Florida Senate - 2011                        COMMITTEE AMENDMENT
       Bill No. SB 1930
                                Barcode 552780                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                   Comm: WD            .                                
                  04/13/2011           .                                

       The Committee on Banking and Insurance (Bogdanoff) recommended
       the following:
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsection (1) of section 316.066, Florida
    6  Statutes, is amended to read:
    7         316.066 Written reports of crashes.—
    8         (1)(a) A Florida Traffic Crash Report, Long Form, must is
    9  required to be completed and submitted to the department within
   10  10 days after completing an investigation is completed by the
   11  every law enforcement officer who in the regular course of duty
   12  investigates a motor vehicle crash:
   13         1. That resulted in death, or personal injury, or any
   14  indication of complaints of pain or discomfort by any of the
   15  parties or passengers involved in the crash;.
   16         2. That involved one or more passengers, other than the
   17  drivers of the vehicles, in any of the vehicles involved in the
   18  crash;
   19         3.2. That involved a violation of s. 316.061(1) or s.
   20  316.193; or.
   21         4.3. In which a vehicle was rendered inoperative to a
   22  degree that required a wrecker to remove it from traffic, if
   23  such action is appropriate, in the officer’s discretion.
   24         (b) In every crash for which a Florida Traffic Crash
   25  Report, Long Form, is not required by this section, the law
   26  enforcement officer may complete a short-form crash report or
   27  provide a short-form crash report to be completed by each party
   28  involved in the crash. Short-form crash reports prepared by the
   29  law enforcement officer shall be maintained by the officer’s
   30  agency.
   31         (c) The long-form and the short-form report must include:
   32         1. The date, time, and location of the crash.
   33         2. A description of the vehicles involved.
   34         3. The names and addresses of the parties involved.
   35         4. The names and addresses of all passengers in all
   36  vehicles involved in the crash, each clearly identified as being
   37  a passenger and the identification of the vehicle in which they
   38  were a passenger.
   39         5.4. The names and addresses of witnesses.
   40         6.5. The name, badge number, and law enforcement agency of
   41  the officer investigating the crash.
   42         7.6. The names of the insurance companies for the
   43  respective parties involved in the crash.
   44         (d)(c) Each party to the crash must shall provide the law
   45  enforcement officer with proof of insurance, which must to be
   46  included in the crash report. If a law enforcement officer
   47  submits a report on the accident, proof of insurance must be
   48  provided to the officer by each party involved in the crash. Any
   49  party who fails to provide the required information commits a
   50  noncriminal traffic infraction, punishable as a nonmoving
   51  violation as provided in chapter 318, unless the officer
   52  determines that due to injuries or other special circumstances
   53  such insurance information cannot be provided immediately. If
   54  the person provides the law enforcement agency, within 24 hours
   55  after the crash, proof of insurance that was valid at the time
   56  of the crash, the law enforcement agency may void the citation.
   57         (e)(d) The driver of a vehicle that was in any manner
   58  involved in a crash resulting in damage to any vehicle or other
   59  property in an amount of $500 or more, which crash was not
   60  investigated by a law enforcement agency, shall, within 10 days
   61  after the crash, submit a written report of the crash to the
   62  department or traffic records center. The entity receiving the
   63  report may require witnesses of the crash crashes to render
   64  reports and may require any driver of a vehicle involved in a
   65  crash of which a written report must be made as provided in this
   66  section to file supplemental written reports if whenever the
   67  original report is deemed insufficient by the receiving entity.
   68         (f) The investigating law enforcement officer may testify
   69  at trial or provide a signed affidavit to confirm or supplement
   70  the information included on the long-form or short-form report.
   71         (e) Short-form crash reports prepared by law enforcement
   72  shall be maintained by the law enforcement officer’s agency.
   73         Section 2. Subsection (6) is added to section 400.991,
   74  Florida Statutes, to read:
   75         400.991 License requirements; background screenings;
   76  prohibitions.—
   77         (6) All forms that constitute part of the application for
   78  licensure or exemption from licensure under this part must
   79  contain the following statement:
   81         INSURANCE FRAUD NOTICE.—Submitting a false,
   82         misleading, or fraudulent application or other
   83         document when applying for licensure as a health care
   84         clinic, when seeking an exemption from licensure as a
   85         health care clinic, or when demonstrating compliance
   86         with part X of chapter 400, Florida Statutes, is a
   87         fraudulent insurance act, as defined in s. 626.989 or
   88         s. 817.234, Florida Statutes, subject to investigation
   89         by the Division of Insurance Fraud, and is grounds for
   90         discipline by the appropriate licensing board of the
   91         Florida Department of Health.
   92         Section 3. Section 626.9894, Florida Statutes, is created
   93  to read:
   94         626.9894Motor vehicle insurance fraud direct-support
   95  organization.—
   96         (1) DEFINITIONS.—As used in this section, the term:
   97         (a) “Division” means the Division of Insurance Fraud of the
   98  Department of Financial Services.
   99         (b) “Motor vehicle insurance fraud” means any act defined
  100  as a “fraudulent insurance act” under s. 626.989, which relates
  101  to the coverage of motor vehicle insurance as described in part
  102  XI of chapter 627.
  103         (c) “Organization” means the direct-support organization
  104  established under this section.
  105         (2) ORGANIZATION ESTABLISHED.—The division may establish a
  106  direct-support organization, to be known as the “Automobile
  107  Insurance Fraud Strike Force,” whose sole purpose is to support
  108  the prosecution, investigation, and prevention of motor vehicle
  109  insurance fraud. The organization shall:
  110         (a) Be a not-for-profit corporation incorporated under
  111  chapter 617 and approved by the Department of State.
  112         (b) Be organized and operated to conduct programs and
  113  activities; to raise funds; to request and receive grants,
  114  gifts, and bequests of money; to acquire, receive, hold, invest,
  115  and administer, in its own name, securities, funds, objects of
  116  value, or other property, real or personal; and to make grants
  117  and expenditures to or for the direct or indirect benefit of the
  118  division, state attorneys’ offices, the statewide prosecutor,
  119  the Agency for Health Care Administration, and the Department of
  120  Health to the extent that such grants and expenditures are to be
  121  used exclusively to advance the purpose of prosecuting,
  122  investigating, or preventing motor vehicle insurance fraud.
  123  Grants and expenditures may include the cost of salaries or
  124  benefits of dedicated motor vehicle insurance fraud
  125  investigators, prosecutors, or support personnel if such grants
  126  and expenditures do not interfere with prosecutorial
  127  independence or otherwise create conflicts of interest which
  128  threaten the success of prosecutions.
  129         (c) Be determined by the division to operate in a manner
  130  that promotes the goals of laws relating to motor vehicle
  131  insurance fraud, that is in the best interest of the state, and
  132  that is in accordance with the adopted goals and mission of the
  133  division.
  134         (d) Use all of its grants and expenditures solely for the
  135  purpose of preventing and decreasing motor vehicle insurance
  136  fraud, and not for the purpose of lobbying as defined in s.
  137  11.045.
  138         (e) Be subject to an annual financial audit in accordance
  139  with s. 215.981.
  140         (3) CONTRACT.—The organization shall operate under written
  141  contract with the division. The contract must provide for:
  142         (a) Approval of the articles of incorporation and bylaws of
  143  the organization by the division.
  144         (b) Submission of an annual budget for the approval of the
  145  division. The budget must require the organization to minimize
  146  costs to the division and its members at all times by using
  147  existing personnel and property and allowing for telephonic
  148  meetings when appropriate.
  149         (c) Certification by the division that the direct-support
  150  organization is complying with the terms of the contract and in
  151  a manner consistent with the goals and purposes of the
  152  department and in the best interest of the state. Such
  153  certification must be made annually and reported in the official
  154  minutes of a meeting of the organization.
  155         (d) Allocation of funds to address motor vehicle insurance
  156  fraud.
  157         (e) Reversion of moneys and property held in trust by the
  158  organization for motor vehicle insurance fraud prosecution,
  159  investigation, and prevention to the division if the
  160  organization is no longer approved to operate for the department
  161  or if the organization ceases to exist, or to the state if the
  162  division ceases to exist.
  163         (f) Specific criteria to be used by the organization’s
  164  board of directors to evaluate the effectiveness of funding used
  165  to combat motor vehicle insurance fraud.
  166         (g) The fiscal year of the organization, which begins July
  167  1 of each year and ends June 30 of the following year.
  168         (h) Disclosure of the material provisions of the contract,
  169  and distinguishing between the department and the organization
  170  to donors of gifts, contributions, or bequests, including
  171  providing such disclosure on all promotional and fundraising
  172  publications.
  173         (4) BOARD OF DIRECTORS.—The board of directors of the
  174  organization shall consist of the following seven members:
  175         (a) The Chief Financial Officer, or designee, who shall
  176  serve as chair.
  177         (b) Two state attorneys appointed by the Attorney General.
  178         (c) Two representatives of motor vehicle insurers appointed
  179  by the Chief Financial Officer.
  180         (d) Two representatives of local law enforcement agencies,
  181  one of whom shall be appointed by the Chief Financial Officer,
  182  and one of whom shall be appointed by the Attorney General.
  184  The officer who appointed a member of the board may remove that
  185  member for cause. The term of office of an appointed member
  186  expires at the same time as the term of the officer who
  187  appointed him or her or at such earlier time as the person
  188  ceases to be qualified.
  189         (5) USE OF PROPERTY.—The department may authorize, without
  190  charge, appropriate use of fixed property and facilities of the
  191  division by the organization, subject to this subsection.
  192         (a) The department may prescribe any condition with which
  193  the organization must comply in order to use the division’s
  194  property or facilities.
  195         (b) The department may not authorize the use of the
  196  division’s property or facilities if the organization does not
  197  provide equal membership and employment opportunities to all
  198  persons regardless of race, religion, sex, age, or national
  199  origin.
  200         (c) The department shall adopt rules prescribing the
  201  procedures by which the organization is governed and any
  202  conditions with which the organization must comply to use the
  203  division’s property or facilities.
  204         (6) CONTRIBUTIONS.—Any contributions made by an insurer to
  205  the organization shall be allowed as appropriate business
  206  expenses for all regulatory purposes.
  207         (7) DEPOSITORY.—Any moneys received by the organization may
  208  be held in a separate depository account in the name of the
  209  organization and subject to the provisions of the contract with
  210  the division.
  211         (8) DIVISION’S RECEIPT OF PROCEEDS.—If the division
  212  receives proceeds from the organization, those proceeds shall be
  213  deposited into the Insurance Regulatory Trust Fund.
