filed or settlement
835has been reached without suit.  An injured party who is entitled
836to bring suit under the provisions of ss. 627.730-627.7405, or
837his or her legal representative, shall have no right to recover
838any damages for which personal injury protection benefits are
839paid or payable. The plaintiff may prove all of his or her
840special damages notwithstanding this limitation, but if special
841damages are introduced in evidence, the trier of facts, whether
842judge or jury, shall not award damages for personal injury
843protection benefits paid or payable.  In all cases in which a
844jury is required to fix damages, the court shall instruct the
845jury that the plaintiff shall not recover such special damages
846for personal injury protection benefits paid or payable.
847     (4)  BENEFITS; WHEN DUE.--Benefits due from an insurer
848under ss. 627.730-627.7405 shall be primary, except that
849benefits received under any workers' compensation law shall be
850credited against the benefits provided by subsection (1) and
851shall be due and payable as loss accrues, upon receipt of
852reasonable proof of such loss and the amount of expenses and
853loss incurred which are covered by the policy issued under ss.
854627.730-627.7405. When the Agency for Health Care Administration
855provides, pays, or becomes liable for medical assistance under
856the Medicaid program related to injury, sickness, disease, or
857death arising out of the ownership, maintenance, or use of a
858motor vehicle, benefits under ss. 627.730-627.7405 shall be
859subject to the provisions of the Medicaid program.
860     (a)  An insurer may require written notice to be given as
861soon as practicable after an accident involving a motor vehicle
862with respect to which the policy affords the security required
863by ss. 627.730-627.7405.
864     (b)  Personal injury protection insurance benefits paid
865pursuant to this section shall be overdue if not paid within 30
866days after the insurer is furnished written notice of the fact
867of a covered loss and of the amount of same. If such written
868notice is not furnished to the insurer as to the entire claim,
869any partial amount supported by written notice is overdue if not
870paid within 30 days after such written notice is furnished to
871the insurer. Any part or all of the remainder of the claim that
872is subsequently supported by written notice is overdue if not
873paid within 30 days after such written notice is furnished to
874the insurer. When an insurer pays only a portion of a claim or
875rejects a claim, the insurer shall provide at the time of the
876partial payment or rejection an itemized specification of each
877item that the insurer had reduced, omitted, or declined to pay
878and any information that the insurer desires the claimant to
879consider related to the medical necessity of the denied
880treatment or to explain the reasonableness of the reduced
881charge, provided that this shall not limit the introduction of
882evidence at trial; and the insurer shall include the name and
883address of the person to whom the claimant should respond and a
884claim number to be referenced in future correspondence. However,
885notwithstanding the fact that written notice has been furnished
886to the insurer, any payment shall not be deemed overdue when the
887insurer has reasonable proof to establish that the insurer is
888not responsible for the payment. For the purpose of calculating
889the extent to which any benefits are overdue, payment shall be
890treated as being made on the date a draft or other valid
891instrument which is equivalent to payment was placed in the
892United States mail in a properly addressed, postpaid envelope
893or, if not so posted, on the date of delivery. This paragraph
894does not preclude or limit the ability of the insurer to assert
895that the claim was unrelated, was not medically necessary, or
896was unreasonable or that the amount of the charge was in excess
897of that permitted under, or in violation of, subsection (5).
898Such assertion by the insurer may be made at any time, including
899after payment of the claim or after the 30-day time period for
900payment set forth in this paragraph.
901     (c)  All overdue payments shall bear simple interest at the
902rate established under s. 55.03 or the rate established in the
903insurance contract, whichever is greater, for the year in which
904the payment became overdue, calculated from the date the insurer
905was furnished with written notice of the amount of covered loss.
906Interest shall be due at the time payment of the overdue claim
907is made.
908     (d)  The insurer of the owner of a motor vehicle shall pay
909personal injury protection benefits for:
910     1.  Accidental bodily injury sustained in this state by the
911owner while occupying a motor vehicle, or while not an occupant
912of a self-propelled vehicle if the injury is caused by physical
913contact with a motor vehicle.
914     2.  Accidental bodily injury sustained outside this state,
915but within the United States of America or its territories or
916possessions or Canada, by the owner while occupying the owner's
917motor vehicle.
918     3.  Accidental bodily injury sustained by a relative of the
919owner residing in the same household, under the circumstances
920described in subparagraph 1. or subparagraph 2., provided the
921relative at the time of the accident is domiciled in the owner's
922household and is not himself or herself the owner of a motor
923vehicle with respect to which security is required under ss.
924627.730-627.7405.
925     4.  Accidental bodily injury sustained in this state by any
926other person while occupying the owner's motor vehicle or, if a
927resident of this state, while not an occupant of a self-
928propelled vehicle, if the injury is caused by physical contact
929with such motor vehicle, provided the injured person is not
930himself or herself:
931     a.  The owner of a motor vehicle with respect to which
932security is required under ss. 627.730-627.7405; or
933     b.  Entitled to personal injury benefits from the insurer
934of the owner or owners of such a motor vehicle.
935     (e)  If two or more insurers are liable to pay personal
936injury protection benefits for the same injury to any one
937person, the maximum payable shall be as specified in subsection
938(1), and any insurer paying the benefits shall be entitled to
939recover from each of the other insurers an equitable pro rata
940share of the benefits paid and expenses incurred in processing
941the claim.
942     (f)  It is a violation of the insurance code for an insurer
943to fail to timely provide benefits as required by this section
944with such frequency as to constitute a general business
945practice.
946     (g)  Benefits shall not be due or payable to or on the
947behalf of an insured person if that person has committed, by a
948material act or omission, any insurance fraud relating to
949personal injury protection coverage under his or her policy, if
950the fraud is admitted to in a sworn statement by the insured or
951if it is established in a court of competent jurisdiction. Any
952insurance fraud shall void all coverage arising from the claim
953related to such fraud under the personal injury protection
954coverage of the insured person who committed the fraud,
955irrespective of whether a portion of the insured person's claim
956may be legitimate, and any benefits paid prior to the discovery
957of the insured person's insurance fraud shall be recoverable by
958the insurer from the person who committed insurance fraud in
959their entirety. The prevailing party is entitled to its costs
960and attorney's fees in any action in which it prevails in an
961insurer's action to enforce its right of recovery under this
962paragraph.
963     (5)  CHARGES FOR TREATMENT OF INJURED PERSONS.--
964     (a)  Any physician, hospital, clinic, or other person or
965institution lawfully rendering treatment to an injured person
966for a bodily injury covered by personal injury protection
967insurance may charge the insurer and injured party only a
968reasonable amount pursuant to this section for the services and
969supplies rendered, and the insurer providing such coverage may
970pay for such charges directly to such person or institution
971lawfully rendering such treatment, if the insured receiving such
972treatment or his or her guardian has countersigned the properly
973completed invoice, bill, or claim form approved by the office
974upon which such charges are to be paid for as having actually
975been rendered, to the best knowledge of the insured or his or
976her guardian. In no event, however, may such a charge be in
977excess of the amount the person or institution customarily
978charges for like services or supplies. With respect to a
979determination of whether a charge for a particular service,
980treatment, or otherwise is reasonable, consideration may be
981given to evidence of usual and customary charges and payments
982accepted by the provider involved in the dispute, and
983reimbursement levels in the community and various federal and
984state medical fee schedules applicable to automobile and other
985insurance coverages, and other information relevant to the
986reasonableness of the reimbursement for the service, treatment,
987or supply.
988     (b)1.  An insurer or insured is not required to pay a claim
989or charges:
990     a.  Made by a broker or by a person making a claim on
991behalf of a broker;
992     b.  For any service or treatment that was not lawful at the
993time rendered;
994     c.  To any person who knowingly submits a false or
995misleading statement relating to the claim or charges;
996     d.  With respect to a bill or statement that does not
997substantially meet the applicable requirements of paragraph (d);
998     e.  For any treatment or service that is upcoded, or that
999is unbundled when such treatment or services should be bundled,
1000in accordance with paragraph (d). To facilitate prompt payment
1001of lawful services, an insurer may change codes that it
1002determines to have been improperly or incorrectly upcoded or
1003unbundled, and may make payment based on the changed codes,
1004without affecting the right of the provider to dispute the
1005change by the insurer, provided that before doing so, the
1006insurer must contact the health care provider and discuss the
1007reasons for the insurer's change and the health care provider's
1008reason for the coding, or make a reasonable good faith effort to
1009do so, as documented in the insurer's file; and
1010     f.  For medical services or treatment billed by a physician
1011and not provided in a hospital unless such services are rendered
1012by the physician or are incident to his or her professional
1013services and are included on the physician's bill, including
1014documentation verifying that the physician is responsible for
1015the medical services that were rendered and billed.
1016     2.  Charges for medically necessary cephalic thermograms,
1017peripheral thermograms, spinal ultrasounds, extremity
1018ultrasounds, video fluoroscopy, and surface electromyography
1019shall not exceed the maximum reimbursement allowance for such
1020procedures as set forth in the applicable fee schedule or other
1021payment methodology established pursuant to s. 440.13.
1022     3.  Allowable amounts that may be charged to a personal
1023injury protection insurance insurer and insured for medically
1024necessary nerve conduction testing when done in conjunction with
1025a needle electromyography procedure and both are performed and
1026billed solely by a physician licensed under chapter 458, chapter
1027459, chapter 460, or chapter 461 who is also certified by the
1028American Board of Electrodiagnostic Medicine or by a board
1029recognized by the American Board of Medical Specialties or the
1030American Osteopathic Association or who holds diplomate status
1031with the American Chiropractic Neurology Board or its
1032predecessors shall not exceed 200 percent of the allowable
1033amount under the participating physician fee schedule of
1034Medicare Part B for year 2001, for the area in which the
1035treatment was rendered, adjusted annually on August 1 to reflect
1036the prior calendar year's changes in the annual Medical Care
1037Item of the Consumer Price Index for All Urban Consumers in the
1038South Region as determined by the Bureau of Labor Statistics of
1039the United States Department of Labor.
1040     4.  Allowable amounts that may be charged to a personal
1041injury protection insurance insurer and insured for medically
1042necessary nerve conduction testing that does not meet the
1043requirements of subparagraph 3. shall not exceed the applicable
1044fee schedule or other payment methodology established pursuant
1045to s. 440.13.
