CS/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; prohibiting attorney's
75fees contingency risk multiplier; restricting the amount
76of attorney's fees; extending the period during which an
77insurer may pay an overdue claim following receipt of a
78demand letter without incurring a penalty; providing for
79penalties to be imposed against certain insurers for
80failing to pay claims for personal injury protection;
81authorizing the Department of Legal Affairs to investigate
82violations and initiate enforcement action; requiring that
83all claims related to the same health care provider for
84the same injured person be brought in one act unless good
85cause is shown; authorizing notices and communications
86required or authorized under the Florida Motor Vehicle No-
87Fault Law to be transmitted electronically under certain
88conditions; providing legislative intent concerning the
89application of the act; requiring insurers to deliver
90revised notices of premium and policy changes to certain
91policyholders; requiring an insurer to cancel the policy
92and return any unearned premium if the insured fails to
93timely respond to the notice; providing for calculating
94the amount of unearned premium; requiring that insurers
95continue to use certain forms and rates until a specified
96date unless the Office of Insurance Regulation approves
97new forms or rates or such new forms or rates are
98otherwise legally allowed; providing that a person
99purchasing a motor vehicle insurance policy without
100personal injury protection coverage is exempt from the
101requirement for such coverage and is not subject to
102certain liability provisions for a specified period;
103requiring that insurers provide notice of the requirement
104for personal injury protection coverage or add an
105endorsement to the policy providing such coverage;
106providing effective dates.
107
108Be It Enacted by the Legislature of the State of Florida:
109
110     Section 1.  Subsections (1) and (3) of section 316.646,
111Florida Statutes, are amended to read:
112     316.646  Security required; proof of security and display
113thereof; dismissal of cases.--
114     (1)  Any person required by s. 324.022 to maintain property
115damage liability security, required by s. 324.023 to maintain
116liability security for bodily injury or death, or any person
117required by s. 627.733 to maintain personal injury protection
118security on a motor vehicle shall have in his or her immediate
119possession at all times while operating such motor vehicle
120proper proof of maintenance of the required security. Such proof
121shall be either a uniform proof-of-insurance card in a form
122prescribed by the department, a valid insurance policy, an
123insurance policy binder, a certificate of insurance, or such
124other proof as may be prescribed by the department.
125     (3)  Any person who violates this section commits a
126nonmoving traffic infraction subject to the penalty provided in
127chapter 318 and shall be required to furnish proof of security
128as provided in this section. If any person charged with a
129violation of this section fails to furnish proof, at or before
130the scheduled court appearance date, that security was in effect
131at the time of the violation, the court may immediately suspend
132the registration and driver's license of such person. Such
133license and registration may only be reinstated only as provided
134in s. 324.0221 627.733.
135     Section 2.  Paragraphs (a) and (d) of subsection (5) of
136section 320.02, Florida Statutes, are amended to read:
137     320.02  Registration required; application for
138registration; forms.--
139     (5)(a)  Proof that personal injury protection benefits have
140been purchased when required under s. 627.733, that property
141damage liability coverage has been purchased as required under
142s. 324.022, that bodily injury or death coverage has been
143purchased if required under s. 324.023, and that combined bodily
144liability insurance and property damage liability insurance have
145been purchased when required under s. 627.7415 shall be provided
146in the manner prescribed by law by the applicant at the time of
147application for registration of any motor vehicle that is
148subject to such requirements owned as defined in s. 627.732. The
149issuing agent shall refuse to issue registration if such proof
150of purchase is not provided. Insurers shall furnish uniform
151proof-of-purchase cards in a form prescribed by the department
152and shall include the name of the insured's insurance company,
153the coverage identification number, and the make, year, and
154vehicle identification number of the vehicle insured. The card
155shall contain a statement notifying the applicant of the penalty
156specified in s. 316.646(4). The card or insurance policy,
157insurance policy binder, or certificate of insurance or a
158photocopy of any of these; an affidavit containing the name of
159the insured's insurance company, the insured's policy number,
160and the make and year of the vehicle insured; or such other
161proof as may be prescribed by the department shall constitute
162sufficient proof of purchase. If an affidavit is provided as
163proof, it shall be in substantially the following form:
164
165Under penalty of perjury, I   (Name of insured)   do hereby
166certify that I have   (Personal Injury Protection, Property
167Damage Liability, and, when required, Bodily Injury Liability)  
168Insurance currently in effect with   (Name of insurance company)  
169under   (policy number)   covering   (make, year, and vehicle
170identification number of vehicle)  .   (Signature of Insured)  
171
172Such affidavit shall include the following warning:
173
174WARNING: GIVING FALSE INFORMATION IN ORDER TO OBTAIN A VEHICLE
175REGISTRATION CERTIFICATE IS A CRIMINAL OFFENSE UNDER FLORIDA
176LAW. ANYONE GIVING FALSE INFORMATION ON THIS AFFIDAVIT IS
177SUBJECT TO PROSECUTION.
178
179When an application is made through a licensed motor vehicle
180dealer as required in s. 319.23, the original or a photostatic
181copy of such card, insurance policy, insurance policy binder, or
182certificate of insurance or the original affidavit from the
183insured shall be forwarded by the dealer to the tax collector of
184the county or the Department of Highway Safety and Motor
185Vehicles for processing. By executing the aforesaid affidavit,
186no licensed motor vehicle dealer will be liable in damages for
187any inadequacy, insufficiency, or falsification of any statement
188contained therein. A card shall also indicate the existence of
189any bodily injury liability insurance voluntarily purchased.
190     (d)  The verifying of proof of personal injury protection
191insurance, proof of property damage liability insurance, proof
192of combined bodily liability insurance and property damage
193liability insurance, or proof of financial responsibility
194insurance and the issuance or failure to issue the motor vehicle
195registration under the provisions of this chapter may not be
196construed in any court as a warranty of the reliability or
197accuracy of the evidence of such proof. Neither the department
198nor any tax collector is liable in damages for any inadequacy,
199insufficiency, falsification, or unauthorized modification of
200any item of the proof of personal injury protection insurance,
201proof of property damage liability insurance, proof of combined
202bodily liability insurance and property damage liability
203insurance, or proof of financial responsibility insurance either
204prior to, during, or subsequent to the verification of the
205proof. The issuance of a motor vehicle registration does not
206constitute prima facie evidence or a presumption of insurance
207coverage.
208     Section 3.  Section 321.245, Florida Statutes, is amended
209to read:
210     321.245  Disposition of certain funds in the Highway Safety
211Operating Trust Fund.--The director of the Florida Highway
212Patrol, after receiving recommendations from the commander of
213the auxiliary, is authorized to purchase uniforms and equipment
214for auxiliary law enforcement officers as defined in s. 321.24
215from funds described in s. 324.0221(3) 627.733(7). The amounts
216expended under this section shall not exceed $50,000 in any one
217fiscal year.
218     Section 4.  Section 324.022, Florida Statutes, is amended
219to read:
220     324.022  Financial responsibility for property damage.--
221     (1)  Every owner or operator of a motor vehicle, which
222motor vehicle is subject to the requirements of ss. 627.730-
223627.7405 and required to be registered in this state, shall, by
224one of the methods established in s. 324.031 or by having a
225policy that complies with s. 627.7275, establish and maintain
226the ability to respond in damages for liability on account of
227accidents arising out of the use of the motor vehicle in the
228amount of $10,000 because of damage to, or destruction of,
229property of others in any one crash. The requirements of this
230section may be met by one of the methods established in s.
231324.031; by self-insuring as authorized by s. 768.28(16); or by
232maintaining an insurance policy providing coverage for property
233damage liability in the amount of at least $10,000 because of
234damage to, or destruction of, property of others in any one
235accident arising out of the use of the motor vehicle. The
236requirements of this section may also be met by having a policy
237which provides coverage in the amount of at least $30,000 for
238combined property damage liability and bodily injury liability
239for any one crash arising out of the use of the motor vehicle.
240The policy, with respect to coverage for property damage
241liability, must meet the applicable requirements of s. 324.151,
242subject to the usual policy exclusions that have been approved
243in policy forms by the Office of Insurance Regulation. No
244insurer shall have any duty to defend uncovered claims
245irrespective of their joinder with covered claims.
246     (2)  As used in this section, the term:
247     (a)  "Motor vehicle" means any self-propelled vehicle that
248has four or more wheels and that is of a type designed and
249required to be licensed for use on the highways of this state,
250and any trailer or semitrailer designed for use with such
251vehicle. The term does not include:
252     1.  A mobile home.
253     2.  A motor vehicle that is used in mass transit and
254designed to transport more than five passengers, exclusive of
255the operator of the motor vehicle, and that is owned by a
256municipality, transit authority, or political subdivision of the
257state.
258     3.  A school bus as defined in s. 1006.25.
259     4.  A vehicle providing for-hire transportation that is
260subject to the provisions of s. 324.031. A taxicab shall
261maintain security as required under s. 324.032(1).
262     (b)  "Owner" means the person who holds legal title to a
263motor vehicle or the debtor or lessee who has the right to
264possession of a motor vehicle that is the subject of a security
265agreement or lease with an option to purchase.
266     (3)  Each nonresident owner or registrant of a motor
267vehicle that, whether operated or not, has been physically
268present within this state for more than 90 days during the
269preceding 365 days shall maintain security as required by
270subsection (1) that is in effect continuously throughout the
271period the motor vehicle remains within this state.
272     (4)  The owner or registrant of a motor vehicle is exempt
273from the requirements of this section if she or he is a member
274of the United States Armed Forces and is called to or on active
275duty outside the United States in an emergency situation. The
276exemption provided by this subsection applies only as long as
277the member of the Armed Forces is on such active duty outside
278the United States and applies only while the vehicle is not
279operated by any person. Upon receipt of a written request by the
280insured to whom the exemption provided in this subsection
281applies, the insurer shall cancel the coverages and return any
282unearned premium or suspend the security required by this
283section. Notwithstanding s. 324.0221(3), the department may not
284suspend the registration or operator's license of any owner or
285registrant of a motor vehicle during the time she or he
286qualifies for an exemption under this subsection. Any owner or
287registrant of a motor vehicle who qualifies for an exemption
288under this subsection shall immediately notify the department
289prior to and at the end of the expiration of the exemption.
290     Section 5.  Section 324.0221, Florida Statutes, is created
291to read:
292     324.0221  Reports by insurers to the department; suspension
293of driver's license and vehicle registrations; reinstatement.--
294     (1)(a)  Each insurer that has issued a policy providing
295personal injury protection coverage or property damage liability
296coverage shall report the renewal, cancellation, or nonrenewal
297thereof to the department within 45 days after the effective
298date of each renewal, cancellation, or nonrenewal. Upon the
299issuance of a policy providing personal injury protection
300coverage or property damage liability coverage to a named
301insured not previously insured by the insurer during that
302calendar year, the insurer shall report the issuance of the new
303policy to the department within 30 days. The report shall be in
304the form and format and contain any information required by the
305department and must be provided in a format that is compatible
306with the data-processing capabilities of the department. The
307department may adopt rules regarding the form and documentation
308required. Failure by an insurer to file proper reports with the
309department as required by this subsection or rules adopted with
310respect to the requirements of this subsection constitutes a
311violation of the Florida Insurance Code. These records shall be
312used by the department only for enforcement and regulatory
313purposes, including the generation by the department of data
314regarding compliance by owners of motor vehicles with the
315requirements for financial responsibility coverage.
316     (b)  With respect to an insurance policy providing personal
317injury protection coverage or property damage liability
318coverage, each insurer shall notify the named insured, or the
319first-named insured in the case of a commercial fleet policy, in
320writing that any cancellation or nonrenewal of the policy will
321be reported by the insurer to the department. The notice must
322also inform the named insured that failure to maintain personal
323injury protection coverage and property damage liability
324coverage on a motor vehicle when required by law may result in
325the loss of registration and driving privileges in this state
326and inform the named insured of the amount of the reinstatement
327fees required by this section. This notice is for informational
328purposes only, and an insurer is not civilly liable for failing
329to provide this notice.
330     (2)  The department shall suspend, after due notice and an
331opportunity to be heard, the registration and driver's license
332of any owner or registrant of a motor vehicle with respect to
333which security is required under ss. 324.022 and 627.733 upon:
334     (a)  The department's records showing that the owner or
335registrant of such motor vehicle did not have in full force and
336effect when required security that complies with the
337requirements of ss. 324.022 and 627.733; or
338     (b)  Notification by the insurer to the department, in a
339form approved by the department, of cancellation or termination
340of the required security.
341     (3)  An operator or owner whose driver's license or
342registration has been suspended under this section or s. 316.646
343may effect its reinstatement upon compliance with the
344requirements of this section and upon payment to the department
345of a nonrefundable reinstatement fee of $150 for the first
346reinstatement. The reinstatement fee is $250 for the second
347reinstatement and $500 for each subsequent reinstatement during
348the 3 years following the first reinstatement. A person
349reinstating her or his insurance under this subsection must also
350secure noncancelable coverage as described in ss. 324.021(8),
351324.023, and 627.7275(2) and present to the appropriate person
352proof that the coverage is in force on a form adopted by the
353department, and such proof shall be maintained for 2 years. If
354the person does not have a second reinstatement within 3 years
355after her or his initial reinstatement, the reinstatement fee is
356$150 for the first reinstatement after that 3-year period. If a
357person's license and registration are suspended under this
358section or s. 316.646, only one reinstatement fee must be paid
359to reinstate the license and the registration. All fees shall be
360collected by the department at the time of reinstatement. The
361department shall issue proper receipts for such fees and shall
362promptly deposit those fees in the Highway Safety Operating
363Trust Fund. One-third of the fees collected under this
364subsection shall be distributed from the Highway Safety
365Operating Trust Fund to the local governmental entity or state
366agency that employed the law enforcement officer seizing the
367license plate pursuant to s. 324.201. The funds may be used by
368the local governmental entity or state agency for any authorized
369purpose.
370     Section 6.  Section 627.7275, Florida Statutes, is amended
371to read:
372     627.7275  Motor vehicle liability.--
373     (1)  A motor vehicle insurance policy providing personal
374injury protection as set forth in s. 627.736 may not be
375delivered or issued for delivery in this state with respect to
376any specifically insured or identified motor vehicle registered
377or principally garaged in this state unless the policy also
378provides coverage for property damage liability as required by
379s. 324.022 in the amount of at least $10,000 because of damage
380to, or destruction of, property of others in any one accident
381arising out of the use of the motor vehicle or unless the policy
382provides coverage in the amount of at least $30,000 for combined
383property damage liability and bodily injury liability in any one
384accident arising out of the use of the motor vehicle. The
385policy, as to coverage of property damage liability, must meet
386the applicable requirements of s. 324.151, subject to the usual
387policy exclusions that have been approved in policy forms by the
388office.
