CS/HB 13C

1
A bill to be entitled
2An act relating to motor vehicle insurance; amending s.
3316.646, F.S.; requiring each person operating a motor
4vehicle to have in his or her possession proof of property
5damage liability coverage; conforming a cross-reference to
6changes made by the act; amending s. 320.02, F.S.;
7clarifying the requirements concerning insurance and
8liability coverage for certain motor vehicles registered
9in this state; amending s. 321.245, F.S., relating to the
10disposition of certain funds in the Highway Safety
11Operating Trust Fund; conforming a cross-reference;
12amending s. 324.022, F.S.; revising provisions requiring
13the owner or operator of a motor vehicle to maintain
14property damage liability coverage; specifying the
15requirements that apply to such a policy; providing
16definitions; requiring that a nonresident owner or
17registrant of a motor vehicle maintain property damage
18liability coverage if the motor vehicle is in the state
19longer than a specified period; providing an exception for
20a member of the United States Armed Forces who is on
21active duty outside the United States; creating s.
22324.0221, F.S.; requiring insurers to report to the
23Department of Highway Safety and Motor Vehicles the
24renewal, cancellation, or nonrenewal of a policy providing
25personal injury protection coverage or motor vehicle
26property damage liability coverage; authorizing the
27department to adopt rules for the reports; providing that
28failure to report as required is a violation of the
29Florida Insurance Code; requiring that an insurer notify
30the named insured that a cancelled or nonrenewed policy
31will be reported to the department; requiring that the
32department suspend the registration and driver's license
33of an owner or registrant of a motor vehicle who fails to
34maintain the required liability coverage; providing for
35the reinstatement of a registration or driver's license
36upon payment of certain fees; requiring that a person
37obtain noncancelable coverage following such
38reinstatement; providing for the deposit and use of
39reinstatement fees; amending ss. 627.7275 and 627.7295,
40F.S., relating to motor vehicle insurance policies and
41contracts; conforming provisions to changes made by the
42act; reviving and reenacting ss. 627.730, 627.731,
43627.732, 627.734, 627.737, 627.739, 627.7401, 627.7403,
44and 627.7405, F.S., and reviving, reenacting, and amending
45ss. 627.733 and 627.736, the Florida Motor Vehicle No-
46Fault Law, notwithstanding the repeal of such law provided
47in s. 19, chapter 2003-411, Laws of Florida; deleting
48certain provisions relating to the suspension and
49reinstatement of a driver's license and registration and
50notice to the Department of Highway Safety and Motor
51Vehicles; conforming provisions to changes made by the
52act; providing legislative intent with respect to the
53reenactment and codification of the Florida Motor Vehicle
54No-Fault Law, notwithstanding its prior repeal; amending
55s. 627.736, F.S., as reenacted and amended; revising
56provisions governing the medical benefits provided as
57required personal injury protection benefits; providing
58medical benefits for services and care ordered or
59prescribed by a physician or chiropractor or provided by
60certain persons or entities that meet certain
61requirements; requiring the Financial services Commission
62to adopt rules; revising a limitation on the amount of
63death benefits payable; requiring personal injury
64protection insurers to reserve benefits for certain
65providers for a specified period; tolling the time period
66for the insurer to pay claims from other providers;
67authorizing an insurer to limit reimbursement for personal
68injury protection benefits to a specified percentage of a
69schedule of maximum charges; prohibiting provider from
70billing or attempting to collect amounts in excess of such
71limits, except for amounts that are not covered by
72personal injury protection coverage; deleting provisions
73specifying allowable amounts for certain tests and
74services; providing for electronic transmission of certain
75statements; revising the application of a specified
76provision concerning attorney's fees; extending the period
77during which an insurer may pay an overdue claim following
78receipt of a demand letter without incurring a penalty;
79providing for penalties to be imposed against certain
80insurers for failing to pay claims for personal injury
81protection; authorizing the Department of Legal Affairs to
82investigate violations and initiate enforcement action;
83requiring that all claims related to the same health care
84provider for the same injured person be brought in one act
85unless good cause is shown; authorizing notices and
86communications required or authorized under the Florida
87Motor Vehicle No-Fault Law to be transmitted
88electronically under certain conditions; requiring persons
89subject to the Florida Motor Vehicle No-Fault Law, as
90revived and amended by this act, to maintain security for
91personal injury protection beginning on a specified date;
92providing that personal injury protection policy in effect
93on or after a specified date are deemed to incorporate the
94Florida Motor Vehicle No-Fault Law, as revived and amended
95by this act; requiring that insurers continue to use
96certain forms and rates until new forms or rates are used
97as authorized by law; requiring that insurers provide
98notice of the requirement for personal injury protection
99coverage or add an endorsement to the policy providing
100such coverage; requiring specified notice to certain
101insureds as of a specified date; providing intent
102concerning application of revived and amended provisions
103prior to a specified date; providing legislative findings;
104providing that a person purchasing a motor vehicle
105insurance policy without personal injury protection
106coverage is exempt from the requirement for such coverage
107for a specified period; providing for severability;
108providing effective dates.
109
110Be It Enacted by the Legislature of the State of Florida:
111
112     Section 1.  Subsections (1) and (3) of section 316.646,
113Florida Statutes, are amended to read:
114     316.646  Security required; proof of security and display
115thereof; dismissal of cases.--
116     (1)  Any person required by s. 324.022 to maintain property
117damage liability security, required by s. 324.023 to maintain
118liability security for bodily injury or death, or any person
119required by s. 627.733 to maintain personal injury protection
120security on a motor vehicle shall have in his or her immediate
121possession at all times while operating such motor vehicle
122proper proof of maintenance of the required security. Such proof
123shall be either a uniform proof-of-insurance card in a form
124prescribed by the department, a valid insurance policy, an
125insurance policy binder, a certificate of insurance, or such
126other proof as may be prescribed by the department.
127     (3)  Any person who violates this section commits a
128nonmoving traffic infraction subject to the penalty provided in
129chapter 318 and shall be required to furnish proof of security
130as provided in this section. If any person charged with a
131violation of this section fails to furnish proof, at or before
132the scheduled court appearance date, that security was in effect
133at the time of the violation, the court may immediately suspend
134the registration and driver's license of such person. Such
135license and registration may only be reinstated only as provided
136in s. 324.0221 627.733.
137     Section 2.  Paragraphs (a) and (d) of subsection (5) of
138section 320.02, Florida Statutes, are amended to read:
139     320.02  Registration required; application for
140registration; forms.--
141     (5)(a)  Proof that personal injury protection benefits have
142been purchased when required under s. 627.733, that property
143damage liability coverage has been purchased as required under
144s. 324.022, that bodily injury or death coverage has been
145purchased if required under s. 324.023, and that combined bodily
146liability insurance and property damage liability insurance have
147been purchased when required under s. 627.7415 shall be provided
148in the manner prescribed by law by the applicant at the time of
149application for registration of any motor vehicle that is
150subject to such requirements owned as defined in s. 627.732. The
151issuing agent shall refuse to issue registration if such proof
152of purchase is not provided. Insurers shall furnish uniform
153proof-of-purchase cards in a form prescribed by the department
154and shall include the name of the insured's insurance company,
155the coverage identification number, and the make, year, and
156vehicle identification number of the vehicle insured. The card
157shall contain a statement notifying the applicant of the penalty
158specified in s. 316.646(4). The card or insurance policy,
159insurance policy binder, or certificate of insurance or a
160photocopy of any of these; an affidavit containing the name of
161the insured's insurance company, the insured's policy number,
162and the make and year of the vehicle insured; or such other
163proof as may be prescribed by the department shall constitute
164sufficient proof of purchase. If an affidavit is provided as
165proof, it shall be in substantially the following form:
166
167Under penalty of perjury, I   (Name of insured)   do hereby
168certify that I have   (Personal Injury Protection, Property
169Damage Liability, and, when required, Bodily Injury Liability)  
170Insurance currently in effect with   (Name of insurance company)  
171under   (policy number)   covering   (make, year, and vehicle
172identification number of vehicle)  .   (Signature of Insured)  
173
174Such affidavit shall include the following warning:
175
176WARNING: GIVING FALSE INFORMATION IN ORDER TO OBTAIN A VEHICLE
177REGISTRATION CERTIFICATE IS A CRIMINAL OFFENSE UNDER FLORIDA
178LAW. ANYONE GIVING FALSE INFORMATION ON THIS AFFIDAVIT IS
179SUBJECT TO PROSECUTION.
180
181When an application is made through a licensed motor vehicle
182dealer as required in s. 319.23, the original or a photostatic
183copy of such card, insurance policy, insurance policy binder, or
184certificate of insurance or the original affidavit from the
185insured shall be forwarded by the dealer to the tax collector of
186the county or the Department of Highway Safety and Motor
187Vehicles for processing. By executing the aforesaid affidavit,
188no licensed motor vehicle dealer will be liable in damages for
189any inadequacy, insufficiency, or falsification of any statement
190contained therein. A card shall also indicate the existence of
191any bodily injury liability insurance voluntarily purchased.
192     (d)  The verifying of proof of personal injury protection
193insurance, proof of property damage liability insurance, proof
194of combined bodily liability insurance and property damage
195liability insurance, or proof of financial responsibility
196insurance and the issuance or failure to issue the motor vehicle
197registration under the provisions of this chapter may not be
198construed in any court as a warranty of the reliability or
199accuracy of the evidence of such proof. Neither the department
200nor any tax collector is liable in damages for any inadequacy,
201insufficiency, falsification, or unauthorized modification of
202any item of the proof of personal injury protection insurance,
203proof of property damage liability insurance, proof of combined
204bodily liability insurance and property damage liability
205insurance, or proof of financial responsibility insurance either
206prior to, during, or subsequent to the verification of the
207proof. The issuance of a motor vehicle registration does not
208constitute prima facie evidence or a presumption of insurance
209coverage.
210     Section 3.  Section 321.245, Florida Statutes, is amended
211to read:
212     321.245  Disposition of certain funds in the Highway Safety
213Operating Trust Fund.--The director of the Florida Highway
214Patrol, after receiving recommendations from the commander of
215the auxiliary, is authorized to purchase uniforms and equipment
216for auxiliary law enforcement officers as defined in s. 321.24
217from funds described in s. 324.0221(3) 627.733(7). The amounts
218expended under this section shall not exceed $50,000 in any one
219fiscal year.
220     Section 4.  Section 324.022, Florida Statutes, is amended
221to read:
222     324.022  Financial responsibility for property damage.--
223     (1)  Every owner or operator of a motor vehicle, which
224motor vehicle is subject to the requirements of ss. 627.730-
225627.7405 and required to be registered in this state, shall, by
226one of the methods established in s. 324.031 or by having a
227policy that complies with s. 627.7275, establish and maintain
228the ability to respond in damages for liability on account of
229accidents arising out of the use of the motor vehicle in the
230amount of $10,000 because of damage to, or destruction of,
231property of others in any one crash. The requirements of this
232section may be met by one of the methods established in s.
233324.031; by self-insuring as authorized by s. 768.28(16); or by
234maintaining an insurance policy providing coverage for property
235damage liability in the amount of at least $10,000 because of
236damage to, or destruction of, property of others in any one
237accident arising out of the use of the motor vehicle. The
238requirements of this section may also be met by having a policy
239which provides coverage in the amount of at least $30,000 for
240combined property damage liability and bodily injury liability
241for any one crash arising out of the use of the motor vehicle.
242The policy, with respect to coverage for property damage
243liability, must meet the applicable requirements of s. 324.151,
244subject to the usual policy exclusions that have been approved
245in policy forms by the Office of Insurance Regulation. No
246insurer shall have any duty to defend uncovered claims
247irrespective 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
250has four or more wheels and that is of a type designed and
251required to be licensed for use on the highways of this state,
252and any trailer or semitrailer designed for use with such
253vehicle. The term does not include:
254     1.  A mobile home.
255     2.  A motor vehicle that is used in mass transit and
256designed to transport more than five passengers, exclusive of
257the operator of the motor vehicle, and that is owned by a
258municipality, transit authority, or political subdivision of the
259state.
260     3.  A school bus as defined in s. 1006.25.
261     4.  A vehicle providing for-hire transportation that is
262subject to the provisions of s. 324.031. A taxicab shall
263maintain security as required under s. 324.032(1).
264     (b)  "Owner" means the person who holds legal title to a
265motor vehicle or the debtor or lessee who has the right to
266possession of a motor vehicle that is the subject of a security
267agreement or lease with an option to purchase.
268     (3)  Each nonresident owner or registrant of a motor
269vehicle that, whether operated or not, has been physically
270present within this state for more than 90 days during the
271preceding 365 days shall maintain security as required by
272subsection (1) that is in effect continuously throughout the
273period the motor vehicle remains within this state.
274     (4)  The owner or registrant of a motor vehicle is exempt
275from the requirements of this section if she or he is a member
276of the United States Armed Forces and is called to or on active
277duty outside the United States in an emergency situation. The
278exemption provided by this subsection applies only as long as
279the member of the Armed Forces is on such active duty outside
280the United States and applies only while the vehicle is not
281operated by any person. Upon receipt of a written request by the
282insured to whom the exemption provided in this subsection
283applies, the insurer shall cancel the coverages and return any
284unearned premium or suspend the security required by this
285section. Notwithstanding s. 324.0221(3), the department may not
286suspend the registration or operator's license of any owner or
287registrant of a motor vehicle during the time she or he
288qualifies for an exemption under this subsection. Any owner or
289registrant of a motor vehicle who qualifies for an exemption
290under this subsection shall immediately notify the department
291prior to and at the end of the expiration of the exemption.
292     Section 5.  Section 324.0221, Florida Statutes, is created
293to read:
294     324.0221  Reports by insurers to the department; suspension
295of driver's license and vehicle registrations; reinstatement.--
296     (1)(a)  Each insurer that has issued a policy providing
297personal injury protection coverage or property damage liability
298coverage shall report the renewal, cancellation, or nonrenewal
299thereof to the department within 45 days after the effective
300date of each renewal, cancellation, or nonrenewal. Upon the
301issuance of a policy providing personal injury protection
302coverage or property damage liability coverage to a named
303insured not previously insured by the insurer during that
304calendar year, the insurer shall report the issuance of the new
305policy to the department within 30 days. The report shall be in
306the form and format and contain any information required by the
307department and must be provided in a format that is compatible
308with the data-processing capabilities of the department. The
309department may adopt rules regarding the form and documentation
310required. Failure by an insurer to file proper reports with the
311department as required by this subsection or rules adopted with
312respect to the requirements of this subsection constitutes a
313violation of the Florida Insurance Code. These records shall be
314used by the department only for enforcement and regulatory
315purposes, including the generation by the department of data
316regarding compliance by owners of motor vehicles with the
317requirements for financial responsibility coverage.
318     (b)  With respect to an insurance policy providing personal
319injury protection coverage or property damage liability
320coverage, each insurer shall notify the named insured, or the
321first-named insured in the case of a commercial fleet policy, in
322writing that any cancellation or nonrenewal of the policy will
323be reported by the insurer to the department. The notice must
324also inform the named insured that failure to maintain personal
325injury protection coverage and property damage liability
326coverage on a motor vehicle when required by law may result in
327the loss of registration and driving privileges in this state
328and inform the named insured of the amount of the reinstatement
329fees required by this section. This notice is for informational
330purposes only, and an insurer is not civilly liable for failing
331to provide this notice.