1046     5.  Allowable amounts that may be charged to a personal
1047injury protection insurance insurer and insured for magnetic
1048resonance imaging services shall not exceed 175 percent of the
1049allowable amount under the participating physician fee schedule
1050of Medicare Part B for year 2001, for the area in which the
1051treatment was rendered, adjusted annually on August 1 to reflect
1052the prior calendar year's changes in the annual Medical Care
1053Item of the Consumer Price Index for All Urban Consumers in the
1054South Region as determined by the Bureau of Labor Statistics of
1055the United States Department of Labor for the 12-month period
1056ending June 30 of that year, except that allowable amounts that
1057may be charged to a personal injury protection insurance insurer
1058and insured for magnetic resonance imaging services provided in
1059facilities accredited by the Accreditation Association for
1060Ambulatory Health Care, the American College of Radiology, or
1061the Joint Commission on Accreditation of Healthcare
1062Organizations shall not exceed 200 percent of the allowable
1063amount under the participating physician fee schedule of
1064Medicare Part B for year 2001, for the area in which the
1065treatment was rendered, adjusted annually on August 1 to reflect
1066the prior calendar year's changes in the annual Medical Care
1067Item of the Consumer Price Index for All Urban Consumers in the
1068South Region as determined by the Bureau of Labor Statistics of
1069the United States Department of Labor for the 12-month period
1070ending June 30 of that year. This paragraph does not apply to
1071charges for magnetic resonance imaging services and nerve
1072conduction testing for inpatients and emergency services and
1073care as defined in chapter 395 rendered by facilities licensed
1074under chapter 395.
1075     6.  The Department of Health, in consultation with the
1076appropriate professional licensing boards, shall adopt, by rule,
1077a list of diagnostic tests deemed not to be medically necessary
1078for use in the treatment of persons sustaining bodily injury
1079covered by personal injury protection benefits under this
1080section. The initial list shall be adopted by January 1, 2004,
1081and shall be revised from time to time as determined by the
1082Department of Health, in consultation with the respective
1083professional licensing boards. Inclusion of a test on the list
1084of invalid diagnostic tests shall be based on lack of
1085demonstrated medical value and a level of general acceptance by
1086the relevant provider community and shall not be dependent for
1087results entirely upon subjective patient response.
1088Notwithstanding its inclusion on a fee schedule in this
1089subsection, an insurer or insured is not required to pay any
1090charges or reimburse claims for any invalid diagnostic test as
1091determined by the Department of Health.
1092     (c)1.  With respect to any treatment or service, other than
1093medical services billed by a hospital or other provider for
1094emergency services as defined in s. 395.002 or inpatient
1095services rendered at a hospital-owned facility, the statement of
1096charges must be furnished to the insurer by the provider and may
1097not include, and the insurer is not required to pay, charges for
1098treatment or services rendered more than 35 days before the
1099postmark date of the statement, except for past due amounts
1100previously billed on a timely basis under this paragraph, and
1101except that, if the provider submits to the insurer a notice of
1102initiation of treatment within 21 days after its first
1103examination or treatment of the claimant, the statement may
1104include charges for treatment or services rendered up to, but
1105not more than, 75 days before the postmark date of the
1106statement. The injured party is not liable for, and the provider
1107shall not bill the injured party for, charges that are unpaid
1108because of the provider's failure to comply with this paragraph.
1109Any agreement requiring the injured person or insured to pay for
1110such charges is unenforceable.
1111     2.  If, however, the insured fails to furnish the provider
1112with the correct name and address of the insured's personal
1113injury protection insurer, the provider has 35 days from the
1114date the provider obtains the correct information to furnish the
1115insurer with a statement of the charges. The insurer is not
1116required to pay for such charges unless the provider includes
1117with the statement documentary evidence that was provided by the
1118insured during the 35-day period demonstrating that the provider
1119reasonably relied on erroneous information from the insured and
1120either:
1121     a.  A denial letter from the incorrect insurer; or
1122     b.  Proof of mailing, which may include an affidavit under
1123penalty of perjury, reflecting timely mailing to the incorrect
1124address or insurer.
1125     3.  For emergency services and care as defined in s.
1126395.002 rendered in a hospital emergency department or for
1127transport and treatment rendered by an ambulance provider
1128licensed pursuant to part III of chapter 401, the provider is
1129not required to furnish the statement of charges within the time
1130periods established by this paragraph; and the insurer shall not
1131be considered to have been furnished with notice of the amount
1132of covered loss for purposes of paragraph (4)(b) until it
1133receives a statement complying with paragraph (d), or copy
1134thereof, which specifically identifies the place of service to
1135be a hospital emergency department or an ambulance in accordance
1136with billing standards recognized by the Health Care Finance
1137Administration.
1138     4.  Each notice of insured's rights under s. 627.7401 must
1139include the following statement in type no smaller than 12
1140points:
1141
1142BILLING REQUIREMENTS.--Florida Statutes provide that with
1143respect to any treatment or services, other than certain
1144hospital and emergency services, the statement of charges
1145furnished to the insurer by the provider may not include, and
1146the insurer and the injured party are not required to pay,
1147charges for treatment or services rendered more than 35 days
1148before the postmark date of the statement, except for past due
1149amounts previously billed on a timely basis, and except that, if
1150the provider submits to the insurer a notice of initiation of
1151treatment within 21 days after its first examination or
1152treatment of the claimant, the statement may include charges for
1153treatment or services rendered up to, but not more than, 75 days
1154before the postmark date of the statement.
1155     (d)  All statements and bills for medical services rendered
1156by any physician, hospital, clinic, or other person or
1157institution shall be submitted to the insurer on a properly
1158completed Centers for Medicare and Medicaid Services (CMS) 1500
1159form, UB 92 forms, or any other standard form approved by the
1160office or adopted by the commission for purposes of this
1161paragraph. All billings for such services rendered by providers
1162shall, to the extent applicable, follow the Physicians' Current
1163Procedural Terminology (CPT) or Healthcare Correct Procedural
1164Coding System (HCPCS), or ICD-9 in effect for the year in which
1165services are rendered and comply with the Centers for Medicare
1166and Medicaid Services (CMS) 1500 form instructions and the
1167American Medical Association Current Procedural Terminology
1168(CPT) Editorial Panel and Healthcare Correct Procedural Coding
1169System (HCPCS). All providers other than hospitals shall include
1170on the applicable claim form the professional license number of
1171the provider in the line or space provided for "Signature of
1172Physician or Supplier, Including Degrees or Credentials." In
1173determining compliance with applicable CPT and HCPCS coding,
1174guidance shall be provided by the Physicians' Current Procedural
1175Terminology (CPT) or the Healthcare Correct Procedural Coding
1176System (HCPCS) in effect for the year in which services were
1177rendered, the Office of the Inspector General (OIG), Physicians
1178Compliance Guidelines, and other authoritative treatises
1179designated by rule by the Agency for Health Care Administration.
1180No statement of medical services may include charges for medical
1181services of a person or entity that performed such services
1182without possessing the valid licenses required to perform such
1183services. For purposes of paragraph (4)(b), an insurer shall not
1184be considered to have been furnished with notice of the amount
1185of covered loss or medical bills due unless the statements or
1186bills comply with this paragraph, and unless the statements or
1187bills are properly completed in their entirety as to all
1188material provisions, with all relevant information being
1189provided therein.
1190     (e)1.  At the initial treatment or service provided, each
1191physician, other licensed professional, clinic, or other medical
1192institution providing medical services upon which a claim for
1193personal injury protection benefits is based shall require an
1194insured person, or his or her guardian, to execute a disclosure
1195and acknowledgment form, which reflects at a minimum that:
1196     a.  The insured, or his or her guardian, must countersign
1197the form attesting to the fact that the services set forth
1198therein were actually rendered;
1199     b.  The insured, or his or her guardian, has both the right
1200and affirmative duty to confirm that the services were actually
1201rendered;
1202     c.  The insured, or his or her guardian, was not solicited
1203by any person to seek any services from the medical provider;
1204     d.  That the physician, other licensed professional,
1205clinic, or other medical institution rendering services for
1206which payment is being claimed explained the services to the
1207insured or his or her guardian; and
1208     e.  If the insured notifies the insurer in writing of a
1209billing error, the insured may be entitled to a certain
1210percentage of a reduction in the amounts paid by the insured's
1211motor vehicle insurer.
1212     2.  The physician, other licensed professional, clinic, or
1213other medical institution rendering services for which payment
1214is being claimed has the affirmative duty to explain the
1215services rendered to the insured, or his or her guardian, so
1216that the insured, or his or her guardian, countersigns the form
1217with informed consent.
1218     3.  Countersignature by the insured, or his or her
1219guardian, is not required for the reading of diagnostic tests or
1220other services that are of such a nature that they are not
1221required to be performed in the presence of the insured.
1222     4.  The licensed medical professional rendering treatment
1223for which payment is being claimed must sign, by his or her own
1224hand, the form complying with this paragraph.
1225     5.  The original completed disclosure and acknowledgment
1226form 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
1229for services billed by a provider for emergency services as
1230defined in s. 395.002, for emergency services and care as
1231defined in s. 395.002 rendered in a hospital emergency
1232department, or for transport and treatment rendered by an
1233ambulance provider licensed pursuant to part III of chapter 401.
1234     7.  The Financial Services Commission shall adopt, by rule,
1235a standard disclosure and acknowledgment form that shall be used
1236to fulfill the requirements of this paragraph, effective 90 days
1237after such form is adopted and becomes final. The commission
1238shall adopt a proposed rule by October 1, 2003. Until the rule
1239is final, the provider may use a form of its own which otherwise
1240complies with the requirements of this paragraph.
1241     8.  As used in this paragraph, "countersigned" means a
1242second or verifying signature, as on a previously signed
1243document, and is not satisfied by the statement "signature on
1244file" or any similar statement.
1245     9.  The requirements of this paragraph apply only with
1246respect to the initial treatment or service of the insured by a
1247provider. For subsequent treatments or service, the provider
1248must maintain a patient log signed by the patient, in
1249chronological order by date of service, that is consistent with
1250the services being rendered to the patient as claimed. The
1251requirements of this subparagraph for maintaining a patient log
1252signed by the patient may be met by a hospital that maintains
1253medical records as required by s. 395.3025 and applicable rules
1254and makes such records available to the insurer upon request.