  214         Section 4. Subsection (3) is added to section 627.4137,
  215  Florida Statutes, to read:
  216         627.4137 Disclosure of certain information required.—
  217         (3)Any request made to a self-insured corporation pursuant
  218  to this section shall be sent by certified mail to the
  219  registered agent of the disclosing entity.
  220         Section 5. Section 627.730, Florida Statutes, is amended to
  221  read:
  222         627.730 Florida Motor Vehicle No-Fault Law.—Sections
  223  627.730-627.7407 627.730-627.7405 may be cited and known as the
  224  “Florida Motor Vehicle No-Fault Law.”
  225         Section 6. Section 627.731, Florida Statutes, is amended to
  226  read:
  227         627.731 Purpose; legislative intent.—The purpose of the no
  228  fault law ss. 627.730-627.7405 is to provide for medical,
  229  surgical, funeral, and disability insurance benefits without
  230  regard to fault, and to require motor vehicle insurance securing
  231  such benefits, for motor vehicles required to be registered in
  232  this state and, with respect to motor vehicle accidents, a
  233  limitation on the right to claim damages for pain, suffering,
  234  mental anguish, and inconvenience.
  235         (1) The Legislature finds that automobile insurance fraud
  236  remains a major problem for state consumers and insurers.
  237  According to the National Insurance Crime Bureau, in recent
  238  years this state has been among those states that have the
  239  highest number of fraudulent and questionable claims.
  240         (2) The Legislature intends to balance the insured’s
  241  interest in prompt payment of valid claims for insurance
  242  benefits under the no-fault law with the public’s interest in
  243  reducing fraud, abuse, and overuse of the no-fault system. To
  244  that end, the Legislature intends that the investigation and
  245  prevention of fraudulent insurance acts in this state be
  246  enhanced, that additional sanctions for such acts be imposed,
  247  and that the no-fault law be revised to remove incentives for
  248  fraudulent insurance acts. The Legislature intends that the no
  249  fault law be construed according to the plain language of the
  250  statutory provisions, which are designed to meet these goals.
  251         (3) The Legislature intends that:
  252         (a) Insurers properly investigate claims, and as such, be
  253  allowed to obtain examinations under oath and sworn statements
  254  from any claimant seeking no-fault insurance benefits, and to
  255  request mental and physical examinations of persons seeking
  256  personal injury protection coverage or benefits.
  257         (b) Any false, misleading, or otherwise fraudulent activity
  258  associated with a claim render the entire claim invalid. An
  259  insurer must be able to raise fraud as a defense to a claim for
  260  no-fault insurance benefits irrespective of any prior
  261  adjudication of guilt or determination of fraud by the
  262  Department of Financial Services.
  263         (c) Insurers toll the payment or denial of a claim, with
  264  respect to any portion of a claim for which the insurer has a
  265  reasonable belief that a fraudulent insurance act, as defined in
  266  s. 626.989, has been committed.
  267         (d) Insurers discover the names of all passengers involved
  268  in an automobile accident before paying claims or benefits
  269  pursuant to an insurance policy governed by the no-fault law. A
  270  rebuttable presumption must be established that a person was not
  271  involved in the event giving rise to the claim if that person’s
  272  name does not appear on the police report.
  273         (e) The insured’s interest in obtaining competent counsel
  274  must be balanced with the public’s interest in preventing a no
  275  fault system that encourages litigation by allowing for
  276  exorbitant attorney’s fees. Courts should limit attorney fee
  277  awards so as to eliminate the incentive for attorneys to
  278  manufacture unnecessary litigation.
  279         Section 7. Section 627.7311, Florida Statutes, is created
  280  to read:
  281         627.7311 Implementation of no-fault law.—The provisions,
  282  schedules, and procedures authorized under the no-fault law
  283  shall be implemented by insurers and have full force and effect
  284  regardless of their express inclusion in an insurance policy,
  285  and an insurer is not required to amend its policy to implement
  286  such provisions, schedules, or procedures.
  287         Section 8. Section 627.732, Florida Statutes, is reordered
  288  and amended to read:
  289         627.732 Definitions.—As used in the no-fault law ss.
  290  627.730-627.7405, the term:
  291         (1) “Broker” means any person not possessing a license
  292  under chapter 395, chapter 400, chapter 429, chapter 458,
  293  chapter 459, chapter 460, chapter 461, or chapter 641 who
  294  charges or receives compensation for any use of medical
  295  equipment and is not the 100-percent owner or the 100-percent
  296  lessee of such equipment. For purposes of this section, such
  297  owner or lessee may be an individual, a corporation, a
  298  partnership, or any other entity and any of its 100-percent
  299  owned affiliates and subsidiaries. For purposes of this
  300  subsection, the term “lessee” means a long-term lessee under a
  301  capital or operating lease, but does not include a part-time
  302  lessee. The term “broker” does not include a hospital or
  303  physician management company whose medical equipment is
  304  ancillary to the practices managed, a debt collection agency, or
  305  an entity that has contracted with the insurer to obtain a
  306  discounted rate for such services; or nor does the term include
  307  a management company that has contracted to provide general
  308  management services for a licensed physician or health care
  309  facility and whose compensation is not materially affected by
  310  the usage or frequency of usage of medical equipment or an
  311  entity that is 100-percent owned by one or more hospitals or
  312  physicians. The term “broker” does not include a person or
  313  entity that certifies, upon request of an insurer, that:
  314         (a) It is a clinic licensed under ss. 400.990-400.995;
  315         (b) It is a 100-percent owner of medical equipment; and
  316         (c) The owner’s only part-time lease of medical equipment
  317  for personal injury protection patients is on a temporary basis,
  318  not to exceed 30 days in a 12-month period, and such lease is
  319  solely for the purposes of necessary repair or maintenance of
  320  the 100-percent-owned medical equipment or pending the arrival
  321  and installation of the newly purchased or a replacement for the
  322  100-percent-owned medical equipment, or for patients for whom,
  323  because of physical size or claustrophobia, it is determined by
  324  the medical director or clinical director to be medically
  325  necessary that the test be performed in medical equipment that
  326  is open-style. The leased medical equipment may not cannot be
  327  used by patients who are not patients of the registered clinic
  328  for medical treatment of services. Any person or entity making a
  329  false certification under this subsection commits insurance
  330  fraud as defined in s. 817.234. However, the 30-day period
  331  provided in this paragraph may be extended for an additional 60
  332  days as applicable to magnetic resonance imaging equipment if
  333  the owner certifies that the extension otherwise complies with
  334  this paragraph.
  335         (9)(2) “Medically necessary” refers to a medical service or
  336  supply that a prudent physician would provide for the purpose of
  337  preventing, diagnosing, or treating an illness, injury, disease,
  338  or symptom in a manner that is:
  339         (a) In accordance with generally accepted standards of
  340  medical practice;
  341         (b) Clinically appropriate in terms of type, frequency,
  342  extent, site, and duration; and
  343         (c) Not primarily for the convenience of the patient,
  344  physician, or other health care provider.
  345         (10)(3) “Motor vehicle” means a any self-propelled vehicle
  346  with four or more wheels which is of a type both designed and
  347  required to be licensed for use on the highways of this state,
  348  and any trailer or semitrailer designed for use with such
  349  vehicle, and includes:
  350         (a) A “private passenger motor vehicle,” which is any motor
  351  vehicle that which is a sedan, station wagon, or jeep-type
  352  vehicle and, if not used primarily for occupational,
  353  professional, or business purposes, a motor vehicle of the
  354  pickup, panel, van, camper, or motor home type.
  355         (b) A “commercial motor vehicle,” which is any motor
  356  vehicle that which is not a private passenger motor vehicle.
  358  The term “motor vehicle” does not include a mobile home or any
  359  motor vehicle that which is used in mass transit, other than
  360  public school transportation, and designed to transport more
  361  than five passengers exclusive of the operator of the motor
  362  vehicle and that which is owned by a municipality, a transit
  363  authority, or a political subdivision of the state.
  364         (11)(4) “Named insured” means a person, usually the owner
  365  of a vehicle, identified in a policy by name as the insured
  366  under the policy.
  367         (12) “No-fault law” means the Florida Motor Vehicle No
  368  Fault Law codifed at ss. 627.730-627.7407.
  369         (13)(5) “Owner” means a person who holds the legal title to
  370  a motor vehicle; or, if in the event a motor vehicle is the
  371  subject of a security agreement or lease with an option to
  372  purchase with the debtor or lessee having the right to
  373  possession, then the debtor or lessee is shall be deemed the
  374  owner for the purposes of the no-fault law ss. 627.730-627.7405.
  375         (15)(6) “Relative residing in the same household” means a
  376  relative of any degree by blood or by marriage who usually makes
  377  her or his home in the same family unit, whether or not
  378  temporarily living elsewhere.
  379         (2)(7) “Certify” means to swear or attest to being true or
  380  represented in writing.
  381         (3) “Claimant” means the person, organization, or entity
  382  seeking benefits, including all assignees.
  383         (5)(8) “Immediate personal supervision,” as it relates to
  384  the performance of medical services by nonphysicians not in a
  385  hospital, means that an individual licensed to perform the
  386  medical service or provide the medical supplies must be present
  387  within the confines of the physical structure where the medical
  388  services are performed or where the medical supplies are
  389  provided such that the licensed individual can respond
  390  immediately to any emergencies if needed.
  391         (6)(9) “Incident,” with respect to services considered as
  392  incident to a physician’s professional service, for a physician
  393  licensed under chapter 458, chapter 459, chapter 460, or chapter
  394  461, if not furnished in a hospital, means such services that
  395  are must be an integral, even if incidental, part of a covered
  396  physician’s service.
  397         (7)(10) “Knowingly” means that a person, with respect to
  398  information, has actual knowledge of the information,; acts in
  399  deliberate ignorance of the truth or falsity of the
  400  information,; or acts in reckless disregard of the information.,
  401  and Proof of specific intent to defraud is not required.
  402         (8)(11) “Lawful” or “lawfully” means in substantial
  403  compliance with all relevant applicable criminal, civil, and
  404  administrative requirements of state and federal law related to
  405  the provision of medical services or treatment.
  406         (4)(12) “Hospital” means a facility that, at the time
  407  services or treatment were rendered, was licensed under chapter
  408  395.
  409         (14)(13) “Properly completed” means providing truthful,
  410  substantially complete, and substantially accurate responses as
  411  to all material elements of to each applicable request for
  412  information or statement by a means that may lawfully be
  413  provided and that complies with this section, or as agreed by
  414  the parties.