332     (2)  The department shall suspend, after due notice and an
333opportunity to be heard, the registration and driver's license
334of any owner or registrant of a motor vehicle with respect to
335which security is required under ss. 324.022 and 627.733 upon:
336     (a)  The department's records showing that the owner or
337registrant of such motor vehicle did not have in full force and
338effect when required security that complies with the
339requirements of ss. 324.022 and 627.733; or
340     (b)  Notification by the insurer to the department, in a
341form approved by the department, of cancellation or termination
342of the required security.
343     (3)  An operator or owner whose driver's license or
344registration has been suspended under this section or s. 316.646
345may effect its reinstatement upon compliance with the
346requirements of this section and upon payment to the department
347of a nonrefundable reinstatement fee of $150 for the first
348reinstatement. The reinstatement fee is $250 for the second
349reinstatement and $500 for each subsequent reinstatement during
350the 3 years following the first reinstatement. A person
351reinstating her or his insurance under this subsection must also
352secure noncancelable coverage as described in ss. 324.021(8),
353324.023, and 627.7275(2) and present to the appropriate person
354proof that the coverage is in force on a form adopted by the
355department, and such proof shall be maintained for 2 years. If
356the person does not have a second reinstatement within 3 years
357after her or his initial reinstatement, the reinstatement fee is
358$150 for the first reinstatement after that 3-year period. If a
359person's license and registration are suspended under this
360section or s. 316.646, only one reinstatement fee must be paid
361to reinstate the license and the registration. All fees shall be
362collected by the department at the time of reinstatement. The
363department shall issue proper receipts for such fees and shall
364promptly deposit those fees in the Highway Safety Operating
365Trust Fund. One-third of the fees collected under this
366subsection shall be distributed from the Highway Safety
367Operating Trust Fund to the local governmental entity or state
368agency that employed the law enforcement officer seizing the
369license plate pursuant to s. 324.201. The funds may be used by
370the local governmental entity or state agency for any authorized
371purpose.
372     Section 6.  Section 627.7275, Florida Statutes, is amended
373to read:
374     627.7275  Motor vehicle liability.--
375     (1)  A motor vehicle insurance policy providing personal
376injury protection as set forth in s. 627.736 may not be
377delivered or issued for delivery in this state with respect to
378any specifically insured or identified motor vehicle registered
379or principally garaged in this state unless the policy also
380provides coverage for property damage liability as required by
381s. 324.022 in the amount of at least $10,000 because of damage
382to, or destruction of, property of others in any one accident
383arising out of the use of the motor vehicle or unless the policy
384provides coverage in the amount of at least $30,000 for combined
385property damage liability and bodily injury liability in any one
386accident arising out of the use of the motor vehicle. The
387policy, as to coverage of property damage liability, must meet
388the applicable requirements of s. 324.151, subject to the usual
389policy exclusions that have been approved in policy forms by the
390office.
391     (2)(a)  Insurers writing motor vehicle insurance in this
392state shall make available, subject to the insurers' usual
393underwriting restrictions:
394     1.  Coverage under policies as described in subsection (1)
395to any applicant for private passenger motor vehicle insurance
396coverage who is seeking the coverage in order to reinstate the
397applicant's driving privileges in this state when the driving
398privileges were revoked or suspended pursuant to s. 316.646 or
399s. 324.0221 627.733 due to the failure of the applicant to
400maintain required security.
401     2.  Coverage under policies as described in subsection (1),
402which also provides liability coverage for bodily injury, death,
403and property damage arising out of the ownership, maintenance,
404or use of the motor vehicle in an amount not less than the
405limits described in s. 324.021(7) and conforms to the
406requirements of s. 324.151, to any applicant for private
407passenger motor vehicle insurance coverage who is seeking the
408coverage in order to reinstate the applicant's driving
409privileges in this state after such privileges were revoked or
410suspended under s. 316.193 or s. 322.26(2) for driving under the
411influence.
412     (b)  The policies described in paragraph (a) shall be
413issued for a period of at least 6 months and as to the minimum
414coverages required under this section shall not be cancelable by
415the insured for any reason or by the insurer after a period not
416to exceed 30 days during which the insurer must complete
417underwriting of the policy. After the insurer has completed
418underwriting the policy within the 30-day period, the insurer
419shall notify the Department of Highway Safety and Motor Vehicles
420that the policy is in full force and effect and the policy shall
421not be cancelable for the remainder of the policy period. A
422premium shall be collected and coverage shall be in effect for
423the 30-day period during which the insurer is completing the
424underwriting of the policy whether or not the person's driver
425license, motor vehicle tag, and motor vehicle registration are
426in effect. Once the noncancelable provisions of the policy
427become effective, the coverage or risk shall not be changed
428during the policy period and the premium shall be nonrefundable.
429If, during the pendency of the 2-year proof of insurance period
430required under s. 324.0221 627.733(7) or during the 3-year proof
431of financial responsibility required under s. 324.131, whichever
432is applicable, the insured obtains additional coverage or
433coverage for an additional risk or changes territories, the
434insured must obtain a new 6-month noncancelable policy in
435accordance with the provisions of this section. However, if the
436insured must obtain a new 6-month policy and obtains the policy
437from the same insurer, the policyholder shall receive credit on
438the new policy for any premium paid on the previously issued
439policy.
440     (c)  This subsection controls to the extent of any conflict
441with any other section.
442     (d)  An insurer issuing a policy subject to this section
443may cancel the policy if, during the policy term, the named
444insured or any other operator, who resides in the same household
445or customarily operates an automobile insured under the policy,
446has his or her driver's license suspended or revoked.
447     (e)  Nothing in this subsection requires an insurer to
448offer a policy of insurance to an applicant if such offer would
449be inconsistent with the insurer's underwriting guidelines and
450procedures.
451     Section 7.  Paragraph (a) of subsection (1) of section
452627.7295, 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
456provides personal injury protection coverage, and property
457damage liability coverage, or both.
458     Section 8.  Notwithstanding the repeal of the Florida Motor
459Vehicle No-Fault Law, which occurred on October 1, 2007, section
460627.730, Florida Statutes, is revived and reenacted to read:
461     627.730  Florida Motor Vehicle No-Fault Law.--Sections
462627.730-627.7405 may be cited and known as the "Florida Motor
463Vehicle No-Fault Law."
464     Section 9.  Notwithstanding the repeal of the Florida Motor
465Vehicle No-Fault Law, which occurred on October 1, 2007, section
466627.731, Florida Statutes, is revived and reenacted to read:
467     627.731  Purpose.--The purpose of ss. 627.730-627.7405 is
468to provide for medical, surgical, funeral, and disability
469insurance benefits without regard to fault, and to require motor
470vehicle insurance securing such benefits, for motor vehicles
471required to be registered in this state and, with respect to
472motor vehicle accidents, a limitation on the right to claim
473damages for pain, suffering, mental anguish, and inconvenience.
474     Section 10.  Notwithstanding the repeal of the Florida
475Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
476section 627.732, Florida Statutes, is revived and reenacted to
477read:
478     627.732  Definitions.--As used in ss. 627.730-627.7405, the
479term:
480     (1)  "Broker" means any person not possessing a license
481under chapter 395, chapter 400, chapter 429, chapter 458,
482chapter 459, chapter 460, chapter 461, or chapter 641 who
483charges or receives compensation for any use of medical
484equipment and is not the 100-percent owner or the 100-percent
485lessee of such equipment. For purposes of this section, such
486owner or lessee may be an individual, a corporation, a
487partnership, or any other entity and any of its 100-percent-
488owned affiliates and subsidiaries. For purposes of this
489subsection, the term "lessee" means a long-term lessee under a
490capital or operating lease, but does not include a part-time
491lessee. The term "broker" does not include a hospital or
492physician management company whose medical equipment is
493ancillary to the practices managed, a debt collection agency, or
494an entity that has contracted with the insurer to obtain a
495discounted rate for such services; nor does the term include a
496management company that has contracted to provide general
497management services for a licensed physician or health care
498facility and whose compensation is not materially affected by
499the usage or frequency of usage of medical equipment or an
500entity that is 100-percent owned by one or more hospitals or
501physicians. The term "broker" does not include a person or
502entity 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
506for personal injury protection patients is on a temporary basis
507not to exceed 30 days in a 12-month period, and such lease is
508solely for the purposes of necessary repair or maintenance of
509the 100-percent-owned medical equipment or pending the arrival
510and installation of the newly purchased or a replacement for the
511100-percent-owned medical equipment, or for patients for whom,
512because of physical size or claustrophobia, it is determined by
513the medical director or clinical director to be medically
514necessary that the test be performed in medical equipment that
515is open-style. The leased medical equipment cannot be used by
516patients who are not patients of the registered clinic for
517medical treatment of services. Any person or entity making a
518false certification under this subsection commits insurance
519fraud as defined in s. 817.234. However, the 30-day period
520provided in this paragraph may be extended for an additional 60
521days as applicable to magnetic resonance imaging equipment if
522the owner certifies that the extension otherwise complies with
523this paragraph.
524     (2)  "Medically necessary" refers to a medical service or
525supply that a prudent physician would provide for the purpose of
526preventing, diagnosing, or treating an illness, injury, disease,
527or symptom in a manner that is:
528     (a)  In accordance with generally accepted standards of
529medical practice;
530     (b)  Clinically appropriate in terms of type, frequency,
531extent, site, and duration; and
532     (c)  Not primarily for the convenience of the patient,
533physician, or other health care provider.
534     (3)  "Motor vehicle" means any self-propelled vehicle with
535four or more wheels which is of a type both designed and
536required to be licensed for use on the highways of this state
537and any trailer or semitrailer designed for use with such
538vehicle and includes:
539     (a)  A "private passenger motor vehicle," which is any
540motor vehicle which is a sedan, station wagon, or jeep-type
541vehicle and, if not used primarily for occupational,
542professional, or business purposes, a motor vehicle of the
543pickup, panel, van, camper, or motor home type.
544     (b)  A "commercial motor vehicle," which is any motor
545vehicle which is not a private passenger motor vehicle.
546
547The term "motor vehicle" does not include a mobile home or any
548motor vehicle which is used in mass transit, other than public
549school transportation, and designed to transport more than five
550passengers exclusive of the operator of the motor vehicle and
551which is owned by a municipality, a transit authority, or a
552political subdivision of the state.
553     (4)  "Named insured" means a person, usually the owner of a
554vehicle, identified in a policy by name as the insured under the
555policy.
556     (5)  "Owner" means a person who holds the legal title to a
557motor vehicle; or, in the event a motor vehicle is the subject
558of a security agreement or lease with an option to purchase with
559the debtor or lessee having the right to possession, then the
560debtor or lessee shall be deemed the owner for the purposes of
561ss. 627.730-627.7405.
562     (6)  "Relative residing in the same household" means a
563relative of any degree by blood or by marriage who usually makes
564her or his home in the same family unit, whether or not
565temporarily living elsewhere.
566     (7)  "Certify" means to swear or attest to being true or
567represented in writing.
568     (8)  "Immediate personal supervision," as it relates to the
569performance of medical services by nonphysicians not in a
570hospital, means that an individual licensed to perform the
571medical service or provide the medical supplies must be present
572within the confines of the physical structure where the medical
573services are performed or where the medical supplies are
574provided such that the licensed individual can respond
575immediately to any emergencies if needed.
576     (9)  "Incident," with respect to services considered as
577incident to a physician's professional service, for a physician
578licensed under chapter 458, chapter 459, chapter 460, or chapter
579461, if not furnished in a hospital, means such services must be
580an integral, even if incidental, part of a covered physician's
581service.
582     (10)  "Knowingly" means that a person, with respect to
583information, has actual knowledge of the information; acts in
584deliberate ignorance of the truth or falsity of the information;
585or acts in reckless disregard of the information, and proof of
586specific intent to defraud is not required.
587     (11)  "Lawful" or "lawfully" means in substantial
588compliance with all relevant applicable criminal, civil, and
589administrative requirements of state and federal law related to
590the provision of medical services or treatment.
591     (12)  "Hospital" means a facility that, at the time
592services or treatment were rendered, was licensed under chapter
593395.
594     (13)  "Properly completed" means providing truthful,
595substantially complete, and substantially accurate responses as
596to all material elements to each applicable request for
597information or statement by a means that may lawfully be
598provided and that complies with this section, or as agreed by
599the parties.
600     (14)  "Upcoding" means an action that submits a billing
601code that would result in payment greater in amount than would
602be paid using a billing code that accurately describes the
603services performed. The term does not include an otherwise
604lawful bill by a magnetic resonance imaging facility, which
605globally combines both technical and professional components, if
606the amount of the global bill is not more than the components if
607billed separately; however, payment of such a bill constitutes
608payment in full for all components of such service.
609     (15)  "Unbundling" means an action that submits a billing
610code that is properly billed under one billing code, but that
611has been separated into two or more billing codes, and would
612result in payment greater in amount than would be paid using one
613billing code.
614     Section 11.  Notwithstanding the repeal of the Florida
615Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
616section 627.733, Florida Statutes, is revived, reenacted, and
617amended to read:
618     627.733  Required security.--
619     (1)(a)  Every owner or registrant of a motor vehicle, other
620than a motor vehicle used as a school bus as defined in s.
6211006.25 or limousine, required to be registered and licensed in
622this state shall maintain security as required by subsection (3)
623in effect continuously throughout the registration or licensing
624period.
625     (b)  Every owner or registrant of a motor vehicle used as a
626taxicab shall not be governed by paragraph (1)(a) but shall
627maintain security as required under s. 324.032(1), and s.
628627.737 shall not apply to any motor vehicle used as a taxicab.
629     (2)  Every nonresident owner or registrant of a motor
630vehicle which, whether operated or not, has been physically
631present within this state for more than 90 days during the
632preceding 365 days shall thereafter maintain security as defined
633by subsection (3) in effect continuously throughout the period
634such motor vehicle remains within this state.
635     (3)  Such security shall be provided:
636     (a)  By an insurance policy delivered or issued for
637delivery in this state by an authorized or eligible motor
638vehicle liability insurer which provides the benefits and
639exemptions contained in ss. 627.730-627.7405. Any policy of
640insurance represented or sold as providing the security required
641hereunder shall be deemed to provide insurance for the payment
642of the required benefits; or
643     (b)  By any other method authorized by s. 324.031(2), (3),
644or (4) and approved by the Department of Highway Safety and
645Motor Vehicles as affording security equivalent to that afforded
646by a policy of insurance or by self-insuring as authorized by s.
647768.28(16). The person filing such security shall have all of
648the obligations and rights of an insurer under ss. 627.730-
649627.7405.
650     (4)  An owner of a motor vehicle with respect to which
651security is required by this section who fails to have such
652security in effect at the time of an accident shall have no
653immunity from tort liability, but shall be personally liable for
654the payment of benefits under s. 627.736. With respect to such
655benefits, such an owner shall have all of the rights and
656obligations of an insurer under ss. 627.730-627.7405.
