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