  415         (17)(14) “Upcoding” means submitting an action that submits
  416  a billing code that would result in payment greater in amount
  417  than would be paid using a billing code that accurately
  418  describes the services performed. The term does not include an
  419  otherwise lawful bill by a magnetic resonance imaging facility,
  420  which globally combines both technical and professional
  421  components, if the amount of the global bill is not more than
  422  the components if billed separately; however, payment of such a
  423  bill constitutes payment in full for all components of such
  424  service.
  425         (16)(15) “Unbundling” means submitting an action that
  426  submits a billing code that is properly billed under one billing
  427  code, but that has been separated into two or more billing
  428  codes, and would result in payment greater than the in amount
  429  that than would be paid using one billing code.
  430         Section 9. Subsections (1) and (4) of section 627.736,
  431  Florida Statutes, are amended, subsections (5) through (16) of
  432  that section are redesignated as subsections (6) through (17),
  433  respectively, a new subsection (5) is added to that section,
  434  present subsection (5), paragraph (b) of present subsection (6),
  435  paragraph (b) of present subsection (7), and present subsections
  436  (8), (9), and (10) of that section are amended, to read:
  437         627.736 Required personal injury protection benefits;
  438  exclusions; priority; claims.—
  439         (1) REQUIRED BENEFITS.—Every insurance policy complying
  440  with the security requirements of s. 627.733 must shall provide
  441  personal injury protection to the named insured, relatives
  442  residing in the same household, persons operating the insured
  443  motor vehicle, passengers in such motor vehicle, and other
  444  persons struck by such motor vehicle and suffering bodily injury
  445  while not an occupant of a self-propelled vehicle, subject to
  446  the provisions of subsection (2) and paragraph (4)(h) (4)(e), to
  447  a limit of $10,000 for loss sustained by any such person as a
  448  result of bodily injury, sickness, disease, or death arising out
  449  of the ownership, maintenance, or use of a motor vehicle as
  450  follows:
  451         (a) Medical benefits.—Eighty percent of all reasonable
  452  expenses, charged pursuant to subsection (6), for medically
  453  necessary medical, surgical, X-ray, dental, and rehabilitative
  454  services, including prosthetic devices, and for medically
  455  necessary ambulance, hospital, and nursing services. However,
  456  the medical benefits shall provide reimbursement only for such
  457  services and care that are lawfully provided, supervised,
  458  ordered, or prescribed by a physician licensed under chapter 458
  459  or chapter 459, a dentist licensed under chapter 466, or a
  460  chiropractic physician licensed under chapter 460 or that are
  461  provided by any of the following persons or entities:
  462         1. A hospital or ambulatory surgical center licensed under
  463  chapter 395.
  464         2. A person or entity licensed under part III of chapter
  465  401 which ss. 401.2101-401.45 that provides emergency
  466  transportation and treatment.
  467         3. An entity wholly owned by one or more physicians
  468  licensed under chapter 458 or chapter 459, chiropractic
  469  physicians licensed under chapter 460, or dentists licensed
  470  under chapter 466 or by such practitioner or practitioners and
  471  the spouse, parent, child, or sibling of such that practitioner
  472  or those practitioners.
  473         4. An entity wholly owned, directly or indirectly, by a
  474  hospital or hospitals.
  475         5. A health care clinic licensed under part X of chapter
  476  400 which ss. 400.990-400.995 that is:
  477         a. Accredited by the Joint Commission on Accreditation of
  478  Healthcare Organizations, the American Osteopathic Association,
  479  the Commission on Accreditation of Rehabilitation Facilities, or
  480  the Accreditation Association for Ambulatory Health Care, Inc.;
  481  or
  482         b. A health care clinic that:
  483         (I) Has a medical director licensed under chapter 458,
  484  chapter 459, or chapter 460;
  485         (II) Has been continuously licensed for more than 3 years
  486  or is a publicly traded corporation that issues securities
  487  traded on an exchange registered with the United States
  488  Securities and Exchange Commission as a national securities
  489  exchange; and
  490         (III) Provides at least four of the following medical
  491  specialties:
  492         (A) General medicine.
  493         (B) Radiography.
  494         (C) Orthopedic medicine.
  495         (D) Physical medicine.
  496         (E) Physical therapy.
  497         (F) Physical rehabilitation.
  498         (G) Prescribing or dispensing outpatient prescription
  499  medication.
  500         (H) Laboratory services.
  501         6. An acupuncturist licensed under chapter 457.
  503  If any services under this paragraph are provided by an entity
  504  or clinic described in subparagraph 3., subparagraph 4., or
  505  subparagraph 5., the entity or clinic must provide the insurer
  506  at the initial submission of the claim with a form adopted by
  507  the Department of Financial Services which documents that the
  508  entity or clinic meets applicable criteria for such entity or
  509  clinic and includes a sworn statement or affidavit to that
  510  effect. Any change in ownership requires the filing of a new
  511  form within 10 days after the date of the change in ownership.
  512  The Financial Services Commission shall adopt by rule the form
  513  that must be used by an insurer and a health care provider
  514  specified in subparagraph 3., subparagraph 4., or subparagraph
  515  5. to document that the health care provider meets the criteria
  516  of this paragraph, which rule must include a requirement for a
  517  sworn statement or affidavit.
  518         (b) Disability benefits.—Sixty percent of any loss of gross
  519  income and loss of earning capacity per individual from
  520  inability to work proximately caused by the injury sustained by
  521  the injured person, plus all expenses reasonably incurred in
  522  obtaining from others ordinary and necessary services in lieu of
  523  those that, but for the injury, the injured person would have
  524  performed without income for the benefit of his or her
  525  household. All disability benefits payable under this provision
  526  must shall be paid at least not less than every 2 weeks.
  527         (c) Death benefits.—Death benefits equal to the lesser of
  528  $5,000 or the remainder of unused personal injury protection
  529  benefits per individual. The insurer may pay such benefits to
  530  the executor or administrator of the deceased, to any of the
  531  deceased’s relatives by blood, or legal adoption, or connection
  532  by marriage, or to any person appearing to the insurer to be
  533  equitably entitled thereto.
  535  Only insurers writing motor vehicle liability insurance in this
  536  state may provide the required benefits of this section, and no
  537  such insurers may not insurer shall require the purchase of any
  538  other motor vehicle coverage other than the purchase of property
  539  damage liability coverage as required by s. 627.7275 as a
  540  condition for providing such required benefits. Insurers may not
  541  require that property damage liability insurance in an amount
  542  greater than $10,000 be purchased in conjunction with personal
  543  injury protection. Such insurers shall make benefits and
  544  required property damage liability insurance coverage available
  545  through normal marketing channels. An Any insurer writing motor
  546  vehicle liability insurance in this state who fails to comply
  547  with such availability requirement as a general business
  548  practice violates shall be deemed to have violated part IX of
  549  chapter 626, and such violation constitutes shall constitute an
  550  unfair method of competition or an unfair or deceptive act or
  551  practice involving the business of insurance. An; and any such
  552  insurer committing such violation is shall be subject to the
  553  penalties afforded in such part, as well as those that are which
  554  may be afforded elsewhere in the insurance code.
  555         (4) BENEFITS; WHEN DUE.—Benefits due from an insurer under
  556  the no-fault law are ss. 627.730-627.7405 shall be primary,
  557  except that benefits received under any workers’ compensation
  558  law shall be credited against the benefits provided by
  559  subsection (1) and are shall be due and payable as loss accrues,
  560  upon the receipt of reasonable proof of such loss and the amount
  561  of expenses and loss incurred which are covered by the policy
  562  issued under the no-fault law ss. 627.730-627.7405. If When the
  563  Agency for Health Care Administration provides, pays, or becomes
  564  liable for medical assistance under the Medicaid program related
  565  to injury, sickness, disease, or death arising out of the
  566  ownership, maintenance, or use of a motor vehicle, the benefits
  567  are under ss. 627.730-627.7405 shall be subject to the
  568  provisions of the Medicaid program.
  569         (a) An insurer may require written notice to be given as
  570  soon as practicable after an accident involving a motor vehicle
  571  with respect to which the policy affords the security required
  572  by the no-fault law ss. 627.730-627.7405.
  573         (b) Personal injury protection insurance benefits paid
  574  pursuant to this section are shall be overdue if not paid within
  575  30 days after the insurer is furnished written notice of the
  576  fact of a covered loss and of the amount of same. If such
  577  written notice is not furnished to the insurer as to the entire
  578  claim, any partial amount supported by written notice is overdue
  579  if not paid within 30 days after such written notice is
  580  furnished to the insurer. Any part or all of the remainder of
  581  the claim that is subsequently supported by written notice is
  582  overdue if not paid within 30 days after such written notice is
  583  furnished to the insurer.
  584         (c) If When an insurer pays only a portion of a claim or
  585  rejects a claim, the insurer shall provide at the time of the
  586  partial payment or rejection an itemized specification of each
  587  item that the insurer had reduced, omitted, or declined to pay
  588  and any information that the insurer desires the claimant to
  589  consider related to the medical necessity of the denied
  590  treatment or to explain the reasonableness of the reduced
  591  charge, provided that this does shall not limit the introduction
  592  of evidence at trial.; and The insurer must shall include the
  593  name and address of the person to whom the claimant should
  594  respond and a claim number to be referenced in future
  595  correspondence. An insurer’s failure to send an itemized
  596  specification or explanation of benefits does not waive other
  597  grounds for rejecting an invalid claim.
  598         (d)A However, notwithstanding the fact that written notice
  599  has been furnished to the insurer, Any payment is shall not be
  600  deemed overdue if when the insurer has reasonable proof to
  601  establish that the insurer is not responsible for the payment.
  602  An insurer may obtain evidence and assert any ground for
  603  adjustment or rejection of a For the purpose of calculating the
  604  extent to which any benefits are overdue, payment shall be
  605  treated as being made on the date a draft or other valid
  606  instrument which is equivalent to payment was placed in the
  607  United States mail in a properly addressed, postpaid envelope
  608  or, if not so posted, on the date of delivery. This paragraph
  609  does not preclude or limit the ability of the insurer to assert
  610  that the claim that is was unrelated, was not medically
  611  necessary, or was unreasonable, or submitted that the amount of
  612  the charge was in excess of that permitted under, or in
  613  violation of, subsection (6) (5). Such assertion by the insurer
  614  may be made at any time, including after payment of the claim,
  615  or after the 30-day time period for payment set forth in this
  616  paragraph (b), or after the filing of a lawsuit.
