CS/HB 1411

A bill to be entitled
2An act relating to motor vehicle personal injury
3protection insurance; providing a short title; providing
4legislative intent; amending s. 316.066, F.S.; revising
5provisions relating to the contents of written reports of
6motor vehicle crashes; authorizing the investigating
7officer to testify at trial or provide an affidavit
8concerning the content of the reports; amending s.
9400.991, F.S.; requiring that an application for licensure
10as a mobile clinic include a statement regarding insurance
11fraud; amending s. 627.730, F.S.; conforming a cross-
12reference; amending s. 627.731, F.S.; providing
13legislative intent with respect to the Florida Motor
14Vehicle No-Fault Law; amending s. 627.732, F.S.; defining
15the terms "claimant" and "no-fault law"; amending s.
16627.736, F.S.; conforming a cross-reference; requiring
17certain entities providing medical services to document
18that they meet required criteria; revising requirements
19relating to the form that must be submitted by providers;
20requiring an entity or clinic to file a new form within a
21specified period after the date of a change of ownership;
22revising provisions relating to when payment for a benefit
23is due; providing that the time period for paying or
24denying a claim is tolled during the investigation of a
25fraudulent insurance act; specifying when benefits are not
26payable; providing that a claimant that violates certain
27provisions is not entitled to any payment, regardless of
28whether a portion of the claim may be legitimate;
29authorizing an insurer to recover payments and bring a
30cause of action to recover payments; forbidding a
31physician, hospital, clinic, or other medical institution
32that fails to comply with certain provisions from billing
33the injured person or the insured; providing that an
34insurer has a right to conduct reasonable investigations
35of claims; authorizing an insurer to require a claimant to
36provide certain records; revising the insurer's
37reimbursement limitation; deleting an obsolete provision;
38revising requirements relating to discovery; authorizing
39an insurer to conduct examinations of claimants under oath
40or sworn statement; requiring the provider to produce
41persons having the most knowledge in specified
42circumstances; providing that an insurer that requests an
43examination under oath without a reasonable basis is
44engaging in an unfair and deceptive trade practice;
45authorizing the insurer to conduct a physical review of
46the treatment location; authorizing an insurer to contract
47with a preferred provider network; authorizing an insurer
48to provide a premium discount to an insured who selects a
49preferred provider; authorizing an insurance policy not to
50pay for nonemergency services performed by a nonpreferred
51provider in specified circumstances; authorizing an
52insurer to contract with a health insurer in specified
53circumstances; amending s. 817.234, F.S.; conforming a
54cross-reference; providing civil penalties for criminal
55acts that result in the unlawful receipt of insurance
56proceeds from a motor vehicle insurance contract; amending
57ss. 324.021, 456.057, 627.7295, 627.733, 627.734, 627.737,
58627.7401, 627.7405, 627.7407, and 628.909, F.S.;
59conforming cross-references; providing an effective date.
61Be It Enacted by the Legislature of the State of Florida:
63     Section 1.  (1)  SHORT TITLE.-This act may be cited as the
64"Comprehensive Insurance Fraud Investigation and Prevention
66     (2)  FINDINGS AND INTENT.-The Legislature intends to
67balance the insured's interest in prompt payment of valid claims
68for insurance benefits under the no-fault law with the public's
69interest in reducing fraud, abuse, and overuse of the no-fault
70system. To that end, the Legislature intends that the
71investigation and prevention of fraudulent insurance acts in
72this state be enhanced, that additional sanctions for such acts
73be imposed, and that the no-fault law be revised to remove
74incentives for fraudulent insurance acts. The Legislature
75intends that the no-fault law be construed according to the
76plain language of the statutory provisions, which are designed
77to meet these goals.
78     (a)  The Legislature finds that:
79     1.  Motor vehicle insurance fraud remains a major problem
80for state consumers and insurers. According to the National
81Insurance Crime Bureau, in recent years this state has been
82among those states that have the highest number of fraudulent
83and questionable claims.
84     2.  The current regulatory process for health care clinics
85under part X of chapter 400, Florida Statutes, which was
86originally enacted to reduce motor vehicle insurance fraud, is
87not adequately preventing fraudulent insurance acts with respect
88to licensure exemptions and compliance with that part.
89     (b)  The Legislature intends that:
90     1.  Insurers properly investigate claims, and as such, this
91act clarifies that insurers are allowed to obtain examinations
92under oath and sworn statements from any claimant seeking no-
93fault insurance benefits and to request mental and physical
94examinations of persons seeking personal injury protection
95coverage or benefits.
96     2.  Any false, misleading, or otherwise fraudulent activity
97associated with a claim render the entire claim invalid. An
98insurer must be able to raise fraud as a defense to a claim for
99no-fault insurance benefits irrespective of any prior
100adjudication of guilt or determination of fraud by the
101Department of Financial Services.
102     3.  Insurers toll the payment or denial of a claim with
103respect to any portion of a claim for which the insurer has a
104reasonable belief that a fraudulent insurance act, as defined in
105s. 626.989 or s. 817.234, Florida Statutes, has been committed.
106     4.  Insurers discover the names of all passengers involved
107in a motor vehicle crash before paying claims or benefits
108pursuant to an insurance policy governed by the no-fault law. A
109rebuttable presumption must be established that a person was not
110involved in the event giving rise to the claim if that person's
111name does not appear on the police report.
112     Section 2.  Subsection (1) of section 316.066, Florida
113Statutes, is amended to read:
114     316.066  Written reports of crashes.-
115     (1)(a)  A Florida Traffic Crash Report, Long Form, must is
116required to be completed and submitted to the department within
11710 days after completing an investigation is completed by the
118every law enforcement officer who in the regular course of duty
119investigates a motor vehicle crash:
120     1.  That resulted in death of, or personal injury to, or
121any indication of complaints of pain or discomfort by any of the
122parties or passengers involved in the crash;
123     2.  That involved one or more passengers, other than the
124drivers of the vehicles, in any of the vehicles involved in the
126     3.2.  That involved a violation of s. 316.061(1) or s.
127316.193; or.
128     4.3.  In which a vehicle was rendered inoperative to a
129degree that required a wrecker to remove it from traffic, if
130such action is appropriate, in the officer's discretion.
131     (b)  The long form must include:
132     1.  The date, time, and location of the crash.
133     2.  A description of the vehicles involved.
134     3.  The names and addresses of the parties involved.
135     4.  The names and addresses of witnesses.
136     5.  The name, badge number, and law enforcement agency of
137the officer investigating the crash.
138     6.  The names of the insurance companies for the respective
139parties involved in the crash.
140     7.  The names and addresses of all passengers in all
141vehicles involved in the crash, each clearly identified as being
142a passenger, including the identification of the vehicle in
143which each was a passenger.
144     (c)(b)  In every crash for which a Florida Traffic Crash
145Report, Long Form, is not required by this section, the law
146enforcement officer may complete a short-form crash report or
147provide a short-form crash report to be completed by each party
148involved in the crash. The short-form report must include all of
149the items listed in subparagraphs (b)1.-6. Short-form crash
150reports prepared by the law enforcement officer shall be
151maintained by the officer's agency.:
152     1.  The date, time, and location of the crash.
153     2.  A description of the vehicles involved.
154     3.  The names and addresses of the parties involved.
155     4.  The names and addresses of witnesses.
156     5.  The name, badge number, and law enforcement agency of
157the officer investigating the crash.
158     6.  The names of the insurance companies for the respective
159parties involved in the crash.
160     (d)(c)  Each party to the crash must shall provide the law
161enforcement officer with proof of insurance, which must to be
162included in the crash report. If a law enforcement officer
163submits a report on the accident, proof of insurance must be
164provided to the officer by each party involved in the crash. Any
165party who fails to provide the required information commits a
166noncriminal traffic infraction, punishable as a nonmoving
167violation as provided in chapter 318, unless the officer
168determines that due to injuries or other special circumstances
169such insurance information cannot be provided immediately. If
170the person provides the law enforcement agency, within 24 hours
171after the crash, proof of insurance that was valid at the time
172of the crash, the law enforcement agency may void the citation.
173     (e)(d)  The driver of a vehicle that was in any manner
174involved in a crash resulting in damage to any vehicle or other
175property in an amount of $500 or more, which crash was not
176investigated by a law enforcement agency, shall, within 10 days
177after the crash, submit a written report of the crash to the
178department or traffic records center. The entity receiving the
179report may require witnesses of the crash crashes to render
180reports and may require any driver of a vehicle involved in the
181a crash of which a written report must be made as provided in
182this section to file supplemental written reports if whenever
183the original report is deemed insufficient by the receiving
185     (f)  The investigating law enforcement officer may testify
186at trial or provide a signed affidavit to confirm or supplement
187the information included on the long-form or short-form report.
188     (e)  Short-form crash reports prepared by law enforcement
189shall be maintained by the law enforcement officer's agency.