389     (2)(a)  Insurers writing motor vehicle insurance in this
390state shall make available, subject to the insurers' usual
391underwriting restrictions:
392     1.  Coverage under policies as described in subsection (1)
393to any applicant for private passenger motor vehicle insurance
394coverage who is seeking the coverage in order to reinstate the
395applicant's driving privileges in this state when the driving
396privileges were revoked or suspended pursuant to s. 316.646 or
397s. 324.0221 627.733 due to the failure of the applicant to
398maintain required security.
399     2.  Coverage under policies as described in subsection (1),
400which also provides liability coverage for bodily injury, death,
401and property damage arising out of the ownership, maintenance,
402or use of the motor vehicle in an amount not less than the
403limits described in s. 324.021(7) and conforms to the
404requirements of s. 324.151, to any applicant for private
405passenger motor vehicle insurance coverage who is seeking the
406coverage in order to reinstate the applicant's driving
407privileges in this state after such privileges were revoked or
408suspended under s. 316.193 or s. 322.26(2) for driving under the
409influence.
410     (b)  The policies described in paragraph (a) shall be
411issued for a period of at least 6 months and as to the minimum
412coverages required under this section shall not be cancelable by
413the insured for any reason or by the insurer after a period not
414to exceed 30 days during which the insurer must complete
415underwriting of the policy. After the insurer has completed
416underwriting the policy within the 30-day period, the insurer
417shall notify the Department of Highway Safety and Motor Vehicles
418that the policy is in full force and effect and the policy shall
419not be cancelable for the remainder of the policy period. A
420premium shall be collected and coverage shall be in effect for
421the 30-day period during which the insurer is completing the
422underwriting of the policy whether or not the person's driver
423license, motor vehicle tag, and motor vehicle registration are
424in effect. Once the noncancelable provisions of the policy
425become effective, the coverage or risk shall not be changed
426during the policy period and the premium shall be nonrefundable.
427If, during the pendency of the 2-year proof of insurance period
428required under s. 324.0221 627.733(7) or during the 3-year proof
429of financial responsibility required under s. 324.131, whichever
430is applicable, the insured obtains additional coverage or
431coverage for an additional risk or changes territories, the
432insured must obtain a new 6-month noncancelable policy in
433accordance with the provisions of this section. However, if the
434insured must obtain a new 6-month policy and obtains the policy
435from the same insurer, the policyholder shall receive credit on
436the new policy for any premium paid on the previously issued
437policy.
438     (c)  This subsection controls to the extent of any conflict
439with any other section.
440     (d)  An insurer issuing a policy subject to this section
441may cancel the policy if, during the policy term, the named
442insured or any other operator, who resides in the same household
443or customarily operates an automobile insured under the policy,
444has his or her driver's license suspended or revoked.
445     (e)  Nothing in this subsection requires an insurer to
446offer a policy of insurance to an applicant if such offer would
447be inconsistent with the insurer's underwriting guidelines and
448procedures.
449     Section 7.  Paragraph (a) of subsection (1) of section
450627.7295, Florida Statutes, is amended to read:
451     627.7295  Motor vehicle insurance contracts.--
452     (1)  As used in this section, the term:
453     (a)  "Policy" means a motor vehicle insurance policy that
454provides personal injury protection coverage, and property
455damage liability coverage, or both.
456     Section 8.  Notwithstanding the repeal of the Florida Motor
457Vehicle No-Fault Law, which occurred on October 1, 2007, section
458627.730, Florida Statutes, is revived and reenacted to read:
459     627.730  Florida Motor Vehicle No-Fault Law.--Sections
460627.730-627.7405 may be cited and known as the "Florida Motor
461Vehicle No-Fault Law."
462     Section 9.  Notwithstanding the repeal of the Florida Motor
463Vehicle No-Fault Law, which occurred on October 1, 2007, section
464627.731, Florida Statutes, is revived and reenacted to read:
465     627.731  Purpose.--The purpose of ss. 627.730-627.7405 is
466to provide for medical, surgical, funeral, and disability
467insurance benefits without regard to fault, and to require motor
468vehicle insurance securing such benefits, for motor vehicles
469required to be registered in this state and, with respect to
470motor vehicle accidents, a limitation on the right to claim
471damages for pain, suffering, mental anguish, and inconvenience.
472     Section 10.  Notwithstanding the repeal of the Florida
473Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
474section 627.732, Florida Statutes, is revived and reenacted to
475read:
476     627.732  Definitions.--As used in ss. 627.730-627.7405, the
477term:
478     (1)  "Broker" means any person not possessing a license
479under chapter 395, chapter 400, chapter 429, chapter 458,
480chapter 459, chapter 460, chapter 461, or chapter 641 who
481charges or receives compensation for any use of medical
482equipment and is not the 100-percent owner or the 100-percent
483lessee of such equipment. For purposes of this section, such
484owner or lessee may be an individual, a corporation, a
485partnership, or any other entity and any of its 100-percent-
486owned affiliates and subsidiaries. For purposes of this
487subsection, the term "lessee" means a long-term lessee under a
488capital or operating lease, but does not include a part-time
489lessee. The term "broker" does not include a hospital or
490physician management company whose medical equipment is
491ancillary to the practices managed, a debt collection agency, or
492an entity that has contracted with the insurer to obtain a
493discounted rate for such services; nor does the term include a
494management company that has contracted to provide general
495management services for a licensed physician or health care
496facility and whose compensation is not materially affected by
497the usage or frequency of usage of medical equipment or an
498entity that is 100-percent owned by one or more hospitals or
499physicians. The term "broker" does not include a person or
500entity that certifies, upon request of an insurer, that:
501     (a)  It is a clinic licensed under ss. 400.990-400.995;
502     (b)  It is a 100-percent owner of medical equipment; and
503     (c)  The owner's only part-time lease of medical equipment
504for personal injury protection patients is on a temporary basis
505not to exceed 30 days in a 12-month period, and such lease is
506solely for the purposes of necessary repair or maintenance of
507the 100-percent-owned medical equipment or pending the arrival
508and installation of the newly purchased or a replacement for the
509100-percent-owned medical equipment, or for patients for whom,
510because of physical size or claustrophobia, it is determined by
511the medical director or clinical director to be medically
512necessary that the test be performed in medical equipment that
513is open-style. The leased medical equipment cannot be used by
514patients who are not patients of the registered clinic for
515medical treatment of services. Any person or entity making a
516false certification under this subsection commits insurance
517fraud as defined in s. 817.234. However, the 30-day period
518provided in this paragraph may be extended for an additional 60
519days as applicable to magnetic resonance imaging equipment if
520the owner certifies that the extension otherwise complies with
521this paragraph.
522     (2)  "Medically necessary" refers to a medical service or
523supply that a prudent physician would provide for the purpose of
524preventing, diagnosing, or treating an illness, injury, disease,
525or symptom in a manner that is:
526     (a)  In accordance with generally accepted standards of
527medical practice;
528     (b)  Clinically appropriate in terms of type, frequency,
529extent, site, and duration; and
530     (c)  Not primarily for the convenience of the patient,
531physician, or other health care provider.
532     (3)  "Motor vehicle" means any self-propelled vehicle with
533four or more wheels which is of a type both designed and
534required to be licensed for use on the highways of this state
535and any trailer or semitrailer designed for use with such
536vehicle and includes:
537     (a)  A "private passenger motor vehicle," which is any
538motor vehicle which is a sedan, station wagon, or jeep-type
539vehicle and, if not used primarily for occupational,
540professional, or business purposes, a motor vehicle of the
541pickup, panel, van, camper, or motor home type.
542     (b)  A "commercial motor vehicle," which is any motor
543vehicle which is not a private passenger motor vehicle.
544
545The term "motor vehicle" does not include a mobile home or any
546motor vehicle which is used in mass transit, other than public
547school transportation, and designed to transport more than five
548passengers exclusive of the operator of the motor vehicle and
549which is owned by a municipality, a transit authority, or a
550political subdivision of the state.
551     (4)  "Named insured" means a person, usually the owner of a
552vehicle, identified in a policy by name as the insured under the
553policy.
554     (5)  "Owner" means a person who holds the legal title to a
555motor vehicle; or, in the event a motor vehicle is the subject
556of a security agreement or lease with an option to purchase with
557the debtor or lessee having the right to possession, then the
558debtor or lessee shall be deemed the owner for the purposes of
559ss. 627.730-627.7405.
560     (6)  "Relative residing in the same household" means a
561relative of any degree by blood or by marriage who usually makes
562her or his home in the same family unit, whether or not
563temporarily living elsewhere.
564     (7)  "Certify" means to swear or attest to being true or
565represented in writing.
566     (8)  "Immediate personal supervision," as it relates to the
567performance of medical services by nonphysicians not in a
568hospital, means that an individual licensed to perform the
569medical service or provide the medical supplies must be present
570within the confines of the physical structure where the medical
571services are performed or where the medical supplies are
572provided such that the licensed individual can respond
573immediately to any emergencies if needed.
574     (9)  "Incident," with respect to services considered as
575incident to a physician's professional service, for a physician
576licensed under chapter 458, chapter 459, chapter 460, or chapter
577461, if not furnished in a hospital, means such services must be
578an integral, even if incidental, part of a covered physician's
579service.
580     (10)  "Knowingly" means that a person, with respect to
581information, has actual knowledge of the information; acts in
582deliberate ignorance of the truth or falsity of the information;
583or acts in reckless disregard of the information, and proof of
584specific intent to defraud is not required.
585     (11)  "Lawful" or "lawfully" means in substantial
586compliance with all relevant applicable criminal, civil, and
587administrative requirements of state and federal law related to
588the provision of medical services or treatment.
589     (12)  "Hospital" means a facility that, at the time
590services or treatment were rendered, was licensed under chapter
591395.
592     (13)  "Properly completed" means providing truthful,
593substantially complete, and substantially accurate responses as
594to all material elements to each applicable request for
595information or statement by a means that may lawfully be
596provided and that complies with this section, or as agreed by
597the parties.
598     (14)  "Upcoding" means an action that submits a billing
599code that would result in payment greater in amount than would
600be paid using a billing code that accurately describes the
601services performed. The term does not include an otherwise
602lawful bill by a magnetic resonance imaging facility, which
603globally combines both technical and professional components, if
604the amount of the global bill is not more than the components if
605billed separately; however, payment of such a bill constitutes
606payment in full for all components of such service.
607     (15)  "Unbundling" means an action that submits a billing
608code that is properly billed under one billing code, but that
609has been separated into two or more billing codes, and would
610result in payment greater in amount than would be paid using one
611billing code.
612     Section 11.  Notwithstanding the repeal of the Florida
613Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
614section 627.733, Florida Statutes, is revived, reenacted, and
615amended to read:
616     627.733  Required security.--
617     (1)(a)  Every owner or registrant of a motor vehicle, other
618than a motor vehicle used as a school bus as defined in s.
6191006.25 or limousine, required to be registered and licensed in
620this state shall maintain security as required by subsection (3)
621in effect continuously throughout the registration or licensing
622period.
623     (b)  Every owner or registrant of a motor vehicle used as a
624taxicab shall not be governed by paragraph (1)(a) but shall
625maintain security as required under s. 324.032(1), and s.
626627.737 shall not apply to any motor vehicle used as a taxicab.
627     (2)  Every nonresident owner or registrant of a motor
628vehicle which, whether operated or not, has been physically
629present within this state for more than 90 days during the
630preceding 365 days shall thereafter maintain security as defined
631by subsection (3) in effect continuously throughout the period
632such motor vehicle remains within this state.
633     (3)  Such security shall be provided:
634     (a)  By an insurance policy delivered or issued for
635delivery in this state by an authorized or eligible motor
636vehicle liability insurer which provides the benefits and
637exemptions contained in ss. 627.730-627.7405. Any policy of
638insurance represented or sold as providing the security required
639hereunder shall be deemed to provide insurance for the payment
640of the required benefits; or
641     (b)  By any other method authorized by s. 324.031(2), (3),
642or (4) and approved by the Department of Highway Safety and
643Motor Vehicles as affording security equivalent to that afforded
644by a policy of insurance or by self-insuring as authorized by s.
645768.28(16). The person filing such security shall have all of
646the obligations and rights of an insurer under ss. 627.730-
647627.7405.
648     (4)  An owner of a motor vehicle with respect to which
649security is required by this section who fails to have such
650security in effect at the time of an accident shall have no
651immunity from tort liability, but shall be personally liable for
652the payment of benefits under s. 627.736. With respect to such
653benefits, such an owner shall have all of the rights and
654obligations of an insurer under ss. 627.730-627.7405.
655     (5)  In addition to other persons who are not required to
656provide required security as required under this section and s.
657324.022, the owner or registrant of a motor vehicle is exempt
658from such requirements if she or he is a member of the United
659States Armed Forces and is called to or on active duty outside
660the United States in an emergency situation. The exemption
661provided by this subsection applies only as long as the member
662of the armed forces is on such active duty outside the United
663States and applies only while the vehicle covered by the
664security required by this section and s. 324.022 is not operated
665by any person. Upon receipt of a written request by the insured
666to whom the exemption provided in this subsection applies, the
667insurer shall cancel the coverages and return any unearned
668premium or suspend the security required by this section and s.
669324.022. Notwithstanding s. 324.0221(2) subsection (6), the
670Department of Highway Safety and Motor Vehicles may not suspend
671the registration or operator's license of any owner or
672registrant of a motor vehicle during the time she or he
673qualifies for an exemption under this subsection. Any owner or
674registrant of a motor vehicle who qualifies for an exemption
675under this subsection shall immediately notify the department
676prior to and at the end of the expiration of the exemption.
677     (6)  The Department of Highway Safety and Motor Vehicles
678shall suspend, after due notice and an opportunity to be heard,
679the registration and driver's license of any owner or registrant
680of a motor vehicle with respect to which security is required
681under this section and s. 324.022:
682     (a)  Upon its records showing that the owner or registrant
683of such motor vehicle did not have in full force and effect when
684required security complying with the terms of this section; or
685     (b)  Upon notification by the insurer to the Department of
686Highway Safety and Motor Vehicles, in a form approved by the
687department, of cancellation or termination of the required
688security.