657     (5)  In addition to other persons who are not required to
658provide required security as required under this section and s.
659324.022, the owner or registrant of a motor vehicle is exempt
660from such requirements if she or he is a member of the United
661States Armed Forces and is called to or on active duty outside
662the United States in an emergency situation. The exemption
663provided by this subsection applies only as long as the member
664of the armed forces is on such active duty outside the United
665States and applies only while the vehicle covered by the
666security required by this section and s. 324.022 is not operated
667by any person. Upon receipt of a written request by the insured
668to whom the exemption provided in this subsection applies, the
669insurer shall cancel the coverages and return any unearned
670premium or suspend the security required by this section and s.
671324.022. Notwithstanding s. 324.0221(2) subsection (6), the
672Department of Highway Safety and Motor Vehicles may not suspend
673the registration or operator's license of any owner or
674registrant of a motor vehicle during the time she or he
675qualifies for an exemption under this subsection. Any owner or
676registrant of a motor vehicle who qualifies for an exemption
677under this subsection shall immediately notify the department
678prior to and at the end of the expiration of the exemption.
679     (6)  The Department of Highway Safety and Motor Vehicles
680shall suspend, after due notice and an opportunity to be heard,
681the registration and driver's license of any owner or registrant
682of a motor vehicle with respect to which security is required
683under this section and s. 324.022:
684     (a)  Upon its records showing that the owner or registrant
685of such motor vehicle did not have in full force and effect when
686required security complying with the terms of this section; or
687     (b)  Upon notification by the insurer to the Department of
688Highway Safety and Motor Vehicles, in a form approved by the
689department, of cancellation or termination of the required
690security.
691     (7)  Any operator or owner whose driver's license or
692registration has been suspended pursuant to this section or s.
693316.646 may effect its reinstatement upon compliance with the
694requirements of this section and upon payment to the Department
695of Highway Safety and Motor Vehicles of a nonrefundable
696reinstatement fee of $150 for the first reinstatement.  Such
697reinstatement fee shall be $250 for the second reinstatement and
698$500 for each subsequent reinstatement during the 3 years
699following the first reinstatement. Any person reinstating her or
700his insurance under this subsection must also secure
701noncancelable coverage as described in ss. 324.021(8), 324.023,
702and 627.7275(2) and present to the appropriate person proof that
703the coverage is in force on a form promulgated by the Department
704of Highway Safety and Motor Vehicles, such proof to be
705maintained for 2 years.  If the person does not have a second
706reinstatement within 3 years after her or his initial
707reinstatement, the reinstatement fee shall be $150 for the first
708reinstatement after that 3-year period. In the event that a
709person's license and registration are suspended pursuant to this
710section or s. 316.646, only one reinstatement fee shall be paid
711to reinstate the license and the registration. All fees shall be
712collected by the Department of Highway Safety and Motor Vehicles
713at the time of reinstatement. The Department of Highway Safety
714and Motor Vehicles shall issue proper receipts for such fees and
715shall promptly deposit those fees in the Highway Safety
716Operating Trust Fund. One-third of the fee collected under this
717subsection shall be distributed from the Highway Safety
718Operating Trust Fund to the local government entity or state
719agency which employed the law enforcement officer who seizes a
720license plate pursuant to s. 324.201. Such funds may be used by
721the local government entity or state agency for any authorized
722purpose.
723     Section 12.  Notwithstanding the repeal of the Florida
724Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
725section 627.734, Florida Statutes, is revived and reenacted to
726read:
727     627.734  Proof of security; security requirements;
728penalties.--
729     (1)  The provisions of chapter 324 which pertain to the
730method of giving and maintaining proof of financial
731responsibility and which govern and define a motor vehicle
732liability policy shall apply to filing and maintaining proof of
733security required by ss. 627.730-627.7405.
734     (2)  Any person who:
735     (a)  Gives information required in a report or otherwise as
736provided for in ss. 627.730-627.7405, knowing or having reason
737to believe that such information is false;
738     (b)  Forges or, without authority, signs any evidence of
739proof of security; or
740     (c)  Files, or offers for filing, any such evidence of
741proof, knowing or having reason to believe that it is forged or
742signed without authority,
743
744is guilty of a misdemeanor of the first degree, punishable as
745provided in s. 775.082 or s. 775.083.
746     Section 13.  Notwithstanding the repeal of the Florida
747Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
748section 627.736, Florida Statutes, is revived, reenacted, and
749amended to read:
750     627.736  Required personal injury protection benefits;
751exclusions; priority; claims.--
752     (1)  REQUIRED BENEFITS.--Every insurance policy complying
753with the security requirements of s. 627.733 shall provide
754personal injury protection to the named insured, relatives
755residing in the same household, persons operating the insured
756motor vehicle, passengers in such motor vehicle, and other
757persons struck by such motor vehicle and suffering bodily injury
758while not an occupant of a self-propelled vehicle, subject to
759the provisions of subsection (2) and paragraph (4)(d), to a
760limit of $10,000 for loss sustained by any such person as a
761result of bodily injury, sickness, disease, or death arising out
762of the ownership, maintenance, or use of a motor vehicle as
763follows:
764     (a)  Medical benefits.--Eighty percent of all reasonable
765expenses for medically necessary medical, surgical, X-ray,
766dental, and rehabilitative services, including prosthetic
767devices, and medically necessary ambulance, hospital, and
768nursing services. Such benefits shall also include necessary
769remedial treatment and services recognized and permitted under
770the laws of the state for an injured person who relies upon
771spiritual means through prayer alone for healing, in accordance
772with his or her religious beliefs; however, this sentence does
773not affect the determination of what other services or
774procedures are medically necessary.
775     (b)  Disability benefits.--Sixty percent of any loss of
776gross income and loss of earning capacity per individual from
777inability to work proximately caused by the injury sustained by
778the injured person, plus all expenses reasonably incurred in
779obtaining from others ordinary and necessary services in lieu of
780those that, but for the injury, the injured person would have
781performed without income for the benefit of his or her
782household. All disability benefits payable under this provision
783shall be paid not less than every 2 weeks.
784     (c)  Death benefits.--Death benefits of $5,000 per
785individual.  The insurer may pay such benefits to the executor
786or administrator of the deceased, to any of the deceased's
787relatives by blood or legal adoption or connection by marriage,
788or to any person appearing to the insurer to be equitably
789entitled thereto.
790
791Only insurers writing motor vehicle liability insurance in this
792state may provide the required benefits of this section, and no
793such insurer shall require the purchase of any other motor
794vehicle coverage other than the purchase of property damage
795liability coverage as required by s. 627.7275 as a condition for
796providing such required benefits. Insurers may not require that
797property damage liability insurance in an amount greater than
798$10,000 be purchased in conjunction with personal injury
799protection.  Such insurers shall make benefits and required
800property damage liability insurance coverage available through
801normal marketing channels. Any insurer writing motor vehicle
802liability insurance in this state who fails to comply with such
803availability requirement as a general business practice shall be
804deemed to have violated part IX of chapter 626, and such
805violation shall constitute an unfair method of competition or an
806unfair or deceptive act or practice involving the business of
807insurance; and any such insurer committing such violation shall
808be subject to the penalties afforded in such part, as well as
809those which may be afforded elsewhere in the insurance code.
810     (2)  AUTHORIZED EXCLUSIONS.--Any insurer may exclude
811benefits:
812     (a)  For injury sustained by the named insured and
813relatives residing in the same household while occupying another
814motor vehicle owned by the named insured and not insured under
815the policy or for injury sustained by any person operating the
816insured motor vehicle without the express or implied consent of
817the insured.
818     (b)  To any injured person, if such person's conduct
819contributed to his or her injury under any of the following
820circumstances:
821     1.  Causing injury to himself or herself intentionally; or
822     2.  Being injured while committing a felony.
823
824Whenever an insured is charged with conduct as set forth in
825subparagraph 2., the 30-day payment provision of paragraph
826(4)(b) shall be held in abeyance, and the insurer shall withhold
827payment of any personal injury protection benefits pending the
828outcome of the case at the trial level.  If the charge is nolle
829prossed or dismissed or the insured is acquitted, the 30-day
830payment provision shall run from the date the insurer is
831notified of such action.
832     (3)  INSURED'S RIGHTS TO RECOVERY OF SPECIAL DAMAGES IN
833TORT CLAIMS.--No insurer shall have a lien on any recovery in
834tort by judgment, settlement, or otherwise for personal injury
835protection benefits, whether suit has been filed or settlement
836has been reached without suit.  An injured party who is entitled
837to bring suit under the provisions of ss. 627.730-627.7405, or
838his or her legal representative, shall have no right to recover
839any damages for which personal injury protection benefits are
840paid or payable. The plaintiff may prove all of his or her
841special damages notwithstanding this limitation, but if special
842damages are introduced in evidence, the trier of facts, whether
843judge or jury, shall not award damages for personal injury
844protection benefits paid or payable.  In all cases in which a
845jury is required to fix damages, the court shall instruct the
846jury that the plaintiff shall not recover such special damages
847for personal injury protection benefits paid or payable.
848     (4)  BENEFITS; WHEN DUE.--Benefits due from an insurer
849under ss. 627.730-627.7405 shall be primary, except that
850benefits received under any workers' compensation law shall be
851credited against the benefits provided by subsection (1) and
852shall be due and payable as loss accrues, upon receipt of
853reasonable proof of such loss and the amount of expenses and
854loss incurred which are covered by the policy issued under ss.
855627.730-627.7405. When the Agency for Health Care Administration
856provides, pays, or becomes liable for medical assistance under
857the Medicaid program related to injury, sickness, disease, or
858death arising out of the ownership, maintenance, or use of a
859motor vehicle, benefits under ss. 627.730-627.7405 shall be
860subject to the provisions of the Medicaid program.
861     (a)  An insurer may require written notice to be given as
862soon as practicable after an accident involving a motor vehicle
863with respect to which the policy affords the security required
864by ss. 627.730-627.7405.
865     (b)  Personal injury protection insurance benefits paid
866pursuant to this section shall be overdue if not paid within 30
867days after the insurer is furnished written notice of the fact
868of a covered loss and of the amount of same. If such written
869notice is not furnished to the insurer as to the entire claim,
870any partial amount supported by written notice is overdue if not
871paid within 30 days after such written notice is furnished to
872the insurer. Any part or all of the remainder of the claim that
873is subsequently supported by written notice is overdue if not
874paid within 30 days after such written notice is furnished to
875the insurer. When an insurer pays only a portion of a claim or
876rejects a claim, the insurer shall provide at the time of the
877partial payment or rejection an itemized specification of each
878item that the insurer had reduced, omitted, or declined to pay
879and any information that the insurer desires the claimant to
880consider related to the medical necessity of the denied
881treatment or to explain the reasonableness of the reduced
882charge, provided that this shall not limit the introduction of
883evidence at trial; and the insurer shall include the name and
884address of the person to whom the claimant should respond and a
885claim number to be referenced in future correspondence. However,
886notwithstanding the fact that written notice has been furnished
887to the insurer, any payment shall not be deemed overdue when the
888insurer has reasonable proof to establish that the insurer is
889not responsible for the payment. For the purpose of calculating
890the extent to which any benefits are overdue, payment shall be
891treated as being made on the date a draft or other valid
892instrument which is equivalent to payment was placed in the
893United States mail in a properly addressed, postpaid envelope
894or, if not so posted, on the date of delivery. This paragraph
895does not preclude or limit the ability of the insurer to assert
896that the claim was unrelated, was not medically necessary, or
897was unreasonable or that the amount of the charge was in excess
898of that permitted under, or in violation of, subsection (5).
899Such assertion by the insurer may be made at any time, including
900after payment of the claim or after the 30-day time period for
901payment set forth in this paragraph.
902     (c)  All overdue payments shall bear simple interest at the
903rate established under s. 55.03 or the rate established in the
904insurance contract, whichever is greater, for the year in which
905the payment became overdue, calculated from the date the insurer
906was furnished with written notice of the amount of covered loss.
907Interest shall be due at the time payment of the overdue claim
908is made.
909     (d)  The insurer of the owner of a motor vehicle shall pay
910personal injury protection benefits for:
911     1.  Accidental bodily injury sustained in this state by the
912owner while occupying a motor vehicle, or while not an occupant
913of a self-propelled vehicle if the injury is caused by physical
914contact with a motor vehicle.
915     2.  Accidental bodily injury sustained outside this state,
916but within the United States of America or its territories or
917possessions or Canada, by the owner while occupying the owner's
918motor vehicle.
919     3.  Accidental bodily injury sustained by a relative of the
920owner residing in the same household, under the circumstances
921described in subparagraph 1. or subparagraph 2., provided the
922relative at the time of the accident is domiciled in the owner's
923household and is not himself or herself the owner of a motor
924vehicle with respect to which security is required under ss.
925627.730-627.7405.
926     4.  Accidental bodily injury sustained in this state by any
927other person while occupying the owner's motor vehicle or, if a
928resident of this state, while not an occupant of a self-
929propelled vehicle, if the injury is caused by physical contact
930with such motor vehicle, provided the injured person is not
931himself or herself:
932     a.  The owner of a motor vehicle with respect to which
933security is required under ss. 627.730-627.7405; or
934     b.  Entitled to personal injury benefits from the insurer
935of the owner or owners of such a motor vehicle.
936     (e)  If two or more insurers are liable to pay personal
937injury protection benefits for the same injury to any one
938person, the maximum payable shall be as specified in subsection
939(1), and any insurer paying the benefits shall be entitled to
940recover from each of the other insurers an equitable pro rata
941share of the benefits paid and expenses incurred in processing
942the claim.
943     (f)  It is a violation of the insurance code for an insurer
944to fail to timely provide benefits as required by this section
945with such frequency as to constitute a general business
946practice.
947     (g)  Benefits shall not be due or payable to or on the
948behalf of an insured person if that person has committed, by a
949material act or omission, any insurance fraud relating to
950personal injury protection coverage under his or her policy, if
951the fraud is admitted to in a sworn statement by the insured or
952if it is established in a court of competent jurisdiction. Any
953insurance fraud shall void all coverage arising from the claim
954related to such fraud under the personal injury protection
955coverage of the insured person who committed the fraud,
956irrespective of whether a portion of the insured person's claim
957may be legitimate, and any benefits paid prior to the discovery
958of the insured person's insurance fraud shall be recoverable by
959the insurer from the person who committed insurance fraud in
960their entirety. The prevailing party is entitled to its costs
961and attorney's fees in any action in which it prevails in an
962insurer's action to enforce its right of recovery under this
963paragraph.