190     Section 3.  Subsection (6) is added to section 400.991,
191Florida Statutes, to read:
192     400.991  License requirements; background screenings;
194     (6)  All forms that constitute part of the application for
195licensure or exemption from licensure under this part must
196contain the following statement:
198INSURANCE FRAUD NOTICE.-Submitting a false,
199misleading, or fraudulent application or other
200document when applying for licensure as a health care
201clinic, when seeking an exemption from licensure as a
202health care clinic, or when demonstrating compliance
203with part X of chapter 400, Florida Statutes, is a
204criminal act under s. 817.234, Florida Statutes, or a
205fraudulent insurance act as defined in s. 626.989,
206Florida Statutes, subject to investigation by the
207Division of Insurance Fraud, and is grounds for
208discipline by the appropriate licensing board of the
209Florida Department of Health.
210     Section 4.  Section 627.730, Florida Statutes, is amended
211to read:
212     627.730  Florida Motor Vehicle No-Fault Law.-Sections
213627.730-627.7407 627.730-627.7405 may be cited and known as the
214"Florida Motor Vehicle No-Fault Law."
215     Section 5.  Section 627.731, Florida Statutes, is amended
216to read:
217     627.731  Purpose; legislative intent.-
218     (1)  The purpose of the no-fault law ss. 627.730-627.7405
219is to provide for medical, surgical, funeral, and disability
220insurance benefits without regard to fault, and to require motor
221vehicle insurance securing such benefits, for motor vehicles
222required to be registered in this state and, with respect to
223motor vehicle accidents, a limitation on the right to claim
224damages for pain, suffering, mental anguish, and inconvenience.
225     (2)  The Legislature intends that the provisions,
226schedules, and procedures authorized under the no-fault law be
227implemented by the insurers offering policies pursuant to the
228no-fault law. These provisions, schedules, and procedures have
229full force and effect regardless of their express inclusion in
230an insurance policy, and an insurer is not required to amend its
231policy to implement and apply such provisions, schedules, or
233     Section 6.  Section 627.732, Florida Statutes, is amended
234to read:
235     627.732  Definitions.-As used in the no-fault law ss.
236627.730-627.7405, the term:
237     (1)  "Broker" means any person not possessing a license
238under chapter 395, chapter 400, chapter 429, chapter 458,
239chapter 459, chapter 460, chapter 461, or chapter 641 who
240charges or receives compensation for any use of medical
241equipment and is not the 100-percent owner or the 100-percent
242lessee of such equipment. For purposes of this section, such
243owner or lessee may be an individual, a corporation, a
244partnership, or any other entity and any of its 100-percent-
245owned affiliates and subsidiaries. For purposes of this
246subsection, the term "lessee" means a long-term lessee under a
247capital or operating lease, but does not include a part-time
248lessee. The term "broker" does not include a hospital or
249physician management company whose medical equipment is
250ancillary to the practices managed, a debt collection agency, or
251an entity that has contracted with the insurer to obtain a
252discounted rate for such services; or nor does the term include
253a management company that has contracted to provide general
254management services for a licensed physician or health care
255facility and whose compensation is not materially affected by
256the usage or frequency of usage of medical equipment or an
257entity that is 100-percent owned by one or more hospitals or
258physicians. The term "broker" does not include a person or
259entity that certifies, upon request of an insurer, that:
260     (a)  It is a clinic licensed under ss. 400.990-400.995;
261     (b)  It is a 100-percent owner of medical equipment; and
262     (c)  The owner's only part-time lease of medical equipment
263for personal injury protection patients is on a temporary basis,
264not to exceed 30 days in a 12-month period, and such lease is
265solely for the purposes of necessary repair or maintenance of
266the 100-percent-owned medical equipment or pending the arrival
267and installation of the newly purchased or a replacement for the
268100-percent-owned medical equipment, or for patients for whom,
269because of physical size or claustrophobia, it is determined by
270the medical director or clinical director to be medically
271necessary that the test be performed in medical equipment that
272is open-style. The leased medical equipment may not cannot be
273used by patients who are not patients of the registered clinic
274for medical treatment of services. Any person or entity making a
275false certification under this subsection commits insurance
276fraud as defined in s. 817.234. However, the 30-day period
277provided in this paragraph may be extended for an additional 60
278days as applicable to magnetic resonance imaging equipment if
279the owner certifies that the extension otherwise complies with
280this paragraph.
281     (2)(7)  "Certify" means to swear or attest to being true or
282represented in writing.
283     (3)  "Claimant" means the person, organization, or entity
284seeking benefits, including all assignees.
285     (4)(12)  "Hospital" means a facility that, at the time
286services or treatment were rendered, was licensed under chapter
288     (5)(8)  "Immediate personal supervision," as it relates to
289the performance of medical services by nonphysicians not in a
290hospital, means that an individual licensed to perform the
291medical service or provide the medical supplies must be present
292within the confines of the physical structure where the medical
293services are performed or where the medical supplies are
294provided such that the licensed individual can respond
295immediately to any emergencies if needed.
296     (6)(9)  "Incident," with respect to services considered as
297incident to a physician's professional service, for a physician
298licensed under chapter 458, chapter 459, chapter 460, or chapter
299461, if not furnished in a hospital, means such services that
300are must be an integral, even if incidental, part of a covered
301physician's service.
302     (7)(10)  "Knowingly" means that a person, with respect to
303information, has actual knowledge of the information,; acts in
304deliberate ignorance of the truth or falsity of the
305information,; or acts in reckless disregard of the information.,
306and Proof of specific intent to defraud is not required.
307     (8)(11)  "Lawful" or "lawfully" means in substantial
308compliance with all relevant applicable criminal, civil, and
309administrative requirements of state and federal law related to
310the provision of medical services or treatment.
311     (9)(2)  "Medically necessary" refers to a medical service
312or supply that a prudent physician would provide for the purpose
313of preventing, diagnosing, or treating an illness, injury,
314disease, or symptom in a manner that is:
315     (a)  In accordance with generally accepted standards of
316medical practice;
317     (b)  Clinically appropriate in terms of type, frequency,
318extent, site, and duration; and
319     (c)  Not primarily for the convenience of the patient,
320physician, or other health care provider.
321     (10)(3)  "Motor vehicle" means a any self-propelled vehicle
322with four or more wheels that which is of a type both designed
323and required to be licensed for use on the highways of this
324state, and any trailer or semitrailer designed for use with such
325vehicle, and includes:
326     (a)  A "private passenger motor vehicle," which is any
327motor vehicle that which is a sedan, station wagon, or jeep-type
328vehicle and, if not used primarily for occupational,
329professional, or business purposes, a motor vehicle of the
330pickup, panel, van, camper, or motor home type.
331     (b)  A "commercial motor vehicle," which is any motor
332vehicle that which is not a private passenger motor vehicle.
334The term "motor vehicle" does not include a mobile home or any
335motor vehicle that which is used in mass transit, other than
336public school transportation, and designed to transport more
337than five passengers exclusive of the operator of the motor
338vehicle and that which is owned by a municipality, a transit
339authority, or a political subdivision of the state.
340     (11)(4)  "Named insured" means a person, usually the owner
341of a vehicle, identified in a policy by name as the insured
342under the policy.
343     (12)  "No-fault law" means the Florida Motor Vehicle No-
344Fault Law, ss. 627.730-627.7407.
345     (13)(5)  "Owner" means a person who holds the legal title
346to a motor vehicle; or, if in the event a motor vehicle is the
347subject of a security agreement or lease with an option to
348purchase with the debtor or lessee having the right to
349possession, then the debtor or lessee is shall be deemed the
350owner for the purposes of the no-fault law ss. 627.730-627.7405.
351     (14)(13)  "Properly completed" means providing truthful,
352substantially complete, and substantially accurate responses as
353to all material elements of to each applicable request for
354information or statement by a means that may lawfully be
355provided and that complies with this section, or as agreed by
356the parties.
357     (15)(6)  "Relative residing in the same household" means a
358relative of any degree by blood or by marriage who usually makes
359her or his home in the same family unit, whether or not
360temporarily living elsewhere.
361     (16)(15)  "Unbundling" means submitting an action that
362submits a billing code that is properly billed under one billing
363code, but that has been separated into two or more billing
364codes, and would result in payment greater than the in amount
365that than would be paid using one billing code.
366     (17)(14)  "Upcoding" means submitting an action that
367submits a billing code that would result in payment greater than
368the in amount that than would be paid using a billing code that
369accurately describes the services performed. The term does not
370include an otherwise lawful bill by a magnetic resonance imaging
371facility, which globally combines both technical and
372professional components, if the amount of the global bill is not
373more than the components if billed separately; however, payment
374of such a bill constitutes payment in full for all components of
375such service.
