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