  617         (e) The 30-day period for payment is tolled while the
  618  insurer investigates a fraudulent insurance act, as defined in
  619  s. 626.989, with respect to any portion of a claim for which the
  620  insurer has a reasonable belief that a fraudulent insurance act
  621  has been committed. The insurer must notify the claimant in
  622  writing that it is investigating a fraudulent insurance act
  623  within 30 days after the date it has a reasonable belief that
  624  such act has been committed. The insurer must pay or deny the
  625  claim, in full or in part, within 90 days after the date the
  626  written notice of the fact of a covered loss and of the amount
  627  of the loss was provided to the insurer. However, no payment is
  628  due to a claimant that has violated paragraph (k).
  629         (f)(c)Notwithstanding any local lien law, upon receiving
  630  notice of an accident that is potentially covered by personal
  631  injury protection benefits, the insurer must reserve $5,000 of
  632  personal injury protection benefits for payment to physicians
  633  licensed under chapter 458 or chapter 459 or dentists licensed
  634  under chapter 466 who provide emergency services and care, as
  635  defined in s. 395.002(9), or who provide hospital inpatient
  636  care. The amount required to be held in reserve may be used only
  637  to pay claims from such physicians or dentists until 30 days
  638  after the date the insurer receives notice of the accident.
  639  After the 30-day period, any amount of the reserve for which the
  640  insurer has not received notice of such a claim from a physician
  641  or dentist who provided emergency services and care or who
  642  provided hospital inpatient care may then be used by the insurer
  643  to pay other claims. The time periods specified in paragraph (b)
  644  for required payment of personal injury protection benefits are
  645  shall be tolled for the period of time that an insurer is
  646  required by this paragraph to hold payment of a claim that is
  647  not from a physician or dentist who provided emergency services
  648  and care or who provided hospital inpatient care to the extent
  649  that the personal injury protection benefits not held in reserve
  650  are insufficient to pay the claim. This paragraph does not
  651  require an insurer to establish a claim reserve for insurance
  652  accounting purposes.
  653         (g)(d) All overdue payments shall bear simple interest at
  654  the rate established under s. 55.03 or the rate established in
  655  the insurance contract, whichever is greater, for the year in
  656  which the payment became overdue, calculated from the date the
  657  insurer was furnished with written notice of the amount of
  658  covered loss. However, interest on a payment that is overdue
  659  pursuant to paragraph (e) shall be calculated from the date the
  660  insurer denies payment. Interest is shall be due at the time
  661  payment of the overdue claim is made.
  662         (h)(e) The insurer of the owner of a motor vehicle shall
  663  pay personal injury protection benefits for:
  664         1. Accidental bodily injury sustained in this state by the
  665  owner while occupying a motor vehicle, or while not an occupant
  666  of a self-propelled vehicle if the injury is caused by physical
  667  contact with a motor vehicle.
  668         2. Accidental bodily injury sustained outside this state,
  669  but within the United States of America or its territories or
  670  possessions or Canada, by the owner while occupying the owner’s
  671  motor vehicle.
  672         3. Accidental bodily injury sustained by a relative of the
  673  owner residing in the same household, under the circumstances
  674  described in subparagraph 1. or subparagraph 2. if, provided the
  675  relative at the time of the accident is domiciled in the owner’s
  676  household and is not himself or herself the owner of a motor
  677  vehicle with respect to which security is required under the no
  678  fault law ss. 627.730-627.7405.
  679         4. Accidental bodily injury sustained in this state by any
  680  other person while occupying the owner’s motor vehicle or, if a
  681  resident of this state, while not an occupant of a self
  682  propelled vehicle, if the injury is caused by physical contact
  683  with such motor vehicle if, provided the injured person is not
  684  himself or herself:
  685         a. The owner of a motor vehicle with respect to which
  686  security is required under the no-fault law ss. 627.730
  687  627.7405; or
  688         b. Entitled to personal injury benefits from the insurer of
  689  the owner or owners of such a motor vehicle.
  690         (i)(f) If two or more insurers are liable to pay personal
  691  injury protection benefits for the same injury to any one
  692  person, the maximum payable is shall be as specified in
  693  subsection (1), and any insurer paying the benefits is shall be
  694  entitled to recover from each of the other insurers an equitable
  695  pro rata share of the benefits paid and expenses incurred in
  696  processing the claim.
  697         (j)(g) It is a violation of the insurance code for an
  698  insurer to fail to timely provide benefits as required by this
  699  section with such frequency as to constitute a general business
  700  practice.
  701         (k)(h) Benefits are shall not be due or payable to a
  702  claimant who knowingly: or on the behalf of an insured person if
  703  that person has
  704         1. Submits a false or misleading statement, document,
  705  record, or bill;
  706         2. Submits false or misleading information; or
  707         3. Has otherwise committed or attempted to commit a
  708  fraudulent insurance act as defined in s. 626.989.
  710  A claimant that violates this paragraph is not entitled to any
  711  personal injury protection benefits or payment for any bills and
  712  services, regardless of whether a portion of the claim may be
  713  legitimate. However, a claimant that does not violate this
  714  paragraph may not be denied benefits solely due to a violation
  715  by another claimant.
  716         (l) Notwithstanding any remedies afforded by law, the
  717  insurer may recover from a claimant who violates paragraph (k)
  718  any sums previously paid to a claimant and may bring any
  719  available common law and statutory causes of action. A claimant
  720  has violated paragraph (k) committed, by a material act or
  721  omission, any insurance fraud relating to personal injury
  722  protection coverage under his or her policy, if the fraud is
  723  admitted to in a sworn statement by the insured or if it is
  724  established in a court of competent jurisdiction. Any insurance
  725  fraud voids shall void all coverage arising from the claim
  726  related to such fraud under the personal injury protection
  727  coverage of the claimant insured person who committed the fraud,
  728  irrespective of whether a portion of the insured person’s claim
  729  may be legitimate, and any benefits paid before prior to the
  730  discovery of the insured person’s insurance fraud is shall be
  731  recoverable by the insurer from the claimant person who
  732  committed insurance fraud in their entirety. The prevailing
  733  party is entitled to its costs and attorney’s fees in any action
  734  in which it prevails in an insurer’s action to enforce its right
  735  of recovery under this paragraph. This paragraph does not
  736  preclude or limit an insurer’s right to deny a claim based on
  737  other evidence of fraud or affect an insurer’s right to plead
  738  and prove a claim or defense of fraud under common law. If a
  739  physician, hospital, clinic, or other medical institution
  740  violates paragraph (k), the injured party is not liable for, and
  741  the physician, hospital, clinic, or other medical institution
  742  may not bill the insured for, charges that are unpaid because of
  743  failure to comply with paragraph (k). Any agreement requiring
  744  the injured person or insured to pay for such charges is
  745  unenforceable.
  746         (5) INSURER INVESTIGATIONS.—An insurer has the right and
  747  duty to conduct a reasonable investigation of a claim. In the
  748  course of the insurer’s investigation of a claim:
  749         (a) Any records review need not be based on a physical
  750  examination and may be obtained at any time, including after
  751  reduction or denial of the claim.
  752         1. The records review must be conducted by a practitioner
  753  within the same licensing chapter as the medical provider whose
  754  records are being reviewed unless the records review is
  755  performed by a physician licensed under chapter 458 or chapter
  756  459.
  757         2. The 30-day period for payment under paragraph (4)(b) is
  758  tolled from the date the insurer sends its request for treatment
  759  records to the date that the insurer receives the treatment
  760  records.
  761         3. The insured, claimant, or medical provider may impose a
  762  reasonable, cost-based fee that includes only the cost of
  763  copying and postage and not the cost of labor for copying.
  764         (b) In all circumstances, an insured seeking benefits under
  765  the no-fault law must comply with the terms of the policy, which
  766  includes, but is not limited to, submitting to examinations
  767  under oath. Compliance with this paragraph is a condition
  768  precedent to receiving benefits.
  769         (c) An insurer may deny benefits if the insured, claimant,
  770  or medical provider fails to:
  771         1. Cooperate in the insurer’s investigation;
  772         2. Commits a fraud or material misrepresentation; or
  773         3. Comply with this subsection.
  774         (d) The claimant may not file suit unless and until it
  775  complies with this subsection.
  777         (a)1. Any physician, hospital, clinic, or other person or
  778  institution lawfully rendering treatment to an injured person
  779  for a bodily injury covered by personal injury protection
  780  insurance may charge the insurer and injured party only a
  781  reasonable amount pursuant to this section for the services and
  782  supplies rendered, and the insurer providing such coverage may
  783  pay for such charges directly to such person or institution
  784  lawfully rendering such treatment, if the insured receiving such
  785  treatment or his or her guardian has countersigned the properly
  786  completed invoice, bill, or claim form approved by the office
  787  upon which such charges are to be paid for as having actually
  788  been rendered, to the best knowledge of the insured or his or
  789  her guardian. In no event, However, may such charges may not
  790  exceed the reimbursement schedule under this paragraph a charge
  791  be in excess of the amount the person or institution customarily
  792  charges for like services or supplies. With respect to a
  793  determination of whether a charge for a particular service,
  794  treatment, or otherwise is reasonable, consideration may be
  795  given to evidence of usual and customary charges and payments
  796  accepted by the provider involved in the dispute, and
  797  reimbursement levels in the community and various federal and
  798  state medical fee schedules applicable to automobile and other
  799  insurance coverages, and other information relevant to the
  800  reasonableness of the reimbursement for the service, treatment,
  801  or supply.
  802         1.2. The insurer shall may limit reimbursement to no more
  803  than 80 percent of the following schedule of maximum charges:
  804         a. For emergency transport and treatment by providers
  805  licensed under chapter 401, 200 percent of Medicare.
  806         b. For emergency services and care provided by a hospital
  807  licensed under chapter 395, 75 percent of the hospital’s usual
  808  and customary charges.
  809         c. For emergency services and care as defined by s.
  810  395.002(9) provided in a facility licensed under chapter 395
  811  rendered by a physician or dentist, and related hospital
  812  inpatient services rendered by a physician or dentist, the usual
  813  and customary charges in the community.
  814         d. For hospital inpatient services, other than emergency
  815  services and care, 200 percent of the Medicare Part A
  816  prospective payment applicable to the specific hospital
  817  providing the inpatient services.
  818         e. For hospital outpatient services, other than emergency
  819  services and care, 200 percent of the Medicare Part A Ambulatory
  820  Payment Classification for the specific hospital providing the
  821  outpatient services.
  822         f. For all other medical services, supplies, and care, 200
  823  percent of the allowable amount under the participating
  824  physicians schedule of Medicare Part B. For all other supplies
  825  and care, including durable medical equipment and care and
  826  services rendered by ambulatory surgical centers and clinical
  827  laboratories, 200 percent of the allowable amount under Medicare
  828  Part B. However, if such services, supplies, or care is not
  829  reimbursable under Medicare Part B, the insurer may limit
  830  reimbursement to 80 percent of the maximum reimbursable
  831  allowance under workers’ compensation, as determined under s.