376     Section 7.  Subsections (1), (3), and (4) of section
377627.736, Florida Statutes, are amended, subsections (5) through
378(16) of that section are renumbered as subsections (6) through
379(17), respectively, a new subsection (5) is added to that
380section, and present subsections (5), (6), (8), and (9),
381paragraph (b) of present subsection (7), and present subsection
382(16) of that section are amended, to read:
383     627.736  Required personal injury protection benefits;
384exclusions; priority; claims.-
385     (1)  REQUIRED BENEFITS.-Every insurance policy complying
386with the security requirements of s. 627.733 must shall provide
387personal injury protection to the named insured, relatives
388residing in the same household, persons operating the insured
389motor vehicle, passengers in such motor vehicle, and other
390persons struck by such motor vehicle and suffering bodily injury
391while not an occupant of a self-propelled vehicle, subject to
392the provisions of subsection (2) and paragraph (4)(g) (4)(e), to
393a limit of $10,000 for loss sustained by any such person as a
394result of bodily injury, sickness, disease, or death arising out
395of the ownership, maintenance, or use of a motor vehicle as
397     (a)  Medical benefits.-Eighty percent of all reasonable
398expenses for medically necessary medical, surgical, X-ray,
399dental, and rehabilitative services, including prosthetic
400devices, and for medically necessary ambulance, hospital, and
401nursing services. However, the medical benefits shall provide
402reimbursement only for such services and care that are lawfully
403provided, supervised, ordered, or prescribed by a physician
404licensed under chapter 458 or chapter 459, a dentist licensed
405under chapter 466, or a chiropractic physician licensed under
406chapter 460 or that are provided by any of the following persons
407or entities:
408     1.  A hospital or ambulatory surgical center licensed under
409chapter 395.
410     2.  A person or entity licensed under part III of chapter
411401 that ss. 401.2101-401.45 that provides emergency
412transportation and treatment.
413     3.  An entity wholly owned by one or more physicians
414licensed under chapter 458 or chapter 459, chiropractic
415physicians licensed under chapter 460, or dentists licensed
416under chapter 466 or by such practitioner or practitioners and
417the spouses, parents, children, or siblings spouse, parent,
418child, or sibling of such that practitioner or those
420     4.  An entity wholly owned, directly or indirectly, by a
421hospital or hospitals.
422     5.  A health care clinic licensed under part X of chapter
423400 ss. 400.990-400.995 that is:
424     a.  Accredited by the Joint Commission on Accreditation of
425Healthcare Organizations, the American Osteopathic Association,
426the Commission on Accreditation of Rehabilitation Facilities, or
427the Accreditation Association for Ambulatory Health Care, Inc.;
429     b.  A health care clinic that:
430     (I)  Has a medical director licensed under chapter 458,
431chapter 459, or chapter 460;
432     (II)  Has been continuously licensed for more than 3 years
433or is a publicly traded corporation that issues securities
434traded on an exchange registered with the United States
435Securities and Exchange Commission as a national securities
436exchange; and
437     (III)  Provides at least four of the following medical
439     (A)  General medicine.
440     (B)  Radiography.
441     (C)  Orthopedic medicine.
442     (D)  Physical medicine.
443     (E)  Physical therapy.
444     (F)  Physical rehabilitation.
445     (G)  Prescribing or dispensing outpatient prescription
447     (H)  Laboratory services.
449If any services under this paragraph are provided by an entity
450or clinic described in subparagraph 3., subparagraph 4., or
451subparagraph 5., the entity or clinic must provide the insurer
452at the initial submission of the claim with a form adopted by
453the Department of Financial Services that documents that the
454entity or clinic meets applicable criteria for such entity or
455clinic and includes a sworn statement or affidavit to that
456effect. Any change in ownership requires the filing of a new
457form within 10 days after the date of the change in ownership.
458The Financial Services Commission shall adopt by rule the form
459that must be used by an insurer and a health care provider
460specified in subparagraph 3., subparagraph 4., or subparagraph
4615. to document that the health care provider meets the criteria
462of this paragraph, which rule must include a requirement for a
463sworn statement or affidavit.
464     (b)  Disability benefits.-Sixty percent of any loss of
465gross income and loss of earning capacity per individual from
466inability to work proximately caused by the injury sustained by
467the injured person, plus all expenses reasonably incurred in
468obtaining from others ordinary and necessary services in lieu of
469those that, but for the injury, the injured person would have
470performed without income for the benefit of his or her
471household. All disability benefits payable under this paragraph
472must provision shall be paid at least not less than every 2
474     (c)  Death benefits.-Death benefits equal to the lesser of
475$5,000 or the remainder of unused personal injury protection
476benefits per individual. The insurer may pay such benefits to
477the executor or administrator of the deceased, to any of the
478deceased's relatives by blood, or legal adoption, or connection
479by marriage, or to any person appearing to the insurer to be
480equitably entitled thereto.
482Only insurers writing motor vehicle liability insurance in this
483state may provide the required benefits of this section, and no
484such insurers may not insurer shall require the purchase of any
485other motor vehicle coverage other than the purchase of property
486damage liability coverage as required by s. 627.7275 as a
487condition for providing such required benefits. Insurers may not
488require that property damage liability insurance in an amount
489greater than $10,000 be purchased in conjunction with personal
490injury protection. Such insurers shall make benefits and
491required property damage liability insurance coverage available
492through normal marketing channels. An Any insurer writing motor
493vehicle liability insurance in this state who fails to comply
494with such availability requirement as a general business
495practice violates shall be deemed to have violated part IX of
496chapter 626, and such violation constitutes shall constitute an
497unfair method of competition or an unfair or deceptive act or
498practice involving the business of insurance. An; and any such
499insurer committing such violation is shall be subject to the
500penalties afforded in such part, as well as those that are which
501may be afforded elsewhere in the insurance code.
503TORT CLAIMS.-An No insurer shall not have a lien on any recovery
504in tort by judgment, settlement, or otherwise for personal
505injury protection benefits, whether suit has been filed or
506settlement has been reached without suit. An injured party who
507is entitled to bring suit under the no-fault law provisions of
508ss. 627.730-627.7405, or his or her legal representative, shall
509have no right to recover any damages for which personal injury
510protection benefits are paid or payable. The plaintiff may prove
511all of his or her special damages notwithstanding this
512limitation, but if special damages are introduced in evidence,
513the trier of facts, whether judge or jury, shall not award
514damages for personal injury protection benefits paid or payable.
515In all cases in which a jury is required to fix damages, the
516court shall instruct the jury that the plaintiff shall not
517recover such special damages for personal injury protection
518benefits paid or payable.
519     (4)  BENEFITS; WHEN DUE.-Benefits due from an insurer under
520the no-fault law are ss. 627.730-627.7405 shall be primary,
521except that benefits received under any workers' compensation
522law shall be credited against the benefits provided by
523subsection (1) and are shall be due and payable as loss accrues,
524upon the receipt of reasonable proof of such loss and the amount
525of expenses and loss incurred that which are covered by the
526policy issued under the no-fault law ss. 627.730-627.7405. If
527When the Agency for Health Care Administration provides, pays,
528or becomes liable for medical assistance under the Medicaid
529program related to injury, sickness, disease, or death arising
530out of the ownership, maintenance, or use of a motor vehicle,
531the benefits are under ss. 627.730-627.7405 shall be subject to
532the provisions of the Medicaid program.
533     (a)  An insurer may require written notice to be given as
534soon as practicable after an accident involving a motor vehicle
535with respect to which the policy affords the security required
536by the no-fault law ss. 627.730-627.7405.
537     (b)  Personal injury protection insurance benefits paid
538pursuant to this section are shall be overdue if not paid within
53930 days after the insurer is furnished written notice of the
540fact of a covered loss and of the amount of same. If such
541written notice is not furnished to the insurer as to the entire
542claim, any partial amount supported by written notice is overdue
543if not paid within 30 days after such written notice is
544furnished to the insurer. Any part or all of the remainder of
545the claim that is subsequently supported by written notice is
546overdue if not paid within 30 days after such written notice is
547furnished to the insurer.
548     (c)  If When an insurer pays only a portion of a claim or
549rejects a claim, the insurer shall provide at the time of the
550partial payment or rejection an itemized specification of each
551item that the insurer had reduced, omitted, or declined to pay
552and any information that the insurer desires the claimant to
553consider related to the medical necessity of the denied
554treatment or to explain the reasonableness of the reduced
555charge, provided that this does shall not limit the introduction
556of evidence at trial.; and The insurer must shall include the
557name and address of the person to whom the claimant should
558respond and a claim number to be referenced in future
560     (d)  A However, notwithstanding the fact that written
561notice has been furnished to the insurer, Any payment is shall
562not be deemed overdue if when the insurer has reasonable proof
563to establish that the insurer is not responsible for the
564payment. For the purpose of calculating the extent to which any
565benefits are overdue, payment shall be treated as being made on
566the date a draft or other valid instrument which is equivalent
567to payment was placed in the United States mail in a properly
568addressed, postpaid envelope or, if not so posted, on the date
569of delivery. This paragraph does not preclude or limit the
570ability of the insurer to assert that the claim is was
571unrelated, was not medically necessary, or was unreasonable, or
572submitted that the amount of the charge was in excess of that
573permitted under, or in violation of, subsection (6) (5). Such
574assertion by the insurer may be made at any time, including
575after payment of the claim or after the 30-day time period for
576payment set forth in this paragraph (b). The 30-day period for
577payment or denial is tolled with respect to any portion of a
578claim for which the insurer has a reasonable belief that a
579fraudulent insurance act as defined in s. 626.989 has been
580committed while the insurer investigates such act. The insurer
581must notify the claimant in writing that it is investigating a
582fraudulent insurance act within 30 days after the date it has a
583reasonable belief that such act has been committed. The insurer
584must pay or deny the claim, in full or in part, within 120 days
585after the date the written notice of the fact of a covered loss
586and of the amount of the loss was provided to the insurer.