964     (5)  CHARGES FOR TREATMENT OF INJURED PERSONS.--
965     (a)  Any physician, hospital, clinic, or other person or
966institution lawfully rendering treatment to an injured person
967for a bodily injury covered by personal injury protection
968insurance may charge the insurer and injured party only a
969reasonable amount pursuant to this section for the services and
970supplies rendered, and the insurer providing such coverage may
971pay for such charges directly to such person or institution
972lawfully rendering such treatment, if the insured receiving such
973treatment or his or her guardian has countersigned the properly
974completed invoice, bill, or claim form approved by the office
975upon which such charges are to be paid for as having actually
976been rendered, to the best knowledge of the insured or his or
977her guardian. In no event, however, may such a charge be in
978excess of the amount the person or institution customarily
979charges for like services or supplies. With respect to a
980determination of whether a charge for a particular service,
981treatment, or otherwise is reasonable, consideration may be
982given to evidence of usual and customary charges and payments
983accepted by the provider involved in the dispute, and
984reimbursement levels in the community and various federal and
985state medical fee schedules applicable to automobile and other
986insurance coverages, and other information relevant to the
987reasonableness of the reimbursement for the service, treatment,
988or supply.
989     (b)1.  An insurer or insured is not required to pay a claim
990or charges:
991     a.  Made by a broker or by a person making a claim on
992behalf of a broker;
993     b.  For any service or treatment that was not lawful at the
994time rendered;
995     c.  To any person who knowingly submits a false or
996misleading statement relating to the claim or charges;
997     d.  With respect to a bill or statement that does not
998substantially meet the applicable requirements of paragraph (d);
999     e.  For any treatment or service that is upcoded, or that
1000is unbundled when such treatment or services should be bundled,
1001in accordance with paragraph (d). To facilitate prompt payment
1002of lawful services, an insurer may change codes that it
1003determines to have been improperly or incorrectly upcoded or
1004unbundled, and may make payment based on the changed codes,
1005without affecting the right of the provider to dispute the
1006change by the insurer, provided that before doing so, the
1007insurer must contact the health care provider and discuss the
1008reasons for the insurer's change and the health care provider's
1009reason for the coding, or make a reasonable good faith effort to
1010do so, as documented in the insurer's file; and
1011     f.  For medical services or treatment billed by a physician
1012and not provided in a hospital unless such services are rendered
1013by the physician or are incident to his or her professional
1014services and are included on the physician's bill, including
1015documentation verifying that the physician is responsible for
1016the medical services that were rendered and billed.
1017     2.  Charges for medically necessary cephalic thermograms,
1018peripheral thermograms, spinal ultrasounds, extremity
1019ultrasounds, video fluoroscopy, and surface electromyography
1020shall not exceed the maximum reimbursement allowance for such
1021procedures as set forth in the applicable fee schedule or other
1022payment methodology established pursuant to s. 440.13.
1023     3.  Allowable amounts that may be charged to a personal
1024injury protection insurance insurer and insured for medically
1025necessary nerve conduction testing when done in conjunction with
1026a needle electromyography procedure and both are performed and
1027billed solely by a physician licensed under chapter 458, chapter
1028459, chapter 460, or chapter 461 who is also certified by the
1029American Board of Electrodiagnostic Medicine or by a board
1030recognized by the American Board of Medical Specialties or the
1031American Osteopathic Association or who holds diplomate status
1032with the American Chiropractic Neurology Board or its
1033predecessors shall not exceed 200 percent of the allowable
1034amount under the participating physician fee schedule of
1035Medicare Part B for year 2001, for the area in which the
1036treatment was rendered, adjusted annually on August 1 to reflect
1037the prior calendar year's changes in the annual Medical Care
1038Item of the Consumer Price Index for All Urban Consumers in the
1039South Region as determined by the Bureau of Labor Statistics of
1040the United States Department of Labor.
1041     4.  Allowable amounts that may be charged to a personal
1042injury protection insurance insurer and insured for medically
1043necessary nerve conduction testing that does not meet the
1044requirements of subparagraph 3. shall not exceed the applicable
1045fee schedule or other payment methodology established pursuant
1046to s. 440.13.
1047     5.  Allowable amounts that may be charged to a personal
1048injury protection insurance insurer and insured for magnetic
1049resonance imaging services shall not exceed 175 percent of the
1050allowable amount under the participating physician fee schedule
1051of Medicare Part B for year 2001, for the area in which the
1052treatment was rendered, adjusted annually on August 1 to reflect
1053the prior calendar year's changes in the annual Medical Care
1054Item of the Consumer Price Index for All Urban Consumers in the
1055South Region as determined by the Bureau of Labor Statistics of
1056the United States Department of Labor for the 12-month period
1057ending June 30 of that year, except that allowable amounts that
1058may be charged to a personal injury protection insurance insurer
1059and insured for magnetic resonance imaging services provided in
1060facilities accredited by the Accreditation Association for
1061Ambulatory Health Care, the American College of Radiology, or
1062the Joint Commission on Accreditation of Healthcare
1063Organizations shall not exceed 200 percent of the allowable
1064amount under the participating physician fee schedule of
1065Medicare Part B for year 2001, for the area in which the
1066treatment was rendered, adjusted annually on August 1 to reflect
1067the prior calendar year's changes in the annual Medical Care
1068Item of the Consumer Price Index for All Urban Consumers in the
1069South Region as determined by the Bureau of Labor Statistics of
1070the United States Department of Labor for the 12-month period
1071ending June 30 of that year. This paragraph does not apply to
1072charges for magnetic resonance imaging services and nerve
1073conduction testing for inpatients and emergency services and
1074care as defined in chapter 395 rendered by facilities licensed
1075under chapter 395.
1076     6.  The Department of Health, in consultation with the
1077appropriate professional licensing boards, shall adopt, by rule,
1078a list of diagnostic tests deemed not to be medically necessary
1079for use in the treatment of persons sustaining bodily injury
1080covered by personal injury protection benefits under this
1081section. The initial list shall be adopted by January 1, 2004,
1082and shall be revised from time to time as determined by the
1083Department of Health, in consultation with the respective
1084professional licensing boards. Inclusion of a test on the list
1085of invalid diagnostic tests shall be based on lack of
1086demonstrated medical value and a level of general acceptance by
1087the relevant provider community and shall not be dependent for
1088results entirely upon subjective patient response.
1089Notwithstanding its inclusion on a fee schedule in this
1090subsection, an insurer or insured is not required to pay any
1091charges or reimburse claims for any invalid diagnostic test as
1092determined by the Department of Health.
1093     (c)1.  With respect to any treatment or service, other than
1094medical services billed by a hospital or other provider for
1095emergency services as defined in s. 395.002 or inpatient
1096services rendered at a hospital-owned facility, the statement of
1097charges must be furnished to the insurer by the provider and may
1098not include, and the insurer is not required to pay, charges for
1099treatment or services rendered more than 35 days before the
1100postmark date of the statement, except for past due amounts
1101previously billed on a timely basis under this paragraph, and
1102except that, if the provider submits to the insurer a notice of
1103initiation of treatment within 21 days after its first
1104examination or treatment of the claimant, the statement may
1105include charges for treatment or services rendered up to, but
1106not more than, 75 days before the postmark date of the
1107statement. The injured party is not liable for, and the provider
1108shall not bill the injured party for, charges that are unpaid
1109because of the provider's failure to comply with this paragraph.
1110Any agreement requiring the injured person or insured to pay for
1111such charges is unenforceable.
1112     2.  If, however, the insured fails to furnish the provider
1113with the correct name and address of the insured's personal
1114injury protection insurer, the provider has 35 days from the
1115date the provider obtains the correct information to furnish the
1116insurer with a statement of the charges. The insurer is not
1117required to pay for such charges unless the provider includes
1118with the statement documentary evidence that was provided by the
1119insured during the 35-day period demonstrating that the provider
1120reasonably relied on erroneous information from the insured and
1121either:
1122     a.  A denial letter from the incorrect insurer; or
1123     b.  Proof of mailing, which may include an affidavit under
1124penalty of perjury, reflecting timely mailing to the incorrect
1125address or insurer.
1126     3.  For emergency services and care as defined in s.
1127395.002 rendered in a hospital emergency department or for
1128transport and treatment rendered by an ambulance provider
1129licensed pursuant to part III of chapter 401, the provider is
1130not required to furnish the statement of charges within the time
1131periods established by this paragraph; and the insurer shall not
1132be considered to have been furnished with notice of the amount
1133of covered loss for purposes of paragraph (4)(b) until it
1134receives a statement complying with paragraph (d), or copy
1135thereof, which specifically identifies the place of service to
1136be a hospital emergency department or an ambulance in accordance
1137with billing standards recognized by the Health Care Finance
1138Administration.
1139     4.  Each notice of insured's rights under s. 627.7401 must
1140include the following statement in type no smaller than 12
1141points:
1142
1143BILLING REQUIREMENTS.--Florida Statutes provide that with
1144respect to any treatment or services, other than certain
1145hospital and emergency services, the statement of charges
1146furnished to the insurer by the provider may not include, and
1147the insurer and the injured party are not required to pay,
1148charges for treatment or services rendered more than 35 days
1149before the postmark date of the statement, except for past due
1150amounts previously billed on a timely basis, and except that, if
1151the provider submits to the insurer a notice of initiation of
1152treatment within 21 days after its first examination or
1153treatment of the claimant, the statement may include charges for
1154treatment or services rendered up to, but not more than, 75 days
1155before the postmark date of the statement.
1156     (d)  All statements and bills for medical services rendered
1157by any physician, hospital, clinic, or other person or
1158institution shall be submitted to the insurer on a properly
1159completed Centers for Medicare and Medicaid Services (CMS) 1500
1160form, UB 92 forms, or any other standard form approved by the
1161office or adopted by the commission for purposes of this
1162paragraph. All billings for such services rendered by providers
1163shall, to the extent applicable, follow the Physicians' Current
1164Procedural Terminology (CPT) or Healthcare Correct Procedural
1165Coding System (HCPCS), or ICD-9 in effect for the year in which
1166services are rendered and comply with the Centers for Medicare
1167and Medicaid Services (CMS) 1500 form instructions and the
1168American Medical Association Current Procedural Terminology
1169(CPT) Editorial Panel and Healthcare Correct Procedural Coding
1170System (HCPCS). All providers other than hospitals shall include
1171on the applicable claim form the professional license number of
1172the provider in the line or space provided for "Signature of
1173Physician or Supplier, Including Degrees or Credentials." In
1174determining compliance with applicable CPT and HCPCS coding,
1175guidance shall be provided by the Physicians' Current Procedural
1176Terminology (CPT) or the Healthcare Correct Procedural Coding
1177System (HCPCS) in effect for the year in which services were
1178rendered, the Office of the Inspector General (OIG), Physicians
1179Compliance Guidelines, and other authoritative treatises
1180designated by rule by the Agency for Health Care Administration.
1181No statement of medical services may include charges for medical
1182services of a person or entity that performed such services
1183without possessing the valid licenses required to perform such
1184services. For purposes of paragraph (4)(b), an insurer shall not
1185be considered to have been furnished with notice of the amount
1186of covered loss or medical bills due unless the statements or
1187bills comply with this paragraph, and unless the statements or
1188bills are properly completed in their entirety as to all
1189material provisions, with all relevant information being
1190provided therein.
1191     (e)1.  At the initial treatment or service provided, each
1192physician, other licensed professional, clinic, or other medical
1193institution providing medical services upon which a claim for
1194personal injury protection benefits is based shall require an
1195insured person, or his or her guardian, to execute a disclosure
1196and acknowledgment form, which reflects at a minimum that:
1197     a.  The insured, or his or her guardian, must countersign
1198the form attesting to the fact that the services set forth
1199therein were actually rendered;
1200     b.  The insured, or his or her guardian, has both the right
1201and affirmative duty to confirm that the services were actually
1202rendered;
1203     c.  The insured, or his or her guardian, was not solicited
1204by any person to seek any services from the medical provider;
1205     d.  That the physician, other licensed professional,
1206clinic, or other medical institution rendering services for
1207which payment is being claimed explained the services to the
1208insured or his or her guardian; and
1209     e.  If the insured notifies the insurer in writing of a
1210billing error, the insured may be entitled to a certain
1211percentage of a reduction in the amounts paid by the insured's
1212motor vehicle insurer.
1213     2.  The physician, other licensed professional, clinic, or
1214other medical institution rendering services for which payment
1215is being claimed has the affirmative duty to explain the
1216services rendered to the insured, or his or her guardian, so
1217that the insured, or his or her guardian, countersigns the form
1218with informed consent.
1219     3.  Countersignature by the insured, or his or her
1220guardian, is not required for the reading of diagnostic tests or
1221other services that are of such a nature that they are not
1222required to be performed in the presence of the insured.
1223     4.  The licensed medical professional rendering treatment
1224for which payment is being claimed must sign, by his or her own
1225hand, the form complying with this paragraph.
1226     5.  The original completed disclosure and acknowledgment
1227form 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
1230for services billed by a provider for emergency services as
1231defined in s. 395.002, for emergency services and care as
1232defined in s. 395.002 rendered in a hospital emergency
1233department, or for transport and treatment rendered by an
1234ambulance provider licensed pursuant to part III of chapter 401.
1235     7.  The Financial Services Commission shall adopt, by rule,
1236a standard disclosure and acknowledgment form that shall be used
1237to fulfill the requirements of this paragraph, effective 90 days
1238after such form is adopted and becomes final. The commission
1239shall adopt a proposed rule by October 1, 2003. Until the rule
1240is final, the provider may use a form of its own which otherwise
1241complies with the requirements of this paragraph.
1242     8.  As used in this paragraph, "countersigned" means a
1243second or verifying signature, as on a previously signed
1244document, and is not satisfied by the statement "signature on
1245file" or any similar statement.
1246     9.  The requirements of this paragraph apply only with
1247respect to the initial treatment or service of the insured by a
1248provider. For subsequent treatments or service, the provider
1249must maintain a patient log signed by the patient, in
1250chronological order by date of service, that is consistent with
1251the services being rendered to the patient as claimed. The
1252requirements of this subparagraph for maintaining a patient log
1253signed by the patient may be met by a hospital that maintains
1254medical records as required by s. 395.3025 and applicable rules
1255and makes such records available to the insurer upon request.
1256     (f)  Upon written notification by any person, an insurer
1257shall investigate any claim of improper billing by a physician
1258or other medical provider. The insurer shall determine if the
1259insured was properly billed for only those services and
1260treatments that the insured actually received. If the insurer
1261determines that the insured has been improperly billed, the
1262insurer shall notify the insured, the person making the written
1263notification and the provider of its findings and shall reduce
1264the amount of payment to the provider by the amount determined
1265to be improperly billed. If a reduction is made due to such
1266written notification by any person, the insurer shall pay to the
1267person 20 percent of the amount of the reduction, up to $500. If
1268the provider is arrested due to the improper billing, then the
1269insurer shall pay to the person 40 percent of the amount of the
1270reduction, up to $500.
1271     (g)  An insurer may not systematically downcode with the
1272intent to deny reimbursement otherwise due. Such action
1273constitutes a material misrepresentation under s.
1274626.9541(1)(i)2.
1275     (6)  DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
1276DISPUTES.--
1277     (a)  Every employer shall, if a request is made by an
1278insurer providing personal injury protection benefits under ss.
1279627.730-627.7405 against whom a claim has been made, furnish
1280forthwith, in a form approved by the office, a sworn statement
1281of the earnings, since the time of the bodily injury and for a
1282reasonable period before the injury, of the person upon whose
1283injury the claim is based.