  832  440.13 and rules adopted thereunder which are in effect at the
  833  time such services, supplies, or care is provided. Services,
  834  supplies, or care that is not reimbursable under Medicare or
  835  workers’ compensation is not required to be reimbursed by the
  836  insurer.
  837         2.3. For purposes of subparagraph 1. 2., the applicable fee
  838  schedule or payment limitation under Medicare is the fee
  839  schedule or payment limitation in effect on January 1 of the
  840  year in which at the time the services, supplies, or care was
  841  rendered and for the area in which such services were rendered,
  842  which shall apply throughout the remainder of the year
  843  notwithstanding any subsequent changes made to the fee schedule
  844  or payment limitation, except that it may not be less than the
  845  allowable amount under the participating physicians schedule of
  846  Medicare Part B for 2007 for medical services, supplies, and
  847  care subject to Medicare Part B.
  848         3.4. Subparagraph 1. 2. does not allow the insurer to apply
  849  any limitation on the number of treatments or other utilization
  850  limits that apply under Medicare or workers’ compensation. An
  851  insurer that applies the allowable payment limitations of
  852  subparagraph 1. 2. must reimburse a provider who lawfully
  853  provided care or treatment under the scope of his or her
  854  license, regardless of whether such provider is would be
  855  entitled to reimbursement under Medicare due to restrictions or
  856  limitations on the types or discipline of health care providers
  857  who may be reimbursed for particular procedures or procedure
  858  codes.
  859         4.5. If an insurer limits payment as authorized by
  860  subparagraph 1. 2., the person providing such services,
  861  supplies, or care may not bill or attempt to collect from the
  862  insured any amount in excess of such limits, except for amounts
  863  that are not covered by the insured’s personal injury protection
  864  coverage due to the coinsurance amount or maximum policy limits.
  865         (b)1. An insurer or insured is not required to pay a claim
  866  or charges:
  867         a. Made by a broker or by a person making a claim on behalf
  868  of a broker;
  869         b. For any service or treatment that was not lawful at the
  870  time rendered;
  871         c. To any person who knowingly submits a false or
  872  misleading statement relating to the claim or charges;
  873         d. With respect to A bill or statement that does not
  874  substantially meet the applicable requirements of paragraphs
  875  (c), paragraph (d), and (e);
  876         e. Except for emergency treatment and care, if the insured
  877  failed to countersign a billing form or patient log related to
  878  such claim or charges. Failure to submit a countersigned billing
  879  form or patient log creates a rebuttable presumption that the
  880  insured did not receive the alleged treatment. The insurer is
  881  not considered to have been furnished with notice of the subject
  882  treatment and loss until the insurer is able to verify that the
  883  insured received the alleged treatment. As used in this sub
  884  subparagraph, the term “countersigned” means a second or
  885  verifying signature, as on a previously signed document, and is
  886  not satisfied by the statement “signature on file” or any
  887  similar statement;
  888         f.e. For any treatment or service that is upcoded, or that
  889  is unbundled if when such treatment or services should be
  890  bundled, in accordance with paragraph (d). To facilitate prompt
  891  payment of lawful services, an insurer may change codes that it
  892  determines to have been improperly or incorrectly upcoded or
  893  unbundled, and may make payment based on the changed codes,
  894  without affecting the right of the provider to dispute the
  895  change by the insurer if, provided that before doing so, the
  896  insurer contacts must contact the health care provider and
  897  discusses discuss the reasons for the insurer’s change and the
  898  health care provider’s reason for the coding, or makes make a
  899  reasonable good faith effort to do so, as documented in the
  900  insurer’s file; and
  901         g.f. For medical services or treatment billed by a
  902  physician and not provided in a hospital unless such services
  903  are rendered by the physician or are incident to his or her
  904  professional services and are included on the physician’s bill,
  905  including documentation verifying that the physician is
  906  responsible for the medical services that were rendered and
  907  billed.
  908         2. The Department of Health, in consultation with the
  909  appropriate professional licensing boards, shall adopt, by rule,
  910  a list of diagnostic tests deemed not to be medically necessary
  911  for use in the treatment of persons sustaining bodily injury
  912  covered by personal injury protection benefits under this
  913  section. The initial list shall be adopted by January 1, 2004,
  914  and shall be revised from time to time as determined by the
  915  Department of Health, in consultation with the respective
  916  professional licensing boards. Inclusion of a test on the list
  917  must of invalid diagnostic tests shall be based on lack of
  918  demonstrated medical value and a level of general acceptance by
  919  the relevant provider community and may shall not be dependent
  920  for results entirely upon subjective patient response.
  921  Notwithstanding its inclusion on a fee schedule in this
  922  subsection, an insurer or insured is not required to pay any
  923  charges or reimburse claims for any invalid diagnostic test as
  924  determined by the Department of Health.
  925         (c)1. With respect to any treatment or service, other than
  926  medical services billed by a hospital or other provider for
  927  emergency services as defined in s. 395.002 or inpatient
  928  services rendered at a hospital-owned facility, the statement of
  929  charges must be furnished to the insurer by the provider and may
  930  not include, and the insurer is not required to pay, charges for
  931  treatment or services rendered more than 35 days before the
  932  postmark date or electronic transmission date of the statement,
  933  except for past due amounts previously billed on a timely basis
  934  under this paragraph, and except that, if the provider submits
  935  to the insurer a notice of initiation of treatment within 21
  936  days after its first examination or treatment of the claimant,
  937  the statement may include charges for treatment or services
  938  rendered up to, but not more than, 75 days before the postmark
  939  date of the statement. The injured party is not liable for, and
  940  the provider may shall not bill the injured party for, charges
  941  that are unpaid because of the provider’s failure to comply with
  942  this paragraph. Any agreement requiring the injured person or
  943  insured to pay for such charges is unenforceable.
  944         1.2. If, however, the insured fails to furnish the provider
  945  with the correct name and address of the insured’s personal
  946  injury protection insurer, the provider has 35 days from the
  947  date the provider obtains the correct information to furnish the
  948  insurer with a statement of the charges. The insurer is not
  949  required to pay for such charges unless the provider includes
  950  with the statement documentary evidence that was provided by the
  951  insured during the 35-day period demonstrating that the provider
  952  reasonably relied on erroneous information from the insured and
  953  either:
  954         a. A denial letter from the incorrect insurer; or
  955         b. Proof of mailing, which may include an affidavit under
  956  penalty of perjury, reflecting timely mailing to the incorrect
  957  address or insurer.
  958         2.3. For emergency services and care as defined in s.
  959  395.002 rendered in a hospital emergency department or for
  960  transport and treatment rendered by an ambulance provider
  961  licensed pursuant to part III of chapter 401, the provider is
  962  not required to furnish the statement of charges within the time
  963  periods established by this paragraph,; and the insurer is shall
  964  not be considered to have been furnished with notice of the
  965  amount of covered loss for purposes of paragraph (4)(b) until it
  966  receives a statement complying with paragraph (d), or copy
  967  thereof, which specifically identifies the place of service to
  968  be a hospital emergency department or an ambulance in accordance
  969  with billing standards recognized by the Centers for Medicare
  970  and Medicaid Services Health Care Finance Administration.
  971         3.4. Each notice of the insured’s rights under s. 627.7401
  972  must include the following statement in type no smaller than 12
  973  points:
  975         BILLING REQUIREMENTS.—Florida Statutes provide that
  976         with respect to any treatment or services, other than
  977         certain hospital and emergency services, the statement
  978         of charges furnished to the insurer by the provider
  979         may not include, and the insurer and the injured party
  980         are not required to pay, charges for treatment or
  981         services rendered more than 35 days before the
  982         postmark date of the statement, except for past due
  983         amounts previously billed on a timely basis, and
  984         except that, if the provider submits to the insurer a
  985         notice of initiation of treatment within 21 days after
  986         its first examination or treatment of the claimant,
  987         the first billing cycle statement may include charges
  988         for treatment or services rendered up to, but not more
  989         than, 75 days before the postmark date of the
  990         statement.
  992         (d) All statements and bills for medical services rendered
  993  by any physician, hospital, clinic, or other person or
  994  institution shall be submitted to the insurer on a properly
  995  completed Centers for Medicare and Medicaid Services (CMS) 1500
  996  form, UB 92 forms, or any other standard form approved by the
  997  office or adopted by the commission for purposes of this
  998  paragraph. All billings for such services rendered by providers
  999  must shall, to the extent applicable, follow the Physicians’
 1000  Current Procedural Terminology (CPT) or Healthcare Correct
 1001  Procedural Coding System (HCPCS), or ICD-9 in effect for the
 1002  year in which services are rendered and comply with the Centers
 1003  for Medicare and Medicaid Services (CMS) 1500 form instructions
 1004  and the American Medical Association Current Procedural
 1005  Terminology (CPT) Editorial Panel and Healthcare Correct
 1006  Procedural Coding System (HCPCS). All providers other than
 1007  hospitals shall include on the applicable claim form the
 1008  professional license number of the provider in the line or space
 1009  provided for “Signature of Physician or Supplier, Including
 1010  Degrees or Credentials.” In determining compliance with
 1011  applicable CPT and HCPCS coding, guidance shall be provided by
 1012  the Physicians’ Current Procedural Terminology (CPT) or the
 1013  Healthcare Correct Procedural Coding System (HCPCS) in effect
 1014  for the year in which services were rendered, the Office of the
 1015  Inspector General (OIG), Physicians Compliance Guidelines, and
 1016  other authoritative treatises designated by rule by the Agency
 1017  for Health Care Administration. A No statement of medical
 1018  services may not include charges for medical services of a
 1019  person or entity that performed such services without possessing
 1020  the valid licenses required to perform such services. For
 1021  purposes of paragraph (4)(b), an insurer is shall not be
 1022  considered to have been furnished with notice of the amount of
 1023  covered loss or medical bills due unless the statements or bills
 1024  comply with this paragraph, and unless the statements or bills
 1025  are comply with this paragraph, and unless the statements or
 1026  bills are properly completed in their entirety as to all
 1027  material provisions, with all relevant information being
 1028  provided therein. If an insurer denies a claim due to a
 1029  provider’s failure to submit a properly completed form, the
 1030  insurer shall notify the provider as to the provisions that were
 1031  improperly completed, and the provider shall have 15 days after
 1032  the receipt of such notice to submit a properly completed form.
 1033  If the provider fails to comply with this requirement, the
 1034  insurer is not required to pay for the services that were billed
 1035  on the improperly completed form.