587     (e)(c)  Upon receiving notice of an accident that is
588potentially covered by personal injury protection benefits, the
589insurer must reserve $5,000 of personal injury protection
590benefits for payment to physicians licensed under chapter 458 or
591chapter 459 or dentists licensed under chapter 466 who provide
592emergency services and care, as defined in s. 395.002(9), or who
593provide hospital inpatient care. The amount required to be held
594in reserve may be used only to pay claims from such physicians
595or dentists until 30 days after the date the insurer receives
596notice of the accident. After the 30-day period, any amount of
597the reserve for which the insurer has not received notice of
598such a claim from a physician or dentist who provided emergency
599services and care or who provided hospital inpatient care may
600then be used by the insurer to pay other claims. The time
601periods specified in paragraph (b) for required payment of
602personal injury protection benefits are shall be tolled for the
603period of time that an insurer is required by this paragraph to
604hold payment of a claim that is not from a physician or dentist
605who provided emergency services and care or who provided
606hospital inpatient care to the extent that the personal injury
607protection benefits not held in reserve are insufficient to pay
608the claim. This paragraph does not require an insurer to
609establish a claim reserve for insurance accounting purposes.
610     (f)(d)  All overdue payments shall bear simple interest at
611the rate established under s. 55.03 or the rate established in
612the insurance contract, whichever is greater, for the year in
613which the payment became overdue, calculated from the date the
614insurer was furnished with written notice of the amount of
615covered loss. Interest is shall be due at the time payment of
616the overdue claim is made.
617     (g)(e)  The insurer of the owner of a motor vehicle shall
618pay personal injury protection benefits for:
619     1.  Accidental bodily injury sustained in this state by the
620owner while occupying a motor vehicle, or while not an occupant
621of a self-propelled vehicle if the injury is caused by physical
622contact with a motor vehicle.
623     2.  Accidental bodily injury sustained outside this state,
624but within the United States of America or its territories or
625possessions or Canada, by the owner while occupying the owner's
626motor vehicle.
627     3.  Accidental bodily injury sustained by a relative of the
628owner residing in the same household, under the circumstances
629described in subparagraph 1. or subparagraph 2. if, provided the
630relative at the time of the accident is domiciled in the owner's
631household and is not himself or herself the owner of a motor
632vehicle with respect to which security is required under the no-
633fault law ss. 627.730-627.7405.
634     4.  Accidental bodily injury sustained in this state by any
635other person while occupying the owner's motor vehicle or, if a
636resident of this state, while not an occupant of a self-
637propelled vehicle, if the injury is caused by physical contact
638with such motor vehicle and if, provided the injured person is
639not himself or herself:
640     a.  The owner of a motor vehicle with respect to which
641security is required under the no-fault law ss. 627.730-
642627.7405; or
643     b.  Entitled to personal injury benefits from the insurer
644of the owner or owners of such a motor vehicle.
645     (h)(f)  If two or more insurers are liable to pay personal
646injury protection benefits for the same injury to any one
647person, the maximum payable is shall be as specified in
648subsection (1), and any insurer paying the benefits is shall be
649entitled to recover from each of the other insurers an equitable
650pro rata share of the benefits paid and expenses incurred in
651processing the claim.
652     (i)(g)  It is a violation of the insurance code for an
653insurer to fail to timely provide benefits as required by this
654section with such frequency as to constitute a general business
656     (j)(h)  Benefits are shall not be due or payable to or on
657the behalf of a claimant who: an insured person if that person
659     1.  Submits a false or misleading statement, document,
660record, or bill;
661     2.  Submits any other false or misleading information; or
662     3.  Has otherwise committed or attempted to commit a
663fraudulent insurance act as defined in s. 626.989.
665A claimant who violates this paragraph is not entitled to any
666personal injury protection benefits or payment for any bills and
667services, regardless of whether a portion of the claim may be
669     (k)  Notwithstanding any remedies afforded by law, the
670insurer may recover from a claimant who has violated paragraph
671(j) any sums previously paid to the claimant and may bring any
672available common law and statutory causes of action committed,
673by a material act or omission, any insurance fraud relating to
674personal injury protection coverage under his or her policy, if
675the fraud is admitted to in a sworn statement by the insured or
676if it is established in a court of competent jurisdiction. If a
677physician, hospital, clinic, or other medical institution
678violates paragraph (j), the injured party is not liable for, and
679the physician, hospital, clinic, or other medical institution
680may not bill the insured for, charges that are unpaid because of
681failure to comply with paragraph (j). Any agreement requiring
682the injured person or insured to pay for such charges is
683unenforceable. Any insurance fraud shall void all coverage
684arising from the claim related to such fraud under the personal
685injury protection coverage of the insured person who committed
686the fraud, irrespective of whether a portion of the insured
687person's claim may be legitimate, and any benefits paid prior to
688the discovery of the insured person's insurance fraud shall be
689recoverable by the insurer from the person who committed
690insurance fraud in their entirety. The prevailing party is
691entitled to its costs and attorney's fees in any action in which
692it prevails in an insurer's action to enforce its right of
693recovery under this paragraph.
694     (5)  INSURER INVESTIGATIONS.-An insurer has the right and
695duty to conduct a reasonable investigation of a claim. In the
696course of the investigation, the insurer may require the
697insured, claimant, or medical provider to provide copies of the
698treatment and examination records so that the insurer can
699provide such records to a physician for a records review. A
700records review need not be based on a physical examination and
701may be obtained at any time, including after reduction or denial
702of the claim. The 30-day period for payment under paragraph
703(4)(b) is tolled from the date the insurer sends its request for
704treatment records to the date that the insurer receives the
705treatment records. The claim may be denied or reduced if the
706medical provider fails to keep adequate records such that the
707insurer is unable to obtain a records review.
709     (a)1.  Any physician, hospital, clinic, or other person or
710institution lawfully rendering treatment to an injured person
711for a bodily injury covered by personal injury protection
712insurance may charge the insurer and injured party only an a
713reasonable amount pursuant to this section for the services and
714supplies rendered, and the insurer providing such coverage may
715pay for such charges directly to such person or institution
716lawfully rendering such treatment, if the insured receiving such
717treatment or his or her guardian has countersigned the properly
718completed invoice, bill, or claim form approved by the office
719upon which such charges are to be paid for as having actually
720been rendered, to the best knowledge of the insured or his or
721her guardian. In no event, However, may such a charge may not
722exceed be in excess of the amount the person or institution
723customarily charges for like services or supplies. When
724determining With respect to a determination of whether a charge
725for a particular service, treatment, or otherwise is reasonable,
726consideration may be given to evidence of usual and customary
727charges and payments accepted by the provider involved in the
728dispute, and reimbursement levels in the community and various
729federal and state medical fee schedules applicable to automobile
730and other insurance coverages, and other information relevant to
731the reasonableness of the reimbursement for the service,
732treatment, or supply.
733     1.2.  The insurer may limit reimbursement to 80 percent of
734the following schedule of maximum charges:
735     a.  For emergency transport and treatment by providers
736licensed under chapter 401, 200 percent of Medicare.
737     b.  For emergency services and care provided by a hospital
738licensed under chapter 395, 75 percent of the hospital's usual
739and customary charges.
740     c.  For emergency services and care as defined by s.
741395.002(9) provided in a facility licensed under chapter 395
742rendered by a physician or dentist, and related hospital
743inpatient services rendered by a physician or dentist, the usual
744and customary charges in the community.
745     d.  For hospital inpatient services, other than emergency
746services and care, 200 percent of the Medicare Part A
747prospective payment applicable to the specific hospital
748providing the inpatient services.
749     e.  For hospital outpatient services, other than emergency
750services and care, 200 percent of the Medicare Part A Ambulatory
751Payment Classification for the specific hospital providing the
752outpatient services.
753     f.  For all other medical services, supplies, and care, 200
754percent of the allowable amount under the participating
755physicians schedule of Medicare Part B. However, if such
756services, supplies, or care is not reimbursable under Medicare
757Part B, the insurer may limit reimbursement to 80 percent of the
758maximum reimbursable allowance under workers' compensation, as
759determined under s. 440.13 and rules adopted thereunder which
760are in effect at the time such services, supplies, or care is
761provided. Services, supplies, or care that is not reimbursable
762under Medicare or workers' compensation is not required to be
763reimbursed by the insurer.