689     (7)  Any operator or owner whose driver's license or
690registration has been suspended pursuant to this section or s.
691316.646 may effect its reinstatement upon compliance with the
692requirements of this section and upon payment to the Department
693of Highway Safety and Motor Vehicles of a nonrefundable
694reinstatement fee of $150 for the first reinstatement.  Such
695reinstatement fee shall be $250 for the second reinstatement and
696$500 for each subsequent reinstatement during the 3 years
697following the first reinstatement. Any person reinstating her or
698his insurance under this subsection must also secure
699noncancelable coverage as described in ss. 324.021(8), 324.023,
700and 627.7275(2) and present to the appropriate person proof that
701the coverage is in force on a form promulgated by the Department
702of Highway Safety and Motor Vehicles, such proof to be
703maintained for 2 years.  If the person does not have a second
704reinstatement within 3 years after her or his initial
705reinstatement, the reinstatement fee shall be $150 for the first
706reinstatement after that 3-year period. In the event that a
707person's license and registration are suspended pursuant to this
708section or s. 316.646, only one reinstatement fee shall be paid
709to reinstate the license and the registration. All fees shall be
710collected by the Department of Highway Safety and Motor Vehicles
711at the time of reinstatement. The Department of Highway Safety
712and Motor Vehicles shall issue proper receipts for such fees and
713shall promptly deposit those fees in the Highway Safety
714Operating Trust Fund. One-third of the fee collected under this
715subsection shall be distributed from the Highway Safety
716Operating Trust Fund to the local government entity or state
717agency which employed the law enforcement officer who seizes a
718license plate pursuant to s. 324.201. Such funds may be used by
719the local government entity or state agency for any authorized
720purpose.
721     Section 12.  Notwithstanding the repeal of the Florida
722Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
723section 627.734, Florida Statutes, is revived and reenacted to
724read:
725     627.734  Proof of security; security requirements;
726penalties.--
727     (1)  The provisions of chapter 324 which pertain to the
728method of giving and maintaining proof of financial
729responsibility and which govern and define a motor vehicle
730liability policy shall apply to filing and maintaining proof of
731security required by ss. 627.730-627.7405.
732     (2)  Any person who:
733     (a)  Gives information required in a report or otherwise as
734provided for in ss. 627.730-627.7405, knowing or having reason
735to believe that such information is false;
736     (b)  Forges or, without authority, signs any evidence of
737proof of security; or
738     (c)  Files, or offers for filing, any such evidence of
739proof, knowing or having reason to believe that it is forged or
740signed without authority,
741
742is guilty of a misdemeanor of the first degree, punishable as
743provided in s. 775.082 or s. 775.083.
744     Section 13.  Notwithstanding the repeal of the Florida
745Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
746section 627.736, Florida Statutes, is revived, reenacted, and
747amended to read:
748     627.736  Required personal injury protection benefits;
749exclusions; priority; claims.--
750     (1)  REQUIRED BENEFITS.--Every insurance policy complying
751with the security requirements of s. 627.733 shall provide
752personal injury protection to the named insured, relatives
753residing in the same household, persons operating the insured
754motor vehicle, passengers in such motor vehicle, and other
755persons struck by such motor vehicle and suffering bodily injury
756while not an occupant of a self-propelled vehicle, subject to
757the provisions of subsection (2) and paragraph (4)(d), to a
758limit of $10,000 for loss sustained by any such person as a
759result of bodily injury, sickness, disease, or death arising out
760of the ownership, maintenance, or use of a motor vehicle as
761follows:
762     (a)  Medical benefits.--Eighty percent of all reasonable
763expenses for medically necessary medical, surgical, X-ray,
764dental, and rehabilitative services, including prosthetic
765devices, and medically necessary ambulance, hospital, and
766nursing services. Such benefits shall also include necessary
767remedial treatment and services recognized and permitted under
768the laws of the state for an injured person who relies upon
769spiritual means through prayer alone for healing, in accordance
770with his or her religious beliefs; however, this sentence does
771not affect the determination of what other services or
772procedures are medically necessary.
773     (b)  Disability benefits.--Sixty percent of any loss of
774gross income and loss of earning capacity per individual from
775inability to work proximately caused by the injury sustained by
776the injured person, plus all expenses reasonably incurred in
777obtaining from others ordinary and necessary services in lieu of
778those that, but for the injury, the injured person would have
779performed without income for the benefit of his or her
780household. All disability benefits payable under this provision
781shall be paid not less than every 2 weeks.
782     (c)  Death benefits.--Death benefits of $5,000 per
783individual.  The insurer may pay such benefits to the executor
784or administrator of the deceased, to any of the deceased's
785relatives by blood or legal adoption or connection by marriage,
786or to any person appearing to the insurer to be equitably
787entitled thereto.
788
789Only insurers writing motor vehicle liability insurance in this
790state may provide the required benefits of this section, and no
791such insurer shall require the purchase of any other motor
792vehicle coverage other than the purchase of property damage
793liability coverage as required by s. 627.7275 as a condition for
794providing such required benefits. Insurers may not require that
795property damage liability insurance in an amount greater than
796$10,000 be purchased in conjunction with personal injury
797protection.  Such insurers shall make benefits and required
798property damage liability insurance coverage available through
799normal marketing channels. Any insurer writing motor vehicle
800liability insurance in this state who fails to comply with such
801availability requirement as a general business practice shall be
802deemed to have violated part IX of chapter 626, and such
803violation shall constitute an unfair method of competition or an
804unfair or deceptive act or practice involving the business of
805insurance; and any such insurer committing such violation shall
806be subject to the penalties afforded in such part, as well as
807those which may be afforded elsewhere in the insurance code.
808     (2)  AUTHORIZED EXCLUSIONS.--Any insurer may exclude
809benefits:
810     (a)  For injury sustained by the named insured and
811relatives residing in the same household while occupying another
812motor vehicle owned by the named insured and not insured under
813the policy or for injury sustained by any person operating the
814insured motor vehicle without the express or implied consent of
815the insured.
816     (b)  To any injured person, if such person's conduct
817contributed to his or her injury under any of the following
818circumstances:
819     1.  Causing injury to himself or herself intentionally; or
820     2.  Being injured while committing a felony.
821
822Whenever an insured is charged with conduct as set forth in
823subparagraph 2., the 30-day payment provision of paragraph
824(4)(b) shall be held in abeyance, and the insurer shall withhold
825payment of any personal injury protection benefits pending the
826outcome of the case at the trial level.  If the charge is nolle
827prossed or dismissed or the insured is acquitted, the 30-day
828payment provision shall run from the date the insurer is
829notified of such action.
830     (3)  INSURED'S RIGHTS TO RECOVERY OF SPECIAL DAMAGES IN
831TORT CLAIMS.--No insurer shall have a lien on any recovery in
832tort by judgment, settlement, or otherwise for personal injury
833protection benefits, whether suit has been filed or settlement
834has been reached without suit.  An injured party who is entitled
835to bring suit under the provisions of ss. 627.730-627.7405, or
836his or her legal representative, shall have no right to recover
837any damages for which personal injury protection benefits are
838paid or payable. The plaintiff may prove all of his or her
839special damages notwithstanding this limitation, but if special
840damages are introduced in evidence, the trier of facts, whether
841judge or jury, shall not award damages for personal injury
842protection benefits paid or payable.  In all cases in which a
843jury is required to fix damages, the court shall instruct the
844jury that the plaintiff shall not recover such special damages
845for personal injury protection benefits paid or payable.
846     (4)  BENEFITS; WHEN DUE.--Benefits due from an insurer
847under ss. 627.730-627.7405 shall be primary, except that
848benefits received under any workers' compensation law shall be
849credited against the benefits provided by subsection (1) and
850shall be due and payable as loss accrues, upon receipt of
851reasonable proof of such loss and the amount of expenses and
852loss incurred which are covered by the policy issued under ss.
853627.730-627.7405. When the Agency for Health Care Administration
854provides, pays, or becomes liable for medical assistance under
855the Medicaid program related to injury, sickness, disease, or
856death arising out of the ownership, maintenance, or use of a
857motor vehicle, benefits under ss. 627.730-627.7405 shall be
858subject to the provisions of the Medicaid program.
859     (a)  An insurer may require written notice to be given as
860soon as practicable after an accident involving a motor vehicle
861with respect to which the policy affords the security required
862by ss. 627.730-627.7405.
863     (b)  Personal injury protection insurance benefits paid
864pursuant to this section shall be overdue if not paid within 30
865days after the insurer is furnished written notice of the fact
866of a covered loss and of the amount of same. If such written
867notice is not furnished to the insurer as to the entire claim,
868any partial amount supported by written notice is overdue if not
869paid within 30 days after such written notice is furnished to
870the insurer. Any part or all of the remainder of the claim that
871is subsequently supported by written notice is overdue if not
872paid within 30 days after such written notice is furnished to
873the insurer. When an insurer pays only a portion of a claim or
874rejects a claim, the insurer shall provide at the time of the
875partial payment or rejection an itemized specification of each
876item that the insurer had reduced, omitted, or declined to pay
877and any information that the insurer desires the claimant to
878consider related to the medical necessity of the denied
879treatment or to explain the reasonableness of the reduced
880charge, provided that this shall not limit the introduction of
881evidence at trial; and the insurer shall include the name and
882address of the person to whom the claimant should respond and a
883claim number to be referenced in future correspondence. However,
884notwithstanding the fact that written notice has been furnished
885to the insurer, any payment shall not be deemed overdue when the
886insurer has reasonable proof to establish that the insurer is
887not responsible for the payment. For the purpose of calculating
888the extent to which any benefits are overdue, payment shall be
889treated as being made on the date a draft or other valid
890instrument which is equivalent to payment was placed in the
891United States mail in a properly addressed, postpaid envelope
892or, if not so posted, on the date of delivery. This paragraph
893does not preclude or limit the ability of the insurer to assert
894that the claim was unrelated, was not medically necessary, or
895was unreasonable or that the amount of the charge was in excess
896of that permitted under, or in violation of, subsection (5).
897Such assertion by the insurer may be made at any time, including
898after payment of the claim or after the 30-day time period for
899payment set forth in this paragraph.
900     (c)  All overdue payments shall bear simple interest at the
901rate established under s. 55.03 or the rate established in the
902insurance contract, whichever is greater, for the year in which
903the payment became overdue, calculated from the date the insurer
904was furnished with written notice of the amount of covered loss.
905Interest shall be due at the time payment of the overdue claim
906is made.
907     (d)  The insurer of the owner of a motor vehicle shall pay
908personal injury protection benefits for:
909     1.  Accidental bodily injury sustained in this state by the
910owner while occupying a motor vehicle, or while not an occupant
911of a self-propelled vehicle if the injury is caused by physical
912contact with a motor vehicle.
913     2.  Accidental bodily injury sustained outside this state,
914but within the United States of America or its territories or
915possessions or Canada, by the owner while occupying the owner's
916motor vehicle.
917     3.  Accidental bodily injury sustained by a relative of the
918owner residing in the same household, under the circumstances
919described in subparagraph 1. or subparagraph 2., provided the
920relative at the time of the accident is domiciled in the owner's
921household and is not himself or herself the owner of a motor
922vehicle with respect to which security is required under ss.
923627.730-627.7405.
924     4.  Accidental bodily injury sustained in this state by any
925other person while occupying the owner's motor vehicle or, if a
926resident of this state, while not an occupant of a self-
927propelled vehicle, if the injury is caused by physical contact
928with such motor vehicle, provided the injured person is not
929himself or herself:
930     a.  The owner of a motor vehicle with respect to which
931security is required under ss. 627.730-627.7405; or
932     b.  Entitled to personal injury benefits from the insurer
933of the owner or owners of such a motor vehicle.
934     (e)  If two or more insurers are liable to pay personal
935injury protection benefits for the same injury to any one
936person, the maximum payable shall be as specified in subsection
937(1), and any insurer paying the benefits shall be entitled to
938recover from each of the other insurers an equitable pro rata
939share of the benefits paid and expenses incurred in processing
940the claim.
941     (f)  It is a violation of the insurance code for an insurer
942to fail to timely provide benefits as required by this section
943with such frequency as to constitute a general business
944practice.
945     (g)  Benefits shall not be due or payable to or on the
946behalf of an insured person if that person has committed, by a
947material act or omission, any insurance fraud relating to
948personal injury protection coverage under his or her policy, if
949the fraud is admitted to in a sworn statement by the insured or
950if it is established in a court of competent jurisdiction. Any
951insurance fraud shall void all coverage arising from the claim
952related to such fraud under the personal injury protection
953coverage of the insured person who committed the fraud,
954irrespective of whether a portion of the insured person's claim
955may be legitimate, and any benefits paid prior to the discovery
956of the insured person's insurance fraud shall be recoverable by
957the insurer from the person who committed insurance fraud in
958their entirety. The prevailing party is entitled to its costs
959and attorney's fees in any action in which it prevails in an
960insurer's action to enforce its right of recovery under this
961paragraph.
962     (5)  CHARGES FOR TREATMENT OF INJURED PERSONS.--
963     (a)  Any physician, hospital, clinic, or other person or
964institution lawfully rendering treatment to an injured person
965for a bodily injury covered by personal injury protection
966insurance may charge the insurer and injured party only a
967reasonable amount pursuant to this section for the services and
968supplies rendered, and the insurer providing such coverage may
969pay for such charges directly to such person or institution
970lawfully rendering such treatment, if the insured receiving such
971treatment or his or her guardian has countersigned the properly
972completed invoice, bill, or claim form approved by the office
973upon which such charges are to be paid for as having actually
974been rendered, to the best knowledge of the insured or his or
975her guardian. In no event, however, may such a charge be in
976excess of the amount the person or institution customarily
977charges for like services or supplies. With respect to a
978determination of whether a charge for a particular service,
979treatment, or otherwise is reasonable, consideration may be
980given to evidence of usual and customary charges and payments
981accepted by the provider involved in the dispute, and
982reimbursement levels in the community and various federal and
983state medical fee schedules applicable to automobile and other
984insurance coverages, and other information relevant to the
985reasonableness of the reimbursement for the service, treatment,
986or supply.