 1036         (e)1. At the initial treatment or service provided, each
 1037  physician, other licensed professional, clinic, or other medical
 1038  institution providing medical services upon which a claim for
 1039  personal injury protection benefits is based shall require an
 1040  insured person, or his or her guardian, to execute a disclosure
 1041  and acknowledgment form, which reflects at a minimum that:
 1042         a. The insured, or his or her guardian, must countersign
 1043  the form attesting to the fact that the services set forth
 1044  therein were actually rendered. The services shall be described
 1045  and listed on the disclosure and acknowledgement form in words
 1046  readable by the insured. If the insured cannot read, the
 1047  provider should verify, under penalty of perjury, that the
 1048  services listed on the form were verbally explained to the
 1049  insured before the insured signs the form. Listing CPT codes or
 1050  other coding on the disclosure and acknowledgment form does not
 1051  satisfy this requirement;
 1052         b. The insured, or his or her guardian, has both the right
 1053  and affirmative duty to confirm that the services were actually
 1054  rendered;
 1055         c. The insured, or his or her guardian, was not solicited
 1056  by any person to seek any services from the medical provider;
 1057         d. The physician, other licensed professional, clinic, or
 1058  other medical institution rendering services for which payment
 1059  is being claimed explained the services to the insured or his or
 1060  her guardian; and
 1061         e. If the insured notifies the insurer in writing of a
 1062  billing error, the insured may be entitled to a certain
 1063  percentage of a reduction in the amounts paid by the insured’s
 1064  motor vehicle insurer.
 1065         2. The physician, other licensed professional, clinic, or
 1066  other medical institution rendering services for which payment
 1067  is being claimed has the affirmative duty to explain the
 1068  services rendered to the insured, or his or her guardian, so
 1069  that the insured, or his or her guardian, countersigns the form
 1070  with informed consent.
 1071         3. Countersignature by the insured, or his or her guardian,
 1072  is not required for the reading of diagnostic tests or other
 1073  services that are of such a nature that they are not required to
 1074  be performed in the presence of the insured.
 1075         4. The licensed medical professional rendering treatment
 1076  for which payment is being claimed must sign, by his or her own
 1077  hand, the form complying with this paragraph.
 1078         5. An insurer is not considered to have been furnished with
 1079  notice of the amount of a covered loss or medical bills unless
 1080  the original completed disclosure and acknowledgment form is
 1081  shall be furnished to the insurer pursuant to paragraph (4)(b)
 1082  and sub-subparagraph 1.a. The disclosure and acknowledgement
 1083  form may not be electronically furnished. A disclosure and
 1084  acknowledgement form that does not meet the minimum requirements
 1085  of sub-subparagraph 1.a. does not provide an insurer with notice
 1086  of the amount of a covered loss or medical bills due.
 1087         6. This disclosure and acknowledgment form is not required
 1088  for services billed by a provider for emergency services as
 1089  defined in s. 395.002, for emergency services and care as
 1090  defined in s. 395.002 rendered in a hospital emergency
 1091  department, or for transport and treatment rendered by an
 1092  ambulance provider licensed pursuant to part III of chapter 401.
 1093         7. The Financial Services Commission shall adopt, by rule,
 1094  a standard disclosure and acknowledgment form to that shall be
 1095  used to fulfill the requirements of this paragraph, effective 90
 1096  days after such form is adopted and becomes final. The
 1097  commission shall adopt a proposed rule by October 1, 2003. Until
 1098  the rule is final, the provider may use a form of its own which
 1099  otherwise complies with the requirements of this paragraph.
 1100         8. As used in this paragraph, the term “countersigned” or
 1101  “countersignature” means a second or verifying signature, as on
 1102  a previously signed document, and is not satisfied by the
 1103  statement “signature on file” or any similar statement.
 1104         9. The requirements of this paragraph apply only with
 1105  respect to the initial treatment or service of the insured by a
 1106  provider. For subsequent treatments or service, the provider
 1107  must maintain a patient log signed by the patient, in
 1108  chronological order by date of service, which describes the
 1109  treatment rendered in a language readable by the insured that is
 1110  consistent with the services being rendered to the patient as
 1111  claimed. Listing CPT codes or other coding on the patient log
 1112  does not satisfy this requirement. The provider must provide
 1113  copies of the patient log to the insurer within 30 days after
 1114  receiving a written request from the insurer. Failure to
 1115  maintain a patient log renders the treatment unlawful and
 1116  noncompensable. The requirements of this subparagraph for
 1117  maintaining a patient log signed by the patient may be met by a
 1118  hospital that maintains medical records as required by s.
 1119  395.3025 and applicable rules and makes such records available
 1120  to the insurer upon request.
 1121         (f) Upon written notification by any person, an insurer
 1122  shall investigate any claim of improper billing by a physician
 1123  or other medical provider. The insurer shall determine if the
 1124  insured was properly billed for only those services and
 1125  treatments that the insured actually received. If the insurer
 1126  determines that the insured has been improperly billed, the
 1127  insurer shall notify the insured, the person making the written
 1128  notification, and the provider of its findings and shall reduce
 1129  the amount of payment to the provider by the amount determined
 1130  to be improperly billed. If a reduction is made due to such
 1131  written notification by any person, the insurer shall pay to the
 1132  person 20 percent of the amount of the reduction, up to $500. If
 1133  the provider is arrested due to the improper billing, then the
 1134  insurer shall pay to the person 40 percent of the amount of the
 1135  reduction, up to $500.
 1136         (g) An insurer may not systematically downcode with the
 1137  intent to deny reimbursement otherwise due. Such action
 1138  constitutes a material misrepresentation under s.
 1139  626.9541(1)(i)2.
 1141  DISPUTES.—
 1142         (b) Every physician, hospital, clinic, or other medical
 1143  institution providing, before or after bodily injury upon which
 1144  a claim for personal injury protection insurance benefits is
 1145  based, any products, services, or accommodations in relation to
 1146  that or any other injury, or in relation to a condition claimed
 1147  to be connected with that or any other injury, shall, if
 1148  requested to do so by the insurer against whom the claim has
 1149  been made, permit the insurer or the insurer’s representative to
 1150  conduct an onsite physical review and examination of the
 1151  treatment location, treatment apparatuses, diagnostic devices,
 1152  and any other medical equipment used for the services rendered
 1153  within 10 days after the insurer’s request, and furnish
 1154  forthwith a written report of the history, condition, treatment,
 1155  dates, and costs of such treatment of the injured person and why
 1156  the items identified by the insurer were reasonable in amount
 1157  and medically necessary, together with a sworn statement that
 1158  the treatment or services rendered were reasonable and necessary
 1159  with respect to the bodily injury sustained and identifying
 1160  which portion of the expenses for such treatment or services was
 1161  incurred as a result of such bodily injury, and produce
 1162  forthwith, and permit the inspection and copying of, his or her
 1163  or its records regarding such history, condition, treatment,
 1164  dates, and costs of treatment if; provided that this does shall
 1165  not limit the introduction of evidence at trial. Such sworn
 1166  statement must shall read as follows: “Under penalty of perjury,
 1167  I declare that I have read the foregoing, and the facts alleged
 1168  are true, to the best of my knowledge and belief.” A No cause of
 1169  action for violation of the physician-patient privilege or
 1170  invasion of the right of privacy may not be brought shall be
 1171  permitted against any physician, hospital, clinic, or other
 1172  medical institution complying with the provisions of this
 1173  section. The person requesting such records and such sworn
 1174  statement shall pay all reasonable costs connected therewith.
 1175         1. If an insurer makes a written request for documentation
 1176  or information under this paragraph within 30 days after having
 1177  received notice of the amount of a covered loss under paragraph
 1178  (4)(a), the amount or the partial amount that which is the
 1179  subject of the insurer’s inquiry is shall become overdue if the
 1180  insurer does not pay in accordance with paragraph (4)(b) or
 1181  within 10 days after the insurer’s receipt of the requested
 1182  documentation or information, whichever occurs later. For
 1183  purposes of this subparagraph paragraph, the term “receipt”
 1184  includes, but is not limited to, inspection and copying pursuant
 1185  to this paragraph. An Any insurer that requests documentation or
 1186  information pertaining to reasonableness of charges or medical
 1187  necessity under this paragraph without a reasonable basis for
 1188  such requests as a general business practice is engaging in an
 1189  unfair trade practice under the insurance code.
 1190         2. If an insured seeking to recover benefits pursuant to
 1191  the no-fault law assigns the contractual right to those benefits
 1192  or payment of those benefits to any person or entity, the
 1193  assignee must comply with the terms of the policy. In all
 1194  circumstances, the assignee is obligated to cooperate under the
 1195  policy, which includes, but is not limited to, participating in
 1196  an examination under oath. Examinations under oath may be
 1197  recorded by audio, video, court reporter, or any combination
 1198  thereof. Compliance with this paragraph is a condition precedent
 1199  to recovery of benefits pursuant to the no-fault law.
 1200         a. If an insurer requests an examination under oath of a
 1201  medical provider, the provider must produce the persons having
 1202  the most knowledge of the issues identified by the insurer in
 1203  the request for examination under oath. All claimants must
 1204  produce and provide for inspection all documents requested by
 1205  the insurer which are reasonably obtainable by the claimant.
 1206         b. Before requesting that an assignee participate in an
 1207  examination under oath, the insurer must send a written request
 1208  to the assignee requesting all information that the insurer
 1209  believes is necessary to process the claim, including the
 1210  information contemplated under this subparagraph.
 1211         c. An insurer that, as a general practice, requests
 1212  examinations under oath of an assignee without a reasonable
 1213  basis is engaging in an unfair and deceptive trade practice.
 1215  REPORTS.—
 1216         (b) If requested by the person examined, a party causing an
 1217  examination to be made shall deliver to him or her a copy of
 1218  every written report concerning the examination rendered by an
 1219  examining physician, at least one of which reports must set out
 1220  the examining physician’s findings and conclusions in detail.
 1221  After such request and delivery, the party causing the
 1222  examination to be made is entitled, upon request, to receive
 1223  from the person examined every written report available to him
 1224  or her or his or her representative concerning any examination,
 1225  previously or thereafter made, of the same mental or physical
 1226  condition. By requesting and obtaining a report of the
 1227  examination so ordered, or by taking the deposition of the
 1228  examiner, the person examined waives any privilege he or she may
 1229  have, in relation to the claim for benefits, regarding the
 1230  testimony of every other person who has examined, or may
 1231  thereafter examine, him or her in respect to the same mental or
 1232  physical condition. If a person fails to appear for unreasonably
 1233  refuses to submit to an examination, the personal injury
 1234  protection carrier is not required to pay no longer liable for
 1235  subsequent personal injury protection benefits incurred after
 1236  the date of the first requested examination until the insured
 1237  appears for the examination. Failure to appear for two scheduled
 1238  examinations raises a rebuttable presumption that such failure
 1239  was unreasonable. Submission to an examination is a condition
 1240  precedent to the recovery of benefits.