764     2.3.  For purposes of subparagraph 1. 2., the applicable
765fee schedule or payment limitation under Medicare is the fee
766schedule or payment limitation in effect on January 1 of the
767year in which at the time the services, supplies, or care was
768rendered and for the area in which such services were rendered,
769notwithstanding any subsequent changes made to such fee schedule
770or payment limitation, except that it may not be less than the
771allowable amount under the participating physicians schedule of
772Medicare Part B for 2007 for medical services, supplies, and
773care subject to Medicare Part B.
774     3.4.  Subparagraph 1. 2. does not allow the insurer to
775apply any limitation on the number of treatments or other
776utilization limits that apply under Medicare or workers'
777compensation. An insurer that applies the allowable payment
778limitations of subparagraph 1. 2. must reimburse a provider who
779lawfully provided care or treatment under the scope of his or
780her license, regardless of whether such provider is would be
781entitled to reimbursement under Medicare due to restrictions or
782limitations on the types or discipline of health care providers
783who may be reimbursed for particular procedures or procedure
785     4.5.  If an insurer limits payment as authorized by
786subparagraph 1. 2., the person providing such services,
787supplies, or care may not bill or attempt to collect from the
788insured any amount in excess of such limits, except for amounts
789that are not covered by the insured's personal injury protection
790coverage due to the coinsurance amount or maximum policy limits.
791     (b)1.  An insurer or insured is not required to pay a claim
792or charges:
793     a.  Made by a broker or by a person making a claim on
794behalf of a broker;
795     b.  For any service or treatment that was not lawful at the
796time rendered;
797     c.  To any person who knowingly submits a false or
798misleading statement relating to the claim or charges;
799     d.  With respect to a bill or statement that does not
800substantially meet the applicable requirements of paragraphs (c)
801and paragraph (d);
802     e.  For any treatment or service that is upcoded, or that
803is unbundled if when such treatment or services should be
804bundled, in accordance with paragraph (d). To facilitate prompt
805payment of lawful services, an insurer may change codes that it
806determines to have been improperly or incorrectly upcoded or
807unbundled, and may make payment based on the changed codes,
808without affecting the right of the provider to dispute the
809change by the insurer if, provided that before doing so, the
810insurer contacts must contact the health care provider and
811discusses discuss the reasons for the insurer's change and the
812health care provider's reason for the coding, or makes make a
813reasonable good faith effort to do so, as documented in the
814insurer's file; and
815     f.  For medical services or treatment billed by a physician
816and not provided in a hospital unless such services are rendered
817by the physician or are incident to his or her professional
818services and are included on the physician's bill, including
819documentation verifying that the physician is responsible for
820the medical services that were rendered and billed.
821     2.  The Department of Health, in consultation with the
822appropriate professional licensing boards, shall adopt, by rule,
823a list of diagnostic tests deemed not to be medically necessary
824for use in the treatment of persons sustaining bodily injury
825covered by personal injury protection benefits under this
826section. The initial list shall be adopted by January 1, 2004,
827and shall be revised from time to time as determined by the
828Department of Health, in consultation with the respective
829professional licensing boards. Inclusion of a test on the list
830must of invalid diagnostic tests shall be based on lack of
831demonstrated medical value and a level of general acceptance by
832the relevant provider community and may shall not be dependent
833for results entirely upon subjective patient response.
834Notwithstanding its inclusion on a fee schedule in this
835subsection, an insurer or insured is not required to pay any
836charges or reimburse claims for any invalid diagnostic test as
837determined by the Department of Health.
838     (c)1.  With respect to any treatment or service, other than
839medical services billed by a hospital or other provider for
840emergency services as defined in s. 395.002 or inpatient
841services rendered at a hospital-owned facility, the statement of
842charges must be furnished to the insurer by the provider and may
843not include, and the insurer is not required to pay, charges for
844treatment or services rendered more than 35 days before the
845postmark date or electronic transmission date of the statement,
846except for past due amounts previously billed on a timely basis
847under this paragraph, and except that, if the provider submits
848to the insurer a notice of initiation of treatment within 21
849days after its first examination or treatment of the claimant,
850the statement may include charges for treatment or services
851rendered up to, but not more than, 75 days before the postmark
852date of the statement. The injured party is not liable for, and
853the provider may shall not bill the injured party for, charges
854that are unpaid because of the provider's failure to comply with
855this paragraph. Any agreement requiring the injured person or
856insured to pay for such charges is unenforceable.
857     1.2.  If, however, the insured fails to furnish the
858provider with the correct name and address of the insured's
859personal injury protection insurer, the provider has 35 days
860from the date the provider obtains the correct information to
861furnish the insurer with a statement of the charges. The insurer
862is not required to pay for such charges unless the provider
863includes with the statement documentary evidence that was
864provided by the insured during the 35-day period demonstrating
865that the provider reasonably relied on erroneous information
866from the insured and either:
867     a.  A denial letter from the incorrect insurer; or
868     b.  Proof of mailing, which may include an affidavit under
869penalty of perjury, reflecting timely mailing to the incorrect
870address or insurer.
871     2.3.  For emergency services and care as defined in s.
872395.002 rendered in a hospital emergency department or for
873transport and treatment rendered by an ambulance provider
874licensed pursuant to part III of chapter 401, the provider is
875not required to furnish the statement of charges within the time
876periods established by this paragraph,; and the insurer is shall
877not be considered to have been furnished with notice of the
878amount of covered loss for purposes of paragraph (4)(b) until it
879receives a statement complying with paragraph (d), or copy
880thereof, which specifically identifies the place of service to
881be a hospital emergency department or an ambulance in accordance
882with billing standards recognized by the Centers for Medicare
883and Medicaid Services (CMS) Health Care Finance Administration.
884     3.4.  Each notice of the insured's rights under s. 627.7401
885must include the following statement in type no smaller than 12
888BILLING REQUIREMENTS.-Florida Statutes provide that
889with respect to any treatment or services, other than
890certain hospital and emergency services, the statement
891of charges furnished to the insurer by the provider
892may not include, and the insurer and the injured party
893are not required to pay, charges for treatment or
894services rendered more than 35 days before the
895postmark date of the statement, except for past due
896amounts previously billed on a timely basis, and
897except that, if the provider submits to the insurer a
898notice of initiation of treatment within 21 days after
899its first examination or treatment of the claimant,
900the first billing cycle statement may include charges
901for treatment or services rendered up to, but not more
902than, 75 days before the postmark date of the
905     (d)  All statements and bills for medical services rendered
906by any physician, hospital, clinic, or other person or
907institution shall be submitted to the insurer on a properly
908completed Centers for Medicare and Medicaid Services (CMS) 1500
909form, UB 92 forms, or any other standard form approved by the
910office or adopted by the commission for purposes of this
911paragraph. All billings for such services rendered by providers
912must shall, to the extent applicable, follow the Physicians'
913Current Procedural Terminology (CPT) or Healthcare Correct
914Procedural Coding System (HCPCS), or ICD-9 in effect for the
915year in which services are rendered and comply with the Centers
916for Medicare and Medicaid Services (CMS) 1500 form instructions
917and the American Medical Association Current Procedural
918Terminology (CPT) Editorial Panel and Healthcare Correct
919Procedural Coding System (HCPCS). All providers other than
920hospitals shall include on the applicable claim form the
921professional license number of the provider in the line or space
922provided for "Signature of Physician or Supplier, Including
923Degrees or Credentials." In determining compliance with
924applicable CPT and HCPCS coding, guidance shall be provided by
925the Physicians' Current Procedural Terminology (CPT) or the
926Healthcare Correct Procedural Coding System (HCPCS) in effect
927for the year in which services were rendered, the Office of the
928Inspector General (OIG), Physicians Compliance Guidelines, and
929other authoritative treatises designated by rule by the Agency
930for Health Care Administration. A No statement of medical
931services may not include charges for medical services of a
932person or entity that performed such services without possessing
933the valid licenses required to perform such services. For
934purposes of paragraph (4)(b), an insurer is shall not be
935considered to have been furnished with notice of the amount of
936covered loss or medical bills due unless the statements or bills
937comply with this paragraph, and unless the statements or bills
938are properly completed in their entirety as to all material
939provisions, with all relevant information being provided
941     (e)1.  At the initial treatment or service provided, each
942physician, other licensed professional, clinic, or other medical
943institution providing medical services upon which a claim for
944personal injury protection benefits is based shall require an
945insured person, or his or her guardian, to execute a disclosure
946and acknowledgment form, which reflects at a minimum that:
947     a.  The insured, or his or her guardian, must countersign
948the form attesting to the fact that the services set forth
949therein were actually rendered;
950     b.  The insured, or his or her guardian, has both the right
951and affirmative duty to confirm that the services were actually
953     c.  The insured, or his or her guardian, was not solicited
954by any person to seek any services from the medical provider;
955     d.  The physician, other licensed professional, clinic, or
956other medical institution rendering services for which payment
957is being claimed explained the services to the insured or his or
958her guardian; and
959     e.  If the insured notifies the insurer in writing of a
960billing error, the insured may be entitled to a certain
961percentage of a reduction in the amounts paid by the insured's
962motor vehicle insurer.