987     (b)1.  An insurer or insured is not required to pay a claim
988or charges:
989     a.  Made by a broker or by a person making a claim on
990behalf of a broker;
991     b.  For any service or treatment that was not lawful at the
992time rendered;
993     c.  To any person who knowingly submits a false or
994misleading statement relating to the claim or charges;
995     d.  With respect to a bill or statement that does not
996substantially meet the applicable requirements of paragraph (d);
997     e.  For any treatment or service that is upcoded, or that
998is unbundled when such treatment or services should be bundled,
999in accordance with paragraph (d). To facilitate prompt payment
1000of lawful services, an insurer may change codes that it
1001determines to have been improperly or incorrectly upcoded or
1002unbundled, and may make payment based on the changed codes,
1003without affecting the right of the provider to dispute the
1004change by the insurer, provided that before doing so, the
1005insurer must contact the health care provider and discuss the
1006reasons for the insurer's change and the health care provider's
1007reason for the coding, or make a reasonable good faith effort to
1008do so, as documented in the insurer's file; and
1009     f.  For medical services or treatment billed by a physician
1010and not provided in a hospital unless such services are rendered
1011by the physician or are incident to his or her professional
1012services and are included on the physician's bill, including
1013documentation verifying that the physician is responsible for
1014the medical services that were rendered and billed.
1015     2.  Charges for medically necessary cephalic thermograms,
1016peripheral thermograms, spinal ultrasounds, extremity
1017ultrasounds, video fluoroscopy, and surface electromyography
1018shall not exceed the maximum reimbursement allowance for such
1019procedures as set forth in the applicable fee schedule or other
1020payment methodology established pursuant to s. 440.13.
1021     3.  Allowable amounts that may be charged to a personal
1022injury protection insurance insurer and insured for medically
1023necessary nerve conduction testing when done in conjunction with
1024a needle electromyography procedure and both are performed and
1025billed solely by a physician licensed under chapter 458, chapter
1026459, chapter 460, or chapter 461 who is also certified by the
1027American Board of Electrodiagnostic Medicine or by a board
1028recognized by the American Board of Medical Specialties or the
1029American Osteopathic Association or who holds diplomate status
1030with the American Chiropractic Neurology Board or its
1031predecessors shall not exceed 200 percent of the allowable
1032amount under the participating physician fee schedule of
1033Medicare Part B for year 2001, for the area in which the
1034treatment was rendered, adjusted annually on August 1 to reflect
1035the prior calendar year's changes in the annual Medical Care
1036Item of the Consumer Price Index for All Urban Consumers in the
1037South Region as determined by the Bureau of Labor Statistics of
1038the United States Department of Labor.
1039     4.  Allowable amounts that may be charged to a personal
1040injury protection insurance insurer and insured for medically
1041necessary nerve conduction testing that does not meet the
1042requirements of subparagraph 3. shall not exceed the applicable
1043fee schedule or other payment methodology established pursuant
1044to s. 440.13.
1045     5.  Allowable amounts that may be charged to a personal
1046injury protection insurance insurer and insured for magnetic
1047resonance imaging services shall not exceed 175 percent of the
1048allowable amount under the participating physician fee schedule
1049of Medicare Part B for year 2001, for the area in which the
1050treatment was rendered, adjusted annually on August 1 to reflect
1051the prior calendar year's changes in the annual Medical Care
1052Item of the Consumer Price Index for All Urban Consumers in the
1053South Region as determined by the Bureau of Labor Statistics of
1054the United States Department of Labor for the 12-month period
1055ending June 30 of that year, except that allowable amounts that
1056may be charged to a personal injury protection insurance insurer
1057and insured for magnetic resonance imaging services provided in
1058facilities accredited by the Accreditation Association for
1059Ambulatory Health Care, the American College of Radiology, or
1060the Joint Commission on Accreditation of Healthcare
1061Organizations shall not exceed 200 percent of the allowable
1062amount under the participating physician fee schedule of
1063Medicare Part B for year 2001, for the area in which the
1064treatment was rendered, adjusted annually on August 1 to reflect
1065the prior calendar year's changes in the annual Medical Care
1066Item of the Consumer Price Index for All Urban Consumers in the
1067South Region as determined by the Bureau of Labor Statistics of
1068the United States Department of Labor for the 12-month period
1069ending June 30 of that year. This paragraph does not apply to
1070charges for magnetic resonance imaging services and nerve
1071conduction testing for inpatients and emergency services and
1072care as defined in chapter 395 rendered by facilities licensed
1073under chapter 395.
1074     6.  The Department of Health, in consultation with the
1075appropriate professional licensing boards, shall adopt, by rule,
1076a list of diagnostic tests deemed not to be medically necessary
1077for use in the treatment of persons sustaining bodily injury
1078covered by personal injury protection benefits under this
1079section. The initial list shall be adopted by January 1, 2004,
1080and shall be revised from time to time as determined by the
1081Department of Health, in consultation with the respective
1082professional licensing boards. Inclusion of a test on the list
1083of invalid diagnostic tests shall be based on lack of
1084demonstrated medical value and a level of general acceptance by
1085the relevant provider community and shall not be dependent for
1086results entirely upon subjective patient response.
1087Notwithstanding its inclusion on a fee schedule in this
1088subsection, an insurer or insured is not required to pay any
1089charges or reimburse claims for any invalid diagnostic test as
1090determined by the Department of Health.
1091     (c)1.  With respect to any treatment or service, other than
1092medical services billed by a hospital or other provider for
1093emergency services as defined in s. 395.002 or inpatient
1094services rendered at a hospital-owned facility, the statement of
1095charges must be furnished to the insurer by the provider and may
1096not include, and the insurer is not required to pay, charges for
1097treatment or services rendered more than 35 days before the
1098postmark date of the statement, except for past due amounts
1099previously billed on a timely basis under this paragraph, and
1100except that, if the provider submits to the insurer a notice of
1101initiation of treatment within 21 days after its first
1102examination or treatment of the claimant, the statement may
1103include charges for treatment or services rendered up to, but
1104not more than, 75 days before the postmark date of the
1105statement. The injured party is not liable for, and the provider
1106shall not bill the injured party for, charges that are unpaid
1107because of the provider's failure to comply with this paragraph.
1108Any agreement requiring the injured person or insured to pay for
1109such charges is unenforceable.
1110     2.  If, however, the insured fails to furnish the provider
1111with the correct name and address of the insured's personal
1112injury protection insurer, the provider has 35 days from the
1113date the provider obtains the correct information to furnish the
1114insurer with a statement of the charges. The insurer is not
1115required to pay for such charges unless the provider includes
1116with the statement documentary evidence that was provided by the
1117insured during the 35-day period demonstrating that the provider
1118reasonably relied on erroneous information from the insured and
1119either:
1120     a.  A denial letter from the incorrect insurer; or
1121     b.  Proof of mailing, which may include an affidavit under
1122penalty of perjury, reflecting timely mailing to the incorrect
1123address or insurer.
1124     3.  For emergency services and care as defined in s.
1125395.002 rendered in a hospital emergency department or for
1126transport and treatment rendered by an ambulance provider
1127licensed pursuant to part III of chapter 401, the provider is
1128not required to furnish the statement of charges within the time
1129periods established by this paragraph; and the insurer shall not
1130be considered to have been furnished with notice of the amount
1131of covered loss for purposes of paragraph (4)(b) until it
1132receives a statement complying with paragraph (d), or copy
1133thereof, which specifically identifies the place of service to
1134be a hospital emergency department or an ambulance in accordance
1135with billing standards recognized by the Health Care Finance
1136Administration.
1137     4.  Each notice of insured's rights under s. 627.7401 must
1138include the following statement in type no smaller than 12
1139points:
1140
1141BILLING REQUIREMENTS.--Florida Statutes provide that with
1142respect to any treatment or services, other than certain
1143hospital and emergency services, the statement of charges
1144furnished to the insurer by the provider may not include, and
1145the insurer and the injured party are not required to pay,
1146charges for treatment or services rendered more than 35 days
1147before the postmark date of the statement, except for past due
1148amounts previously billed on a timely basis, and except that, if
1149the provider submits to the insurer a notice of initiation of
1150treatment within 21 days after its first examination or
1151treatment of the claimant, the statement may include charges for
1152treatment or services rendered up to, but not more than, 75 days
1153before the postmark date of the statement.
1154     (d)  All statements and bills for medical services rendered
1155by any physician, hospital, clinic, or other person or
1156institution shall be submitted to the insurer on a properly
1157completed Centers for Medicare and Medicaid Services (CMS) 1500
1158form, UB 92 forms, or any other standard form approved by the
1159office or adopted by the commission for purposes of this
1160paragraph. All billings for such services rendered by providers
1161shall, to the extent applicable, follow the Physicians' Current
1162Procedural Terminology (CPT) or Healthcare Correct Procedural
1163Coding System (HCPCS), or ICD-9 in effect for the year in which
1164services are rendered and comply with the Centers for Medicare
1165and Medicaid Services (CMS) 1500 form instructions and the
1166American Medical Association Current Procedural Terminology
1167(CPT) Editorial Panel and Healthcare Correct Procedural Coding
1168System (HCPCS). All providers other than hospitals shall include
1169on the applicable claim form the professional license number of
1170the provider in the line or space provided for "Signature of
1171Physician or Supplier, Including Degrees or Credentials." In
1172determining compliance with applicable CPT and HCPCS coding,
1173guidance shall be provided by the Physicians' Current Procedural
1174Terminology (CPT) or the Healthcare Correct Procedural Coding
1175System (HCPCS) in effect for the year in which services were
1176rendered, the Office of the Inspector General (OIG), Physicians
1177Compliance Guidelines, and other authoritative treatises
1178designated by rule by the Agency for Health Care Administration.
1179No statement of medical services may include charges for medical
1180services of a person or entity that performed such services
1181without possessing the valid licenses required to perform such
1182services. For purposes of paragraph (4)(b), an insurer shall not
1183be considered to have been furnished with notice of the amount
1184of covered loss or medical bills due unless the statements or
1185bills comply with this paragraph, and unless the statements or
1186bills are properly completed in their entirety as to all
1187material provisions, with all relevant information being
1188provided therein.
1189     (e)1.  At the initial treatment or service provided, each
1190physician, other licensed professional, clinic, or other medical
1191institution providing medical services upon which a claim for
1192personal injury protection benefits is based shall require an
1193insured person, or his or her guardian, to execute a disclosure
1194and acknowledgment form, which reflects at a minimum that:
1195     a.  The insured, or his or her guardian, must countersign
1196the form attesting to the fact that the services set forth
1197therein were actually rendered;
1198     b.  The insured, or his or her guardian, has both the right
1199and affirmative duty to confirm that the services were actually
1200rendered;
1201     c.  The insured, or his or her guardian, was not solicited
1202by any person to seek any services from the medical provider;
1203     d.  That the physician, other licensed professional,
1204clinic, or other medical institution rendering services for
1205which payment is being claimed explained the services to the
1206insured or his or her guardian; and
1207     e.  If the insured notifies the insurer in writing of a
1208billing error, the insured may be entitled to a certain
1209percentage of a reduction in the amounts paid by the insured's
1210motor vehicle insurer.
1211     2.  The physician, other licensed professional, clinic, or
1212other medical institution rendering services for which payment
1213is being claimed has the affirmative duty to explain the
1214services rendered to the insured, or his or her guardian, so
1215that the insured, or his or her guardian, countersigns the form
1216with informed consent.
1217     3.  Countersignature by the insured, or his or her
1218guardian, is not required for the reading of diagnostic tests or
1219other services that are of such a nature that they are not
1220required to be performed in the presence of the insured.
1221     4.  The licensed medical professional rendering treatment
1222for which payment is being claimed must sign, by his or her own
1223hand, the form complying with this paragraph.
1224     5.  The original completed disclosure and acknowledgment
1225form shall be furnished to the insurer pursuant to paragraph
1226(4)(b) and may not be electronically furnished.
1227     6.  This disclosure and acknowledgment form is not required
1228for services billed by a provider for emergency services as
1229defined in s. 395.002, for emergency services and care as
1230defined in s. 395.002 rendered in a hospital emergency
1231department, or for transport and treatment rendered by an
1232ambulance provider licensed pursuant to part III of chapter 401.
1233     7.  The Financial Services Commission shall adopt, by rule,
1234a standard disclosure and acknowledgment form that shall be used
1235to fulfill the requirements of this paragraph, effective 90 days
1236after such form is adopted and becomes final. The commission
1237shall adopt a proposed rule by October 1, 2003. Until the rule
1238is final, the provider may use a form of its own which otherwise
1239complies with the requirements of this paragraph.
1240     8.  As used in this paragraph, "countersigned" means a
1241second or verifying signature, as on a previously signed
1242document, and is not satisfied by the statement "signature on
1243file" or any similar statement.
1244     9.  The requirements of this paragraph apply only with
1245respect to the initial treatment or service of the insured by a
1246provider. For subsequent treatments or service, the provider
1247must maintain a patient log signed by the patient, in
1248chronological order by date of service, that is consistent with
1249the services being rendered to the patient as claimed. The
1250requirements of this subparagraph for maintaining a patient log
1251signed by the patient may be met by a hospital that maintains
1252medical records as required by s. 395.3025 and applicable rules
1253and makes such records available to the insurer upon request.
1254     (f)  Upon written notification by any person, an insurer
1255shall investigate any claim of improper billing by a physician
1256or other medical provider. The insurer shall determine if the
1257insured was properly billed for only those services and
1258treatments that the insured actually received. If the insurer
1259determines that the insured has been improperly billed, the
1260insurer shall notify the insured, the person making the written
1261notification and the provider of its findings and shall reduce
1262the amount of payment to the provider by the amount determined
1263to be improperly billed. If a reduction is made due to such
1264written notification by any person, the insurer shall pay to the
1265person 20 percent of the amount of the reduction, up to $500. If
1266the provider is arrested due to the improper billing, then the
1267insurer shall pay to the person 40 percent of the amount of the
1268reduction, up to $500.
1269     (g)  An insurer may not systematically downcode with the
1270intent to deny reimbursement otherwise due. Such action
1271constitutes a material misrepresentation under s.
1272626.9541(1)(i)2.
1273     (6)  DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
1274DISPUTES.--
1275     (a)  Every employer shall, if a request is made by an
1276insurer providing personal injury protection benefits under ss.
1277627.730-627.7405 against whom a claim has been made, furnish
1278forthwith, in a form approved by the office, a sworn statement
1279of the earnings, since the time of the bodily injury and for a
1280reasonable period before the injury, of the person upon whose
1281injury the claim is based.