 1242  FEES.—With respect to any dispute under the provisions of ss.
 1243  627.730-627.7405 between the insured and the insurer under the
 1244  no-fault law, or between an assignee of an insured’s rights and
 1245  the insurer, the provisions of s. 627.428 shall apply, except as
 1246  provided in subsections (11) and (16) (10) and (15).
 1247         (10)(9)PREFERRED PROVIDERS.—An insurer may negotiate and
 1248  enter into contracts with preferred licensed health care
 1249  providers for the benefits described in this section, referred
 1250  to in this section as “preferred providers,” which include shall
 1251  include health care providers licensed under chapter 457,
 1252  chapter chapters 458, chapter 459, chapter 460, chapter 461, or
 1253  chapter and 463.
 1254         (a) The insurer may provide an option to an insured to use
 1255  a preferred provider at the time of purchase of the policy for
 1256  personal injury protection benefits, if the requirements of this
 1257  subsection are met. However, if the insurer offers a preferred
 1258  provider option, it must also offer a nonpreferred provider
 1259  policy. If the insured elects to use a provider who is not a
 1260  preferred provider, whether the insured purchased a preferred
 1261  provider policy or a nonpreferred provider policy, the medical
 1262  benefits provided by the insurer shall be as required by this
 1263  section.
 1264         (b) If the insured elects the to use a provider who is a
 1265  preferred provider option, the insurer may pay medical benefits
 1266  in excess of the benefits required by this section and may waive
 1267  or lower the amount of any deductible that applies to such
 1268  medical benefits. As an alternative, or in addition to such
 1269  benefits, waiver, or reduction, the insurer may provide an
 1270  actuarially appropriate premium discount as specified in an
 1271  approved rate filing to an insured who selects the preferred
 1272  provider option. If the preferred provider option provides a
 1273  premium discount, the policy may provide that charges for
 1274  nonemergency services provided within this state are payable
 1275  only if performed by members of the preferred provider network
 1276  unless there is no member of the preferred provider network
 1277  located within 15 miles of the insured’s place of residence
 1278  whose scope of practice includes the required services, or
 1279  unless the nonemergency services are rendered in the emergency
 1280  room of a hospital licensed under chapter 395. If the insurer
 1281  offers a preferred provider policy to a policyholder or
 1282  applicant, it must also offer a nonpreferred provider policy.
 1283         (c) The insurer shall provide each insured policyholder
 1284  with a current roster of preferred providers in the county in
 1285  which the insured resides at the time of purchasing purchase of
 1286  such policy, and shall make such list available for public
 1287  inspection during regular business hours at the insurer’s
 1288  principal office of the insurer within the state. The insurer
 1289  may contract with a health insurer for the right to use an
 1290  existing preferred provider network to implement the preferred
 1291  provider option. Any other arrangement is subject to the
 1292  approval of the Office of Insurance Regulation.
 1293         (11)(10) DEMAND LETTER.—
 1294         (a) As a condition precedent to filing any action for
 1295  benefits under this section, the claimant filing suit must
 1296  provide the insurer must be provided with written notice of an
 1297  intent to initiate litigation. Such notice may not be sent until
 1298  the claim is overdue, including any additional time the insurer
 1299  has to pay the claim pursuant to paragraph (4)(b). A premature
 1300  demand letter is defective and cannot be cured unless the court
 1301  first abates the action or the claimant first voluntarily
 1302  dismisses the action.
 1303         (b) The notice required notice must shall state that it is
 1304  a “demand letter under s. 627.736(10)” and shall state with
 1305  specificity:
 1306         1. The name of the insured upon which such benefits are
 1307  being sought, including a copy of the assignment giving rights
 1308  to the claimant if the claimant is not the insured.
 1309         2. The claim number or policy number upon which such claim
 1310  was originally submitted to the insurer.
 1311         3. To the extent applicable, the name of any medical
 1312  provider who rendered to an insured the treatment, services,
 1313  accommodations, or supplies that form the basis of such claim;
 1314  and an itemized statement specifying each exact amount, the date
 1315  of treatment, service, or accommodation, and the type of benefit
 1316  claimed to be due. A completed form satisfying the requirements
 1317  of paragraph (6)(5)(d) or the lost-wage statement previously
 1318  submitted may be used as the itemized statement. To the extent
 1319  that the demand involves an insurer’s withdrawal of payment
 1320  under paragraph (7)(a) for future treatment not yet rendered,
 1321  the claimant shall attach a copy of the insurer’s notice
 1322  withdrawing such payment and an itemized statement of the type,
 1323  frequency, and duration of future treatment claimed to be
 1324  reasonable and medically necessary.
 1325         (c) Each notice required by this subsection must be
 1326  delivered to the insurer by United States certified or
 1327  registered mail, return receipt requested. Such postal costs
 1328  shall be reimbursed by the insurer if so requested by the
 1329  claimant in the notice, when the insurer pays the claim. Such
 1330  notice must be sent to the person and address specified by the
 1331  insurer for the purposes of receiving notices under this
 1332  subsection. Each licensed insurer, whether domestic, foreign, or
 1333  alien, shall file with the office designation of the name and
 1334  address of the person to whom notices must pursuant to this
 1335  subsection shall be sent which the office shall make available
 1336  on its Internet website. The name and address on file with the
 1337  office pursuant to s. 624.422 shall be deemed the authorized
 1338  representative to accept notice pursuant to this subsection if
 1339  in the event no other designation has been made.
 1340         (d) If, within 30 days after receipt of notice by the
 1341  insurer, the overdue claim specified in the notice is paid by
 1342  the insurer together with applicable interest and a penalty of
 1343  10 percent of the overdue amount paid by the insurer, subject to
 1344  a maximum penalty of $250, no action may be brought against the
 1345  insurer. If the demand involves an insurer’s withdrawal of
 1346  payment under paragraph (7)(a) for future treatment not yet
 1347  rendered, no action may be brought against the insurer if,
 1348  within 30 days after its receipt of the notice, the insurer
 1349  mails to the person filing the notice a written statement of the
 1350  insurer’s agreement to pay for such treatment in accordance with
 1351  the notice and to pay a penalty of 10 percent, subject to a
 1352  maximum penalty of $250, when it pays for such future treatment
 1353  in accordance with the requirements of this section. To the
 1354  extent the insurer determines not to pay any amount demanded,
 1355  the penalty is shall not be payable in any subsequent action.
 1356  For purposes of this subsection, payment or the insurer’s
 1357  agreement is shall be treated as being made on the date a draft
 1358  or other valid instrument that is equivalent to payment, or the
 1359  insurer’s written statement of agreement, is placed in the
 1360  United States mail in a properly addressed, postpaid envelope,
 1361  or if not so posted, on the date of delivery. The insurer is not
 1362  obligated to pay any attorney’s fees if the insurer pays the
 1363  claim or mails its agreement to pay for future treatment within
 1364  the time prescribed by this subsection.
 1365         (e) The applicable statute of limitation for an action
 1366  under this section shall be tolled for a period of 30 business
 1367  days by the mailing of the notice required by this subsection.
 1368         (f)A demand letter that does not meet the minimum
 1369  requirements set forth in this subsection or that is sent during
 1370  the pendency of the lawsuit is defective. A defective demand
 1371  letter cannot be cured unless the court first abates the action
 1372  or the claimant first voluntarily dismisses the action.
 1373         (g)(f)An Any insurer making a general business practice of
 1374  not paying valid claims until receipt of the notice required by
 1375  this subsection is engaging in an unfair trade practice under
 1376  the insurance code.
 1377         (h) If the insurer pays in response to a demand letter and
 1378  the claimant disputes the amount paid, the claimant must send a
 1379  second demand letter by certified or registered mail stating the
 1380  exact amount that the claimant believes the insurer owes and why
 1381  the claimant believes the amount paid is incorrect. The insurer
 1382  has an additional 10 days after receipt of the second letter to
 1383  issue any additional payment that is owed. The purpose of this
 1384  provision is to avoid unnecessary litigation over miscalculated
 1385  payments.
 1386         (i) Demand letters may not be used to request the
 1387  production of claim documents or other records from the insurer.
 1388         Section 10. Paragraph (c) of subsection (7), and
 1389  subsections (10) through (12) of section 817.234, Florida
 1390  Statutes, are amended to read:
 1391         817.234 False and fraudulent insurance claims.—
 1392         (7)
 1393         (c) An insurer, or any person acting at the direction of or
 1394  on behalf of an insurer, may not change an opinion in a mental
 1395  or physical report prepared under s. 627.736(8) 627.736(7) or
 1396  direct the physician preparing the report to change such
 1397  opinion; however, this provision does not preclude the insurer
 1398  from calling to the attention of the physician errors of fact in
 1399  the report based upon information in the claim file. Any person
 1400  who violates this paragraph commits a felony of the third
 1401  degree, punishable as provided in s. 775.082, s. 775.083, or s.
 1402  775.084.
 1403         (10) As used in this section, the term “insurer” means any
 1404  insurer, health maintenance organization, self-insurer, self
 1405  insurance fund, or other similar entity or person regulated
 1406  under chapter 440 or chapter 641 or by the Office of Insurance
 1407  Regulation under the Florida Insurance Code.
 1408         (10)(11) If the value of any property involved in a
 1409  violation of this section:
 1410         (a) Is less than $20,000, the offender commits a felony of
 1411  the third degree, punishable as provided in s. 775.082, s.
 1412  775.083, or s. 775.084.
 1413         (b) Is $20,000 or more, but less than $100,000, the
 1414  offender commits a felony of the second degree, punishable as
 1415  provided in s. 775.082, s. 775.083, or s. 775.084.
 1416         (c) Is $100,000 or more, the offender commits a felony of
 1417  the first degree, punishable as provided in s. 775.082, s.
 1418  775.083, or s. 775.084.
 1419         (11) In addition to any criminal liability, a person
 1420  convicted of violating any provision of this section for the
 1421  purpose of receiving insurance proceeds from a motor vehicle
 1422  insurance contract is subject to a civil penalty.
 1423         (a) Except for a violation of subsection (9), the civil
 1424  penalty shall be:
 1425         1. A fine up to $5,000 for a first offense.
 1426         2. A fine greater than $5,000, but not to exceed $10,000,
 1427  for a second offense.