963     2.  The physician, other licensed professional, clinic, or
964other medical institution rendering services for which payment
965is being claimed has the affirmative duty to explain the
966services rendered to the insured, or his or her guardian, so
967that the insured, or his or her guardian, countersigns the form
968with informed consent.
969     3.  Countersignature by the insured, or his or her
970guardian, is not required for the reading of diagnostic tests or
971other services that are of such a nature that they are not
972required to be performed in the presence of the insured.
973     4.  The licensed medical professional rendering treatment
974for which payment is being claimed must sign, by his or her own
975hand, the form complying with this paragraph.
976     5.  The original completed disclosure and acknowledgment
977form is shall be furnished to the insurer pursuant to paragraph
978(4)(b) and may not be electronically furnished.
979     6.  This disclosure and acknowledgment form is not required
980for services billed by a provider for emergency services as
981defined in s. 395.002, for emergency services and care as
982defined in s. 395.002 rendered in a hospital emergency
983department, or for transport and treatment rendered by an
984ambulance provider licensed pursuant to part III of chapter 401.
985     7.  The Financial Services Commission shall adopt, by rule,
986a standard disclosure and acknowledgment form to that shall be
987used to fulfill the requirements of this paragraph, effective 90
988days after such form is adopted and becomes final. The
989commission shall adopt a proposed rule by October 1, 2003. Until
990the rule is final, the provider may use a form of its own which
991otherwise complies with the requirements of this paragraph.
992     8.  As used in this paragraph, the term "countersigned" or
993"countersignature" means a second or verifying signature, as on
994a previously signed document, and is not satisfied by the
995statement "signature on file" or any similar statement.
996     9.  The requirements of this paragraph apply only with
997respect to the initial treatment or service of the insured by a
998provider. For subsequent treatments or service, the provider
999must maintain a patient log signed by the patient, in
1000chronological order by date of service, that is consistent with
1001the services being rendered to the patient as claimed. The
1002requirements of this subparagraph for maintaining a patient log
1003signed by the patient may be met by a hospital that maintains
1004medical records as required by s. 395.3025 and applicable rules
1005and makes such records available to the insurer upon request.
1006     (f)  Upon written notification by any person, an insurer
1007shall investigate any claim of improper billing by a physician
1008or other medical provider. The insurer shall determine if the
1009insured was properly billed for only those services and
1010treatments that the insured actually received. If the insurer
1011determines that the insured has been improperly billed, the
1012insurer shall notify the insured, the person making the written
1013notification, and the provider of its findings and shall reduce
1014the amount of payment to the provider by the amount determined
1015to be improperly billed. If a reduction is made due to such
1016written notification by any person, the insurer shall pay to the
1017person 20 percent of the amount of the reduction, up to $500. If
1018the provider is arrested due to the improper billing, then the
1019insurer shall pay to the person 40 percent of the amount of the
1020reduction, up to $500.
1021     (g)  An insurer may not systematically downcode with the
1022intent to deny reimbursement otherwise due. Such action
1023constitutes a material misrepresentation under s.
1027     (a)  An insurer may require a claimant to submit to an
1028examination under oath or sworn statement as often as reasonably
1029requested by an insurer and at any reasonable location
1030designated by the insurer. Submission to an examination under
1031oath or sworn statement is a condition precedent to recovery or
1032filing suit. The insurer is not liable for benefits under the
1033no-fault law if the claimant fails to fully and truthfully
1034answer all questions asked or violates any provision of
1035paragraph (4)(j).
1036     1.  The insurer may conduct the examination outside the
1037presence of any other person seeking coverage.
1038     2.  If an insurer requests an examination of a claimant
1039that is in a hospital, clinic, or other medical institution,
1040such claimant shall produce the persons with the most knowledge
1041relating to the issues set forth by the insurer in the notice of
1043     3.  The claimant must provide the insurer at the
1044examination with all documents, papers, receipts, invoices,
1045bills, records, or other tangible items requested by the
1047     4.  The examination may be recorded by audio, video, or
1048court report or any combination thereof. The claimant may record
1049the examination at the claimant's expense.
1050     5.  The claimant may have an attorney present at the
1051examination at the claimant's expense.
1052     6.  An insurer that unreasonably requests an examination
1053without a reasonable basis as a general business practice is
1054engaging in an unfair insurance trade practice pursuant to s.
1056     (a)  Every employer shall, if a request is made by an
1057insurer providing personal injury protection benefits under ss.
1058627.730-627.7405 against whom a claim has been made, furnish
1059forthwith, in a form approved by the office, a sworn statement
1060of the earnings, since the time of the bodily injury and for a
1061reasonable period before the injury, of the person upon whose
1062injury the claim is based.
1063     (b)  Every physician, hospital, clinic, or other medical
1064institution providing, before or after bodily injury upon which
1065a claim for personal injury protection insurance benefits is
1066based, any products, services, or accommodations in relation to
1067that or any other injury, or in relation to a condition claimed
1068to be connected with that or any other injury, shall, if
1069requested to do so by the insurer against whom the claim has
1070been made, permit the insurer or the insurer's representative to
1071conduct an onsite physical review and examination of the
1072treatment location, treatment apparatuses, diagnostic devices,
1073and any other medical equipment used for the services rendered
1074within 10 days after the insurer's request and furnish forthwith
1075a written report of the history, condition, treatment, dates,
1076and costs of such treatment of the injured person and why the
1077items identified by the insurer were reasonable in amount and
1078medically necessary, together with a sworn statement that the
1079treatment or services rendered were reasonable and necessary
1080with respect to the bodily injury sustained and identifying
1081which portion of the expenses for such treatment or services was
1082incurred as a result of such bodily injury, and produce
1083forthwith, and permit the inspection and copying of, his or her
1084or its records regarding such history, condition, treatment,
1085dates, and costs of treatment if; provided that this does shall
1086not limit the introduction of evidence at trial. Such sworn
1087statement must shall read as follows: "Under penalty of perjury,
1088I declare that I have read the foregoing, and the facts alleged
1089are true, to the best of my knowledge and belief." A No cause of
1090action for violation of the physician-patient privilege or
1091invasion of the right of privacy may not be brought shall be
1092permitted against any physician, hospital, clinic, or other
1093medical institution complying with the provisions of this
1094section. The person requesting such records and such sworn
1095statement shall pay all reasonable costs connected therewith. If
1096an insurer makes a written request for documentation or
1097information under this paragraph within 30 days after having
1098received notice of the amount of a covered loss under paragraph
1099(4)(a), the amount or the partial amount that which is the
1100subject of the insurer's inquiry is shall become overdue if the
1101insurer does not pay in accordance with paragraph (4)(b) or
1102within 10 days after the insurer's receipt of the requested
1103documentation or information, whichever occurs later. For
1104purposes of this paragraph, the term "receipt" includes, but is
1105not limited to, inspection and copying pursuant to this
1106paragraph. An Any insurer that requests documentation or
1107information pertaining to reasonableness of charges or medical
1108necessity under this paragraph without a reasonable basis for
1109such requests as a general business practice is engaging in an
1110unfair trade practice under the insurance code.
1111     (c)  If a request is made by an insurer, an employer must
1112furnish, in a form approved by the office, a sworn statement of
1113the earnings of the person upon whose injury a claim is based
1114since the time of the bodily injury and for a reasonable period
1115before the injury.
1116     (d)(c)  If there is a In the event of any dispute regarding
1117an insurer's right to discovery of facts under this section, the
1118insurer may petition the a court of competent jurisdiction to
1119enter an order permitting such discovery. The order may be made
1120only on motion for good cause shown and upon notice to all
1121persons having an interest, and must it shall specify the time,
1122place, manner, conditions, and scope of the discovery. The Such
1123court may, in order to protect against annoyance, embarrassment,
1124or oppression, as justice requires, enter an order refusing
1125discovery or specifying conditions of discovery and may order
1126payments of costs and expenses of the proceeding, including
1127reasonable fees for the appearance of attorneys at the
1128proceedings, as justice requires.
1131     (b)  If requested by the person examined, a party causing
1132an examination to be made shall deliver to him or her a copy of
1133every written report concerning the examination rendered by an
1134examining physician, at least one of which reports must set out
1135the examining physician's findings and conclusions in detail.