1284     (b)  Every physician, hospital, clinic, or other medical
1285institution providing, before or after bodily injury upon which
1286a claim for personal injury protection insurance benefits is
1287based, any products, services, or accommodations in relation to
1288that or any other injury, or in relation to a condition claimed
1289to be connected with that or any other injury, shall, if
1290requested to do so by the insurer against whom the claim has
1291been made, furnish forthwith a written report of the history,
1292condition, treatment, dates, and costs of such treatment of the
1293injured person and why the items identified by the insurer were
1294reasonable in amount and medically necessary, together with a
1295sworn statement that the treatment or services rendered were
1296reasonable and necessary with respect to the bodily injury
1297sustained and identifying which portion of the expenses for such
1298treatment or services was incurred as a result of such bodily
1299injury, and produce forthwith, and permit the inspection and
1300copying of, his or her or its records regarding such history,
1301condition, treatment, dates, and costs of treatment; provided
1302that this shall not limit the introduction of evidence at trial.
1303Such sworn statement shall read as follows: "Under penalty of
1304perjury, I declare that I have read the foregoing, and the facts
1305alleged are true, to the best of my knowledge and belief." No
1306cause of action for violation of the physician-patient privilege
1307or invasion of the right of privacy shall be permitted against
1308any physician, hospital, clinic, or other medical institution
1309complying with the provisions of this section. The person
1310requesting such records and such sworn statement shall pay all
1311reasonable costs connected therewith. If an insurer makes a
1312written request for documentation or information under this
1313paragraph within 30 days after having received notice of the
1314amount of a covered loss under paragraph (4)(a), the amount or
1315the partial amount which is the subject of the insurer's inquiry
1316shall become overdue if the insurer does not pay in accordance
1317with paragraph (4)(b) or within 10 days after the insurer's
1318receipt of the requested documentation or information, whichever
1319occurs later. For purposes of this paragraph, the term "receipt"
1320includes, but is not limited to, inspection and copying pursuant
1321to this paragraph. Any insurer that requests documentation or
1322information pertaining to reasonableness of charges or medical
1323necessity under this paragraph without a reasonable basis for
1324such requests as a general business practice is engaging in an
1325unfair trade practice under the insurance code.
1326     (c)  In the event of any dispute regarding an insurer's
1327right to discovery of facts under this section, the insurer may
1328petition a court of competent jurisdiction to enter an order
1329permitting such discovery. The order may be made only on motion
1330for good cause shown and upon notice to all persons having an
1331interest, and it shall specify the time, place, manner,
1332conditions, and scope of the discovery. Such court may, in order
1333to protect against annoyance, embarrassment, or oppression, as
1334justice requires, enter an order refusing discovery or
1335specifying conditions of discovery and may order payments of
1336costs and expenses of the proceeding, including reasonable fees
1337for the appearance of attorneys at the proceedings, as justice
1338requires.
1339     (d)  The injured person shall be furnished, upon request, a
1340copy of all information obtained by the insurer under the
1341provisions of this section, and shall pay a reasonable charge,
1342if required by the insurer.
1343     (e)  Notice to an insurer of the existence of a claim shall
1344not be unreasonably withheld by an insured.
1345     (7)  MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON;
1346REPORTS.--
1347     (a)  Whenever the mental or physical condition of an
1348injured person covered by personal injury protection is material
1349to any claim that has been or may be made for past or future
1350personal injury protection insurance benefits, such person
1351shall, upon the request of an insurer, submit to mental or
1352physical examination by a physician or physicians. The costs of
1353any examinations requested by an insurer shall be borne entirely
1354by the insurer. Such examination shall be conducted within the
1355municipality where the insured is receiving treatment, or in a
1356location reasonably accessible to the insured, which, for
1357purposes of this paragraph, means any location within the
1358municipality in which the insured resides, or any location
1359within 10 miles by road of the insured's residence, provided
1360such location is within the county in which the insured resides.
1361If the examination is to be conducted in a location reasonably
1362accessible to the insured, and if there is no qualified
1363physician to conduct the examination in a location reasonably
1364accessible to the insured, then such examination shall be
1365conducted in an area of the closest proximity to the insured's
1366residence. Personal protection insurers are authorized to
1367include reasonable provisions in personal injury protection
1368insurance policies for mental and physical examination of those
1369claiming personal injury protection insurance benefits. An
1370insurer may not withdraw payment of a treating physician without
1371the consent of the injured person covered by the personal injury
1372protection, unless the insurer first obtains a valid report by a
1373Florida physician licensed under the same chapter as the
1374treating physician whose treatment authorization is sought to be
1375withdrawn, stating that treatment was not reasonable, related,
1376or necessary. A valid report is one that is prepared and signed
1377by the physician examining the injured person or reviewing the
1378treatment records of the injured person and is factually
1379supported by the examination and treatment records if reviewed
1380and that has not been modified by anyone other than the
1381physician. The physician preparing the report must be in active
1382practice, unless the physician is physically disabled. Active
1383practice means that during the 3 years immediately preceding the
1384date of the physical examination or review of the treatment
1385records the physician must have devoted professional time to the
1386active clinical practice of evaluation, diagnosis, or treatment
1387of medical conditions or to the instruction of students in an
1388accredited health professional school or accredited residency
1389program or a clinical research program that is affiliated with
1390an accredited health professional school or teaching hospital or
1391accredited residency program. The physician preparing a report
1392at the request of an insurer and physicians rendering expert
1393opinions on behalf of persons claiming medical benefits for
1394personal injury protection, or on behalf of an insured through
1395an attorney or another entity, shall maintain, for at least 3
1396years, copies of all examination reports as medical records and
1397shall maintain, for at least 3 years, records of all payments
1398for the examinations and reports. Neither an insurer nor any
1399person acting at the direction of or on behalf of an insurer may
1400materially change an opinion in a report prepared under this
1401paragraph or direct the physician preparing the report to change
1402such opinion. The denial of a payment as the result of such a
1403changed opinion constitutes a material misrepresentation under
1404s. 626.9541(1)(i)2.; however, this provision does not preclude
1405the insurer from calling to the attention of the physician
1406errors of fact in the report based upon information in the claim
1407file.
1408     (b)  If requested by the person examined, a party causing
1409an examination to be made shall deliver to him or her a copy of
1410every written report concerning the examination rendered by an
1411examining physician, at least one of which reports must set out
1412the examining physician's findings and conclusions in detail.
1413After such request and delivery, the party causing the
1414examination to be made is entitled, upon request, to receive
1415from the person examined every written report available to him
1416or her or his or her representative concerning any examination,
1417previously or thereafter made, of the same mental or physical
1418condition. By requesting and obtaining a report of the
1419examination so ordered, or by taking the deposition of the
1420examiner, the person examined waives any privilege he or she may
1421have, in relation to the claim for benefits, regarding the
1422testimony of every other person who has examined, or may
1423thereafter examine, him or her in respect to the same mental or
1424physical condition. If a person unreasonably refuses to submit
1425to an examination, the personal injury protection carrier is no
1426longer liable for subsequent personal injury protection
1427benefits.
1428     (8)  APPLICABILITY OF PROVISION REGULATING ATTORNEY'S
1429FEES.--With respect to any dispute under the provisions of ss.
1430627.730-627.7405 between the insured and the insurer, or between
1431an assignee of an insured's rights and the insurer, the
1432provisions of s. 627.428 shall apply, except as provided in
1433subsection (10) (11).
1434     (9)(a)  Each insurer which has issued a policy providing
1435personal injury protection benefits shall report the renewal,
1436cancellation, or nonrenewal thereof to the Department of Highway
1437Safety and Motor Vehicles within 45 days from the effective date
1438of the renewal, cancellation, or nonrenewal.  Upon the issuance
1439of a policy providing personal injury protection benefits to a
1440named insured not previously insured by the insurer thereof
1441during that calendar year, the insurer shall report the issuance
1442of the new policy to the Department of Highway Safety and Motor
1443Vehicles within 30 days.  The report shall be in such form and
1444format and contain such information as may be required by the
1445Department of Highway Safety and Motor Vehicles which shall
1446include a format compatible with the data processing
1447capabilities of said department, and the Department of Highway
1448Safety and Motor Vehicles is authorized to adopt rules necessary
1449with respect thereto. Failure by an insurer to file proper
1450reports with the Department of Highway Safety and Motor Vehicles
1451as required by this subsection or rules adopted with respect to
1452the requirements of this subsection constitutes a violation of
1453the Florida Insurance Code. Reports of cancellations and policy
1454renewals and reports of the issuance of new policies received by
1455the Department of Highway Safety and Motor Vehicles are
1456confidential and exempt from the provisions of s. 119.07(1).
1457These records are to be used for enforcement and regulatory
1458purposes only, including the generation by the department of
1459data regarding compliance by owners of motor vehicles with
1460financial responsibility coverage requirements. In addition, the
1461Department of Highway Safety and Motor Vehicles shall release,
1462upon a written request by a person involved in a motor vehicle
1463accident, by the person's attorney, or by a representative of
1464the person's motor vehicle insurer, the name of the insurance
1465company and the policy number for the policy covering the
1466vehicle named by the requesting party.  The written request must
1467include a copy of the appropriate accident form as provided in
1468s. 316.065, s. 316.066, or s. 316.068.
1469     (b)  Every insurer with respect to each insurance policy
1470providing personal injury protection benefits shall notify the
1471named insured or in the case of a commercial fleet policy, the
1472first named insured in writing that any cancellation or
1473nonrenewal of the policy will be reported by the insurer to the
1474Department of Highway Safety and Motor Vehicles.  The notice
1475shall also inform the named insured that failure to maintain
1476personal injury protection and property damage liability
1477insurance on a motor vehicle when required by law may result in
1478the loss of registration and driving privileges in this state,
1479and the notice shall inform the named insured of the amount of
1480the reinstatement fees required by s. 627.733(7).  This notice
1481is for informational purposes only, and no civil liability shall
1482attach to an insurer due to failure to provide this notice.
1483     (9)(10)  An insurer may negotiate and enter into contracts
1484with licensed health care providers for the benefits described
1485in this section, referred to in this section as "preferred
1486providers," which shall include health care providers licensed
1487under chapters 458, 459, 460, 461, and 463. The insurer may
1488provide an option to an insured to use a preferred provider at
1489the time of purchase of the policy for personal injury
1490protection benefits, if the requirements of this subsection are
1491met. If the insured elects to use a provider who is not a
1492preferred provider, whether the insured purchased a preferred
1493provider policy or a nonpreferred provider policy, the medical
1494benefits provided by the insurer shall be as required by this
1495section. If the insured elects to use a provider who is a
1496preferred provider, the insurer may pay medical benefits in
1497excess of the benefits required by this section and may waive or
1498lower the amount of any deductible that applies to such medical
1499benefits. If the insurer offers a preferred provider policy to a
1500policyholder or applicant, it must also offer a nonpreferred
1501provider policy. The insurer shall provide each policyholder
1502with a current roster of preferred providers in the county in
1503which the insured resides at the time of purchase of such
1504policy, and shall make such list available for public inspection
1505during regular business hours at the principal office of the
1506insurer within the state.
1507     (10)(11)  DEMAND LETTER.--
1508     (a)  As a condition precedent to filing any action for
1509benefits under this section, the insurer must be provided with
1510written notice of an intent to initiate litigation. Such notice
1511may not be sent until the claim is overdue, including any
1512additional time the insurer has to pay the claim pursuant to
1513paragraph (4)(b).
1514     (b)  The notice required shall state that it is a "demand
1515letter under s. 627.736(10)(11)" and shall state with
1516specificity:
1517     1.  The name of the insured upon which such benefits are
1518being sought, including a copy of the assignment giving rights
1519to the claimant if the claimant is not the insured.
1520     2.  The claim number or policy number upon which such claim
1521was originally submitted to the insurer.
1522     3.  To the extent applicable, the name of any medical
1523provider who rendered to an insured the treatment, services,
1524accommodations, or supplies that form the basis of such claim;
1525and an itemized statement specifying each exact amount, the date
1526of treatment, service, or accommodation, and the type of benefit
1527claimed to be due. A completed form satisfying the requirements
1528of paragraph (5)(d) or the lost-wage statement previously
1529submitted may be used as the itemized statement. To the extent
1530that the demand involves an insurer's withdrawal of payment
1531under paragraph (7)(a) for future treatment not yet rendered,
1532the claimant shall attach a copy of the insurer's notice
1533withdrawing such payment and an itemized statement of the type,
1534frequency, and duration of future treatment claimed to be
1535reasonable and medically necessary.
1536     (c)  Each notice required by this subsection must be
1537delivered to the insurer by United States certified or
1538registered mail, return receipt requested. Such postal costs
1539shall be reimbursed by the insurer if so requested by the
1540claimant in the notice, when the insurer pays the claim. Such
1541notice must be sent to the person and address specified by the
1542insurer for the purposes of receiving notices under this
1543subsection. Each licensed insurer, whether domestic, foreign, or
1544alien, shall file with the office designation of the name and
1545address of the person to whom notices pursuant to this
1546subsection shall be sent which the office shall make available
1547on its Internet website. The name and address on file with the
1548office pursuant to s. 624.422 shall be deemed the authorized
1549representative to accept notice pursuant to this subsection in
1550the event no other designation has been made.
1551     (d)  If, within 15 days after receipt of notice by the
1552insurer, the overdue claim specified in the notice is paid by
1553the insurer together with applicable interest and a penalty of
155410 percent of the overdue amount paid by the insurer, subject to
1555a maximum penalty of $250, no action may be brought against the
1556insurer. If the demand involves an insurer's withdrawal of
1557payment under paragraph (7)(a) for future treatment not yet
1558rendered, no action may be brought against the insurer if,
1559within 15 days after its receipt of the notice, the insurer
1560mails to the person filing the notice a written statement of the
1561insurer's agreement to pay for such treatment in accordance with
1562the notice and to pay a penalty of 10 percent, subject to a
1563maximum penalty of $250, when it pays for such future treatment
1564in accordance with the requirements of this section. To the
1565extent the insurer determines not to pay any amount demanded,
1566the penalty shall not be payable in any subsequent action. For
1567purposes of this subsection, payment or the insurer's agreement
1568shall be treated as being made on the date a draft or other
1569valid instrument that is equivalent to payment, or the insurer's
1570written statement of agreement, is placed in the United States
1571mail in a properly addressed, postpaid envelope, or if not so
1572posted, on the date of delivery. The insurer shall not be
1573obligated to pay any attorney's fees if the insurer pays the
1574claim or mails its agreement to pay for future treatment within
1575the time prescribed by this subsection.
1576     (e)  The applicable statute of limitation for an action
1577under this section shall be tolled for a period of 15 business
1578days by the mailing of the notice required by this subsection.
1579     (f)  Any insurer making a general business practice of not
1580paying valid claims until receipt of the notice required by this
1581subsection is engaging in an unfair trade practice under the
1582insurance code.