 1428         3. A fine greater than $10,000, but not to exceed $15,000,
 1429  for a third or subsequent offense.
 1430         (b) The civil penalty for a violation of subsection (9)
 1431  must be at least $15,000, but may not exceed $50,000.
 1432         (c) The civil penalty shall be paid to the Insurance
 1433  Regulatory Trust Fund within the Department of Financial
 1434  Services and used by the department for the investigation and
 1435  prosecution of insurance fraud.
 1436         (d) This subsection does not prohibit a state attorney from
 1437  entering into a written agreement in which the person charged
 1438  with the violation does not admit to or deny the charges but
 1439  consents to payment of the civil penalty.
 1440         (12) As used in this section, the term:
 1441         (a) “Insurer” means any insurer, health maintenance
 1442  organization, self-insurer, self-insurance fund, or similar
 1443  entity or person regulated under chapter 440 or chapter 641 or
 1444  by the Office of Insurance Regulation under the Florida
 1445  Insurance Code.
 1446         (b)(a) “Property” means property as defined in s. 812.012.
 1447         (c)(b) “Value” has the same meaning means value as defined
 1448  in s. 812.012.
 1449         Section 11. Subsection (1) of section 324.021, Florida
 1450  Statutes, is amended to read:
 1451         324.021 Definitions; minimum insurance required.—The
 1452  following words and phrases when used in this chapter shall, for
 1453  the purpose of this chapter, have the meanings respectively
 1454  ascribed to them in this section, except in those instances
 1455  where the context clearly indicates a different meaning:
 1456         (1) MOTOR VEHICLE.—Every self-propelled vehicle that which
 1457  is designed and required to be licensed for use upon a highway,
 1458  including trailers and semitrailers designed for use with such
 1459  vehicles, except traction engines, road rollers, farm tractors,
 1460  power shovels, and well drillers, and every vehicle that which
 1461  is propelled by electric power obtained from overhead wires but
 1462  not operated upon rails, but not including any bicycle or moped.
 1463  However, the term does “motor vehicle” shall not include a any
 1464  motor vehicle as defined in s. 627.732(3) if when the owner of
 1465  such vehicle has complied with the no-fault law requirements of
 1466  ss. 627.730-627.7405, inclusive, unless the provisions of s.
 1467  324.051 apply; and, in such case, the applicable proof of
 1468  insurance provisions of s. 320.02 apply.
 1469         Section 12. Paragraph (k) of subsection (2) of section
 1470  456.057, Florida Statutes, is amended to read:
 1471         456.057 Ownership and control of patient records; report or
 1472  copies of records to be furnished.—
 1473         (2) As used in this section, the terms “records owner,”
 1474  “health care practitioner,” and “health care practitioner’s
 1475  employer” do not include any of the following persons or
 1476  entities; furthermore, the following persons or entities are not
 1477  authorized to acquire or own medical records, but are authorized
 1478  under the confidentiality and disclosure requirements of this
 1479  section to maintain those documents required by the part or
 1480  chapter under which they are licensed or regulated:
 1481         (k) Persons or entities practicing under s. 627.736(8)
 1482  627.736(7).
 1483         Section 13. Paragraph (b) of subsection (1) of section
 1484  627.7401, Florida Statutes, is amended to read:
 1485         627.7401 Notification of insured’s rights.—
 1486         (1) The commission, by rule, shall adopt a form for the
 1487  notification of insureds of their right to receive personal
 1488  injury protection benefits under the Florida Motor Vehicle no
 1489  fault law. Such notice shall include:
 1490         (b) An advisory informing insureds that:
 1491         1. Pursuant to s. 626.9892, the Department of Financial
 1492  Services may pay rewards of up to $25,000 to persons providing
 1493  information leading to the arrest and conviction of persons
 1494  committing crimes investigated by the Division of Insurance
 1495  Fraud arising from violations of s. 440.105, s. 624.15, s.
 1496  626.9541, s. 626.989, or s. 817.234.
 1497         2. Pursuant to s. 627.736(6)(e)1. 627.736(5)(e)1., if the
 1498  insured notifies the insurer of a billing error, the insured may
 1499  be entitled to a certain percentage of a reduction in the amount
 1500  paid by the insured’s motor vehicle insurer.
 1501         Section 14. This act shall take effect July 1, 2011.
 1503  ================= T I T L E  A M E N D M E N T ================
 1504         And the title is amended as follows:
 1505         Delete everything before the enacting clause
 1506  and insert:
 1507                        A bill to be entitled                      
 1508         An act relating to motor vehicle personal injury
 1509         protection insurance; amending s. 316.066, F.S.;
 1510         revising provisions relating to the contents of
 1511         written reports of motor vehicle crashes; requiring
 1512         short-form crash reports by a law enforcement officer
 1513         to be maintained by the officer’s agency; authorizing
 1514         the investigation officer to testify at trial or
 1515         provide an affidavit concerning the content of the
 1516         reports; amending s. 400.991, F.S.; requiring that an
 1517         application for licensure as a mobile clinic include a
 1518         statement regarding insurance fraud; creating s.
 1519         626.9894, F.S.; providing definitions; authorizing the
 1520         Division of Insurance Fraud to establish a direct
 1521         support organization for the purpose of prosecuting,
 1522         investigating, and preventing motor vehicle insurance
 1523         fraud; providing requirements for the organization and
 1524         the organization’s contract with the division;
 1525         providing for a board of directors; authorizing the
 1526         organization to use the division’s property and
 1527         facilities subject to certain requirements;
 1528         authorizing contributions from insurers; providing
 1529         that any moneys received by the organization may be
 1530         held in a separate depository account in the name of
 1531         the organization; requiring the division to deposit
 1532         certain proceeds into the Insurance Regulatory Trust
 1533         Fund; amending s. 627.4137, F.S.; requiring a
 1534         claimant’s request about insurance coverage to be
 1535         appropriately served upon the disclosing entity;
 1536         amending s. 627.730, F.S.; conforming a cross
 1537         reference; amending s. 627.731, F.S.; providing
 1538         legislative intent with respect to the Florida Motor
 1539         Vehicle No-Fault Law; creating s. 627.7311, F.S.;
 1540         requiring the provisions, schedules, and procedures of
 1541         the no-fault law to be implemented by insurers
 1542         regardless of whether they are expressly stated in the
 1543         policy; amending s. 627.732, F.S.; defining the terms
 1544         “claimant” and “no-fault law”; amending s. 627.736,
 1545         F.S.; conforming a cross-reference; adding
 1546         acupuncturists to the list of authorized
 1547         practitioners; requiring certain entities providing
 1548         medical services to document that they meet required
 1549         criteria; revising requirements relating to the form
 1550         that must be submitted by providers; requiring an
 1551         entity or clinic to file a new form within a specified
 1552         period after the date of a change of ownership;
 1553         revising provisions relating to when payment for a
 1554         benefit is due; providing that an insurer’s failure to
 1555         send certain specification or explanation does not
 1556         waive other grounds for rejecting an invalid claim;
 1557         authorizing an insurer to obtain evidence and assert
 1558         any ground for adjusting or rejecting a claim;
 1559         providing that the time period for paying a claim is
 1560         tolled during the investigation of a fraudulent
 1561         insurance act; specifying when benefits are not
 1562         payable; preempting local lien laws with respect to
 1563         payment of benefits to medical providers; providing
 1564         that a claimant that violates certain provisions is
 1565         not entitled to any payment, regardless of whether a
 1566         portion of the claim may be legitimate; authorizing an
 1567         insurer to recover payments and bring a cause of
 1568         action to recover payments; providing that an insurer
 1569         may deny any claim based on other evidence of fraud;
 1570         forbidding a physician, hospital, clinic, or other
 1571         medical institution that fails to comply with certain
 1572         provisions from billing the injured person or the
 1573         insured; providing that an insurer has a right to
 1574         conduct reasonable investigations of claims;
 1575         authorizing an insurer to require a claimant to
 1576         provide certain records; requiring a records review to
 1577         be conducted by the same type of practitioner as the
 1578         medical provider whose records are being reviewed or
 1579         by a physician; specifying when the period for payment
 1580         is tolled; authorizing an insurer to deny benefits if
 1581         an insured, claimant, or medical provider fails to
 1582         comply with certain provisions; forbidding the
 1583         claimant from filing suit unless the claimant complies
 1584         with the act; revising the insurer’s reimbursement
 1585         limitation; providing a limit on the amount of
 1586         reimbursement; creating a rebuttable presumption that
 1587         the insured did not receive the alleged treatment if
 1588         the insured does not countersign the patient log;
 1589         authorizing the insurer to deny a claim if the
 1590         provider does not properly complete the required form
 1591         within a certain time; requiring the provider to
 1592         ensure that the insured understands the services being
 1593         provided; specifying requirements for furnishing the
 1594         insured with notice of the amount of covered loss;
 1595         deleting an obsolete provision; requiring the provider
 1596         to provide copies of the patient log within a certain
 1597         time if requested by the insurer; providing that
 1598         failure to maintain a patient log renders the
 1599         treatment unlawful and noncompensable; revising
 1600         requirements relating to discovery; authorizing the
 1601         insurer to conduct a physical review of the treatment
 1602         location; requiring the insured and assignee to comply
 1603         with certain provisions to recover benefits; requiring
 1604         the provider to produce persons having the most
 1605         knowledge in specified circumstances; requiring the
 1606         insurer to request certain information before
 1607         requesting an assignee to participate in an
 1608         examination under oath; providing that an insurer that
 1609         requests an examination under oath without a
 1610         reasonable basis is engaging in an unfair and
 1611         deceptive trade practice; providing that failure to
 1612         appear for scheduled examinations establishes a
 1613         rebuttable presumption that such failure was
 1614         unreasonable; authorizing an insurer to contract with
 1615         a preferred provider network; authorizing an insurer
 1616         to provide a premium discount to an insured who
 1617         selects a preferred provider; authorizing an insurance
 1618         policy to not pay for nonemergency services performed
 1619         by a nonpreferred provider in specified circumstances;
 1620         authorizing an insurer to contract with a health
 1621         insurer in specified circumstances; revising
 1622         requirements relating to demand letters in an action
 1623         for benefits; specifying when a demand letter is
 1624         defective; requiring a second demand letter under
 1625         certain circumstances; deleting obsolete provisions;
 1626         providing that a demand letter may not be used to
 1627         request the production of claim documents or records
 1628         from the insurer; amending s. 817.234, F.S.;
 1629         conforming a cross-reference; providing civil
 1630         penalties for fraudulent insurance claims; amending
 1631         ss. 324.021, 456.057, and 627.7401, F.S.; conforming
 1632         cross-references; providing an effective date.