1255     (f)  Upon written notification by any person, an insurer
1256shall investigate any claim of improper billing by a physician
1257or other medical provider. The insurer shall determine if the
1258insured was properly billed for only those services and
1259treatments that the insured actually received. If the insurer
1260determines that the insured has been improperly billed, the
1261insurer shall notify the insured, the person making the written
1262notification and the provider of its findings and shall reduce
1263the amount of payment to the provider by the amount determined
1264to be improperly billed. If a reduction is made due to such
1265written notification by any person, the insurer shall pay to the
1266person 20 percent of the amount of the reduction, up to $500. If
1267the provider is arrested due to the improper billing, then the
1268insurer shall pay to the person 40 percent of the amount of the
1269reduction, up to $500.
1270     (g)  An insurer may not systematically downcode with the
1271intent to deny reimbursement otherwise due. Such action
1272constitutes a material misrepresentation under s.
1273626.9541(1)(i)2.
1274     (6)  DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
1275DISPUTES.--
1276     (a)  Every employer shall, if a request is made by an
1277insurer providing personal injury protection benefits under ss.
1278627.730-627.7405 against whom a claim has been made, furnish
1279forthwith, in a form approved by the office, a sworn statement
1280of the earnings, since the time of the bodily injury and for a
1281reasonable period before the injury, of the person upon whose
1282injury the claim is based.
1283     (b)  Every physician, hospital, clinic, or other medical
1284institution providing, before or after bodily injury upon which
1285a claim for personal injury protection insurance benefits is
1286based, any products, services, or accommodations in relation to
1287that or any other injury, or in relation to a condition claimed
1288to be connected with that or any other injury, shall, if
1289requested to do so by the insurer against whom the claim has
1290been made, furnish forthwith a written report of the history,
1291condition, treatment, dates, and costs of such treatment of the
1292injured person and why the items identified by the insurer were
1293reasonable in amount and medically necessary, together with a
1294sworn statement that the treatment or services rendered were
1295reasonable and necessary with respect to the bodily injury
1296sustained and identifying which portion of the expenses for such
1297treatment or services was incurred as a result of such bodily
1298injury, and produce forthwith, and permit the inspection and
1299copying of, his or her or its records regarding such history,
1300condition, treatment, dates, and costs of treatment; provided
1301that this shall not limit the introduction of evidence at trial.
1302Such sworn statement shall read as follows: "Under penalty of
1303perjury, I declare that I have read the foregoing, and the facts
1304alleged are true, to the best of my knowledge and belief." No
1305cause of action for violation of the physician-patient privilege
1306or invasion of the right of privacy shall be permitted against
1307any physician, hospital, clinic, or other medical institution
1308complying with the provisions of this section. The person
1309requesting such records and such sworn statement shall pay all
1310reasonable costs connected therewith. If an insurer makes a
1311written request for documentation or information under this
1312paragraph within 30 days after having received notice of the
1313amount of a covered loss under paragraph (4)(a), the amount or
1314the partial amount which is the subject of the insurer's inquiry
1315shall become overdue if the insurer does not pay in accordance
1316with paragraph (4)(b) or within 10 days after the insurer's
1317receipt of the requested documentation or information, whichever
1318occurs later. For purposes of this paragraph, the term "receipt"
1319includes, but is not limited to, inspection and copying pursuant
1320to this paragraph. Any insurer that requests documentation or
1321information pertaining to reasonableness of charges or medical
1322necessity under this paragraph without a reasonable basis for
1323such requests as a general business practice is engaging in an
1324unfair trade practice under the insurance code.
1325     (c)  In the event of any dispute regarding an insurer's
1326right to discovery of facts under this section, the insurer may
1327petition a court of competent jurisdiction to enter an order
1328permitting such discovery. The order may be made only on motion
1329for good cause shown and upon notice to all persons having an
1330interest, and it shall specify the time, place, manner,
1331conditions, and scope of the discovery. Such court may, in order
1332to protect against annoyance, embarrassment, or oppression, as
1333justice requires, enter an order refusing discovery or
1334specifying conditions of discovery and may order payments of
1335costs and expenses of the proceeding, including reasonable fees
1336for the appearance of attorneys at the proceedings, as justice
1337requires.
1338     (d)  The injured person shall be furnished, upon request, a
1339copy of all information obtained by the insurer under the
1340provisions of this section, and shall pay a reasonable charge,
1341if required by the insurer.
1342     (e)  Notice to an insurer of the existence of a claim shall
1343not be unreasonably withheld by an insured.
1344     (7)  MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON;
1345REPORTS.--
1346     (a)  Whenever the mental or physical condition of an
1347injured person covered by personal injury protection is material
1348to any claim that has been or may be made for past or future
1349personal injury protection insurance benefits, such person
1350shall, upon the request of an insurer, submit to mental or
1351physical examination by a physician or physicians. The costs of
1352any examinations requested by an insurer shall be borne entirely
1353by the insurer. Such examination shall be conducted within the
1354municipality where the insured is receiving treatment, or in a
1355location reasonably accessible to the insured, which, for
1356purposes of this paragraph, means any location within the
1357municipality in which the insured resides, or any location
1358within 10 miles by road of the insured's residence, provided
1359such location is within the county in which the insured resides.
1360If the examination is to be conducted in a location reasonably
1361accessible to the insured, and if there is no qualified
1362physician to conduct the examination in a location reasonably
1363accessible to the insured, then such examination shall be
1364conducted in an area of the closest proximity to the insured's
1365residence. Personal protection insurers are authorized to
1366include reasonable provisions in personal injury protection
1367insurance policies for mental and physical examination of those
1368claiming personal injury protection insurance benefits. An
1369insurer may not withdraw payment of a treating physician without
1370the consent of the injured person covered by the personal injury
1371protection, unless the insurer first obtains a valid report by a
1372Florida physician licensed under the same chapter as the
1373treating physician whose treatment authorization is sought to be
1374withdrawn, stating that treatment was not reasonable, related,
1375or necessary. A valid report is one that is prepared and signed
1376by the physician examining the injured person or reviewing the
1377treatment records of the injured person and is factually
1378supported by the examination and treatment records if reviewed
1379and that has not been modified by anyone other than the
1380physician. The physician preparing the report must be in active
1381practice, unless the physician is physically disabled. Active
1382practice means that during the 3 years immediately preceding the
1383date of the physical examination or review of the treatment
1384records the physician must have devoted professional time to the
1385active clinical practice of evaluation, diagnosis, or treatment
1386of medical conditions or to the instruction of students in an
1387accredited health professional school or accredited residency
1388program or a clinical research program that is affiliated with
1389an accredited health professional school or teaching hospital or
1390accredited residency program. The physician preparing a report
1391at the request of an insurer and physicians rendering expert
1392opinions on behalf of persons claiming medical benefits for
1393personal injury protection, or on behalf of an insured through
1394an attorney or another entity, shall maintain, for at least 3
1395years, copies of all examination reports as medical records and
1396shall maintain, for at least 3 years, records of all payments
1397for the examinations and reports. Neither an insurer nor any
1398person acting at the direction of or on behalf of an insurer may
1399materially change an opinion in a report prepared under this
1400paragraph or direct the physician preparing the report to change
1401such opinion. The denial of a payment as the result of such a
1402changed opinion constitutes a material misrepresentation under
1403s. 626.9541(1)(i)2.; however, this provision does not preclude
1404the insurer from calling to the attention of the physician
1405errors of fact in the report based upon information in the claim
1406file.
1407     (b)  If requested by the person examined, a party causing
1408an examination to be made shall deliver to him or her a copy of
1409every written report concerning the examination rendered by an
1410examining physician, at least one of which reports must set out
1411the examining physician's findings and conclusions in detail.
1412After such request and delivery, the party causing the
1413examination to be made is entitled, upon request, to receive
1414from the person examined every written report available to him
1415or her or his or her representative concerning any examination,
1416previously or thereafter made, of the same mental or physical
1417condition. By requesting and obtaining a report of the
1418examination so ordered, or by taking the deposition of the
1419examiner, the person examined waives any privilege he or she may
1420have, in relation to the claim for benefits, regarding the
1421testimony of every other person who has examined, or may
1422thereafter examine, him or her in respect to the same mental or
1423physical condition. If a person unreasonably refuses to submit
1424to an examination, the personal injury protection carrier is no
1425longer liable for subsequent personal injury protection
1426benefits.
1427     (8)  APPLICABILITY OF PROVISION REGULATING ATTORNEY'S
1428FEES.--With respect to any dispute under the provisions of ss.
1429627.730-627.7405 between the insured and the insurer, or between
1430an assignee of an insured's rights and the insurer, the
1431provisions of s. 627.428 shall apply, except as provided in
1432subsection (10) (11).
1433     (9)(a)  Each insurer which has issued a policy providing
1434personal injury protection benefits shall report the renewal,
1435cancellation, or nonrenewal thereof to the Department of Highway
1436Safety and Motor Vehicles within 45 days from the effective date
1437of the renewal, cancellation, or nonrenewal.  Upon the issuance
1438of a policy providing personal injury protection benefits to a
1439named insured not previously insured by the insurer thereof
1440during that calendar year, the insurer shall report the issuance
1441of the new policy to the Department of Highway Safety and Motor
1442Vehicles within 30 days.  The report shall be in such form and
1443format and contain such information as may be required by the
1444Department of Highway Safety and Motor Vehicles which shall
1445include a format compatible with the data processing
1446capabilities of said department, and the Department of Highway
1447Safety and Motor Vehicles is authorized to adopt rules necessary
1448with respect thereto. Failure by an insurer to file proper
1449reports with the Department of Highway Safety and Motor Vehicles
1450as required by this subsection or rules adopted with respect to
1451the requirements of this subsection constitutes a violation of
1452the Florida Insurance Code. Reports of cancellations and policy
1453renewals and reports of the issuance of new policies received by
1454the Department of Highway Safety and Motor Vehicles are
1455confidential and exempt from the provisions of s. 119.07(1).
1456These records are to be used for enforcement and regulatory
1457purposes only, including the generation by the department of
1458data regarding compliance by owners of motor vehicles with
1459financial responsibility coverage requirements. In addition, the
1460Department of Highway Safety and Motor Vehicles shall release,
1461upon a written request by a person involved in a motor vehicle
1462accident, by the person's attorney, or by a representative of
1463the person's motor vehicle insurer, the name of the insurance
1464company and the policy number for the policy covering the
1465vehicle named by the requesting party.  The written request must
1466include a copy of the appropriate accident form as provided in
1467s. 316.065, s. 316.066, or s. 316.068.