1583     (11)(12)  CIVIL ACTION FOR INSURANCE FRAUD.--An insurer
1584shall have a cause of action against any person convicted of, or
1585who, regardless of adjudication of guilt, pleads guilty or nolo
1586contendere to insurance fraud under s. 817.234, patient
1587brokering under s. 817.505, or kickbacks under s. 456.054,
1588associated with a claim for personal injury protection benefits
1589in accordance with this section. An insurer prevailing in an
1590action brought under this subsection may recover compensatory,
1591consequential, and punitive damages subject to the requirements
1592and limitations of part II of chapter 768, and attorney's fees
1593and costs incurred in litigating a cause of action against any
1594person convicted of, or who, regardless of adjudication of
1595guilt, pleads guilty or nolo contendere to insurance fraud under
1596s. 817.234, patient brokering under s. 817.505, or kickbacks
1597under s. 456.054, associated with a claim for personal injury
1598protection benefits in accordance with this section.
1599     (12)(13)  MINIMUM BENEFIT COVERAGE.--If the Financial
1600Services Commission determines that the cost savings under
1601personal injury protection insurance benefits paid by insurers
1602have been realized due to the provisions of this act, prior
1603legislative reforms, or other factors, the commission may
1604increase the minimum $10,000 benefit coverage requirement. In
1605establishing the amount of such increase, the commission must
1606determine that the additional premium for such coverage is
1607approximately equal to the premium cost savings that have been
1608realized for the personal injury protection coverage with limits
1609of $10,000.
1610     (13)(14)  FRAUD ADVISORY NOTICE.--Upon receiving notice of
1611a claim under this section, an insurer shall provide a notice to
1612the insured or to a person for whom a claim for reimbursement
1613for diagnosis or treatment of injuries has been filed, advising
1614that:
1615     (a)  Pursuant to s. 626.9892, the Department of Financial
1616Services may pay rewards of up to $25,000 to persons providing
1617information leading to the arrest and conviction of persons
1618committing crimes investigated by the Division of Insurance
1619Fraud arising from violations of s. 440.105, s. 624.15, s.
1620626.9541, s. 626.989, or s. 817.234.
1621     (b)  Solicitation of a person injured in a motor vehicle
1622crash for purposes of filing personal injury protection or tort
1623claims could be a violation of s. 817.234, s. 817.505, or the
1624rules regulating The Florida Bar and should be immediately
1625reported to the Division of Insurance Fraud if such conduct has
1626taken place.
1627     Section 14.  Notwithstanding the repeal of the Florida
1628Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
1629section 627.737, Florida Statutes, is revived and reenacted to
1630read:
1631     627.737  Tort exemption; limitation on right to damages;
1632punitive damages.--
1633     (1)  Every owner, registrant, operator, or occupant of a
1634motor vehicle with respect to which security has been provided
1635as required by ss. 627.730-627.7405, and every person or
1636organization legally responsible for her or his acts or
1637omissions, is hereby exempted from tort liability for damages
1638because of bodily injury, sickness, or disease arising out of
1639the ownership, operation, maintenance, or use of such motor
1640vehicle in this state to the extent that the benefits described
1641in s. 627.736(1) are payable for such injury, or would be
1642payable but for any exclusion authorized by ss. 627.730-
1643627.7405, under any insurance policy or other method of security
1644complying with the requirements of s. 627.733, or by an owner
1645personally liable under s. 627.733 for the payment of such
1646benefits, unless a person is entitled to maintain an action for
1647pain, suffering, mental anguish, and inconvenience for such
1648injury under the provisions of subsection (2).
1649     (2)  In any action of tort brought against the owner,
1650registrant, operator, or occupant of a motor vehicle with
1651respect to which security has been provided as required by ss.
1652627.730-627.7405, or against any person or organization legally
1653responsible for her or his acts or omissions, a plaintiff may
1654recover damages in tort for pain, suffering, mental anguish, and
1655inconvenience because of bodily injury, sickness, or disease
1656arising out of the ownership, maintenance, operation, or use of
1657such motor vehicle only in the event that the injury or disease
1658consists in whole or in part of:
1659     (a)  Significant and permanent loss of an important bodily
1660function.
1661     (b)  Permanent injury within a reasonable degree of medical
1662probability, 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
1666ss. 627.730-627.7405, questions whether the plaintiff has met
1667the requirements of subsection (2), then the defendant may file
1668an appropriate motion with the court, and the court shall, on a
1669one-time basis only, 30 days before the date set for the trial
1670or the pretrial hearing, whichever is first, by examining the
1671pleadings and the evidence before it, ascertain whether the
1672plaintiff will be able to submit some evidence that the
1673plaintiff will meet the requirements of subsection (2).  If the
1674court finds that the plaintiff will not be able to submit such
1675evidence, then the court shall dismiss the plaintiff's claim
1676without prejudice.
1677     (4)  In any action brought against an automobile liability
1678insurer for damages in excess of its policy limits, no claim for
1679punitive damages shall be allowed.
1680     Section 15.  Notwithstanding the repeal of the Florida
1681Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
1682section 627.739, Florida Statutes, is revived and reenacted to
1683read:
1684     627.739  Personal injury protection; optional limitations;
1685deductibles.--
1686     (1)  The named insured may elect a deductible or modified
1687coverage or combination thereof to apply to the named insured
1688alone or to the named insured and dependent relatives residing
1689in the same household, but may not elect a deductible or
1690modified coverage to apply to any other person covered under the
1691policy.
1692     (2)  Insurers shall offer to each applicant and to each
1693policyholder, upon the renewal of an existing policy,
1694deductibles, in amounts of $250, $500, and $1,000. The
1695deductible amount must be applied to 100 percent of the expenses
1696and losses described in s. 627.736. After the deductible is met,
1697each insured is eligible to receive up to $10,000 in total
1698benefits described in s. 627.736(1). However, this subsection
1699shall not be applied to reduce the amount of any benefits
1700received in accordance with s. 627.736(1)(c).
1701     (3)  Insurers shall offer coverage wherein, at the election
1702of the named insured, the benefits for loss of gross income and
1703loss of earning capacity described in s. 627.736(1)(b) shall be
1704excluded.
1705     (4)  The named insured shall not be prevented from electing
1706a deductible under subsection (2) and modified coverage under
1707subsection (3). Each election made by the named insured under
1708this section shall result in an appropriate reduction of premium
1709associated with that election.
1710     (5)  All such offers shall be made in clear and unambiguous
1711language at the time the initial application is taken and prior
1712to each annual renewal and shall indicate that a premium
1713reduction will result from each election. At the option of the
1714insurer, the requirements of the preceding sentence are met by
1715using forms of notice approved by the office, or by providing
1716the following notice in 10-point type in the insurer's
1717application for initial issuance of a policy of motor vehicle
1718insurance and the insurer's annual notice of renewal premium:
1719 For personal injury protection insurance, the named insured may
1720elect a deductible and to exclude coverage for loss of gross
1721income and loss of earning capacity ("lost wages"). These
1722elections apply to the named insured alone, or to the named
1723insured and all dependent resident relatives. A premium
1724reduction will result from these elections. The named insured is
1725hereby advised not to elect the lost wage exclusion if the named
1726insured or dependent resident relatives are employed, since lost
1727wages will not be payable in the event of an accident.
1728     Section 16.  Notwithstanding the repeal of the Florida
1729Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
1730section 627.7401, Florida Statutes, is revived and reenacted to
1731read:
1732     627.7401  Notification of insured's rights.--
1733     (1)  The commission, by rule, shall adopt a form for the
1734notification of insureds of their right to receive personal
1735injury protection benefits under the Florida Motor Vehicle No-
1736Fault Law. Such notice shall include:
1737     (a)  A description of the benefits provided by personal
1738injury protection, including, but not limited to, the specific
1739types of services for which medical benefits are paid,
1740disability benefits, death benefits, significant exclusions from
1741and limitations on personal injury protection benefits, when
1742payments are due, how benefits are coordinated with other
1743insurance benefits that the insured may have, penalties and
1744interest that may be imposed on insurers for failure to make
1745timely payments of benefits, and rights of parties regarding
1746disputes as to benefits.
1747     (b)  An advisory informing insureds that:
1748     1.  Pursuant to s. 626.9892, the Department of Financial
1749Services may pay rewards of up to $25,000 to persons providing
1750information leading to the arrest and conviction of persons
1751committing crimes investigated by the Division of Insurance
1752Fraud arising from violations of s. 440.105, s. 624.15, s.
1753626.9541, s. 626.989, or s. 817.234.
1754     2.  Pursuant to s. 627.736(5)(e)1., if the insured notifies
1755the insurer of a billing error, the insured may be entitled to a
1756certain percentage of a reduction in the amount paid by the
1757insured's motor vehicle insurer.
1758     (c)  A notice that solicitation of a person injured in a
1759motor vehicle crash for purposes of filing personal injury
1760protection or tort claims could be a violation of s. 817.234, s
1761817.505, or the rules regulating The Florida Bar and should be
1762immediately reported to the Division of Insurance Fraud if such
1763conduct has taken place.
1764     (2)  Each insurer issuing a policy in this state providing
1765personal injury protection benefits must mail or deliver the
1766notice as specified in subsection (1) to an insured within 21
1767days after receiving from the insured notice of an automobile
1768accident or claim involving personal injury to an insured who is
1769covered under the policy. The office may allow an insurer
1770additional time to provide the notice specified in subsection
1771(1) not to exceed 30 days, upon a showing by the insurer that an
1772emergency justifies an extension of time.
1773     (3)  The notice required by this section does not alter or
1774modify the terms of the insurance contract or other requirements
1775of this act.
1776     Section 17.  Notwithstanding the repeal of the Florida
1777Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
1778section 627.7403, Florida Statutes, is revived and reenacted to
1779read:
1780     627.7403  Mandatory joinder of derivative claim.--In any
1781action brought pursuant to the provisions of s. 627.737 claiming
1782personal injuries, all claims arising out of the plaintiff's
1783injuries, including all derivative claims, shall be brought
1784together, unless good cause is shown why such claims should be
1785brought separately.
1786     Section 18.  Notwithstanding the repeal of the Florida
1787Motor Vehicle No-Fault Law, which occurred on October 1, 2007,
1788section 627.7405, Florida Statutes, is revived and reenacted to
1789read:
1790     627.7405  Insurers' right of
1791reimbursement.--Notwithstanding any other provisions of ss.
1792627.730-627.7405, any insurer providing personal injury
1793protection benefits on a private passenger motor vehicle shall
1794have, to the extent of any personal injury protection benefits
1795paid to any person as a benefit arising out of such private
1796passenger motor vehicle insurance, a right of reimbursement
1797against the owner or the insurer of the owner of a commercial
1798motor vehicle, if the benefits paid result from such person
1799having been an occupant of the commercial motor vehicle or
1800having been struck by the commercial motor vehicle while not an
1801occupant of any self-propelled vehicle.
1802     Section 19.  This act revives and reenacts, with
1803amendments, the Florida Motor Vehicle No-Fault Law, which
1804expired by operation of law on October 1, 2007. This act is
1805intended to be remedial and curative in nature and to minimize
1806confusion concerning the changes made by this act to ss.
1807627.730-627.7405, Florida Statutes. Therefore, the Florida Motor
1808Vehicle No-Fault Law shall continue to be codified as ss.
1809627.730-627.7405, Florida Statutes, notwithstanding the repeal
1810of those sections contained in s. 19, chapter 2003-411, Laws of
1811Florida.
1812     Section 20.  Subsections (1) and (4), paragraphs (a), (b),
1813and (c) of subsection (5), subsection (8), and paragraphs (d)
1814and (e) of subsection (10) of section 627.736, Florida Statutes,
1815as reenacted and amended by this act, are amended, subsections
1816(11), (12), and (13) of that section, as reenacted and amended
1817by this act, are renumbered as subsections (12), (13), and (14),
1818respectively, 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;
1821exclusions; priority; claims.--
1822     (1)  REQUIRED BENEFITS.--Every insurance policy complying
1823with the security requirements of s. 627.733 shall provide
1824personal injury protection to the named insured, relatives
1825residing in the same household, persons operating the insured
1826motor vehicle, passengers in such motor vehicle, and other
1827persons struck by such motor vehicle and suffering bodily injury
1828while not an occupant of a self-propelled vehicle, subject to
1829the provisions of subsection (2) and paragraph (4)(e)(d), to a
1830limit of $10,000 for loss sustained by any such person as a
1831result of bodily injury, sickness, disease, or death arising out
1832of the ownership, maintenance, or use of a motor vehicle as
1833follows:
1834     (a)  Medical benefits.--Eighty percent of all reasonable
1835expenses for medically necessary medical, surgical, X-ray,
1836dental, and rehabilitative services, including prosthetic
1837devices, and medically necessary ambulance, hospital, and
1838nursing services. However, the medical benefits shall provide
1839reimbursement only for such services and care that are lawfully
1840provided, supervised, ordered, or prescribed by a physician
1841licensed under chapter 458 or chapter 459, a dentist licensed
1842under chapter 466, or a chiropractic physician licensed under
1843chapter 460 or that are provided by any of the following persons
1844or entities:
1845     1.  A hospital or ambulatory surgical center licensed under
1846chapter 395.
1847     2.  A person or entity licensed under ss. 401.2101-401.45
1848that provides emergency transportation and treatment.
1849     3.  An entity wholly owned by one or more physicians
1850licensed under chapter 458 or chapter 459, chiropractic
1851physicians licensed under chapter 460, or dentists licensed
1852under chapter 466 or by such practitioner or practitioners and
1853the spouse, parent, child, or sibling of that practitioner or
1854those practitioners.
1855     4.  An entity wholly owned, directly or indirectly, by a
1856hospital or hospitals.
1857     5.  A health care clinic licensed under ss. 400.990-400.995
1858that is:
1859     a.  Accredited by the Joint Commission on Accreditation of
1860Healthcare Organizations, the American Osteopathic Association,
1861the Commission on Accreditation of Rehabilitation Facilities, or
1862the Accreditation Association for Ambulatory Health Care, Inc.;
1863or
1864     b.  A health care clinic that:
1865     (I)  Has a medical director licensed under chapter 458,
1866chapter 459, or chapter 460;
1867     (II)  Has been continuously licensed for more than 3 years
1868or is a publicly traded corporation that issues securities
1869traded on an exchange registered with the United States
1870Securities and Exchange Commission as a national securities
1871exchange; and
1872     (III)  Provides at least four of the following medical
1873specialties:
1874     (A)  General medicine.
1875     (B)  Radiography.
1876     (C)  Orthopedic medicine.
1877     (D)  Physical medicine.
1878     (E)  Physical therapy.
1879     (F)  Physical rehabilitation.
1880     (G)  Prescribing or dispensing outpatient prescription
1881medication.
1882     (H)  Laboratory services.
1883
1884The Financial Services Commission shall adopt by rule the form
1885that must be used by an insurer and a health care provider
1886specified in subparagraph 3., subparagraph 4., or subparagraph
18875. to document that the health care provider meets the criteria
1888of this paragraph, which rule must include a requirement for a
1889sworn statement or affidavit Such benefits shall also include
1890necessary remedial treatment and services recognized and
1891permitted under the laws of the state for an injured person who
1892relies upon spiritual means through prayer alone for healing, in
1893accordance with his or her religious beliefs; however, this
1894sentence does not affect the determination of what other
1895services or procedures are medically necessary.