1136After such request and delivery, the party causing the
1137examination to be made is entitled, upon request, to receive
1138from the person examined every written report available to him
1139or her or his or her representative concerning any examination,
1140previously or thereafter made, of the same mental or physical
1141condition. By requesting and obtaining a report of the
1142examination so ordered, or by taking the deposition of the
1143examiner, the person examined waives any privilege he or she may
1144have, in relation to the claim for benefits, regarding the
1145testimony of every other person who has examined, or may
1146thereafter examine, him or her in respect to the same mental or
1147physical condition. If a person unreasonably refuses to submit
1148to an examination, the personal injury protection carrier is no
1149longer liable for subsequent personal injury protection benefits
1150incurred after the date of the first request for examination.
1151Failure to appear for an examination raises a rebuttable
1152presumption that such failure was unreasonable. Submission to an
1153examination is a condition precedent to the recovery of
1156FEES.-With respect to any dispute under the provisions of ss.
1157627.730-627.7405 between the insured and the insurer under the
1158no-fault law, or between an assignee of an insured's rights and
1159the insurer, the provisions of s. 627.428 applies shall apply,
1160except as provided in subsections (11) and (16) (10) and (15).
1161     (10)(9)  PREFERRED PROVIDERS.-An insurer may negotiate and
1162enter into contracts with preferred licensed health care
1163providers for the benefits described in this section, referred
1164to in this section as "preferred providers," which shall include
1165health care providers licensed under chapter chapters 458,
1166chapter 459, chapter 460, chapter 461, or chapter and 463.
1167     (a)  The insurer may provide an option to an insured to use
1168a preferred provider at the time of purchase of the policy for
1169personal injury protection benefits, if the requirements of this
1170subsection are met. However, if the insurer offers a preferred
1171provider option, it must also offer a nonpreferred provider
1172policy. If the insured elects to use a provider who is not a
1173preferred provider, whether the insured purchased a preferred
1174provider policy or a nonpreferred provider policy, the medical
1175benefits provided by the insurer shall be as required by this
1177     (b)  If the insured elects the to use a provider who is a
1178preferred provider option, the insurer may pay medical benefits
1179in excess of the benefits required by this section and may waive
1180or lower the amount of any deductible that applies to such
1181medical benefits. As an alternative, or in addition to such
1182benefits, waiver, or reduction, the insurer may provide an
1183actuarially appropriate premium discount as specified in an
1184approved rate filing to an insured who selects the preferred
1185provider option. If the preferred provider option provides a
1186premium discount, the policy may provide that charges for
1187nonemergency services provided within this state are payable
1188only if performed by members of the preferred provider network
1189unless there is no member of the preferred provider network
1190located within 15 miles of the insured's place of residence
1191whose scope of practice includes the required services. If the
1192insurer offers a preferred provider policy to a policyholder or
1193applicant, it must also offer a nonpreferred provider policy.
1194     (c)  The insurer shall provide each insured policyholder
1195with a current roster of preferred providers in the county in
1196which the insured resides at the time of purchasing purchase of
1197such policy, and shall make such list available for public
1198inspection during regular business hours at the insurer's
1199principal office of the insurer within the state. The insurer
1200may contract with another health insurer for the right to use an
1201existing preferred provider network to implement the preferred
1202provider option. Any other arrangement is subject to the
1203approval of the Office of Insurance Regulation.
1204     (17)(16)  SECURE ELECTRONIC DATA TRANSFER.-If all parties
1205mutually and expressly agree, a notice, documentation,
1206transmission, or communication of any kind required or
1207authorized under the no-fault law ss. 627.730-627.7405 may be
1208transmitted electronically if it is transmitted by secure
1209electronic data transfer that is consistent with state and
1210federal privacy and security laws.
1211     Section 8.  Paragraph (c) of subsection (7) of section
1212817.234, Florida Statutes, is amended, present subsection (12)
1213of that section is renumbered as subsection (13), and a new
1214subsection (12) is added to that section, to read:
1215     817.234  False and fraudulent insurance claims.-
1216     (7)
1217     (c)  An insurer, or any person acting at the direction of
1218or on behalf of an insurer, may not change an opinion in a
1219mental or physical report prepared under s. 627.736(8)
1220627.736(7) or direct the physician preparing the report to
1221change such opinion; however, this provision does not preclude
1222the insurer from calling to the attention of the physician
1223errors of fact in the report based upon information in the claim
1224file. Any person who violates this paragraph commits a felony of
1225the third degree, punishable as provided in s. 775.082, s.
1226775.083, or s. 775.084.
1227     (12)  In addition to any criminal liability, a person
1228convicted of violating any provision of this section for the
1229purpose of receiving insurance proceeds from a motor vehicle
1230insurance contract is subject to a civil penalty.
1231     (a)  Except for a violation of subsection (9), the civil
1232penalty shall be:
1233     1.  A fine up to $5,000 for a first offense.
1234     2.  A fine greater than $5,000, but not to exceed $10,000,
1235for a second offense.
1236     3.  A fine greater than $10,000, but not to exceed $15,000,
1237for a third or subsequent offense.
1238     (b)  The civil penalty for a violation of subsection
1239(9)_must be at least $15,000 but may not exceed $50,000.
1240     (c)  The civil penalty shall be paid to the Insurance
1241Regulatory Trust Fund within the Department of Financial
1242Services and used by the department for the investigation and
1243prosecution of insurance fraud.
1244     (d)  This subsection does not prohibit a state attorney
1245from entering into a written agreement in which the person
1246charged with the violation does not admit to or deny the charges
1247but consents to payment of the civil penalty.
1248     Section 9.  Subsection (1) of section 324.021, Florida
1249Statutes, is amended to read:
1250     324.021  Definitions; minimum insurance required.-The
1251following words and phrases when used in this chapter shall, for
1252the purpose of this chapter, have the meanings respectively
1253ascribed to them in this section, except in those instances
1254where the context clearly indicates a different meaning:
1255     (1)  MOTOR VEHICLE.-Every self-propelled vehicle that which
1256is designed and required to be licensed for use upon a highway,
1257including trailers and semitrailers designed for use with such
1258vehicles, except traction engines, road rollers, farm tractors,
1259power shovels, and well drillers, and every vehicle that which
1260is propelled by electric power obtained from overhead wires but
1261not operated upon rails, but not including any bicycle or moped.
1262However, the term does "motor vehicle" shall not include a any
1263motor vehicle as defined in s. 627.732(3) if when the owner of
1264such vehicle has complied with the no-fault law requirements of
1265ss. 627.730-627.7405, inclusive, unless the provisions of s.
1266324.051 apply; and, in such case, the applicable proof of
1267insurance provisions of s. 320.02 apply.
1268     Section 10.  Paragraph (k) of subsection (2) of section
1269456.057, Florida Statutes, is amended to read:
1270     456.057  Ownership and control of patient records; report
1271or copies of records to be furnished.-
1272     (2)  As used in this section, the terms "records owner,"
1273"health care practitioner," and "health care practitioner's
1274employer" do not include any of the following persons or
1275entities; furthermore, the following persons or entities are not
1276authorized to acquire or own medical records, but are authorized
1277under the confidentiality and disclosure requirements of this
1278section to maintain those documents required by the part or
1279chapter under which they are licensed or regulated:
1280     (k)  Persons or entities practicing under s. 627.736(8)
1282     Section 11.  Subsection (7) of section 627.7295, Florida
1283Statutes, is amended to read:
1284     627.7295  Motor vehicle insurance contracts.-
1285     (7)  A policy of private passenger motor vehicle insurance
1286or a binder for such a policy may be initially issued in this
1287state only if the insurer or agent has collected from the
1288insured an amount equal to 2 months' premium. An insurer, agent,
1289or premium finance company may not, directly or indirectly, take
1290any action resulting in the insured having paid from the
1291insured's own funds an amount less than the 2 months' premium
1292required by this subsection. This subsection applies without
1293regard to whether the premium is financed by a premium finance
1294company or is paid pursuant to a periodic payment plan of an
1295insurer or an insurance agent. This subsection does not apply if
1296an insured or member of the insured's family is renewing or
1297replacing a policy or a binder for such policy written by the
1298same insurer or a member of the same insurer group. This
1299subsection does not apply to an insurer that issues private
1300passenger motor vehicle coverage primarily to active duty or
1301former military personnel or their dependents. This subsection
1302does not apply if all policy payments are paid pursuant to a
1303payroll deduction plan or an automatic electronic funds transfer
1304payment plan from the policyholder, provided that the first
1305policy payment is made by cash, cashier's check, check, or a
1306money order. This subsection and subsection (4) do not apply if
1307all policy payments to an insurer are paid pursuant to an
1308automatic electronic funds transfer payment plan from an agent,
1309a managing general agent, or a premium finance company and if
1310the policy includes, at a minimum, personal injury protection
1311pursuant to ss. 627.730-627.7407 627.730-627.7405; motor vehicle
1312property damage liability pursuant to s. 627.7275; and bodily
1313injury liability in at least the amount of $10,000 because of
1314bodily injury to, or death of, one person in any one accident
1315and in the amount of $20,000 because of bodily injury to, or
1316death of, two or more persons in any one accident. This
1317subsection and subsection (4) do not apply if an insured has had
1318a policy in effect for at least 6 months, the insured's agent is
1319terminated by the insurer that issued the policy, and the
1320insured obtains coverage on the policy's renewal date with a new
1321company through the terminated agent.