1468     (b)  Every insurer with respect to each insurance policy
1469providing personal injury protection benefits shall notify the
1470named insured or in the case of a commercial fleet policy, the
1471first named insured in writing that any cancellation or
1472nonrenewal of the policy will be reported by the insurer to the
1473Department of Highway Safety and Motor Vehicles.  The notice
1474shall also inform the named insured that failure to maintain
1475personal injury protection and property damage liability
1476insurance on a motor vehicle when required by law may result in
1477the loss of registration and driving privileges in this state,
1478and the notice shall inform the named insured of the amount of
1479the reinstatement fees required by s. 627.733(7).  This notice
1480is for informational purposes only, and no civil liability shall
1481attach to an insurer due to failure to provide this notice.
1482     (9)(10)  An insurer may negotiate and enter into contracts
1483with licensed health care providers for the benefits described
1484in this section, referred to in this section as "preferred
1485providers," which shall include health care providers licensed
1486under chapters 458, 459, 460, 461, and 463. The insurer may
1487provide an option to an insured to use a preferred provider at
1488the time of purchase of the policy for personal injury
1489protection benefits, if the requirements of this subsection are
1490met. If the insured elects to use a provider who is not a
1491preferred provider, whether the insured purchased a preferred
1492provider policy or a nonpreferred provider policy, the medical
1493benefits provided by the insurer shall be as required by this
1494section. If the insured elects to use a provider who is a
1495preferred provider, the insurer may pay medical benefits in
1496excess of the benefits required by this section and may waive or
1497lower the amount of any deductible that applies to such medical
1498benefits. If the insurer offers a preferred provider policy to a
1499policyholder or applicant, it must also offer a nonpreferred
1500provider policy. The insurer shall provide each policyholder
1501with a current roster of preferred providers in the county in
1502which the insured resides at the time of purchase of such
1503policy, and shall make such list available for public inspection
1504during regular business hours at the principal office of the
1505insurer within the state.
1506     (10)(11)  DEMAND LETTER.--
1507     (a)  As a condition precedent to filing any action for
1508benefits under this section, the insurer must be provided with
1509written notice of an intent to initiate litigation. Such notice
1510may not be sent until the claim is overdue, including any
1511additional time the insurer has to pay the claim pursuant to
1512paragraph (4)(b).
1513     (b)  The notice required shall state that it is a "demand
1514letter under s. 627.736(10)(11)" and shall state with
1515specificity:
1516     1.  The name of the insured upon which such benefits are
1517being sought, including a copy of the assignment giving rights
1518to the claimant if the claimant is not the insured.
1519     2.  The claim number or policy number upon which such claim
1520was originally submitted to the insurer.
1521     3.  To the extent applicable, the name of any medical
1522provider who rendered to an insured the treatment, services,
1523accommodations, or supplies that form the basis of such claim;
1524and an itemized statement specifying each exact amount, the date
1525of treatment, service, or accommodation, and the type of benefit
1526claimed to be due. A completed form satisfying the requirements
1527of paragraph (5)(d) or the lost-wage statement previously
1528submitted may be used as the itemized statement. To the extent
1529that the demand involves an insurer's withdrawal of payment
1530under paragraph (7)(a) for future treatment not yet rendered,
1531the claimant shall attach a copy of the insurer's notice
1532withdrawing such payment and an itemized statement of the type,
1533frequency, and duration of future treatment claimed to be
1534reasonable and medically necessary.
1535     (c)  Each notice required by this subsection must be
1536delivered to the insurer by United States certified or
1537registered mail, return receipt requested. Such postal costs
1538shall be reimbursed by the insurer if so requested by the
1539claimant in the notice, when the insurer pays the claim. Such
1540notice must be sent to the person and address specified by the
1541insurer for the purposes of receiving notices under this
1542subsection. Each licensed insurer, whether domestic, foreign, or
1543alien, shall file with the office designation of the name and
1544address of the person to whom notices pursuant to this
1545subsection shall be sent which the office shall make available
1546on its Internet website. The name and address on file with the
1547office pursuant to s. 624.422 shall be deemed the authorized
1548representative to accept notice pursuant to this subsection in
1549the event no other designation has been made.
1550     (d)  If, within 15 days after receipt of notice by the
1551insurer, the overdue claim specified in the notice is paid by
1552the insurer together with applicable interest and a penalty of
155310 percent of the overdue amount paid by the insurer, subject to
1554a maximum penalty of $250, no action may be brought against the
1555insurer. If the demand involves an insurer's withdrawal of
1556payment under paragraph (7)(a) for future treatment not yet
1557rendered, no action may be brought against the insurer if,
1558within 15 days after its receipt of the notice, the insurer
1559mails to the person filing the notice a written statement of the
1560insurer's agreement to pay for such treatment in accordance with
1561the notice and to pay a penalty of 10 percent, subject to a
1562maximum penalty of $250, when it pays for such future treatment
1563in accordance with the requirements of this section. To the
1564extent the insurer determines not to pay any amount demanded,
1565the penalty shall not be payable in any subsequent action. For
1566purposes of this subsection, payment or the insurer's agreement
1567shall be treated as being made on the date a draft or other
1568valid instrument that is equivalent to payment, or the insurer's
1569written statement of agreement, is placed in the United States
1570mail in a properly addressed, postpaid envelope, or if not so
1571posted, on the date of delivery. The insurer shall not be
1572obligated to pay any attorney's fees if the insurer pays the
1573claim or mails its agreement to pay for future treatment within
1574the time prescribed by this subsection.
1575     (e)  The applicable statute of limitation for an action
1576under this section shall be tolled for a period of 15 business
1577days by the mailing of the notice required by this subsection.
1578     (f)  Any insurer making a general business practice of not
1579paying valid claims until receipt of the notice required by this
1580subsection is engaging in an unfair trade practice under the
1581insurance code.
1582     (11)(12)  CIVIL ACTION FOR INSURANCE FRAUD.--An insurer
1583shall have a cause of action against any person convicted of, or
1584who, regardless of adjudication of guilt, pleads guilty or nolo
1585contendere to insurance fraud under s. 817.234, patient
1586brokering under s. 817.505, or kickbacks under s. 456.054,
1587associated with a claim for personal injury protection benefits
1588in accordance with this section. An insurer prevailing in an
1589action brought under this subsection may recover compensatory,
1590consequential, and punitive damages subject to the requirements
1591and limitations of part II of chapter 768, and attorney's fees
1592and costs incurred in litigating a cause of action against any
1593person convicted of, or who, regardless of adjudication of
1594guilt, pleads guilty or nolo contendere to insurance fraud under
1595s. 817.234, patient brokering under s. 817.505, or kickbacks
1596under s. 456.054, associated with a claim for personal injury
1597protection benefits in accordance with this section.
1598     (12)(13)  MINIMUM BENEFIT COVERAGE.--If the Financial
1599Services Commission determines that the cost savings under
1600personal injury protection insurance benefits paid by insurers
1601have been realized due to the provisions of this act, prior
1602legislative reforms, or other factors, the commission may
1603increase the minimum $10,000 benefit coverage requirement. In
1604establishing the amount of such increase, the commission must
1605determine that the additional premium for such coverage is
1606approximately equal to the premium cost savings that have been
1607realized for the personal injury protection coverage with limits
1608of $10,000.
1609     (13)(14)  FRAUD ADVISORY NOTICE.--Upon receiving notice of
1610a claim under this section, an insurer shall provide a notice to
1611the insured or to a person for whom a claim for reimbursement
1612for diagnosis or treatment of injuries has been filed, advising
1613that:
1614     (a)  Pursuant to s. 626.9892, the Department of Financial
1615Services may pay rewards of up to $25,000 to persons providing
1616information leading to the arrest and conviction of persons
1617committing crimes investigated by the Division of Insurance
1618Fraud arising from violations of s. 440.105, s. 624.15, s.
1619626.9541, s. 626.989, or s. 817.234.
1620     (b)  Solicitation of a person injured in a motor vehicle
1621crash for purposes of filing personal injury protection or tort
1622claims could be a violation of s. 817.234, s. 817.505, or the
1623rules regulating The Florida Bar and should be immediately
1624reported to the Division of Insurance Fraud if such conduct has
1625taken place.
1626     Section 14.  Notwithstanding the repeal of the Florida
1627Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
1628section 627.737, Florida Statutes, is revived and reenacted to
1629read:
1630     627.737  Tort exemption; limitation on right to damages;
1631punitive damages.--
1632     (1)  Every owner, registrant, operator, or occupant of a
1633motor vehicle with respect to which security has been provided
1634as required by ss. 627.730-627.7405, and every person or
1635organization legally responsible for her or his acts or
1636omissions, is hereby exempted from tort liability for damages
1637because of bodily injury, sickness, or disease arising out of
1638the ownership, operation, maintenance, or use of such motor
1639vehicle in this state to the extent that the benefits described
1640in s. 627.736(1) are payable for such injury, or would be
1641payable but for any exclusion authorized by ss. 627.730-
1642627.7405, under any insurance policy or other method of security
1643complying with the requirements of s. 627.733, or by an owner
1644personally liable under s. 627.733 for the payment of such
1645benefits, unless a person is entitled to maintain an action for
1646pain, suffering, mental anguish, and inconvenience for such
1647injury under the provisions of subsection (2).
1648     (2)  In any action of tort brought against the owner,
1649registrant, operator, or occupant of a motor vehicle with
1650respect to which security has been provided as required by ss.
1651627.730-627.7405, or against any person or organization legally
1652responsible for her or his acts or omissions, a plaintiff may
1653recover damages in tort for pain, suffering, mental anguish, and
1654inconvenience because of bodily injury, sickness, or disease
1655arising out of the ownership, maintenance, operation, or use of
1656such motor vehicle only in the event that the injury or disease
1657consists in whole or in part of:
1658     (a)  Significant and permanent loss of an important bodily
1659function.
1660     (b)  Permanent injury within a reasonable degree of medical
1661probability, 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
1665ss. 627.730-627.7405, questions whether the plaintiff has met
1666the requirements of subsection (2), then the defendant may file
1667an appropriate motion with the court, and the court shall, on a
1668one-time basis only, 30 days before the date set for the trial
1669or the pretrial hearing, whichever is first, by examining the
1670pleadings and the evidence before it, ascertain whether the
1671plaintiff will be able to submit some evidence that the
1672plaintiff will meet the requirements of subsection (2).  If the
1673court finds that the plaintiff will not be able to submit such
1674evidence, then the court shall dismiss the plaintiff's claim
1675without prejudice.