1896     (b)  Disability benefits.--Sixty percent of any loss of
1897gross income and loss of earning capacity per individual from
1898inability to work proximately caused by the injury sustained by
1899the injured person, plus all expenses reasonably incurred in
1900obtaining from others ordinary and necessary services in lieu of
1901those that, but for the injury, the injured person would have
1902performed without income for the benefit of his or her
1903household. All disability benefits payable under this provision
1904shall be paid not less than every 2 weeks.
1905     (c)  Death benefits.--Death benefits equal to the lesser of
1906$5,000 or the remainder of unused personal injury protection
1907benefits per individual. The insurer may pay such benefits to
1908the executor or administrator of the deceased, to any of the
1909deceased's relatives by blood or legal adoption or connection by
1910marriage, or to any person appearing to the insurer to be
1911equitably entitled thereto.
1912
1913Only insurers writing motor vehicle liability insurance in this
1914state may provide the required benefits of this section, and no
1915such insurer shall require the purchase of any other motor
1916vehicle coverage other than the purchase of property damage
1917liability coverage as required by s. 627.7275 as a condition for
1918providing such required benefits. Insurers may not require that
1919property damage liability insurance in an amount greater than
1920$10,000 be purchased in conjunction with personal injury
1921protection. Such insurers shall make benefits and required
1922property damage liability insurance coverage available through
1923normal marketing channels. Any insurer writing motor vehicle
1924liability insurance in this state who fails to comply with such
1925availability requirement as a general business practice shall be
1926deemed to have violated part IX of chapter 626, and such
1927violation shall constitute an unfair method of competition or an
1928unfair or deceptive act or practice involving the business of
1929insurance; and any such insurer committing such violation shall
1930be subject to the penalties afforded in such part, as well as
1931those which may be afforded elsewhere in the insurance code.
1932     (4)  BENEFITS; WHEN DUE.--Benefits due from an insurer
1933under ss. 627.730-627.7405 shall be primary, except that
1934benefits received under any workers' compensation law shall be
1935credited against the benefits provided by subsection (1) and
1936shall be due and payable as loss accrues, upon receipt of
1937reasonable proof of such loss and the amount of expenses and
1938loss incurred which are covered by the policy issued under ss.
1939627.730-627.7405. When the Agency for Health Care Administration
1940provides, pays, or becomes liable for medical assistance under
1941the Medicaid program related to injury, sickness, disease, or
1942death arising out of the ownership, maintenance, or use of a
1943motor vehicle, benefits under ss. 627.730-627.7405 shall be
1944subject to the provisions of the Medicaid program.
1945     (a)  An insurer may require written notice to be given as
1946soon as practicable after an accident involving a motor vehicle
1947with respect to which the policy affords the security required
1948by ss. 627.730-627.7405.
1949     (b)  Personal injury protection insurance benefits paid
1950pursuant to this section shall be overdue if not paid within 30
1951days after the insurer is furnished written notice of the fact
1952of a covered loss and of the amount of same. If such written
1953notice is not furnished to the insurer as to the entire claim,
1954any partial amount supported by written notice is overdue if not
1955paid within 30 days after such written notice is furnished to
1956the insurer. Any part or all of the remainder of the claim that
1957is subsequently supported by written notice is overdue if not
1958paid within 30 days after such written notice is furnished to
1959the insurer. When an insurer pays only a portion of a claim or
1960rejects a claim, the insurer shall provide at the time of the
1961partial payment or rejection an itemized specification of each
1962item that the insurer had reduced, omitted, or declined to pay
1963and any information that the insurer desires the claimant to
1964consider related to the medical necessity of the denied
1965treatment or to explain the reasonableness of the reduced
1966charge, provided that this shall not limit the introduction of
1967evidence at trial; and the insurer shall include the name and
1968address of the person to whom the claimant should respond and a
1969claim number to be referenced in future correspondence. However,
1970notwithstanding the fact that written notice has been furnished
1971to the insurer, any payment shall not be deemed overdue when the
1972insurer has reasonable proof to establish that the insurer is
1973not responsible for the payment. For the purpose of calculating
1974the extent to which any benefits are overdue, payment shall be
1975treated as being made on the date a draft or other valid
1976instrument which is equivalent to payment was placed in the
1977United States mail in a properly addressed, postpaid envelope
1978or, if not so posted, on the date of delivery. This paragraph
1979does not preclude or limit the ability of the insurer to assert
1980that the claim was unrelated, was not medically necessary, or
1981was unreasonable or that the amount of the charge was in excess
1982of that permitted under, or in violation of, subsection (5).
1983Such assertion by the insurer may be made at any time, including
1984after payment of the claim or after the 30-day time period for
1985payment set forth in this paragraph.
1986     (c)  Upon receiving notice of an accident that is
1987potentially covered by personal injury protection benefits, the
1988insurer must reserve $5,000 of personal injury protection
1989benefits for payment to physicians licensed under chapter 458 or
1990chapter 459 or dentists licensed under chapter 466 who provide
1991emergency services and care, as defined in s. 395.002(9), or who
1992provide hospital inpatient care. The amount required to be held
1993in reserve may be used only to pay claims from such physicians
1994or dentists until 30 days after the date the insurer receives
1995notice of the accident. After the 30-day period, any amount of
1996the reserve for which the insurer has not received notice of a
1997claim from a physician or dentist who provided emergency
1998services and care or who provided hospital inpatient care may
1999then be used by the insurer to pay other claims. The time
2000periods specified in paragraph (b) for required payment of
2001personal injury protection benefits shall be tolled for the
2002period of time that an insurer is required by this paragraph to
2003hold payment of a claim that is not from a physician or dentist
2004who provided emergency services and care or who provided
2005hospital inpatient care to the extent that the personal injury
2006protection benefits not held in reserve are insufficient to pay
2007the claim. This paragraph does not require an insurer to
2008establish a claim reserve for insurance accounting purposes.
2009     (d)(c)  All overdue payments shall bear simple interest at
2010the rate established under s. 55.03 or the rate established in
2011the insurance contract, whichever is greater, for the year in
2012which the payment became overdue, calculated from the date the
2013insurer was furnished with written notice of the amount of
2014covered loss. Interest shall be due at the time payment of the
2015overdue claim is made.
2016     (e)(d)  The insurer of the owner of a motor vehicle shall
2017pay personal injury protection benefits for:
2018     1.  Accidental bodily injury sustained in this state by the
2019owner while occupying a motor vehicle, or while not an occupant
2020of a self-propelled vehicle if the injury is caused by physical
2021contact with a motor vehicle.
2022     2.  Accidental bodily injury sustained outside this state,
2023but within the United States of America or its territories or
2024possessions or Canada, by the owner while occupying the owner's
2025motor vehicle.
2026     3.  Accidental bodily injury sustained by a relative of the
2027owner residing in the same household, under the circumstances
2028described in subparagraph 1. or subparagraph 2., provided the
2029relative at the time of the accident is domiciled in the owner's
2030household and is not himself or herself the owner of a motor
2031vehicle with respect to which security is required under ss.
2032627.730-627.7405.
2033     4.  Accidental bodily injury sustained in this state by any
2034other person while occupying the owner's motor vehicle or, if a
2035resident of this state, while not an occupant of a self-
2036propelled vehicle, if the injury is caused by physical contact
2037with such motor vehicle, provided the injured person is not
2038himself or herself:
2039     a.  The owner of a motor vehicle with respect to which
2040security is required under ss. 627.730-627.7405; or
2041     b.  Entitled to personal injury benefits from the insurer
2042of the owner or owners of such a motor vehicle.
2043     (f)(e)  If two or more insurers are liable to pay personal
2044injury protection benefits for the same injury to any one
2045person, the maximum payable shall be as specified in subsection
2046(1), and any insurer paying the benefits shall be entitled to
2047recover from each of the other insurers an equitable pro rata
2048share of the benefits paid and expenses incurred in processing
2049the claim.
2050     (g)(f)  It is a violation of the insurance code for an
2051insurer to fail to timely provide benefits as required by this
2052section with such frequency as to constitute a general business
2053practice.
2054     (h)(g)  Benefits shall not be due or payable to or on the
2055behalf of an insured person if that person has committed, by a
2056material act or omission, any insurance fraud relating to
2057personal injury protection coverage under his or her policy, if
2058the fraud is admitted to in a sworn statement by the insured or
2059if it is established in a court of competent jurisdiction. Any
2060insurance fraud shall void all coverage arising from the claim
2061related to such fraud under the personal injury protection
2062coverage of the insured person who committed the fraud,
2063irrespective of whether a portion of the insured person's claim
2064may be legitimate, and any benefits paid prior to the discovery
2065of the insured person's insurance fraud shall be recoverable by
2066the insurer from the person who committed insurance fraud in
2067their entirety. The prevailing party is entitled to its costs
2068and attorney's fees in any action in which it prevails in an
2069insurer's action to enforce its right of recovery under this
2070paragraph.
2071     (5)  CHARGES FOR TREATMENT OF INJURED PERSONS.--
2072     (a)1.  Any physician, hospital, clinic, or other person or
2073institution lawfully rendering treatment to an injured person
2074for a bodily injury covered by personal injury protection
2075insurance may charge the insurer and injured party only a
2076reasonable amount pursuant to this section for the services and
2077supplies rendered, and the insurer providing such coverage may
2078pay for such charges directly to such person or institution
2079lawfully rendering such treatment, if the insured receiving such
2080treatment or his or her guardian has countersigned the properly
2081completed invoice, bill, or claim form approved by the office
2082upon which such charges are to be paid for as having actually
2083been rendered, to the best knowledge of the insured or his or
2084her guardian. In no event, however, may such a charge be in
2085excess of the amount the person or institution customarily
2086charges for like services or supplies. With respect to a
2087determination of whether a charge for a particular service,
2088treatment, or otherwise is reasonable, consideration may be
2089given to evidence of usual and customary charges and payments
2090accepted by the provider involved in the dispute, and
2091reimbursement levels in the community and various federal and
2092state medical fee schedules applicable to automobile and other
2093insurance coverages, and other information relevant to the
2094reasonableness of the reimbursement for the service, treatment,
2095or supply.
2096     2.  The insurer may limit reimbursement to 80 percent of
2097the following schedule of maximum charges:
2098     a.  For emergency transport and treatment by providers
2099licensed under chapter 401, 200 percent of Medicare.
2100     b.  For emergency services and care provided by a hospital
2101licensed under chapter 395, 75 percent of the hospital's usual
2102and customary charges.
2103     c.  For emergency services and care as defined by
2104s.395.002(10) provided in a facility licensed under chapter 395
2105rendered by a physician or dentist, and related hospital
2106inpatient services rendered by a physician or dentist, the usual
2107and customary charges in the community.
2108     d.  For hospital inpatient services, other than emergency
2109services and care, 200 percent of the Medicare Part A
2110prospective payment applicable to the specific hospital
2111providing the inpatient services.
2112     e.  For hospital outpatient services, other than emergency
2113services and care, 200 percent of the Medicare Part A Ambulatory
2114Payment Classification for the specific hospital providing the
2115outpatient services.
2116     f.  For all other medical services, supplies, and care, 200
2117percent of the applicable Medicare Part B fee schedule. However,
2118if such services, supplies, or care are not reimbursable under
2119Medicare Part B, the insurer may limit reimbursement to 80
2120percent of the maximum reimbursable allowance under workers'
2121compensation, as determined under s. 440.13 and rules adopted
2122thereunder which are in effect at the time such services,
2123supplies, or care are provided. Services, supplies, or care that
2124are not reimbursable under Medicare or workers' compensation are
2125not required to be reimbursed by the insurer.
2126     3.  For purposes of subparagraph 2., the applicable fee
2127schedule or payment limitation under Medicare is the fee
2128schedule or payment limitation in effect at the time the
2129services, supplies, or care were rendered and for the area in
2130which such services were rendered, except that it may not be
2131less than the applicable 2007 Medicare Part B fee schedule for
2132medical services, supplies, and care subject to Medicare Part B.
2133     4.  Subparagraph 2. does not allow the insurer to apply any
2134limitation on the number of treatments or other utilization
2135limits that apply under Medicare or workers' compensation. An
2136insurer that applies the allowable payment limitations of
2137subparagraph 2. must reimburse a provider who lawfully provided
2138care or treatment under the scope of his or her license,
2139regardless of whether such provider would be entitled to
2140reimbursement under Medicare due to restrictions or limitations
2141on the types or discipline of health care providers who may be
2142reimbursed for particular procedures or procedure codes.
2143     5.  If an insurer limits payment as authorized by
2144subparagraph 2., the person providing such services, supplies,
2145or care may not bill or attempt to collect from the insured any
2146amount in excess of such limits, except for amounts that are not
2147covered by the insured's personal injury protection coverage due
2148to the coinsurance amount or maximum policy limits.
2149     (b)1.  An insurer or insured is not required to pay a claim
2150or charges:
2151     a.  Made by a broker or by a person making a claim on
2152behalf of a broker;
2153     b.  For any service or treatment that was not lawful at the
2154time rendered;
2155     c.  To any person who knowingly submits a false or
2156misleading statement relating to the claim or charges;
2157     d.  With respect to a bill or statement that does not
2158substantially meet the applicable requirements of paragraph (d);
2159     e.  For any treatment or service that is upcoded, or that
2160is unbundled when such treatment or services should be bundled,
2161in accordance with paragraph (d). To facilitate prompt payment
2162of lawful services, an insurer may change codes that it
2163determines to have been improperly or incorrectly upcoded or
2164unbundled, and may make payment based on the changed codes,
2165without affecting the right of the provider to dispute the
2166change by the insurer, provided that before doing so, the
2167insurer must contact the health care provider and discuss the
2168reasons for the insurer's change and the health care provider's
2169reason for the coding, or make a reasonable good faith effort to
2170do so, as documented in the insurer's file; and
2171     f.  For medical services or treatment billed by a physician
2172and not provided in a hospital unless such services are rendered
2173by the physician or are incident to his or her professional
2174services and are included on the physician's bill, including
2175documentation verifying that the physician is responsible for
2176the medical services that were rendered and billed.
2177     2.  Charges for medically necessary cephalic thermograms,
2178peripheral thermograms, spinal ultrasounds, extremity
2179ultrasounds, video fluoroscopy, and surface electromyography
2180shall not exceed the maximum reimbursement allowance for such
2181procedures as set forth in the applicable fee schedule or other
2182payment methodology established pursuant to s. 440.13.
2183     3.  Allowable amounts that may be charged to a personal
2184injury protection insurance insurer and insured for medically
2185necessary nerve conduction testing when done in conjunction with
2186a needle electromyography procedure and both are performed and
2187billed solely by a physician licensed under chapter 458, chapter
2188459, chapter 460, or chapter 461 who is also certified by the
2189American Board of Electrodiagnostic Medicine or by a board
2190recognized by the American Board of Medical Specialties or the
2191American Osteopathic Association or who holds diplomate status
2192with the American Chiropractic Neurology Board or its
2193predecessors shall not exceed 200 percent of the allowable
2194amount under the participating physician fee schedule of
2195Medicare Part B for year 2001, for the area in which the
2196treatment was rendered, adjusted annually on August 1 to reflect
2197the prior calendar year's changes in the annual Medical Care
2198Item of the Consumer Price Index for All Urban Consumers in the
2199South Region as determined by the Bureau of Labor Statistics of
2200the United States Department of Labor.