1282     (b)  Every physician, hospital, clinic, or other medical
1283institution providing, before or after bodily injury upon which
1284a claim for personal injury protection insurance benefits is
1285based, any products, services, or accommodations in relation to
1286that or any other injury, or in relation to a condition claimed
1287to be connected with that or any other injury, shall, if
1288requested to do so by the insurer against whom the claim has
1289been made, furnish forthwith a written report of the history,
1290condition, treatment, dates, and costs of such treatment of the
1291injured person and why the items identified by the insurer were
1292reasonable in amount and medically necessary, together with a
1293sworn statement that the treatment or services rendered were
1294reasonable and necessary with respect to the bodily injury
1295sustained and identifying which portion of the expenses for such
1296treatment or services was incurred as a result of such bodily
1297injury, and produce forthwith, and permit the inspection and
1298copying of, his or her or its records regarding such history,
1299condition, treatment, dates, and costs of treatment; provided
1300that this shall not limit the introduction of evidence at trial.
1301Such sworn statement shall read as follows: "Under penalty of
1302perjury, I declare that I have read the foregoing, and the facts
1303alleged are true, to the best of my knowledge and belief." No
1304cause of action for violation of the physician-patient privilege
1305or invasion of the right of privacy shall be permitted against
1306any physician, hospital, clinic, or other medical institution
1307complying with the provisions of this section. The person
1308requesting such records and such sworn statement shall pay all
1309reasonable costs connected therewith. If an insurer makes a
1310written request for documentation or information under this
1311paragraph within 30 days after having received notice of the
1312amount of a covered loss under paragraph (4)(a), the amount or
1313the partial amount which is the subject of the insurer's inquiry
1314shall become overdue if the insurer does not pay in accordance
1315with paragraph (4)(b) or within 10 days after the insurer's
1316receipt of the requested documentation or information, whichever
1317occurs later. For purposes of this paragraph, the term "receipt"
1318includes, but is not limited to, inspection and copying pursuant
1319to this paragraph. Any insurer that requests documentation or
1320information pertaining to reasonableness of charges or medical
1321necessity under this paragraph without a reasonable basis for
1322such requests as a general business practice is engaging in an
1323unfair trade practice under the insurance code.
1324     (c)  In the event of any dispute regarding an insurer's
1325right to discovery of facts under this section, the insurer may
1326petition a court of competent jurisdiction to enter an order
1327permitting such discovery. The order may be made only on motion
1328for good cause shown and upon notice to all persons having an
1329interest, and it shall specify the time, place, manner,
1330conditions, and scope of the discovery. Such court may, in order
1331to protect against annoyance, embarrassment, or oppression, as
1332justice requires, enter an order refusing discovery or
1333specifying conditions of discovery and may order payments of
1334costs and expenses of the proceeding, including reasonable fees
1335for the appearance of attorneys at the proceedings, as justice
1336requires.
1337     (d)  The injured person shall be furnished, upon request, a
1338copy of all information obtained by the insurer under the
1339provisions of this section, and shall pay a reasonable charge,
1340if required by the insurer.
1341     (e)  Notice to an insurer of the existence of a claim shall
1342not be unreasonably withheld by an insured.
1343     (7)  MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON;
1344REPORTS.--
1345     (a)  Whenever the mental or physical condition of an
1346injured person covered by personal injury protection is material
1347to any claim that has been or may be made for past or future
1348personal injury protection insurance benefits, such person
1349shall, upon the request of an insurer, submit to mental or
1350physical examination by a physician or physicians. The costs of
1351any examinations requested by an insurer shall be borne entirely
1352by the insurer. Such examination shall be conducted within the
1353municipality where the insured is receiving treatment, or in a
1354location reasonably accessible to the insured, which, for
1355purposes of this paragraph, means any location within the
1356municipality in which the insured resides, or any location
1357within 10 miles by road of the insured's residence, provided
1358such location is within the county in which the insured resides.
1359If the examination is to be conducted in a location reasonably
1360accessible to the insured, and if there is no qualified
1361physician to conduct the examination in a location reasonably
1362accessible to the insured, then such examination shall be
1363conducted in an area of the closest proximity to the insured's
1364residence. Personal protection insurers are authorized to
1365include reasonable provisions in personal injury protection
1366insurance policies for mental and physical examination of those
1367claiming personal injury protection insurance benefits. An
1368insurer may not withdraw payment of a treating physician without
1369the consent of the injured person covered by the personal injury
1370protection, unless the insurer first obtains a valid report by a
1371Florida physician licensed under the same chapter as the
1372treating physician whose treatment authorization is sought to be
1373withdrawn, stating that treatment was not reasonable, related,
1374or necessary. A valid report is one that is prepared and signed
1375by the physician examining the injured person or reviewing the
1376treatment records of the injured person and is factually
1377supported by the examination and treatment records if reviewed
1378and that has not been modified by anyone other than the
1379physician. The physician preparing the report must be in active
1380practice, unless the physician is physically disabled. Active
1381practice means that during the 3 years immediately preceding the
1382date of the physical examination or review of the treatment
1383records the physician must have devoted professional time to the
1384active clinical practice of evaluation, diagnosis, or treatment
1385of medical conditions or to the instruction of students in an
1386accredited health professional school or accredited residency
1387program or a clinical research program that is affiliated with
1388an accredited health professional school or teaching hospital or
1389accredited residency program. The physician preparing a report
1390at the request of an insurer and physicians rendering expert
1391opinions on behalf of persons claiming medical benefits for
1392personal injury protection, or on behalf of an insured through
1393an attorney or another entity, shall maintain, for at least 3
1394years, copies of all examination reports as medical records and
1395shall maintain, for at least 3 years, records of all payments
1396for the examinations and reports. Neither an insurer nor any
1397person acting at the direction of or on behalf of an insurer may
1398materially change an opinion in a report prepared under this
1399paragraph or direct the physician preparing the report to change
1400such opinion. The denial of a payment as the result of such a
1401changed opinion constitutes a material misrepresentation under
1402s. 626.9541(1)(i)2.; however, this provision does not preclude
1403the insurer from calling to the attention of the physician
1404errors of fact in the report based upon information in the claim
1405file.
1406     (b)  If requested by the person examined, a party causing
1407an examination to be made shall deliver to him or her a copy of
1408every written report concerning the examination rendered by an
1409examining physician, at least one of which reports must set out
1410the examining physician's findings and conclusions in detail.
1411After such request and delivery, the party causing the
1412examination to be made is entitled, upon request, to receive
1413from the person examined every written report available to him
1414or her or his or her representative concerning any examination,
1415previously or thereafter made, of the same mental or physical
1416condition. By requesting and obtaining a report of the
1417examination so ordered, or by taking the deposition of the
1418examiner, the person examined waives any privilege he or she may
1419have, in relation to the claim for benefits, regarding the
1420testimony of every other person who has examined, or may
1421thereafter examine, him or her in respect to the same mental or
1422physical condition. If a person unreasonably refuses to submit
1423to an examination, the personal injury protection carrier is no
1424longer liable for subsequent personal injury protection
1425benefits.
1426     (8)  APPLICABILITY OF PROVISION REGULATING ATTORNEY'S
1427FEES.--With respect to any dispute under the provisions of ss.
1428627.730-627.7405 between the insured and the insurer, or between
1429an assignee of an insured's rights and the insurer, the
1430provisions of s. 627.428 shall apply, except as provided in
1431subsection (10) (11).
1432     (9)(a)  Each insurer which has issued a policy providing
1433personal injury protection benefits shall report the renewal,
1434cancellation, or nonrenewal thereof to the Department of Highway
1435Safety and Motor Vehicles within 45 days from the effective date
1436of the renewal, cancellation, or nonrenewal.  Upon the issuance
1437of a policy providing personal injury protection benefits to a
1438named insured not previously insured by the insurer thereof
1439during that calendar year, the insurer shall report the issuance
1440of the new policy to the Department of Highway Safety and Motor
1441Vehicles within 30 days.  The report shall be in such form and
1442format and contain such information as may be required by the
1443Department of Highway Safety and Motor Vehicles which shall
1444include a format compatible with the data processing
1445capabilities of said department, and the Department of Highway
1446Safety and Motor Vehicles is authorized to adopt rules necessary
1447with respect thereto. Failure by an insurer to file proper
1448reports with the Department of Highway Safety and Motor Vehicles
1449as required by this subsection or rules adopted with respect to
1450the requirements of this subsection constitutes a violation of
1451the Florida Insurance Code. Reports of cancellations and policy
1452renewals and reports of the issuance of new policies received by
1453the Department of Highway Safety and Motor Vehicles are
1454confidential and exempt from the provisions of s. 119.07(1).
1455These records are to be used for enforcement and regulatory
1456purposes only, including the generation by the department of
1457data regarding compliance by owners of motor vehicles with
1458financial responsibility coverage requirements. In addition, the
1459Department of Highway Safety and Motor Vehicles shall release,
1460upon a written request by a person involved in a motor vehicle
1461accident, by the person's attorney, or by a representative of
1462the person's motor vehicle insurer, the name of the insurance
1463company and the policy number for the policy covering the
1464vehicle named by the requesting party.  The written request must
1465include a copy of the appropriate accident form as provided in
1466s. 316.065, s. 316.066, or s. 316.068.
1467     (b)  Every insurer with respect to each insurance policy
1468providing personal injury protection benefits shall notify the
1469named insured or in the case of a commercial fleet policy, the
1470first named insured in writing that any cancellation or
1471nonrenewal of the policy will be reported by the insurer to the
1472Department of Highway Safety and Motor Vehicles.  The notice
1473shall also inform the named insured that failure to maintain
1474personal injury protection and property damage liability
1475insurance on a motor vehicle when required by law may result in
1476the loss of registration and driving privileges in this state,
1477and the notice shall inform the named insured of the amount of
1478the reinstatement fees required by s. 627.733(7).  This notice
1479is for informational purposes only, and no civil liability shall
1480attach to an insurer due to failure to provide this notice.
1481     (9)(10)  An insurer may negotiate and enter into contracts
1482with licensed health care providers for the benefits described
1483in this section, referred to in this section as "preferred
1484providers," which shall include health care providers licensed
1485under chapters 458, 459, 460, 461, and 463. The insurer may
1486provide an option to an insured to use a preferred provider at
1487the time of purchase of the policy for personal injury
1488protection benefits, if the requirements of this subsection are
1489met. If the insured elects to use a provider who is not a
1490preferred provider, whether the insured purchased a preferred
1491provider policy or a nonpreferred provider policy, the medical
1492benefits provided by the insurer shall be as required by this
1493section. If the insured elects to use a provider who is a
1494preferred provider, the insurer may pay medical benefits in
1495excess of the benefits required by this section and may waive or
1496lower the amount of any deductible that applies to such medical
1497benefits. If the insurer offers a preferred provider policy to a
1498policyholder or applicant, it must also offer a nonpreferred
1499provider policy. The insurer shall provide each policyholder
1500with a current roster of preferred providers in the county in
1501which the insured resides at the time of purchase of such
1502policy, and shall make such list available for public inspection
1503during regular business hours at the principal office of the
1504insurer within the state.
1505     (10)(11)  DEMAND LETTER.--
1506     (a)  As a condition precedent to filing any action for
1507benefits under this section, the insurer must be provided with
1508written notice of an intent to initiate litigation. Such notice
1509may not be sent until the claim is overdue, including any
1510additional time the insurer has to pay the claim pursuant to
1511paragraph (4)(b).
1512     (b)  The notice required shall state that it is a "demand
1513letter under s. 627.736(10)(11)" and shall state with
1514specificity:
1515     1.  The name of the insured upon which such benefits are
1516being sought, including a copy of the assignment giving rights
1517to the claimant if the claimant is not the insured.
1518     2.  The claim number or policy number upon which such claim
1519was originally submitted to the insurer.
1520     3.  To the extent applicable, the name of any medical
1521provider who rendered to an insured the treatment, services,
1522accommodations, or supplies that form the basis of such claim;
1523and an itemized statement specifying each exact amount, the date
1524of treatment, service, or accommodation, and the type of benefit
1525claimed to be due. A completed form satisfying the requirements
1526of paragraph (5)(d) or the lost-wage statement previously
1527submitted may be used as the itemized statement. To the extent
1528that the demand involves an insurer's withdrawal of payment
1529under paragraph (7)(a) for future treatment not yet rendered,
1530the claimant shall attach a copy of the insurer's notice
1531withdrawing such payment and an itemized statement of the type,
1532frequency, and duration of future treatment claimed to be
1533reasonable and medically necessary.
1534     (c)  Each notice required by this subsection must be
1535delivered to the insurer by United States certified or
1536registered mail, return receipt requested. Such postal costs
1537shall be reimbursed by the insurer if so requested by the
1538claimant in the notice, when the insurer pays the claim. Such
1539notice must be sent to the person and address specified by the
1540insurer for the purposes of receiving notices under this
1541subsection. Each licensed insurer, whether domestic, foreign, or
1542alien, shall file with the office designation of the name and
1543address of the person to whom notices pursuant to this
1544subsection shall be sent which the office shall make available
1545on its Internet website. The name and address on file with the
1546office pursuant to s. 624.422 shall be deemed the authorized
1547representative to accept notice pursuant to this subsection in
1548the event no other designation has been made.
1549     (d)  If, within 15 days after receipt of notice by the
1550insurer, the overdue claim specified in the notice is paid by
1551the insurer together with applicable interest and a penalty of
155210 percent of the overdue amount paid by the insurer, subject to
1553a maximum penalty of $250, no action may be brought against the
1554insurer. If the demand involves an insurer's withdrawal of
1555payment under paragraph (7)(a) for future treatment not yet
1556rendered, no action may be brought against the insurer if,
1557within 15 days after its receipt of the notice, the insurer
1558mails to the person filing the notice a written statement of the
1559insurer's agreement to pay for such treatment in accordance with
1560the notice and to pay a penalty of 10 percent, subject to a
1561maximum penalty of $250, when it pays for such future treatment
1562in accordance with the requirements of this section. To the
1563extent the insurer determines not to pay any amount demanded,
1564the penalty shall not be payable in any subsequent action. For
1565purposes of this subsection, payment or the insurer's agreement
1566shall be treated as being made on the date a draft or other
1567valid instrument that is equivalent to payment, or the insurer's
1568written statement of agreement, is placed in the United States
1569mail in a properly addressed, postpaid envelope, or if not so
1570posted, on the date of delivery. The insurer shall not be
1571obligated to pay any attorney's fees if the insurer pays the
1572claim or mails its agreement to pay for future treatment within
1573the time prescribed by this subsection.