1676     (4)  In any action brought against an automobile liability
1677insurer for damages in excess of its policy limits, no claim for
1678punitive damages shall be allowed.
1679     Section 15.  Notwithstanding the repeal of the Florida
1680Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
1681section 627.739, Florida Statutes, is revived and reenacted to
1682read:
1683     627.739  Personal injury protection; optional limitations;
1684deductibles.--
1685     (1)  The named insured may elect a deductible or modified
1686coverage or combination thereof to apply to the named insured
1687alone or to the named insured and dependent relatives residing
1688in the same household, but may not elect a deductible or
1689modified coverage to apply to any other person covered under the
1690policy.
1691     (2)  Insurers shall offer to each applicant and to each
1692policyholder, upon the renewal of an existing policy,
1693deductibles, in amounts of $250, $500, and $1,000. The
1694deductible amount must be applied to 100 percent of the expenses
1695and losses described in s. 627.736. After the deductible is met,
1696each insured is eligible to receive up to $10,000 in total
1697benefits described in s. 627.736(1). However, this subsection
1698shall not be applied to reduce the amount of any benefits
1699received in accordance with s. 627.736(1)(c).
1700     (3)  Insurers shall offer coverage wherein, at the election
1701of the named insured, the benefits for loss of gross income and
1702loss of earning capacity described in s. 627.736(1)(b) shall be
1703excluded.
1704     (4)  The named insured shall not be prevented from electing
1705a deductible under subsection (2) and modified coverage under
1706subsection (3). Each election made by the named insured under
1707this section shall result in an appropriate reduction of premium
1708associated with that election.
1709     (5)  All such offers shall be made in clear and unambiguous
1710language at the time the initial application is taken and prior
1711to each annual renewal and shall indicate that a premium
1712reduction will result from each election. At the option of the
1713insurer, the requirements of the preceding sentence are met by
1714using forms of notice approved by the office, or by providing
1715the following notice in 10-point type in the insurer's
1716application for initial issuance of a policy of motor vehicle
1717insurance and the insurer's annual notice of renewal premium:
1718 For personal injury protection insurance, the named insured may
1719elect a deductible and to exclude coverage for loss of gross
1720income and loss of earning capacity ("lost wages"). These
1721elections apply to the named insured alone, or to the named
1722insured and all dependent resident relatives. A premium
1723reduction will result from these elections. The named insured is
1724hereby advised not to elect the lost wage exclusion if the named
1725insured or dependent resident relatives are employed, since lost
1726wages will not be payable in the event of an accident.
1727     Section 16.  Notwithstanding the repeal of the Florida
1728Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
1729section 627.7401, Florida Statutes, is revived and reenacted to
1730read:
1731     627.7401  Notification of insured's rights.--
1732     (1)  The commission, by rule, shall adopt a form for the
1733notification of insureds of their right to receive personal
1734injury protection benefits under the Florida Motor Vehicle No-
1735Fault Law. Such notice shall include:
1736     (a)  A description of the benefits provided by personal
1737injury protection, including, but not limited to, the specific
1738types of services for which medical benefits are paid,
1739disability benefits, death benefits, significant exclusions from
1740and limitations on personal injury protection benefits, when
1741payments are due, how benefits are coordinated with other
1742insurance benefits that the insured may have, penalties and
1743interest that may be imposed on insurers for failure to make
1744timely payments of benefits, and rights of parties regarding
1745disputes as to benefits.
1746     (b)  An advisory informing insureds that:
1747     1.  Pursuant to s. 626.9892, the Department of Financial
1748Services may pay rewards of up to $25,000 to persons providing
1749information leading to the arrest and conviction of persons
1750committing crimes investigated by the Division of Insurance
1751Fraud arising from violations of s. 440.105, s. 624.15, s.
1752626.9541, s. 626.989, or s. 817.234.
1753     2.  Pursuant to s. 627.736(5)(e)1., if the insured notifies
1754the insurer of a billing error, the insured may be entitled to a
1755certain percentage of a reduction in the amount paid by the
1756insured's motor vehicle insurer.
1757     (c)  A notice that solicitation of a person injured in a
1758motor vehicle crash for purposes of filing personal injury
1759protection or tort claims could be a violation of s. 817.234, s
1760817.505, or the rules regulating The Florida Bar and should be
1761immediately reported to the Division of Insurance Fraud if such
1762conduct has taken place.
1763     (2)  Each insurer issuing a policy in this state providing
1764personal injury protection benefits must mail or deliver the
1765notice as specified in subsection (1) to an insured within 21
1766days after receiving from the insured notice of an automobile
1767accident or claim involving personal injury to an insured who is
1768covered under the policy. The office may allow an insurer
1769additional time to provide the notice specified in subsection
1770(1) not to exceed 30 days, upon a showing by the insurer that an
1771emergency justifies an extension of time.
1772     (3)  The notice required by this section does not alter or
1773modify the terms of the insurance contract or other requirements
1774of this act.
1775     Section 17.  Notwithstanding the repeal of the Florida
1776Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
1777section 627.7403, Florida Statutes, is revived and reenacted to
1778read:
1779     627.7403  Mandatory joinder of derivative claim.--In any
1780action brought pursuant to the provisions of s. 627.737 claiming
1781personal injuries, all claims arising out of the plaintiff's
1782injuries, including all derivative claims, shall be brought
1783together, unless good cause is shown why such claims should be
1784brought separately.
1785     Section 18.  Notwithstanding the repeal of the Florida
1786Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
1787section 627.7405, Florida Statutes, is revived and reenacted to
1788read:
1789     627.7405  Insurers' right of
1790reimbursement.--Notwithstanding any other provisions of ss.
1791627.730-627.7405, any insurer providing personal injury
1792protection benefits on a private passenger motor vehicle shall
1793have, to the extent of any personal injury protection benefits
1794paid to any person as a benefit arising out of such private
1795passenger motor vehicle insurance, a right of reimbursement
1796against the owner or the insurer of the owner of a commercial
1797motor vehicle, if the benefits paid result from such person
1798having been an occupant of the commercial motor vehicle or
1799having been struck by the commercial motor vehicle while not an
1800occupant of any self-propelled vehicle.
1801     Section 19.  This act revives and reenacts, with
1802amendments, the Florida Motor Vehicle No-Fault Law, which
1803expired by operation of law on October 1, 2007. This act is
1804intended to be remedial and curative in nature and to minimize
1805confusion concerning the changes made by this act to ss.
1806627.730-627.7405, Florida Statutes. Therefore, the Florida Motor
1807Vehicle No-Fault Law shall continue to be codified as ss.
1808627.730-627.7405, Florida Statutes, notwithstanding the repeal
1809of those sections contained in s. 19, chapter 2003-411, Laws of
1810Florida.
1811     Section 20.  Effective January 15, 2008, and applicable to
1812policies issued or renewed on or after that date, subsections
1813(1) and (4), paragraphs (a), (b), and (c) of subsection (5),
1814subsection (8), and paragraphs (d) and (e) of subsection (10) of
1815section 627.736, Florida Statutes, as reenacted and amended by
1816this act, are amended, subsections (11), (12), and (13) of that
1817section, as reenacted and amended by this act, are renumbered as
1818subsections (12), (13), and (14), respectively, and a new
1819subsection (11) and subsections (15) and (16) are added to that
1820section, to read:
1821     627.736  Required personal injury protection benefits;
1822exclusions; priority; claims.--
1823     (1)  REQUIRED BENEFITS.--Every insurance policy complying
1824with the security requirements of s. 627.733 shall provide
1825personal injury protection to the named insured, relatives
1826residing in the same household, persons operating the insured
1827motor vehicle, passengers in such motor vehicle, and other
1828persons struck by such motor vehicle and suffering bodily injury
1829while not an occupant of a self-propelled vehicle, subject to
1830the provisions of subsection (2) and paragraph (4)(e)(d), to a
1831limit of $10,000 for loss sustained by any such person as a
1832result of bodily injury, sickness, disease, or death arising out
1833of the ownership, maintenance, or use of a motor vehicle as
1834follows:
1835     (a)  Medical benefits.--Eighty percent of all reasonable
1836expenses for medically necessary medical, surgical, X-ray,
1837dental, and rehabilitative services, including prosthetic
1838devices, and medically necessary ambulance, hospital, and
1839nursing services. However, the medical benefits shall provide
1840reimbursement only for such services and care that are provided,
1841ordered, or prescribed by a physician licensed under chapter 458
1842or chapter 459 or a dentist licensed under chapter 466 or that
1843are 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
1846chapter 395.
1847     3.  A person or entity licensed under ss. 401.2101-401.45
1848that provides emergency transportation and treatment.
1849     4.  An entity wholly owned by one or more physicians
1850licensed under chapter 458 or chapter 459, chiropractic
1851physicians licensed under chapter 460, or dentists licensed
1852under chapter 466 or by such practitioner or practitioners and
1853the spouse, parent, child, or sibling of that practitioner or
1854those practitioners.
1855     5.  An entity wholly owned, directly or indirectly, by a
1856hospital or hospitals.
1857     6.  A health care clinic licensed under ss. 400.990-400.995
1858that is:
1859     a.  Accredited by the Joint Commission on Accreditation of
1860Healthcare Organizations, the American Osteopathic Association,
1861the Commission on Accreditation of Rehabilitation Facilities, or
1862the Accreditation Association for Ambulatory Health Care, Inc.;
1863or
1864     b.  A health care clinic that:
1865     (I)  Has a medical director licensed under chapter 458,
1866chapter 459, or chapter 460;
1867     (II)  Has been continuously licensed for more than 3 years
1868or is a publicly traded corporation that issues securities
1869traded on an exchange registered with the United States
1870Securities and Exchange Commission as a national securities
1871exchange; and
1872     (III)  Provides at least four of the following medical
1873specialties:
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
1881medication.
1882     (H)  Laboratory services.