2201     4.  Allowable amounts that may be charged to a personal
2202injury protection insurance insurer and insured for medically
2203necessary nerve conduction testing that does not meet the
2204requirements of subparagraph 3. shall not exceed the applicable
2205fee schedule or other payment methodology established pursuant
2206to s. 440.13.
2207     5.  Allowable amounts that may be charged to a personal
2208injury protection insurance insurer and insured for magnetic
2209resonance imaging services shall not exceed 175 percent of the
2210allowable amount under the participating physician fee schedule
2211of Medicare Part B for year 2001, for the area in which the
2212treatment was rendered, adjusted annually on August 1 to reflect
2213the prior calendar year's changes in the annual Medical Care
2214Item of the Consumer Price Index for All Urban Consumers in the
2215South Region as determined by the Bureau of Labor Statistics of
2216the United States Department of Labor for the 12-month period
2217ending June 30 of that year, except that allowable amounts that
2218may be charged to a personal injury protection insurance insurer
2219and insured for magnetic resonance imaging services provided in
2220facilities accredited by the Accreditation Association for
2221Ambulatory Health Care, the American College of Radiology, or
2222the Joint Commission on Accreditation of Healthcare
2223Organizations shall not exceed 200 percent of the allowable
2224amount under the participating physician fee schedule of
2225Medicare Part B for year 2001, for the area in which the
2226treatment was rendered, adjusted annually on August 1 to reflect
2227the prior calendar year's changes in the annual Medical Care
2228Item of the Consumer Price Index for All Urban Consumers in the
2229South Region as determined by the Bureau of Labor Statistics of
2230the United States Department of Labor for the 12-month period
2231ending June 30 of that year. This paragraph does not apply to
2232charges for magnetic resonance imaging services and nerve
2233conduction testing for inpatients and emergency services and
2234care as defined in chapter 395 rendered by facilities licensed
2235under chapter 395.
2236     2.6.  The Department of Health, in consultation with the
2237appropriate professional licensing boards, shall adopt, by rule,
2238a list of diagnostic tests deemed not to be medically necessary
2239for use in the treatment of persons sustaining bodily injury
2240covered by personal injury protection benefits under this
2241section. The initial list shall be adopted by January 1, 2004,
2242and shall be revised from time to time as determined by the
2243Department of Health, in consultation with the respective
2244professional licensing boards. Inclusion of a test on the list
2245of invalid diagnostic tests shall be based on lack of
2246demonstrated medical value and a level of general acceptance by
2247the relevant provider community and shall not be dependent for
2248results entirely upon subjective patient response.
2249Notwithstanding its inclusion on a fee schedule in this
2250subsection, an insurer or insured is not required to pay any
2251charges or reimburse claims for any invalid diagnostic test as
2252determined by the Department of Health.
2253     (c)1.  With respect to any treatment or service, other than
2254medical services billed by a hospital or other provider for
2255emergency services as defined in s. 395.002 or inpatient
2256services rendered at a hospital-owned facility, the statement of
2257charges must be furnished to the insurer by the provider and may
2258not include, and the insurer is not required to pay, charges for
2259treatment or services rendered more than 35 days before the
2260postmark date or electronic transmission date of the statement,
2261except for past due amounts previously billed on a timely basis
2262under this paragraph, and except that, if the provider submits
2263to the insurer a notice of initiation of treatment within 21
2264days after its first examination or treatment of the claimant,
2265the statement may include charges for treatment or services
2266rendered up to, but not more than, 75 days before the postmark
2267date of the statement. The injured party is not liable for, and
2268the provider shall not bill the injured party for, charges that
2269are unpaid because of the provider's failure to comply with this
2270paragraph. Any agreement requiring the injured person or insured
2271to pay for such charges is unenforceable.
2272     2.  If, however, the insured fails to furnish the provider
2273with the correct name and address of the insured's personal
2274injury protection insurer, the provider has 35 days from the
2275date the provider obtains the correct information to furnish the
2276insurer with a statement of the charges. The insurer is not
2277required to pay for such charges unless the provider includes
2278with the statement documentary evidence that was provided by the
2279insured during the 35-day period demonstrating that the provider
2280reasonably relied on erroneous information from the insured and
2281either:
2282     a.  A denial letter from the incorrect insurer; or
2283     b.  Proof of mailing, which may include an affidavit under
2284penalty of perjury, reflecting timely mailing to the incorrect
2285address or insurer.
2286     3.  For emergency services and care as defined in s.
2287395.002 rendered in a hospital emergency department or for
2288transport and treatment rendered by an ambulance provider
2289licensed pursuant to part III of chapter 401, the provider is
2290not required to furnish the statement of charges within the time
2291periods established by this paragraph; and the insurer shall not
2292be considered to have been furnished with notice of the amount
2293of covered loss for purposes of paragraph (4)(b) until it
2294receives a statement complying with paragraph (d), or copy
2295thereof, which specifically identifies the place of service to
2296be a hospital emergency department or an ambulance in accordance
2297with billing standards recognized by the Health Care Finance
2298Administration.
2299     4.  Each notice of insured's rights under s. 627.7401 must
2300include the following statement in type no smaller than 12
2301points:
2302
2303BILLING REQUIREMENTS.--Florida Statutes provide that with
2304respect to any treatment or services, other than certain
2305hospital and emergency services, the statement of charges
2306furnished to the insurer by the provider may not include, and
2307the insurer and the injured party are not required to pay,
2308charges for treatment or services rendered more than 35 days
2309before the postmark date of the statement, except for past due
2310amounts previously billed on a timely basis, and except that, if
2311the provider submits to the insurer a notice of initiation of
2312treatment within 21 days after its first examination or
2313treatment of the claimant, the statement may include charges for
2314treatment or services rendered up to, but not more than, 75 days
2315before the postmark date of the statement.
2316     (8)  APPLICABILITY OF PROVISION REGULATING ATTORNEY'S
2317FEES.--With respect to any dispute under the provisions of ss.
2318627.730-627.7405 between the insured and the insurer, or between
2319an assignee of an insured's rights and the insurer, the
2320provisions of s. 627.428 shall apply, except as provided in
2321subsections subsection (10) and (15).
2322     (10)  DEMAND LETTER.--
2323     (d)  If, within 30 15 days after receipt of notice by the
2324insurer, the overdue claim specified in the notice is paid by
2325the insurer together with applicable interest and a penalty of
232610 percent of the overdue amount paid by the insurer, subject to
2327a maximum penalty of $250, no action may be brought against the
2328insurer. If the demand involves an insurer's withdrawal of
2329payment under paragraph (7)(a) for future treatment not yet
2330rendered, no action may be brought against the insurer if,
2331within 30 15 days after its receipt of the notice, the insurer
2332mails to the person filing the notice a written statement of the
2333insurer's agreement to pay for such treatment in accordance with
2334the notice and to pay a penalty of 10 percent, subject to a
2335maximum penalty of $250, when it pays for such future treatment
2336in accordance with the requirements of this section. To the
2337extent the insurer determines not to pay any amount demanded,
2338the penalty shall not be payable in any subsequent action. For
2339purposes of this subsection, payment or the insurer's agreement
2340shall be treated as being made on the date a draft or other
2341valid instrument that is equivalent to payment, or the insurer's
2342written statement of agreement, is placed in the United States
2343mail in a properly addressed, postpaid envelope, or if not so
2344posted, on the date of delivery. The insurer is shall not be
2345obligated to pay any attorney's fees if the insurer pays the
2346claim or mails its agreement to pay for future treatment within
2347the time prescribed by this subsection.
2348     (e)  The applicable statute of limitation for an action
2349under this section shall be tolled for a period of 30 15
2350business days by the mailing of the notice required by this
2351subsection.
2352     (11)  FAILURE TO PAY VALID CLAIMS; UNFAIR OR DECEPTIVE
2353PRACTICE.--
2354     (a)  If an insurer fails to pay valid claims for personal
2355injury protection with such frequency so as to indicate a
2356general business practice, the insurer is engaging in a
2357prohibited unfair or deceptive practice that is subject to the
2358penalties provided in s. 626.9521 and the office has the powers
2359and duties specified in ss. 626.9561-626.9601 with respect
2360thereto.
2361     (b)  Notwithstanding s. 501.212, the Department of Legal
2362Affairs may investigate and initiate actions for a violation of
2363this subsection, including, but not limited to, the powers and
2364duties specified in part II of chapter 501.
2365     (15)  ALL CLAIMS BROUGHT IN A SINGLE ACTION.--In any civil
2366action to recover personal injury protection benefits brought by
2367a claimant pursuant to this section against an insurer, all
2368claims related to the same health care provider for the same
2369injured person shall be brought in one action, unless good cause
2370is shown why such claims should be brought separately. If the
2371court determines that a civil action is filed for a claim that
2372should have been brought in a prior civil action, the court may
2373not award attorney's fees to the claimant.
2374     (16)  SECURE ELECTRONIC DATA TRANSFER.--If all parties
2375mutually and expressly agree, a notice, documentation,
2376transmission, or communication of any kind required or
2377authorized under ss. 627.730-627.7405 may be transmitted
2378electronically if it is transmitted by secure electronic data
2379transfer that is consistent with state and federal privacy and
2380security laws.
2381     Section 21.  Application of the Florida Motor Vehicle No-
2382Fault Law.--
2383     (1)  Any person subject to the requirements of ss. 627.730-
2384627.7405, Florida Statutes, the Florida Motor Vehicle No-Fault
2385Law, as revived and amended by this act, must maintain security
2386for personal injury protection as required by the Florida Motor
2387Vehicle No-Fault Law, as revived and amended by this act,
2388beginning on January 1, 2008.
2389     (2)  Any personal injury protection policy in effect on or
2390after January 1, 2008, shall be deemed to incorporate the
2391provisions of the Florida Motor Vehicle No-Fault Law, as revived
2392and amended by this act.
2393     (3)  An insurer shall continue to use the personal injury
2394protection forms and rates that were in effect on September 30,
23952007, until new forms or rates are used as authorized by law.
2396     (4)  Each motor vehicle insurer shall provide personal
2397injury protection coverage to each of its motor vehicle insureds
2398who is subject to subsection (1) beginning on January 1, 2008.
2399With respect to a person who does not have a personal injury
2400protection policy in effect on such date, the initial
2401endorsement shall not be considered a new policy and shall be
2402issued for a period that terminates on the same date as the
2403person's other motor vehicle insurance coverage. Except as
2404modified by the insured, the deductibles and exclusions that
2405applied to the insured's previous personal injury protection
2406coverage with that insurer shall apply to the new personal
2407injury protection coverage. The insurer is not required to
2408provide the coverage if the insured does not pay the required
2409premium by January 1, 2008, or such later date that the insurer
2410may allow.
2411     (5)  No later than November 15, 2007, each motor vehicle
2412insurer shall provide notice of the provisions of this section
2413to each motor vehicle insured who is subject to subsection (1).
2414The notice is not subject to approval by the Office of Insurance
2415Regulation. The notice must clearly inform the policyholder:
2416     (a)  That beginning on January 1, 2008, Florida law
2417requires the policyholder to maintain personal injury protection
2418("PIP") insurance coverage and that this insurance pays covered
2419medical expenses for injuries sustained in a motor vehicle crash
2420by the policyholder, passengers, and relatives residing in the
2421policyholder's household.
2422     (b)  That if the policyholder does not maintain personal
2423injury protection coverage, the State of Florida may suspend the
2424policyholder's driver's license and vehicle registration.
2425     (c)  That if the policyholder already has personal injury
2426protection coverage, that coverage will be amended effective
2427January 1, 2008, to incorporate legally required changes without
2428any additional premium and that the policyholder is not required
2429to take any further action.
2430     (d)  That, if the policyholder does not currently have
2431personal injury protection coverage, the current motor vehicle
2432policy will be amended to incorporate the required personal
2433injury protection coverage effective January 1, 2008.
2434     (e)  The additional premium that is due, if any, and the
2435date that it is due, which may be no earlier than January 1,
24362008.
2437     (f)  That if the policyholder has any questions, the name
2438and phone number of whom they should contact.
2439     (6)  This section does not apply the Florida Motor Vehicle
2440No-Fault law, as revived an amended by this act, prior to
2441January 1, 2008. However, for lawsuits for injuries arising out
2442of an auto accident that occurs between the effective date of
2443this act and December 31, 2007, inclusive, the limitation on
2444lawsuits and tort immunity provided in s. 627.737, Florida
2445Statutes, shall apply if, and only if, the plaintiff and the
2446defendant are insured for personal injury protection coverage
2447that meets the requirements of Florida Motor Vehicle No-Fault
2448Law that was in effect on September 30, 2007.
2449     (7)  The Legislature finds that in order to protect the
2450public health, safety, and welfare, it is necessary to revise or
2451endorse policies in effect on January 1, 2008, to add personal
2452injury protection coverage as required by this section, and to
2453provide a uniform date for motor vehicle owners to obtain or
2454continue such coverage and for insurance policies to provide
2455such coverage. In order to avoid revising in-force policies,
2456enforcement would depend on policyholders electing to add such
2457coverage, or providing a nonuniform date for coverage to be
2458mandatory as policies renew which results in unequal treatment
2459under the law, or delaying the effective date for at least 1
2460year to provide a uniform date after all policies have renewed,
2461any of which options would result in a much greater number of
2462uninsured vehicles, an inability of accident victims to obtain
2463medical care, a greater level of uncompensated medical care,
2464higher costs to other public and private health care systems,
2465and greater numbers of persons being subject to penalties for
2466noncompliance.
2467     (8)  The Legislature recognizes that the Florida Motor
2468Vehicle No-Fault Law was repealed on October 1, 2007, and that
2469vehicle owners are not required to maintain personal injury
2470protection coverage on or after that date until January 1, 2008.
2471Notwithstanding any other law, an insurer is not required to
2472report the issuance, cancellation, or nonrenewal of personal
2473injury protection coverage occurring between October 1, 2007,
2474and December 31, 2007, inclusive, to the Department of Highway
2475Safety and Motor Vehicles. Any law requiring personal injury
2476protection coverage or providing sanctions for failure to
2477maintain or demonstrate proof of such coverage does not apply
2478during this time period. However, this subsection does not
2479relieve a motor vehicle owner from responsibility for
2480maintaining property damage liability coverage as required by
2481law and does not relieve an insurer from reporting the issuance,
2482cancellation, or nonrenewal of property damage liability
2483coverage as required by law.
2484     Section 22.  If any provision of this act or its
2485application to any person or circumstance is held invalid, the
2486invalidity does not affect other provisions or applications of
2487the act which can be given effect without the invalid provision
2488or application, and to this end the provisions of this act are
2489declared severable.
2490     Section 23.  This act shall take effect upon becoming a
2491law, except that sections 8 through 20 of this act shall take
2492effect January 1, 2008.


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