1574     (e)  The applicable statute of limitation for an action
1575under this section shall be tolled for a period of 15 business
1576days by the mailing of the notice required by this subsection.
1577     (f)  Any insurer making a general business practice of not
1578paying valid claims until receipt of the notice required by this
1579subsection is engaging in an unfair trade practice under the
1580insurance code.
1581     (11)(12)  CIVIL ACTION FOR INSURANCE FRAUD.--An insurer
1582shall have a cause of action against any person convicted of, or
1583who, regardless of adjudication of guilt, pleads guilty or nolo
1584contendere to insurance fraud under s. 817.234, patient
1585brokering under s. 817.505, or kickbacks under s. 456.054,
1586associated with a claim for personal injury protection benefits
1587in accordance with this section. An insurer prevailing in an
1588action brought under this subsection may recover compensatory,
1589consequential, and punitive damages subject to the requirements
1590and limitations of part II of chapter 768, and attorney's fees
1591and costs incurred in litigating a cause of action against any
1592person convicted of, or who, regardless of adjudication of
1593guilt, pleads guilty or nolo contendere to insurance fraud under
1594s. 817.234, patient brokering under s. 817.505, or kickbacks
1595under s. 456.054, associated with a claim for personal injury
1596protection benefits in accordance with this section.
1597     (12)(13)  MINIMUM BENEFIT COVERAGE.--If the Financial
1598Services Commission determines that the cost savings under
1599personal injury protection insurance benefits paid by insurers
1600have been realized due to the provisions of this act, prior
1601legislative reforms, or other factors, the commission may
1602increase the minimum $10,000 benefit coverage requirement. In
1603establishing the amount of such increase, the commission must
1604determine that the additional premium for such coverage is
1605approximately equal to the premium cost savings that have been
1606realized for the personal injury protection coverage with limits
1607of $10,000.
1608     (13)(14)  FRAUD ADVISORY NOTICE.--Upon receiving notice of
1609a claim under this section, an insurer shall provide a notice to
1610the insured or to a person for whom a claim for reimbursement
1611for diagnosis or treatment of injuries has been filed, advising
1612that:
1613     (a)  Pursuant to s. 626.9892, the Department of Financial
1614Services may pay rewards of up to $25,000 to persons providing
1615information leading to the arrest and conviction of persons
1616committing crimes investigated by the Division of Insurance
1617Fraud arising from violations of s. 440.105, s. 624.15, s.
1618626.9541, s. 626.989, or s. 817.234.
1619     (b)  Solicitation of a person injured in a motor vehicle
1620crash for purposes of filing personal injury protection or tort
1621claims could be a violation of s. 817.234, s. 817.505, or the
1622rules regulating The Florida Bar and should be immediately
1623reported to the Division of Insurance Fraud if such conduct has
1624taken place.
1625     Section 14.  Notwithstanding the repeal of the Florida
1626Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
1627section 627.737, Florida Statutes, is revived and reenacted to
1628read:
1629     627.737  Tort exemption; limitation on right to damages;
1630punitive damages.--
1631     (1)  Every owner, registrant, operator, or occupant of a
1632motor vehicle with respect to which security has been provided
1633as required by ss. 627.730-627.7405, and every person or
1634organization legally responsible for her or his acts or
1635omissions, is hereby exempted from tort liability for damages
1636because of bodily injury, sickness, or disease arising out of
1637the ownership, operation, maintenance, or use of such motor
1638vehicle in this state to the extent that the benefits described
1639in s. 627.736(1) are payable for such injury, or would be
1640payable but for any exclusion authorized by ss. 627.730-
1641627.7405, under any insurance policy or other method of security
1642complying with the requirements of s. 627.733, or by an owner
1643personally liable under s. 627.733 for the payment of such
1644benefits, unless a person is entitled to maintain an action for
1645pain, suffering, mental anguish, and inconvenience for such
1646injury under the provisions of subsection (2).
1647     (2)  In any action of tort brought against the owner,
1648registrant, operator, or occupant of a motor vehicle with
1649respect to which security has been provided as required by ss.
1650627.730-627.7405, or against any person or organization legally
1651responsible for her or his acts or omissions, a plaintiff may
1652recover damages in tort for pain, suffering, mental anguish, and
1653inconvenience because of bodily injury, sickness, or disease
1654arising out of the ownership, maintenance, operation, or use of
1655such motor vehicle only in the event that the injury or disease
1656consists in whole or in part of:
1657     (a)  Significant and permanent loss of an important bodily
1658function.
1659     (b)  Permanent injury within a reasonable degree of medical
1660probability, other than scarring or disfigurement.
1661     (c)  Significant and permanent scarring or disfigurement.
1662     (d)  Death.
1663     (3)  When a defendant, in a proceeding brought pursuant to
1664ss. 627.730-627.7405, questions whether the plaintiff has met
1665the requirements of subsection (2), then the defendant may file
1666an appropriate motion with the court, and the court shall, on a
1667one-time basis only, 30 days before the date set for the trial
1668or the pretrial hearing, whichever is first, by examining the
1669pleadings and the evidence before it, ascertain whether the
1670plaintiff will be able to submit some evidence that the
1671plaintiff will meet the requirements of subsection (2).  If the
1672court finds that the plaintiff will not be able to submit such
1673evidence, then the court shall dismiss the plaintiff's claim
1674without prejudice.
1675     (4)  In any action brought against an automobile liability
1676insurer for damages in excess of its policy limits, no claim for
1677punitive damages shall be allowed.
1678     Section 15.  Notwithstanding the repeal of the Florida
1679Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
1680section 627.739, Florida Statutes, is revived and reenacted to
1681read:
1682     627.739  Personal injury protection; optional limitations;
1683deductibles.--
1684     (1)  The named insured may elect a deductible or modified
1685coverage or combination thereof to apply to the named insured
1686alone or to the named insured and dependent relatives residing
1687in the same household, but may not elect a deductible or
1688modified coverage to apply to any other person covered under the
1689policy.
1690     (2)  Insurers shall offer to each applicant and to each
1691policyholder, upon the renewal of an existing policy,
1692deductibles, in amounts of $250, $500, and $1,000. The
1693deductible amount must be applied to 100 percent of the expenses
1694and losses described in s. 627.736. After the deductible is met,
1695each insured is eligible to receive up to $10,000 in total
1696benefits described in s. 627.736(1). However, this subsection
1697shall not be applied to reduce the amount of any benefits
1698received in accordance with s. 627.736(1)(c).
1699     (3)  Insurers shall offer coverage wherein, at the election
1700of the named insured, the benefits for loss of gross income and
1701loss of earning capacity described in s. 627.736(1)(b) shall be
1702excluded.
1703     (4)  The named insured shall not be prevented from electing
1704a deductible under subsection (2) and modified coverage under
1705subsection (3). Each election made by the named insured under
1706this section shall result in an appropriate reduction of premium
1707associated with that election.
1708     (5)  All such offers shall be made in clear and unambiguous
1709language at the time the initial application is taken and prior
1710to each annual renewal and shall indicate that a premium
1711reduction will result from each election. At the option of the
1712insurer, the requirements of the preceding sentence are met by
1713using forms of notice approved by the office, or by providing
1714the following notice in 10-point type in the insurer's
1715application for initial issuance of a policy of motor vehicle
1716insurance and the insurer's annual notice of renewal premium:
1717 For personal injury protection insurance, the named insured may
1718elect a deductible and to exclude coverage for loss of gross
1719income and loss of earning capacity ("lost wages"). These
1720elections apply to the named insured alone, or to the named
1721insured and all dependent resident relatives. A premium
1722reduction will result from these elections. The named insured is
1723hereby advised not to elect the lost wage exclusion if the named
1724insured or dependent resident relatives are employed, since lost
1725wages will not be payable in the event of an accident.
1726     Section 16.  Notwithstanding the repeal of the Florida
1727Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
1728section 627.7401, Florida Statutes, is revived and reenacted to
1729read:
1730     627.7401  Notification of insured's rights.--
1731     (1)  The commission, by rule, shall adopt a form for the
1732notification of insureds of their right to receive personal
1733injury protection benefits under the Florida Motor Vehicle No-
1734Fault Law. Such notice shall include:
1735     (a)  A description of the benefits provided by personal
1736injury protection, including, but not limited to, the specific
1737types of services for which medical benefits are paid,
1738disability benefits, death benefits, significant exclusions from
1739and limitations on personal injury protection benefits, when
1740payments are due, how benefits are coordinated with other
1741insurance benefits that the insured may have, penalties and
1742interest that may be imposed on insurers for failure to make
1743timely payments of benefits, and rights of parties regarding
1744disputes as to benefits.
1745     (b)  An advisory informing insureds that:
1746     1.  Pursuant to s. 626.9892, the Department of Financial
1747Services may pay rewards of up to $25,000 to persons providing
1748information leading to the arrest and conviction of persons
1749committing crimes investigated by the Division of Insurance
1750Fraud arising from violations of s. 440.105, s. 624.15, s.
1751626.9541, s. 626.989, or s. 817.234.
1752     2.  Pursuant to s. 627.736(5)(e)1., if the insured notifies
1753the insurer of a billing error, the insured may be entitled to a
1754certain percentage of a reduction in the amount paid by the
1755insured's motor vehicle insurer.
1756     (c)  A notice that solicitation of a person injured in a
1757motor vehicle crash for purposes of filing personal injury
1758protection or tort claims could be a violation of s. 817.234, s
1759817.505, or the rules regulating The Florida Bar and should be
1760immediately reported to the Division of Insurance Fraud if such
1761conduct has taken place.
1762     (2)  Each insurer issuing a policy in this state providing
1763personal injury protection benefits must mail or deliver the
1764notice as specified in subsection (1) to an insured within 21
1765days after receiving from the insured notice of an automobile
1766accident or claim involving personal injury to an insured who is
1767covered under the policy. The office may allow an insurer
1768additional time to provide the notice specified in subsection
1769(1) not to exceed 30 days, upon a showing by the insurer that an
1770emergency justifies an extension of time.
1771     (3)  The notice required by this section does not alter or
1772modify the terms of the insurance contract or other requirements
1773of this act.
1774     Section 17.  Notwithstanding the repeal of the Florida
1775Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
1776section 627.7403, Florida Statutes, is revived and reenacted to
1777read:
1778     627.7403  Mandatory joinder of derivative claim.--In any
1779action brought pursuant to the provisions of s. 627.737 claiming
1780personal injuries, all claims arising out of the plaintiff's
1781injuries, including all derivative claims, shall be brought
1782together, unless good cause is shown why such claims should be
1783brought separately.
1784     Section 18.  Notwithstanding the repeal of the Florida
1785Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
1786section 627.7405, Florida Statutes, is revived and reenacted to
1787read:
1788     627.7405  Insurers' right of
1789reimbursement.--Notwithstanding any other provisions of ss.
1790627.730-627.7405, any insurer providing personal injury
1791protection benefits on a private passenger motor vehicle shall
1792have, to the extent of any personal injury protection benefits
1793paid to any person as a benefit arising out of such private
1794passenger motor vehicle insurance, a right of reimbursement
1795against the owner or the insurer of the owner of a commercial
1796motor vehicle, if the benefits paid result from such person
1797having been an occupant of the commercial motor vehicle or
1798having been struck by the commercial motor vehicle while not an
1799occupant of any self-propelled vehicle.
1800     Section 19.  This act revives and reenacts, with
1801amendments, the Florida Motor Vehicle No-Fault Law, which
1802expired by operation of law on October 1, 2007. This act is
1803intended to be remedial and curative in nature and to minimize
1804confusion concerning the changes made by this act to ss.
1805627.730-627.7405, Florida Statutes. Therefore, the Florida Motor
1806Vehicle No-Fault Law shall continue to be codified as ss.
1807627.730-627.7405, Florida Statutes, notwithstanding the repeal
1808of those sections contained in s. 19, chapter 2003-411, Laws of
1809Florida.
1810     Section 20.  Effective January 15, 2008, and applicable to
1811policies issued or renewed on or after that date, subsections
1812(1) and (4), paragraphs (a), (b), and (c) of subsection (5),
1813subsection (8), and paragraphs (d) and (e) of subsection (10) of
1814section 627.736, Florida Statutes, as reenacted and amended by
1815this act, are amended, subsections (11), (12), and (13) of that
1816section, as reenacted and amended by this act, are renumbered as
1817subsections (12), (13), and (14), respectively, and a new
1818subsection (11) and subsections (15) and (16) are added to that
1819section, to read:
1820     627.736  Required personal injury protection benefits;
1821exclusions; priority; claims.--
1822     (1)  REQUIRED BENEFITS.--Every insurance policy complying
1823with the security requirements of s. 627.733 shall provide
1824personal injury protection to the named insured, relatives
1825residing in the same household, persons operating the insured
1826motor vehicle, passengers in such motor vehicle, and other
1827persons struck by such motor vehicle and suffering bodily injury
1828while not an occupant of a self-propelled vehicle, subject to
1829the provisions of subsection (2) and paragraph (4)(e)(d), to a
1830limit of $10,000 for loss sustained by any such person as a
1831result of bodily injury, sickness, disease, or death arising out
1832of the ownership, maintenance, or use of a motor vehicle as
1833follows:
1834     (a)  Medical benefits.--Eighty percent of all reasonable
1835expenses for medically necessary medical, surgical, X-ray,
1836dental, and rehabilitative services, including prosthetic
1837devices, and medically necessary ambulance, hospital, and
1838nursing services. However, the medical benefits shall provide
1839reimbursement only for such services and care that are provided,
1840lawfully supervised, ordered, or prescribed by a physician
1841licensed under chapter 458 or chapter 459 or a dentist licensed
1842under chapter 466 or that are provided by any of the following
1843persons 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     7.  A person or entity providing magnetic resonance imaging
1884services if such services have been lawfully ordered by a
1885licensed health care practitioner.
1886
1887The Financial Services Commission shall adopt by rule the form
1888that must be used by an insurer and a health care provider
1889specified in subparagraph 4., subparagraph 5., or subparagraph
18906. to document that the health care provider meets the criteria
1891of this paragraph, which rule must include a requirement for a
1892sworn statement or affidavit Such benefits shall also include
1893necessary remedial treatment and services recognized and
1894permitted under the laws of the state for an injured person who
1895relies upon spiritual means through prayer alone for healing, in
1896accordance with his or her religious beliefs; however, this
1897sentence does not affect the determination of what other
1898services or procedures are medically necessary.