1883
1884The Financial Services Commission shall adopt by rule the form
1885that must be used by an insurer and a health care provider
1886specified in subparagraph 4., subparagraph 5., or subparagraph
18876. to document that the health care provider meets the criteria
1888of this paragraph, which rule must include a requirement for a
1889sworn statement or affidavit Such benefits shall also include
1890necessary remedial treatment and services recognized and
1891permitted under the laws of the state for an injured person who
1892relies upon spiritual means through prayer alone for healing, in
1893accordance with his or her religious beliefs; however, this
1894sentence does not affect the determination of what other
1895services or procedures are medically necessary.
1896     (b)  Disability benefits.--Sixty percent of any loss of
1897gross income and loss of earning capacity per individual from
1898inability to work proximately caused by the injury sustained by
1899the injured person, plus all expenses reasonably incurred in
1900obtaining from others ordinary and necessary services in lieu of
1901those that, but for the injury, the injured person would have
1902performed without income for the benefit of his or her
1903household. All disability benefits payable under this provision
1904shall 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
1907benefits per individual. The insurer may pay such benefits to
1908the executor or administrator of the deceased, to any of the
1909deceased's relatives by blood or legal adoption or connection by
1910marriage, or to any person appearing to the insurer to be
1911equitably entitled thereto.
1912
1913Only insurers writing motor vehicle liability insurance in this
1914state may provide the required benefits of this section, and no
1915such insurer shall require the purchase of any other motor
1916vehicle coverage other than the purchase of property damage
1917liability coverage as required by s. 627.7275 as a condition for
1918providing such required benefits. Insurers may not require that
1919property damage liability insurance in an amount greater than
1920$10,000 be purchased in conjunction with personal injury
1921protection. Such insurers shall make benefits and required
1922property damage liability insurance coverage available through
1923normal marketing channels. Any insurer writing motor vehicle
1924liability insurance in this state who fails to comply with such
1925availability requirement as a general business practice shall be
1926deemed to have violated part IX of chapter 626, and such
1927violation shall constitute an unfair method of competition or an
1928unfair or deceptive act or practice involving the business of
1929insurance; and any such insurer committing such violation shall
1930be subject to the penalties afforded in such part, as well as
1931those which may be afforded elsewhere in the insurance code.
1932     (4)  BENEFITS; WHEN DUE.--Benefits due from an insurer
1933under ss. 627.730-627.7405 shall be primary, except that
1934benefits received under any workers' compensation law shall be
1935credited against the benefits provided by subsection (1) and
1936shall be due and payable as loss accrues, upon receipt of
1937reasonable proof of such loss and the amount of expenses and
1938loss incurred which are covered by the policy issued under ss.
1939627.730-627.7405. When the Agency for Health Care Administration
1940provides, pays, or becomes liable for medical assistance under
1941the Medicaid program related to injury, sickness, disease, or
1942death arising out of the ownership, maintenance, or use of a
1943motor vehicle, benefits under ss. 627.730-627.7405 shall be
1944subject to the provisions of the Medicaid program.
1945     (a)  An insurer may require written notice to be given as
1946soon as practicable after an accident involving a motor vehicle
1947with respect to which the policy affords the security required
1948by ss. 627.730-627.7405.
1949     (b)  Personal injury protection insurance benefits paid
1950pursuant to this section shall be overdue if not paid within 30
1951days after the insurer is furnished written notice of the fact
1952of a covered loss and of the amount of same. If such written
1953notice is not furnished to the insurer as to the entire claim,
1954any partial amount supported by written notice is overdue if not
1955paid within 30 days after such written notice is furnished to
1956the insurer. Any part or all of the remainder of the claim that
1957is subsequently supported by written notice is overdue if not
1958paid within 30 days after such written notice is furnished to
1959the insurer. When an insurer pays only a portion of a claim or
1960rejects a claim, the insurer shall provide at the time of the
1961partial payment or rejection an itemized specification of each
1962item that the insurer had reduced, omitted, or declined to pay
1963and any information that the insurer desires the claimant to
1964consider related to the medical necessity of the denied
1965treatment or to explain the reasonableness of the reduced
1966charge, provided that this shall not limit the introduction of
1967evidence at trial; and the insurer shall include the name and
1968address of the person to whom the claimant should respond and a
1969claim number to be referenced in future correspondence. However,
1970notwithstanding the fact that written notice has been furnished
1971to the insurer, any payment shall not be deemed overdue when the
1972insurer has reasonable proof to establish that the insurer is
1973not responsible for the payment. For the purpose of calculating
1974the extent to which any benefits are overdue, payment shall be
1975treated as being made on the date a draft or other valid
1976instrument which is equivalent to payment was placed in the
1977United States mail in a properly addressed, postpaid envelope
1978or, if not so posted, on the date of delivery. This paragraph
1979does not preclude or limit the ability of the insurer to assert
1980that the claim was unrelated, was not medically necessary, or
1981was unreasonable or that the amount of the charge was in excess
1982of that permitted under, or in violation of, subsection (5).
1983Such assertion by the insurer may be made at any time, including
1984after payment of the claim or after the 30-day time period for
1985payment set forth in this paragraph.
1986     (c)  Upon receiving notice of an accident that is
1987potentially covered by personal injury protection benefits, the
1988insurer must reserve $5,000 of personal injury protection
1989benefits for payment to physicians licensed under chapter 458 or
1990chapter 459 who provide emergency services and care, as defined
1991in s. 395.002(9), or who provide hospital inpatient care. The
1992amount required to be held in reserve may be used only to pay
1993claims from such physicians until 30 days after the date the
1994insurer receives notice of the accident. After the 30-day
1995period, any amount of the reserve for which the insurer has not
1996received notice of a claim from a physician who provided
1997emergency services and care or who provided hospital inpatient
1998care may then be used by the insurer to pay other claims. The
1999time periods specified in paragraph (b) for required payment of
2000personal injury protection benefits shall be tolled for the
2001period of time that an insurer is required by this paragraph to
2002hold payment of a claim that is not from a physician who
2003provided emergency services and care or who provided hospital
2004inpatient care.
2005     (d)(c)  All overdue payments shall bear simple interest at
2006the rate established under s. 55.03 or the rate established in
2007the insurance contract, whichever is greater, for the year in
2008which the payment became overdue, calculated from the date the
2009insurer was furnished with written notice of the amount of
2010covered loss. Interest shall be due at the time payment of the
2011overdue claim is made.
2012     (e)(d)  The insurer of the owner of a motor vehicle shall
2013pay personal injury protection benefits for:
2014     1.  Accidental bodily injury sustained in this state by the
2015owner while occupying a motor vehicle, or while not an occupant
2016of a self-propelled vehicle if the injury is caused by physical
2017contact with a motor vehicle.
2018     2.  Accidental bodily injury sustained outside this state,
2019but within the United States of America or its territories or
2020possessions or Canada, by the owner while occupying the owner's
2021motor vehicle.
2022     3.  Accidental bodily injury sustained by a relative of the
2023owner residing in the same household, under the circumstances
2024described in subparagraph 1. or subparagraph 2., provided the
2025relative at the time of the accident is domiciled in the owner's
2026household and is not himself or herself the owner of a motor
2027vehicle with respect to which security is required under ss.
2028627.730-627.7405.
2029     4.  Accidental bodily injury sustained in this state by any
2030other person while occupying the owner's motor vehicle or, if a
2031resident of this state, while not an occupant of a self-
2032propelled vehicle, if the injury is caused by physical contact
2033with such motor vehicle, provided the injured person is not
2034himself or herself:
2035     a.  The owner of a motor vehicle with respect to which
2036security is required under ss. 627.730-627.7405; or
2037     b.  Entitled to personal injury benefits from the insurer
2038of the owner or owners of such a motor vehicle.
2039     (f)(e)  If two or more insurers are liable to pay personal
2040injury protection benefits for the same injury to any one
2041person, the maximum payable shall be as specified in subsection
2042(1), and any insurer paying the benefits shall be entitled to
2043recover from each of the other insurers an equitable pro rata
2044share of the benefits paid and expenses incurred in processing
2045the claim.
2046     (g)(f)  It is a violation of the insurance code for an
2047insurer to fail to timely provide benefits as required by this
2048section with such frequency as to constitute a general business
2049practice.
2050     (h)(g)  Benefits shall not be due or payable to or on the
2051behalf of an insured person if that person has committed, by a
2052material act or omission, any insurance fraud relating to
2053personal injury protection coverage under his or her policy, if
2054the fraud is admitted to in a sworn statement by the insured or
2055if it is established in a court of competent jurisdiction. Any
2056insurance fraud shall void all coverage arising from the claim
2057related to such fraud under the personal injury protection
2058coverage of the insured person who committed the fraud,
2059irrespective of whether a portion of the insured person's claim
2060may be legitimate, and any benefits paid prior to the discovery
2061of the insured person's insurance fraud shall be recoverable by
2062the insurer from the person who committed insurance fraud in
2063their entirety. The prevailing party is entitled to its costs
2064and attorney's fees in any action in which it prevails in an
2065insurer's action to enforce its right of recovery under this
2066paragraph.
2067     (5)  CHARGES FOR TREATMENT OF INJURED PERSONS.--
2068     (a)1.  Any physician, hospital, clinic, or other person or
2069institution lawfully rendering treatment to an injured person
2070for a bodily injury covered by personal injury protection
2071insurance may charge the insurer and injured party only a
2072reasonable amount pursuant to this section for the services and
2073supplies rendered, and the insurer providing such coverage may
2074pay for such charges directly to such person or institution
2075lawfully rendering such treatment, if the insured receiving such
2076treatment or his or her guardian has countersigned the properly
2077completed invoice, bill, or claim form approved by the office
2078upon which such charges are to be paid for as having actually
2079been rendered, to the best knowledge of the insured or his or
2080her guardian. In no event, however, may such a charge be in
2081excess of the amount the person or institution customarily
2082charges for like services or supplies. With respect to a
2083determination of whether a charge for a particular service,
2084treatment, or otherwise is reasonable, consideration may be
2085given to evidence of usual and customary charges and payments
2086accepted by the provider involved in the dispute, and
2087reimbursement levels in the community and various federal and
2088state medical fee schedules applicable to automobile and other
2089insurance coverages, and other information relevant to the
2090reasonableness of the reimbursement for the service, treatment,
2091or supply.
2092     2.  The insurer may limit reimbursement to 80 percent of
2093the following schedule of maximum charges:
2094     a.  For emergency transport and treatment by providers
2095licensed under chapter 401, 200 percent of Medicare.