1322     Section 12.  Subsections (3) and (4) of section 627.733,
1323Florida Statutes, are amended to read:
1324     627.733  Required security.-
1325     (3)  Such security shall be provided:
1326     (a)  By an insurance policy delivered or issued for
1327delivery in this state by an authorized or eligible motor
1328vehicle liability insurer which provides the benefits and
1329exemptions contained in the no-fault law ss. 627.730-627.7405.
1330Any policy of insurance represented or sold as providing the
1331security required hereunder shall be deemed to provide insurance
1332for the payment of the required benefits; or
1333     (b)  By any other method authorized by s. 324.031(2), (3),
1334or (4) and approved by the Department of Highway Safety and
1335Motor Vehicles as affording security equivalent to that afforded
1336by a policy of insurance or by self-insuring as authorized by s.
1337768.28(16). The person filing such security shall have all of
1338the obligations and rights of an insurer under the no-fault law
1339ss. 627.730-627.7405.
1340     (4)  An owner of a motor vehicle with respect to which
1341security is required by this section who fails to have such
1342security in effect at the time of an accident shall have no
1343immunity from tort liability, but shall be personally liable for
1344the payment of benefits under s. 627.736. With respect to such
1345benefits, such an owner shall have all of the rights and
1346obligations of an insurer under the no-fault law ss. 627.730-
1348     Section 13.  Section 627.734, Florida Statutes, is amended
1349to read:
1350     627.734  Proof of security; security requirements;
1352     (1)  The provisions of chapter 324 that which pertain to
1353the method of giving and maintaining proof of financial
1354responsibility and that which govern and define a motor vehicle
1355liability policy shall apply to filing and maintaining proof of
1356security required by the no-fault law ss. 627.730-627.7405.
1357     (2)  Any person who:
1358     (a)  Gives information required in a report or otherwise as
1359provided for in the no-fault law ss. 627.730-627.7405, knowing
1360or having reason to believe that such information is false;
1361     (b)  Forges or, without authority, signs any evidence of
1362proof of security; or
1363     (c)  Files, or offers for filing, any such evidence of
1364proof, knowing or having reason to believe that it is forged or
1365signed without authority,
1367commits is guilty of a misdemeanor of the first degree,
1368punishable as provided in s. 775.082 or s. 775.083.
1369     Section 14.  Subsections (1), (2), and (3) of section
1370627.737, Florida Statutes, are amended to read:
1371     627.737  Tort exemption; limitation on right to damages;
1372punitive damages.-
1373     (1)  Every owner, registrant, operator, or occupant of a
1374motor vehicle with respect to which security has been provided
1375as required by the no-fault law ss. 627.730-627.7405, and every
1376person or organization legally responsible for her or his acts
1377or omissions, is hereby exempted from tort liability for damages
1378because of bodily injury, sickness, or disease arising out of
1379the ownership, operation, maintenance, or use of such motor
1380vehicle in this state to the extent that the benefits described
1381in s. 627.736(1) are payable for such injury, or would be
1382payable but for any exclusion authorized by the no-fault law ss.
1383627.730-627.7405, under any insurance policy or other method of
1384security complying with the requirements of s. 627.733, or by an
1385owner personally liable under s. 627.733 for the payment of such
1386benefits, unless a person is entitled to maintain an action for
1387pain, suffering, mental anguish, and inconvenience for such
1388injury under the provisions of subsection (2).
1389     (2)  In any action of tort brought against the owner,
1390registrant, operator, or occupant of a motor vehicle with
1391respect to which security has been provided as required by the
1392no-fault law ss. 627.730-627.7405, or against any person or
1393organization legally responsible for her or his acts or
1394omissions, a plaintiff may recover damages in tort for pain,
1395suffering, mental anguish, and inconvenience because of bodily
1396injury, sickness, or disease arising out of the ownership,
1397maintenance, operation, or use of such motor vehicle only in the
1398event that the injury or disease consists in whole or in part
1400     (a)  Significant and permanent loss of an important bodily
1402     (b)  Permanent injury within a reasonable degree of medical
1403probability, other than scarring or disfigurement.
1404     (c)  Significant and permanent scarring or disfigurement.
1405     (d)  Death.
1406     (3)  When a defendant, in a proceeding brought pursuant to
1407the no-fault law ss. 627.730-627.7405, questions whether the
1408plaintiff has met the requirements of subsection (2), then the
1409defendant may file an appropriate motion with the court, and the
1410court shall, on a one-time basis only, 30 days before the date
1411set for the trial or the pretrial hearing, whichever is first,
1412by examining the pleadings and the evidence before it, ascertain
1413whether the plaintiff will be able to submit some evidence that
1414the plaintiff will meet the requirements of subsection (2). If
1415the court finds that the plaintiff will not be able to submit
1416such evidence, then the court shall dismiss the plaintiff's
1417claim without prejudice.
1418     Section 15.  Subsection (1) of section 627.7401, Florida
1419Statutes, is amended to read:
1420     627.7401  Notification of insured's rights.-
1421     (1)  The commission, by rule, shall adopt a form for the
1422notification of insureds of their right to receive personal
1423injury protection benefits under the Florida Motor Vehicle no-
1424fault law. Such notice shall include:
1425     (a)  A description of the benefits provided by personal
1426injury protection, including, but not limited to, the specific
1427types of services for which medical benefits are paid,
1428disability benefits, death benefits, significant exclusions from
1429and limitations on personal injury protection benefits, when
1430payments are due, how benefits are coordinated with other
1431insurance benefits that the insured may have, penalties and
1432interest that may be imposed on insurers for failure to make
1433timely payments of benefits, and rights of parties regarding
1434disputes as to benefits.
1435     (b)  An advisory informing insureds that:
1436     1.  Pursuant to s. 626.9892, the Department of Financial
1437Services may pay rewards of up to $25,000 to persons providing
1438information leading to the arrest and conviction of persons
1439committing crimes investigated by the Division of Insurance
1440Fraud arising from violations of s. 440.105, s. 624.15, s.
1441626.9541, s. 626.989, or s. 817.234.
1442     2.  Pursuant to s. 627.736(6)(e)1. 627.736(5)(e)1., if the
1443insured notifies the insurer of a billing error, the insured may
1444be entitled to a certain percentage of a reduction in the amount
1445paid by the insured's motor vehicle insurer.
1446     (c)  A notice that solicitation of a person injured in a
1447motor vehicle crash for purposes of filing personal injury
1448protection or tort claims could be a violation of s. 817.234, s
1449817.505, or the rules regulating The Florida Bar and should be
1450immediately reported to the Division of Insurance Fraud if such
1451conduct has taken place.
1452     Section 16.  Section 627.7405, Florida Statutes, is amended
1453to read:
1454     627.7405  Insurers' right of reimbursement.-Notwithstanding
1455any other provisions of the no-fault law ss. 627.730-627.7405,
1456any insurer providing personal injury protection benefits on a
1457private passenger motor vehicle has shall have, to the extent of
1458any personal injury protection benefits paid to any person as a
1459benefit arising out of such private passenger motor vehicle
1460insurance, a right of reimbursement against the owner or the
1461insurer of the owner of a commercial motor vehicle, if the
1462benefits paid result from such person having been an occupant of
1463the commercial motor vehicle or having been struck by the
1464commercial motor vehicle while not an occupant of any self-
1465propelled vehicle.
1466     Section 17.  Subsection (1) of section 627.7407, Florida
1467Statutes, is amended to read:
1468     627.7407  Application of the Florida Motor Vehicle No-Fault
1470     (1)  Any person subject to the requirements of ss. 627.730-
1471627.7405, the Florida Motor Vehicle No-Fault Law, as revived and
1472amended by this act, must maintain security for personal injury
1473protection as required by the Florida Motor Vehicle No-Fault
1474Law, as revived and amended by this act, beginning on January 1,
1476     Section 18.  Paragraph (d) of subsection (2) and paragraph
1477(d) of subsection (3) of section 628.909, Florida Statutes, are
1478amended to read:
1479     628.909  Applicability of other laws.-
1480     (2)  The following provisions of the Florida Insurance Code
1481shall apply to captive insurers who are not industrial insured
1482captive insurers to the extent that such provisions are not
1483inconsistent with this part:
1484     (d)  Sections 627.730-627.7407 627.730-627.7405, when no-
1485fault coverage is provided.
1486     (3)  The following provisions of the Florida Insurance Code
1487shall apply to industrial insured captive insurers to the extent
1488that such provisions are not inconsistent with this part:
1489     (d)  Sections 627.730-627.7407 627.730-627.7405 when no-
1490fault coverage is provided.
1491     Section 19.  This act shall take effect July 1, 2011.

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