1899     (b)  Disability benefits.--Sixty percent of any loss of
1900gross income and loss of earning capacity per individual from
1901inability to work proximately caused by the injury sustained by
1902the injured person, plus all expenses reasonably incurred in
1903obtaining from others ordinary and necessary services in lieu of
1904those that, but for the injury, the injured person would have
1905performed without income for the benefit of his or her
1906household. All disability benefits payable under this provision
1907shall be paid not less than every 2 weeks.
1908     (c)  Death benefits.--Death benefits equal to the lesser of
1909$5,000 or the remainder of unused personal injury protection
1910benefits per individual. The insurer may pay such benefits to
1911the executor or administrator of the deceased, to any of the
1912deceased's relatives by blood or legal adoption or connection by
1913marriage, or to any person appearing to the insurer to be
1914equitably entitled thereto.
1915
1916Only insurers writing motor vehicle liability insurance in this
1917state may provide the required benefits of this section, and no
1918such insurer shall require the purchase of any other motor
1919vehicle coverage other than the purchase of property damage
1920liability coverage as required by s. 627.7275 as a condition for
1921providing such required benefits. Insurers may not require that
1922property damage liability insurance in an amount greater than
1923$10,000 be purchased in conjunction with personal injury
1924protection. Such insurers shall make benefits and required
1925property damage liability insurance coverage available through
1926normal marketing channels. Any insurer writing motor vehicle
1927liability insurance in this state who fails to comply with such
1928availability requirement as a general business practice shall be
1929deemed to have violated part IX of chapter 626, and such
1930violation shall constitute an unfair method of competition or an
1931unfair or deceptive act or practice involving the business of
1932insurance; and any such insurer committing such violation shall
1933be subject to the penalties afforded in such part, as well as
1934those which may be afforded elsewhere in the insurance code.
1935     (4)  BENEFITS; WHEN DUE.--Benefits due from an insurer
1936under ss. 627.730-627.7405 shall be primary, except that
1937benefits received under any workers' compensation law shall be
1938credited against the benefits provided by subsection (1) and
1939shall be due and payable as loss accrues, upon receipt of
1940reasonable proof of such loss and the amount of expenses and
1941loss incurred which are covered by the policy issued under ss.
1942627.730-627.7405. When the Agency for Health Care Administration
1943provides, pays, or becomes liable for medical assistance under
1944the Medicaid program related to injury, sickness, disease, or
1945death arising out of the ownership, maintenance, or use of a
1946motor vehicle, benefits under ss. 627.730-627.7405 shall be
1947subject to the provisions of the Medicaid program.
1948     (a)  An insurer may require written notice to be given as
1949soon as practicable after an accident involving a motor vehicle
1950with respect to which the policy affords the security required
1951by ss. 627.730-627.7405.
1952     (b)  Personal injury protection insurance benefits paid
1953pursuant to this section shall be overdue if not paid within 30
1954days after the insurer is furnished written notice of the fact
1955of a covered loss and of the amount of same. If such written
1956notice is not furnished to the insurer as to the entire claim,
1957any partial amount supported by written notice is overdue if not
1958paid within 30 days after such written notice is furnished to
1959the insurer. Any part or all of the remainder of the claim that
1960is subsequently supported by written notice is overdue if not
1961paid within 30 days after such written notice is furnished to
1962the insurer. When an insurer pays only a portion of a claim or
1963rejects a claim, the insurer shall provide at the time of the
1964partial payment or rejection an itemized specification of each
1965item that the insurer had reduced, omitted, or declined to pay
1966and any information that the insurer desires the claimant to
1967consider related to the medical necessity of the denied
1968treatment or to explain the reasonableness of the reduced
1969charge, provided that this shall not limit the introduction of
1970evidence at trial; and the insurer shall include the name and
1971address of the person to whom the claimant should respond and a
1972claim number to be referenced in future correspondence. However,
1973notwithstanding the fact that written notice has been furnished
1974to the insurer, any payment shall not be deemed overdue when the
1975insurer has reasonable proof to establish that the insurer is
1976not responsible for the payment. For the purpose of calculating
1977the extent to which any benefits are overdue, payment shall be
1978treated as being made on the date a draft or other valid
1979instrument which is equivalent to payment was placed in the
1980United States mail in a properly addressed, postpaid envelope
1981or, if not so posted, on the date of delivery. This paragraph
1982does not preclude or limit the ability of the insurer to assert
1983that the claim was unrelated, was not medically necessary, or
1984was unreasonable or that the amount of the charge was in excess
1985of that permitted under, or in violation of, subsection (5).
1986Such assertion by the insurer may be made at any time, including
1987after payment of the claim or after the 30-day time period for
1988payment set forth in this paragraph.
1989     (c)  Upon receiving notice of an accident that is
1990potentially covered by personal injury protection benefits, the
1991insurer must reserve $5,000 of personal injury protection
1992benefits for payment to physicians licensed under chapter 458 or
1993chapter 459 or dentists licensed under chapter 466 who provide
1994emergency services and care, as defined in s. 395.002(9), or who
1995provide hospital inpatient care. The amount required to be held
1996in reserve may be used only to pay claims from such physicians
1997or dentists until 30 days after the date the insurer receives
1998notice of the accident. After the 30-day period, any amount of
1999the reserve for which the insurer has not received notice of a
2000claim from a physician or dentist who provided emergency
2001services and care or who provided hospital inpatient care may
2002then be used by the insurer to pay other claims. The time
2003periods specified in paragraph (b) for required payment of
2004personal injury protection benefits shall be tolled for the
2005period of time that an insurer is required by this paragraph to
2006hold payment of a claim that is not from a physician or dentist
2007who provided emergency services and care or who provided
2008hospital inpatient care to the extent that the personal injury
2009protection benefits not held in reserve are insufficient to pay
2010the claim. This paragraph does not require an insurer to
2011establish a claim reserve for insurance accounting purposes.
2012     (d)(c)  All overdue payments shall bear simple interest at
2013the rate established under s. 55.03 or the rate established in
2014the insurance contract, whichever is greater, for the year in
2015which the payment became overdue, calculated from the date the
2016insurer was furnished with written notice of the amount of
2017covered loss. Interest shall be due at the time payment of the
2018overdue claim is made.
2019     (e)(d)  The insurer of the owner of a motor vehicle shall
2020pay personal injury protection benefits for:
2021     1.  Accidental bodily injury sustained in this state by the
2022owner while occupying a motor vehicle, or while not an occupant
2023of a self-propelled vehicle if the injury is caused by physical
2024contact with a motor vehicle.
2025     2.  Accidental bodily injury sustained outside this state,
2026but within the United States of America or its territories or
2027possessions or Canada, by the owner while occupying the owner's
2028motor vehicle.
2029     3.  Accidental bodily injury sustained by a relative of the
2030owner residing in the same household, under the circumstances
2031described in subparagraph 1. or subparagraph 2., provided the
2032relative at the time of the accident is domiciled in the owner's
2033household and is not himself or herself the owner of a motor
2034vehicle with respect to which security is required under ss.
2035627.730-627.7405.
2036     4.  Accidental bodily injury sustained in this state by any
2037other person while occupying the owner's motor vehicle or, if a
2038resident of this state, while not an occupant of a self-
2039propelled vehicle, if the injury is caused by physical contact
2040with such motor vehicle, provided the injured person is not
2041himself or herself:
2042     a.  The owner of a motor vehicle with respect to which
2043security is required under ss. 627.730-627.7405; or
2044     b.  Entitled to personal injury benefits from the insurer
2045of the owner or owners of such a motor vehicle.
2046     (f)(e)  If two or more insurers are liable to pay personal
2047injury protection benefits for the same injury to any one
2048person, the maximum payable shall be as specified in subsection
2049(1), and any insurer paying the benefits shall be entitled to
2050recover from each of the other insurers an equitable pro rata
2051share of the benefits paid and expenses incurred in processing
2052the claim.
2053     (g)(f)  It is a violation of the insurance code for an
2054insurer to fail to timely provide benefits as required by this
2055section with such frequency as to constitute a general business
2056practice.
2057     (h)(g)  Benefits shall not be due or payable to or on the
2058behalf of an insured person if that person has committed, by a
2059material act or omission, any insurance fraud relating to
2060personal injury protection coverage under his or her policy, if
2061the fraud is admitted to in a sworn statement by the insured or
2062if it is established in a court of competent jurisdiction. Any
2063insurance fraud shall void all coverage arising from the claim
2064related to such fraud under the personal injury protection
2065coverage of the insured person who committed the fraud,
2066irrespective of whether a portion of the insured person's claim
2067may be legitimate, and any benefits paid prior to the discovery
2068of the insured person's insurance fraud shall be recoverable by
2069the insurer from the person who committed insurance fraud in
2070their entirety. The prevailing party is entitled to its costs
2071and attorney's fees in any action in which it prevails in an
2072insurer's action to enforce its right of recovery under this
2073paragraph.
2074     (5)  CHARGES FOR TREATMENT OF INJURED PERSONS.--
2075     (a)1.  Any physician, hospital, clinic, or other person or
2076institution lawfully rendering treatment to an injured person
2077for a bodily injury covered by personal injury protection
2078insurance may charge the insurer and injured party only a
2079reasonable amount pursuant to this section for the services and
2080supplies rendered, and the insurer providing such coverage may
2081pay for such charges directly to such person or institution
2082lawfully rendering such treatment, if the insured receiving such
2083treatment or his or her guardian has countersigned the properly
2084completed invoice, bill, or claim form approved by the office
2085upon which such charges are to be paid for as having actually
2086been rendered, to the best knowledge of the insured or his or
2087her guardian. In no event, however, may such a charge be in
2088excess of the amount the person or institution customarily
2089charges for like services or supplies. With respect to a
2090determination of whether a charge for a particular service,
2091treatment, or otherwise is reasonable, consideration may be
2092given to evidence of usual and customary charges and payments
2093accepted by the provider involved in the dispute, and
2094reimbursement levels in the community and various federal and
2095state medical fee schedules applicable to automobile and other
2096insurance coverages, and other information relevant to the
2097reasonableness of the reimbursement for the service, treatment,
2098or supply.
2099     2.  The insurer may limit reimbursement to 80 percent of
2100the following schedule of maximum charges:
2101     a.  For emergency transport and treatment by providers
2102licensed under chapter 401, 200 percent of Medicare.
2103     b.  For emergency services and care provided by a hospital
2104licensed under chapter 395, 75 percent of the hospital's usual
2105and customary charges.
2106     c.  For emergency services and care rendered by a physician
2107and related hospital inpatient services rendered by a physician,
2108the usual and customary charges in the community.
2109     d.  For hospital inpatient services, other than emergency
2110services and care, 200 percent of the Medicare Part A
2111prospective payment applicable to the specific hospital
2112providing the inpatient services.
2113     e.  For hospital outpatient services, other than emergency
2114services and care, 200 percent of the Medicare Part A Ambulatory
2115Payment Classification for the specific hospital providing the
2116outpatient services.
2117     f.  For all other medical services, supplies, and care, 200
2118percent of the applicable Medicare Part B fee schedule. However,
2119if such services, supplies, or care are not reimbursable under
2120Medicare Part B, the insurer may limit reimbursement to 80
2121percent of the maximum reimbursable allowance under workers'
2122compensation, as determined under s. 440.13 and rules adopted
2123thereunder which are in effect at the time such services,
2124supplies, or care are provided. Services, supplies, or care that
2125are not reimbursable under Medicare or workers' compensation are
2126not required to be reimbursed by the insurer.
2127     3.  For purposes of subparagraph 2., the applicable fee
2128schedule or payment limitation under Medicare is the fee
2129schedule or payment limitation in effect at the time the
2130services, supplies, or care were rendered and for the area in
2131which such services were rendered, except that it may not be
2132less than the applicable Medicare Part B fee schedule for
2133medical services, supplies, and care subject to Medicare Part B.
2134     4.  Subparagraph 2. does not allow the insurer to apply any
2135limitation on the number of treatments or other utilization
2136limits that apply under Medicare or workers' compensation. An
2137insurer that applies the allowable payment limitations of
2138subparagraph 2. must reimburse a provider who lawfully provided
2139care or treatment under the scope of his or her license,
2140regardless of whether such provider would be entitled to
2141reimbursement under Medicare due to restrictions or limitations
2142on the types or discipline of health care providers who may be
2143reimbursed for particular procedures or procedure codes.
2144     5.  If an insurer limits payment as authorized by
2145subparagraph 2., the person providing such services, supplies,
2146or care may not bill or attempt to collect from the insured any
2147amount in excess of such limits, except for amounts that are not
2148covered by the insured's personal injury protection coverage due
2149to the coinsurance amount or maximum policy limits.
2150     (b)1.  An insurer or insured is not required to pay a claim
2151or charges:
2152     a.  Made by a broker or by a person making a claim on
2153behalf of a broker;
2154     b.  For any service or treatment that was not lawful at the
2155time rendered;
2156     c.  To any person who knowingly submits a false or
2157misleading statement relating to the claim or charges;
2158     d.  With respect to a bill or statement that does not
2159substantially meet the applicable requirements of paragraph (d);
2160     e.  For any treatment or service that is upcoded, or that
2161is unbundled when such treatment or services should be bundled,
2162in accordance with paragraph (d). To facilitate prompt payment
2163of lawful services, an insurer may change codes that it
2164determines to have been improperly or incorrectly upcoded or
2165unbundled, and may make payment based on the changed codes,
2166without affecting the right of the provider to dispute the
2167change by the insurer, provided that before doing so, the
2168insurer must contact the health care provider and discuss the
2169reasons for the insurer's change and the health care provider's
2170reason for the coding, or make a reasonable good faith effort to
2171do so, as documented in the insurer's file; and
2172     f.  For medical services or treatment billed by a physician
2173and not provided in a hospital unless such services are rendered
2174by the physician or are incident to his or her professional
2175services and are included on the physician's bill, including
2176documentation verifying that the physician is responsible for
2177the medical services that were rendered and billed.
2178     2.  Charges for medically necessary cephalic thermograms,
2179peripheral thermograms, spinal ultrasounds, extremity
2180ultrasounds, video fluoroscopy, and surface electromyography
2181shall not exceed the maximum reimbursement allowance for such
2182procedures as set forth in the applicable fee schedule or other
2183payment methodology established pursuant to s. 440.13.