2096     b.  For emergency services and care provided by a hospital
2097licensed under chapter 395, 75 percent of the hospital's usual
2098and customary charges.
2099     c.  For emergency services and care rendered by a physician
2100and related hospital inpatient services rendered by a physician,
2101the usual and customary charges in the community.
2102     d.  For hospital inpatient services, other than emergency
2103services and care, 200 percent of the Medicare Part A
2104prospective payment applicable to the specific hospital
2105providing the inpatient services.
2106     e.  For hospital outpatient services, other than emergency
2107services and care, 200 percent of the Medicare Part A Ambulatory
2108Payment Classification for the specific hospital providing the
2109outpatient services.
2110     f.  For all other medical services, supplies, and care, 200
2111percent of the applicable Medicare Part B fee schedule. However,
2112if such services, supplies, or care are not reimbursable under
2113Medicare Part B, the insurer may limit reimbursement to 80
2114percent of the maximum reimbursable allowance under workers'
2115compensation, as determined under s. 440.13 and rules adopted
2116thereunder which are in effect at the time such services,
2117supplies, or care are provided. Services, supplies, or care that
2118are not reimbursable under Medicare or workers' compensation are
2119not required to be reimbursed by the insurer.
2120     3.  For purposes of subparagraph 2., the applicable fee
2121schedule or payment limitation under Medicare is the fee
2122schedule or payment limitation in effect at the time the
2123services, supplies, or care were rendered and for the area in
2124which such services were rendered.
2125     4.  Subparagraph 2. does not allow the insurer to apply any
2126limitation on the number of treatments or other utilization
2127limits that apply under Medicare or workers' compensation. An
2128insurer that applies the allowable payment limitations of
2129subparagraph 2. must reimburse a provider who lawfully provided
2130care or treatment under the scope of his or her license,
2131regardless of whether such provider would be entitled to
2132reimbursement under Medicare due to restrictions or limitations
2133on the types or discipline of health care providers who may be
2134reimbursed for particular procedures or procedure codes.
2135     5.  If an insurer limits payment as authorized by
2136subparagraph 2., the person providing such services, supplies,
2137or care may not bill or attempt to collect from the insured any
2138amount in excess of such limits, except for amounts that are not
2139covered by the insured's personal injury protection coverage due
2140to the coinsurance amount or maximum policy limits.
2141     (b)1.  An insurer or insured is not required to pay a claim
2142or charges:
2143     a.  Made by a broker or by a person making a claim on
2144behalf of a broker;
2145     b.  For any service or treatment that was not lawful at the
2146time rendered;
2147     c.  To any person who knowingly submits a false or
2148misleading statement relating to the claim or charges;
2149     d.  With respect to a bill or statement that does not
2150substantially meet the applicable requirements of paragraph (d);
2151     e.  For any treatment or service that is upcoded, or that
2152is unbundled when such treatment or services should be bundled,
2153in accordance with paragraph (d). To facilitate prompt payment
2154of lawful services, an insurer may change codes that it
2155determines to have been improperly or incorrectly upcoded or
2156unbundled, and may make payment based on the changed codes,
2157without affecting the right of the provider to dispute the
2158change by the insurer, provided that before doing so, the
2159insurer must contact the health care provider and discuss the
2160reasons for the insurer's change and the health care provider's
2161reason for the coding, or make a reasonable good faith effort to
2162do so, as documented in the insurer's file; and
2163     f.  For medical services or treatment billed by a physician
2164and not provided in a hospital unless such services are rendered
2165by the physician or are incident to his or her professional
2166services and are included on the physician's bill, including
2167documentation verifying that the physician is responsible for
2168the medical services that were rendered and billed.
2169     2.  Charges for medically necessary cephalic thermograms,
2170peripheral thermograms, spinal ultrasounds, extremity
2171ultrasounds, video fluoroscopy, and surface electromyography
2172shall not exceed the maximum reimbursement allowance for such
2173procedures as set forth in the applicable fee schedule or other
2174payment methodology established pursuant to s. 440.13.
2175     3.  Allowable amounts that may be charged to a personal
2176injury protection insurance insurer and insured for medically
2177necessary nerve conduction testing when done in conjunction with
2178a needle electromyography procedure and both are performed and
2179billed solely by a physician licensed under chapter 458, chapter
2180459, chapter 460, or chapter 461 who is also certified by the
2181American Board of Electrodiagnostic Medicine or by a board
2182recognized by the American Board of Medical Specialties or the
2183American Osteopathic Association or who holds diplomate status
2184with the American Chiropractic Neurology Board or its
2185predecessors shall not exceed 200 percent of the allowable
2186amount under the participating physician fee schedule of
2187Medicare Part B for year 2001, for the area in which the
2188treatment was rendered, adjusted annually on August 1 to reflect
2189the prior calendar year's changes in the annual Medical Care
2190Item of the Consumer Price Index for All Urban Consumers in the
2191South Region as determined by the Bureau of Labor Statistics of
2192the United States Department of Labor.
2193     4.  Allowable amounts that may be charged to a personal
2194injury protection insurance insurer and insured for medically
2195necessary nerve conduction testing that does not meet the
2196requirements of subparagraph 3. shall not exceed the applicable
2197fee schedule or other payment methodology established pursuant
2198to s. 440.13.
2199     5.  Allowable amounts that may be charged to a personal
2200injury protection insurance insurer and insured for magnetic
2201resonance imaging services shall not exceed 175 percent of the
2202allowable amount under the participating physician fee schedule
2203of Medicare Part B for year 2001, for the area in which the
2204treatment was rendered, adjusted annually on August 1 to reflect
2205the prior calendar year's changes in the annual Medical Care
2206Item of the Consumer Price Index for All Urban Consumers in the
2207South Region as determined by the Bureau of Labor Statistics of
2208the United States Department of Labor for the 12-month period
2209ending June 30 of that year, except that allowable amounts that
2210may be charged to a personal injury protection insurance insurer
2211and insured for magnetic resonance imaging services provided in
2212facilities accredited by the Accreditation Association for
2213Ambulatory Health Care, the American College of Radiology, or
2214the Joint Commission on Accreditation of Healthcare
2215Organizations shall not exceed 200 percent of the allowable
2216amount under the participating physician fee schedule of
2217Medicare Part B for year 2001, for the area in which the
2218treatment was rendered, adjusted annually on August 1 to reflect
2219the prior calendar year's changes in the annual Medical Care
2220Item of the Consumer Price Index for All Urban Consumers in the
2221South Region as determined by the Bureau of Labor Statistics of
2222the United States Department of Labor for the 12-month period
2223ending June 30 of that year. This paragraph does not apply to
2224charges for magnetic resonance imaging services and nerve
2225conduction testing for inpatients and emergency services and
2226care as defined in chapter 395 rendered by facilities licensed
2227under chapter 395.
2228     2.6.  The Department of Health, in consultation with the
2229appropriate professional licensing boards, shall adopt, by rule,
2230a list of diagnostic tests deemed not to be medically necessary
2231for use in the treatment of persons sustaining bodily injury
2232covered by personal injury protection benefits under this
2233section. The initial list shall be adopted by January 1, 2004,
2234and shall be revised from time to time as determined by the
2235Department of Health, in consultation with the respective
2236professional licensing boards. Inclusion of a test on the list
2237of invalid diagnostic tests shall be based on lack of
2238demonstrated medical value and a level of general acceptance by
2239the relevant provider community and shall not be dependent for
2240results entirely upon subjective patient response.
2241Notwithstanding its inclusion on a fee schedule in this
2242subsection, an insurer or insured is not required to pay any
2243charges or reimburse claims for any invalid diagnostic test as
2244determined by the Department of Health.
2245     (c)1.  With respect to any treatment or service, other than
2246medical services billed by a hospital or other provider for
2247emergency services as defined in s. 395.002 or inpatient
2248services rendered at a hospital-owned facility, the statement of
2249charges must be furnished to the insurer by the provider and may
2250not include, and the insurer is not required to pay, charges for
2251treatment or services rendered more than 35 days before the
2252postmark date or electronic transmission date of the statement,
2253except for past due amounts previously billed on a timely basis
2254under this paragraph, and except that, if the provider submits
2255to the insurer a notice of initiation of treatment within 21
2256days after its first examination or treatment of the claimant,
2257the statement may include charges for treatment or services
2258rendered up to, but not more than, 75 days before the postmark
2259date of the statement. The injured party is not liable for, and
2260the provider shall not bill the injured party for, charges that
2261are unpaid because of the provider's failure to comply with this
2262paragraph. Any agreement requiring the injured person or insured
2263to pay for such charges is unenforceable.
2264     2.  If, however, the insured fails to furnish the provider
2265with the correct name and address of the insured's personal
2266injury protection insurer, the provider has 35 days from the
2267date the provider obtains the correct information to furnish the
2268insurer with a statement of the charges. The insurer is not
2269required to pay for such charges unless the provider includes
2270with the statement documentary evidence that was provided by the
2271insured during the 35-day period demonstrating that the provider
2272reasonably relied on erroneous information from the insured and
2273either:
2274     a.  A denial letter from the incorrect insurer; or
2275     b.  Proof of mailing, which may include an affidavit under
2276penalty of perjury, reflecting timely mailing to the incorrect
2277address or insurer.
2278     3.  For emergency services and care as defined in s.
2279395.002 rendered in a hospital emergency department or for
2280transport and treatment rendered by an ambulance provider
2281licensed pursuant to part III of chapter 401, the provider is
2282not required to furnish the statement of charges within the time
2283periods established by this paragraph; and the insurer shall not
2284be considered to have been furnished with notice of the amount
2285of covered loss for purposes of paragraph (4)(b) until it
2286receives a statement complying with paragraph (d), or copy
2287thereof, which specifically identifies the place of service to
2288be a hospital emergency department or an ambulance in accordance
2289with billing standards recognized by the Health Care Finance
2290Administration.
2291     4.  Each notice of insured's rights under s. 627.7401 must
2292include the following statement in type no smaller than 12
2293points:
2294
2295BILLING REQUIREMENTS.--Florida Statutes provide that with
2296respect to any treatment or services, other than certain
2297hospital and emergency services, the statement of charges
2298furnished to the insurer by the provider may not include, and
2299the insurer and the injured party are not required to pay,
2300charges for treatment or services rendered more than 35 days
2301before the postmark date of the statement, except for past due
2302amounts previously billed on a timely basis, and except that, if
2303the provider submits to the insurer a notice of initiation of
2304treatment within 21 days after its first examination or
2305treatment of the claimant, the statement may include charges for
2306treatment or services rendered up to, but not more than, 75 days
2307before the postmark date of the statement.
2308     (8)  APPLICABILITY OF PROVISION REGULATING ATTORNEY'S
2309FEES.--With respect to any dispute under the provisions of ss.
2310627.730-627.7405 between the insured and the insurer, or between
2311an assignee of an insured's rights and the insurer, the
2312provisions of s. 627.428 shall apply, except as provided in
2313subsections subsection (10) and (15).
2314     (10)  DEMAND LETTER.--
2315     (d)  If, within 30 15 days after receipt of notice by the
2316insurer, the overdue claim specified in the notice is paid by
2317the insurer together with applicable interest and a penalty of
231810 percent of the overdue amount paid by the insurer, subject to
2319a maximum penalty of $250, no action may be brought against the
2320insurer. If the demand involves an insurer's withdrawal of
2321payment under paragraph (7)(a) for future treatment not yet
2322rendered, no action may be brought against the insurer if,
2323within 30 15 days after its receipt of the notice, the insurer
2324mails to the person filing the notice a written statement of the
2325insurer's agreement to pay for such treatment in accordance with
2326the notice and to pay a penalty of 10 percent, subject to a
2327maximum penalty of $250, when it pays for such future treatment
2328in accordance with the requirements of this section. To the
2329extent the insurer determines not to pay any amount demanded,
2330the penalty shall not be payable in any subsequent action. For
2331purposes of this subsection, payment or the insurer's agreement
2332shall be treated as being made on the date a draft or other
2333valid instrument that is equivalent to payment, or the insurer's
2334written statement of agreement, is placed in the United States
2335mail in a properly addressed, postpaid envelope, or if not so
2336posted, on the date of delivery. The insurer is shall not be
2337obligated to pay any attorney's fees if the insurer pays the
2338claim or mails its agreement to pay for future treatment within
2339the time prescribed by this subsection.
2340     (e)  The applicable statute of limitation for an action
2341under this section shall be tolled for a period of 30 15
2342business days by the mailing of the notice required by this
2343subsection.
2344     (11)  FAILURE TO PAY VALID CLAIMS; UNFAIR OR DECEPTIVE
2345PRACTICE.--
2346     (a)  If an insurer fails to pay valid claims for personal
2347injury protection with such frequency so as to indicate a
2348general business practice, the insurer is engaging in a
2349prohibited unfair or deceptive practice that is subject to the
2350penalties provided in s. 626.9521 and the office has the powers
2351and duties specified in ss. 626.9561-626.9601 with respect
2352thereto.
2353     (b)  Notwithstanding s. 501.212, the Department of Legal
2354Affairs may investigate and initiate actions for a violation of
2355this subsection, including, but not limited to, the powers and
2356duties specified in part II of chapter 501.
2357     (15)  ALL CLAIMS BROUGHT IN A SINGLE ACTION.--In any civil
2358action to recover personal injury protection benefits brought by
2359a claimant pursuant to this section against an insurer, all
2360claims related to the same health care provider for the same
2361injured person shall be brought in one action, unless good cause
2362is shown why such claims should be brought separately. If the
2363court determines that a civil action is filed for a claim that
2364should have been brought in a prior civil action, the court may
2365not award attorney's fees to the claimant.
2366     (16)  SECURE ELECTRONIC DATA TRANSFER.--An electronic
2367notice, documentation, transmission, or communication of any
2368kind required or authorized under ss. 627.730-627.7405 must be
2369transmitted by secure electronic data transfer that is
2370consistent with state and federal privacy and security laws.
2371     Section 21.  Effective January 15, 2008, and applicable to
2372policies issued or renewed on or after that date, section
2373627.739, Florida Statutes, as reenacted by this act, is amended
2374to read:
2375     627.739  Personal injury protection; optional limitations;
2376deductibles.--
2377     (1)  The named insured may elect a deductible or modified
2378coverage as specified in subsection (2) or combination thereof
2379to apply to the named insured alone or to the named insured and
2380dependent relatives residing in the same household, but may not
2381elect a deductible or modified coverage to apply to any other
2382person covered under the policy.
2383     (2)  Insurers shall offer to each applicant and to each
2384policyholder, upon the renewal of an existing policy,
2385deductibles, in amounts of $250, $500, and $1,000. The
2386deductible amount must be applied to 100 percent of the expenses
2387and losses described in s. 627.736. After the deductible is met,
2388each insured is eligible to receive up to $10,000 in total
2389benefits described in s. 627.736(1). However, this subsection
2390shall not be applied to reduce the amount of any benefits
2391received in accordance with s. 627.736(1)(c).
2392     (2)(3)  Insurers shall offer coverage wherein, at the
2393election of the named insured, the benefits for loss of gross
2394income and loss of earning capacity described in s.
2395627.736(1)(b) shall be excluded.
2396     (3)(4)  The named insured shall not be prevented from
2397electing a deductible under subsection (2) and modified coverage
2398under subsection (2) (3). Each election made by the named
2399insured under this section shall result in an appropriate
2400reduction of premium associated with that election.
2401     (4)(5)  All Such offer offers shall be made in clear and
2402unambiguous language at the time the initial application is
2403taken and prior to each annual renewal and shall indicate that a
2404premium reduction will result from such each election. At the
2405option of the insurer, the requirements of the preceding
2406sentence are met by using forms of notice approved by the
2407office, or by providing the following notice in 10-point type in
2408the insurer's application for initial issuance of a policy of
2409motor vehicle insurance and the insurer's annual notice of
2410renewal premium:
2411
2412For personal injury protection insurance, the named insured may
2413elect a deductible and to exclude coverage for loss of gross
2414income and loss of earning capacity ("lost wages"). This
2415election applies These elections apply to the named insured
2416alone, or to the named insured and all dependent resident
2417relatives. A premium reduction will result from this election
2418these elections. The named insured is hereby advised not to
2419elect the lost wage exclusion if the named insured or dependent
2420resident relatives are employed, since lost wages will not be
2421payable in the event of an accident.
2422     Section 22.  (1)  The Legislature intends that the
2423provisions of this act reviving and reenacting the Florida Motor
2424Vehicle No-Fault Law apply to policies issued on or after the
2425effective date of this act.
2426     (2)  Each insurer that issued coverage for a motor vehicle
2427that is subject to the Florida Motor Vehicle No-Fault Law shall,
2428within 30 days after the effective date of this act, mail or
2429deliver a revised notice of the premium and policy changes to
2430each policyholder whose policy has an effective date on or after
2431the effective date of this act and who was previously issued a
2432motor vehicle insurance policy or sent a renewal notice based on
2433the assumption that the Florida Motor Vehicle No-Fault Law would
2434be repealed on October 1, 2007. For a renewal policy, the
2435coverage must provide the same limits of personal injury
2436protection coverage, the same deductible from personal injury
2437protection coverage, and the same limits of medical payments
2438coverage as provided in the prior policy, unless the
2439policyholder elects different limits that are available. The
2440effective date of the revised policy or renewal shall be the
2441same as the effective date specified in the prior notice. The
2442revised notice of premium and coverage changes is exempt from
2443the requirements of ss. 627.7277, 627.728, and 627.7282, Florida
2444Statutes. The policyholder has a period of 30 days, or a longer
2445period if specified by the insurer, following receipt of the
2446revised notice within which to pay any additional amount of
2447premium due and thereby maintain the policy in force as
2448specified in this section. Alternatively, the policyholder may
2449cancel the policy within this time period and obtain a refund of
2450the unearned premium. If the policyholder fails to timely
2451respond to the notice, the insurer must cancel the policy and
2452return any unearned premium to the insured. The date on which
2453the policy will be canceled shall be stated in the notice and
2454may not be less than 35 days after the date of the notice. The
2455amount of unearned premium due to the policyholder shall be
2456calculated on a pro rata basis. The failure of an insurer to
2457timely mail or deliver a revised notice as required by this
2458subsection does not affect the other requirements of this
2459section.
2460     (3)  With respect to a policy providing personal injury
2461protection coverage having an effective date between the
2462effective date of this act and January 14, 2008, inclusive, the
2463insurer shall use the forms and rates it had in effect on
2464September 30, 2007, for all coverages in that policy unless the
2465insurer makes a new rate or form filing that is approved by the
2466Office of Insurance Regulation or otherwise legally allowed.
2467     (4)  The Legislature recognizes that some persons have been
2468issued a motor vehicle insurance policy effective on or after
2469October 1, 2007, and before the effective date of this act,
2470which does not include personal injury protection, based upon
2471the expected repeal of the Florida Motor Vehicle No-Fault Law on
2472October 1, 2007, pursuant to s. 19, chapter 2003-411, Laws of
2473Florida. Any such person:
2474     (a)  May continue to own and operate a motor vehicle in
2475this state without being subject to any sanction for failing to
2476maintain personal injury protection coverage if that person
2477continues to meet statutory requirements relating to property
2478damage liability coverage and obtains personal injury protection
2479coverage that takes effect no later than December 1, 2007.
2480     (b)  Is not subject to the provisions of s. 627.737,
2481Florida Statutes, relating to the exemption from tort liability
2482with respect to injuries sustained by the person in a motor
2483vehicle crash occurring while the policy without personal injury
2484protection coverage is in effect but not later than November 30,
24852007. This paragraph also applies during such period to any
2486person who would have been covered under a personal injury
2487protection policy if such a policy had been maintained on such
2488motor vehicle.
2489     (5)  Each insurer shall, by October 31, 2007, provide
2490written notification to each insured referred to in subsection
2491(4) informing the insured that he or she must obtain personal
2492injury protection coverage that takes effect no later than
2493December 1, 2007. Such notice must include the premium for such
2494coverage and the premium credit, if any, which will be provided
2495for other coverage, such as bodily injury liability coverage or
2496uninsured motorist coverage, as required by subsection (4).
2497Alternatively, the insurer may add an endorsement to the policy
2498to provide personal injury protection coverage as required by
2499law, effective no later than December 1, 2007, without requiring
2500any additional payment from the insured, and shall provide
2501written notification to the insured of such endorsement by
2502October 31, 2007.
2503     Section 23.  Except as otherwise expressly provided in this
2504act, this act shall take effect upon becoming a law.


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