2184     3.  Allowable amounts that may be charged to a personal
2185injury protection insurance insurer and insured for medically
2186necessary nerve conduction testing when done in conjunction with
2187a needle electromyography procedure and both are performed and
2188billed solely by a physician licensed under chapter 458, chapter
2189459, chapter 460, or chapter 461 who is also certified by the
2190American Board of Electrodiagnostic Medicine or by a board
2191recognized by the American Board of Medical Specialties or the
2192American Osteopathic Association or who holds diplomate status
2193with the American Chiropractic Neurology Board or its
2194predecessors shall not exceed 200 percent of the allowable
2195amount under the participating physician fee schedule of
2196Medicare Part B for year 2001, for the area in which the
2197treatment was rendered, adjusted annually on August 1 to reflect
2198the prior calendar year's changes in the annual Medical Care
2199Item of the Consumer Price Index for All Urban Consumers in the
2200South Region as determined by the Bureau of Labor Statistics of
2201the United States Department of Labor.
2202     4.  Allowable amounts that may be charged to a personal
2203injury protection insurance insurer and insured for medically
2204necessary nerve conduction testing that does not meet the
2205requirements of subparagraph 3. shall not exceed the applicable
2206fee schedule or other payment methodology established pursuant
2207to s. 440.13.
2208     5.  Allowable amounts that may be charged to a personal
2209injury protection insurance insurer and insured for magnetic
2210resonance imaging services shall not exceed 175 percent of the
2211allowable amount under the participating physician fee schedule
2212of Medicare Part B for year 2001, for the area in which the
2213treatment was rendered, adjusted annually on August 1 to reflect
2214the prior calendar year's changes in the annual Medical Care
2215Item of the Consumer Price Index for All Urban Consumers in the
2216South Region as determined by the Bureau of Labor Statistics of
2217the United States Department of Labor for the 12-month period
2218ending June 30 of that year, except that allowable amounts that
2219may be charged to a personal injury protection insurance insurer
2220and insured for magnetic resonance imaging services provided in
2221facilities accredited by the Accreditation Association for
2222Ambulatory Health Care, the American College of Radiology, or
2223the Joint Commission on Accreditation of Healthcare
2224Organizations shall not exceed 200 percent of the allowable
2225amount under the participating physician fee schedule of
2226Medicare Part B for year 2001, for the area in which the
2227treatment was rendered, adjusted annually on August 1 to reflect
2228the prior calendar year's changes in the annual Medical Care
2229Item of the Consumer Price Index for All Urban Consumers in the
2230South Region as determined by the Bureau of Labor Statistics of
2231the United States Department of Labor for the 12-month period
2232ending June 30 of that year. This paragraph does not apply to
2233charges for magnetic resonance imaging services and nerve
2234conduction testing for inpatients and emergency services and
2235care as defined in chapter 395 rendered by facilities licensed
2236under chapter 395.
2237     2.6.  The Department of Health, in consultation with the
2238appropriate professional licensing boards, shall adopt, by rule,
2239a list of diagnostic tests deemed not to be medically necessary
2240for use in the treatment of persons sustaining bodily injury
2241covered by personal injury protection benefits under this
2242section. The initial list shall be adopted by January 1, 2004,
2243and shall be revised from time to time as determined by the
2244Department of Health, in consultation with the respective
2245professional licensing boards. Inclusion of a test on the list
2246of invalid diagnostic tests shall be based on lack of
2247demonstrated medical value and a level of general acceptance by
2248the relevant provider community and shall not be dependent for
2249results entirely upon subjective patient response.
2250Notwithstanding its inclusion on a fee schedule in this
2251subsection, an insurer or insured is not required to pay any
2252charges or reimburse claims for any invalid diagnostic test as
2253determined by the Department of Health.
2254     (c)1.  With respect to any treatment or service, other than
2255medical services billed by a hospital or other provider for
2256emergency services as defined in s. 395.002 or inpatient
2257services rendered at a hospital-owned facility, the statement of
2258charges must be furnished to the insurer by the provider and may
2259not include, and the insurer is not required to pay, charges for
2260treatment or services rendered more than 35 days before the
2261postmark date or electronic transmission date of the statement,
2262except for past due amounts previously billed on a timely basis
2263under this paragraph, and except that, if the provider submits
2264to the insurer a notice of initiation of treatment within 21
2265days after its first examination or treatment of the claimant,
2266the statement may include charges for treatment or services
2267rendered up to, but not more than, 75 days before the postmark
2268date of the statement. The injured party is not liable for, and
2269the provider shall not bill the injured party for, charges that
2270are unpaid because of the provider's failure to comply with this
2271paragraph. Any agreement requiring the injured person or insured
2272to pay for such charges is unenforceable.
2273     2.  If, however, the insured fails to furnish the provider
2274with the correct name and address of the insured's personal
2275injury protection insurer, the provider has 35 days from the
2276date the provider obtains the correct information to furnish the
2277insurer with a statement of the charges. The insurer is not
2278required to pay for such charges unless the provider includes
2279with the statement documentary evidence that was provided by the
2280insured during the 35-day period demonstrating that the provider
2281reasonably relied on erroneous information from the insured and
2282either:
2283     a.  A denial letter from the incorrect insurer; or
2284     b.  Proof of mailing, which may include an affidavit under
2285penalty of perjury, reflecting timely mailing to the incorrect
2286address or insurer.
2287     3.  For emergency services and care as defined in s.
2288395.002 rendered in a hospital emergency department or for
2289transport and treatment rendered by an ambulance provider
2290licensed pursuant to part III of chapter 401, the provider is
2291not required to furnish the statement of charges within the time
2292periods established by this paragraph; and the insurer shall not
2293be considered to have been furnished with notice of the amount
2294of covered loss for purposes of paragraph (4)(b) until it
2295receives a statement complying with paragraph (d), or copy
2296thereof, which specifically identifies the place of service to
2297be a hospital emergency department or an ambulance in accordance
2298with billing standards recognized by the Health Care Finance
2299Administration.
2300     4.  Each notice of insured's rights under s. 627.7401 must
2301include the following statement in type no smaller than 12
2302points:
2303
2304BILLING REQUIREMENTS.--Florida Statutes provide that with
2305respect to any treatment or services, other than certain
2306hospital and emergency services, the statement of charges
2307furnished to the insurer by the provider may not include, and
2308the insurer and the injured party are not required to pay,
2309charges for treatment or services rendered more than 35 days
2310before the postmark date of the statement, except for past due
2311amounts previously billed on a timely basis, and except that, if
2312the provider submits to the insurer a notice of initiation of
2313treatment within 21 days after its first examination or
2314treatment of the claimant, the statement may include charges for
2315treatment or services rendered up to, but not more than, 75 days
2316before the postmark date of the statement.
2317     (8)  APPLICABILITY OF PROVISION REGULATING ATTORNEY'S
2318FEES.--With respect to any dispute under the provisions of ss.
2319627.730-627.7405 between the insured and the insurer, or between
2320an assignee of an insured's rights and the insurer, the
2321provisions of s. 627.428 shall apply, except:
2322     (a)  As provided in subsections subsection (10) and (15).
2323     (b)  That attorney's fees chargeable under this subsection
2324shall be calculated without regard to any contingency risk
2325multiplier.
2326     (c)  That any attorney's fees recovered under ss. 627.730-
2327627.7405 shall be limited to the greater of $10,000 or three
2328times the amount of benefits secured by the attorney under ss.
2329627.730-627.7405.
2330     (10)  DEMAND LETTER.--
2331     (d)  If, within 30 15 days after receipt of notice by the
2332insurer, the overdue claim specified in the notice is paid by
2333the insurer together with applicable interest and a penalty of
233410 percent of the overdue amount paid by the insurer, subject to
2335a maximum penalty of $250, no action may be brought against the
2336insurer. If the demand involves an insurer's withdrawal of
2337payment under paragraph (7)(a) for future treatment not yet
2338rendered, no action may be brought against the insurer if,
2339within 30 15 days after its receipt of the notice, the insurer
2340mails to the person filing the notice a written statement of the
2341insurer's agreement to pay for such treatment in accordance with
2342the notice and to pay a penalty of 10 percent, subject to a
2343maximum penalty of $250, when it pays for such future treatment
2344in accordance with the requirements of this section. To the
2345extent the insurer determines not to pay any amount demanded,
2346the penalty shall not be payable in any subsequent action. For
2347purposes of this subsection, payment or the insurer's agreement
2348shall be treated as being made on the date a draft or other
2349valid instrument that is equivalent to payment, or the insurer's
2350written statement of agreement, is placed in the United States
2351mail in a properly addressed, postpaid envelope, or if not so
2352posted, on the date of delivery. The insurer is shall not be
2353obligated to pay any attorney's fees if the insurer pays the
2354claim or mails its agreement to pay for future treatment within
2355the time prescribed by this subsection.
2356     (e)  The applicable statute of limitation for an action
2357under this section shall be tolled for a period of 30 15
2358business days by the mailing of the notice required by this
2359subsection.
2360     (11)  FAILURE TO PAY VALID CLAIMS; UNFAIR OR DECEPTIVE
2361PRACTICE.--
2362     (a)  If an insurer fails to pay valid claims for personal
2363injury protection with such frequency so as to indicate a
2364general business practice, the insurer is engaging in a
2365prohibited unfair or deceptive practice that is subject to the
2366penalties provided in s. 626.9521 and the office has the powers
2367and duties specified in ss. 626.9561-626.9601 with respect
2368thereto.
2369     (b)  Notwithstanding s. 501.212, the Department of Legal
2370Affairs may investigate and initiate actions for a violation of
2371this subsection, including, but not limited to, the powers and
2372duties specified in part II of chapter 501.
2373     (15)  ALL CLAIMS BROUGHT IN A SINGLE ACTION.--In any civil
2374action to recover personal injury protection benefits brought by
2375a claimant pursuant to this section against an insurer, all
2376claims related to the same health care provider for the same
2377injured person shall be brought in one action, unless good cause
2378is shown why such claims should be brought separately. If the
2379court determines that a civil action is filed for a claim that
2380should have been brought in a prior civil action, the court may
2381not award attorney's fees to the claimant.
2382     (16)  SECURE ELECTRONIC DATA TRANSFER.--If all parties
2383mutually and expressly agree, a notice, documentation,
2384transmission, or communication of any kind required or
2385authorized under ss. 627.730-627.7405 may be transmitted
2386electronically if it is transmitted by secure electronic data
2387transfer that is consistent with state and federal privacy and
2388security laws.
2389     Section 21.  (1)  The Legislature intends that the
2390provisions of this act reviving and reenacting the Florida Motor
2391Vehicle No-Fault Law apply to policies issued on or after the
2392effective date of this act.
2393     (2)  Each insurer that issued coverage for a motor vehicle
2394that is subject to the Florida Motor Vehicle No-Fault Law shall,
2395within 30 days after the effective date of this act, mail or
2396deliver a revised notice of the premium and policy changes to
2397each policyholder whose policy has an effective date on or after
2398the effective date of this act and who was previously issued a
2399motor vehicle insurance policy or sent a renewal notice based on
2400the assumption that the Florida Motor Vehicle No-Fault Law would
2401be repealed on October 1, 2007. For a renewal policy, the
2402coverage must provide the same limits of personal injury
2403protection coverage, the same deductible from personal injury
2404protection coverage, and the same limits of medical payments
2405coverage as provided in the prior policy, unless the
2406policyholder elects different limits that are available. The
2407effective date of the revised policy or renewal shall be the
2408same as the effective date specified in the prior notice. The
2409revised notice of premium and coverage changes is exempt from
2410the requirements of ss. 627.7277, 627.728, and 627.7282, Florida
2411Statutes. The policyholder has a period of 30 days, or a longer
2412period if specified by the insurer, following receipt of the
2413revised notice within which to pay any additional amount of
2414premium due and thereby maintain the policy in force as
2415specified in this section. Alternatively, the policyholder may
2416cancel the policy within this time period and obtain a refund of
2417the unearned premium. If the policyholder fails to timely
2418respond to the notice, the insurer must cancel the policy and
2419return any unearned premium to the insured. The date on which
2420the policy will be canceled shall be stated in the notice and
2421may not be less than 35 days after the date of the notice. The
2422amount of unearned premium due to the policyholder shall be
2423calculated on a pro rata basis. The failure of an insurer to
2424timely mail or deliver a revised notice as required by this
2425subsection does not affect the other requirements of this
2426section.
2427     (3)  With respect to a policy providing personal injury
2428protection coverage having an effective date between the
2429effective date of this act and January 14, 2008, inclusive, the
2430insurer shall use the forms and rates it had in effect on
2431September 30, 2007, for all coverages in that policy unless the
2432insurer makes a new rate or form filing that is approved by the
2433Office of Insurance Regulation or otherwise legally allowed.
2434     (4)  The Legislature recognizes that some persons have been
2435issued a motor vehicle insurance policy effective on or after
2436October 1, 2007, and before the effective date of this act,
2437which does not include personal injury protection, based upon
2438the expected repeal of the Florida Motor Vehicle No-Fault Law on
2439October 1, 2007, pursuant to s. 19, chapter 2003-411, Laws of
2440Florida. Any such person:
2441     (a)  May continue to own and operate a motor vehicle in
2442this state without being subject to any sanction for failing to
2443maintain personal injury protection coverage if that person
2444continues to meet statutory requirements relating to property
2445damage liability coverage and obtains personal injury protection
2446coverage that takes effect no later than December 1, 2007.
2447     (b)  Is not subject to the provisions of s. 627.737,
2448Florida Statutes, relating to the exemption from tort liability
2449with respect to injuries sustained by the person in a motor
2450vehicle crash occurring while the policy without personal injury
2451protection coverage is in effect but not later than November 30,
24522007. This paragraph also applies during such period to any
2453person who would have been covered under a personal injury
2454protection policy if such a policy had been maintained on such
2455motor vehicle.
2456     (5)  Each insurer shall, by October 31, 2007, provide
2457written notification to each insured referred to in subsection
2458(4) informing the insured that he or she must obtain personal
2459injury protection coverage that takes effect no later than
2460December 1, 2007. Such notice must include the premium for such
2461coverage and the premium credit, if any, which will be provided
2462for other coverage, such as bodily injury liability coverage or
2463uninsured motorist coverage, as required by subsection (4).
2464Alternatively, the insurer may add an endorsement to the policy
2465to provide personal injury protection coverage as required by
2466law, effective no later than December 1, 2007, without requiring
2467any additional payment from the insured, and shall provide
2468written notification to the insured of such endorsement by
2469October 31, 2007.
2470     Section 22.  Except as otherwise expressly provided in this
2471act, this act shall take effect upon becoming a law.


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