Florida Senate - 2011                                    SB 1930
       By Senator Bogdanoff
       25-01013C-11                                          20111930__
    1                        A bill to be entitled                      
    2         An act relating to motor vehicle personal injury
    3         protection insurance; amending s. 316.066, F.S.;
    4         revising provisions relating to the contents of
    5         written reports of motor vehicle crashes; requiring
    6         short-form crash reports by a law enforcement officer
    7         to be maintained by the officer’s agency; authorizing
    8         the investigation officer to testify at trial or
    9         provide an affidavit concerning the content of the
   10         reports; amending s. 400.991, F.S.; requiring that an
   11         application for licensure as a mobile clinic include a
   12         statement regarding insurance fraud; creating s.
   13         626.9894, F.S.; providing definitions; authorizing the
   14         Division of Insurance Fraud to establish a direct
   15         support organization for the purpose of prosecuting,
   16         investigating, and preventing motor vehicle insurance
   17         fraud; providing requirements for the organization and
   18         the organization’s contract with the division;
   19         providing for a board of directors; authorizing the
   20         organization to use the division’s property and
   21         facilities subject to certain requirements;
   22         authorizing contributions from insurers; providing
   23         that any moneys received by the organization may be
   24         held in a separate depository account in the name of
   25         the organization; requiring the division to deposit
   26         certain proceeds into the Insurance Regulatory Trust
   27         Fund; amending s. 627.4137, F.S.; requiring a
   28         claimant’s request about insurance coverage to be
   29         appropriately served upon the disclosing entity;
   30         amending s. 627.730, F.S.; conforming a cross
   31         reference; amending s. 627.731, F.S.; providing
   32         legislative intent with respect to the Florida Motor
   33         Vehicle No-Fault Law; amending s. 627.732, F.S.;
   34         defining the terms “claimant” and “no-fault law”;
   35         amending s. 627.736, F.S.; conforming a cross
   36         reference; requiring certain entities providing
   37         medical services to document that they meet required
   38         criteria; revising requirements relating to the form
   39         that must be submitted by providers; requiring an
   40         entity or clinic to file a new form within a specified
   41         period after the date of a change of ownership;
   42         revising provisions relating to when payment for a
   43         benefit is due; providing that an insurer’s failure to
   44         send certain specification or explanation does not
   45         waive any ground for rejecting an invalid claim;
   46         authorizing an insurer to define “reasonable proof” in
   47         its policy and to request information for its
   48         investigation; providing that the time period for
   49         paying a claim is tolled during the investigation of a
   50         fraudulent insurance act; specifying when benefits are
   51         not payable; providing that a claimant that violates
   52         certain provisions is not entitled to any payment,
   53         regardless of whether a portion of the claim may be
   54         legitimate; authorizing an insurer to recover payments
   55         and bring a cause of action to recover payments;
   56         providing that an insurer may deny any claim based on
   57         other evidence of fraud; forbidding a physician,
   58         hospital, clinic, or other medical institution that
   59         fails to comply with certain provisions from billing
   60         the injured person or the insured; providing that an
   61         insurer has a right to conduct reasonable
   62         investigations of claims; authorizing an insurer to
   63         require a claimant to provide certain records;
   64         authorizing an insurer to deny or reduce a claim if a
   65         medical provider fails to keep adequate records;
   66         providing that an insurer’s choice of physician is not
   67         limited by the physician’s area of practice or
   68         licensing chapter; authorizing an insurer to deny
   69         benefits if an insured, claimant, or medical provider
   70         fails to comply with certain provisions; forbidding
   71         the claimant from filing suit unless the claimant
   72         complies with the act; revising the insurer’s
   73         reimbursement limitation; providing that an insurer is
   74         not required to pay a claim that the insured did not
   75         countersign; requiring the provider to submit the
   76         statements or bills on an approved form; requiring the
   77         provider to ensure that the insured understands the
   78         services being provided; specifying requirements for
   79         furnishing the insured with notice of the amount of
   80         covered loss; deleting an obsolete provision;
   81         requiring the provider to provide copies of the
   82         patient log within a certain time if requested by the
   83         insurer; providing that failure to maintain a patient
   84         log renders the treatment unlawful and noncompensable;
   85         revising requirements relating to discovery;
   86         authorizing the insurer to conduct a physical review
   87         of the treatment location; requiring the insured and
   88         assignee to comply with certain provisions to recover
   89         benefits; requiring the provider to produce persons
   90         having the most knowledge in specified circumstances;
   91         providing that an insurer that requests an examination
   92         under oath without a reasonable basis is engaging in
   93         an unfair and deceptive trade practice; providing that
   94         failure to appear for an examination establishes a
   95         rebuttable presumption that such failure was
   96         unreasonable; authorizing an insurer to contract with
   97         a preferred provider network; authorizing an insurer
   98         to provide a premium discount to an insured who
   99         selects a preferred provider; authorizing an insurance
  100         policy to not pay for nonemergency services performed
  101         by a nonpreferred provider in specified circumstances;
  102         authorizing an insurer to contract with a health
  103         insurer in specified circumstances; revising
  104         requirements relating to demand letters in an action
  105         for benefits; specifying when a demand letter is
  106         defective; requiring a second demand letter under
  107         certain circumstances; deleting obsolete provisions;
  108         providing that a demand letter may not be used to
  109         request the production of claim documents or records
  110         from the insurer; amending ss. 324.021, 456.057,
  111         627.7401, and 817.234, F.S.; conforming cross
  112         references; providing an effective date.
  114  Be It Enacted by the Legislature of the State of Florida:
  116         Section 1. Subsection (1) of section 316.066, Florida
  117  Statutes, is amended to read:
  118         316.066 Written reports of crashes.—
  119         (1)(a) A Florida Traffic Crash Report, Long Form, must is
  120  required to be completed and submitted to the department within
  121  10 days after completing an investigation is completed by the
  122  every law enforcement officer who in the regular course of duty
  123  investigates a motor vehicle crash:
  124         1. That resulted in death, or personal injury, or any
  125  indication of complaints of pain or discomfort by any of the
  126  parties or passengers involved in the crash;.
  127         2. That involved one or more passengers, other than the
  128  drivers of the vehicles, in any of the vehicles involved in the
  129  crash;
  130         3.2. That involved a violation of s. 316.061(1) or s.
  131  316.193; or.
  132         4.3. In which a vehicle was rendered inoperative to a
  133  degree that required a wrecker to remove it from traffic, if
  134  such action is appropriate, in the officer’s discretion.
  135         (b) In every crash for which a Florida Traffic Crash
  136  Report, Long Form, is not required by this section, the law
  137  enforcement officer may complete a short-form crash report or
  138  provide a short-form crash report to be completed by each party
  139  involved in the crash. Short-form crash reports prepared by the
  140  law enforcement officer shall be maintained by the officer’s
  141  agency.
  142         (c) The long-form and the short-form report must include:
  143         1. The date, time, and location of the crash.
  144         2. A description of the vehicles involved.
  145         3. The names and addresses of the parties involved.
  146         4. The names and addresses of all passengers in all
  147  vehicles involved in the crash, each clearly identified as being
  148  a passenger and the identification of the vehicle in which they
  149  were a passenger.
  150         5.4. The names and addresses of witnesses.
  151         6.5. The name, badge number, and law enforcement agency of
  152  the officer investigating the crash.
  153         7.6. The names of the insurance companies for the
  154  respective parties involved in the crash.
  155         (d)(c) Each party to the crash must shall provide the law
  156  enforcement officer with proof of insurance, which must to be
  157  included in the crash report. If a law enforcement officer
  158  submits a report on the accident, proof of insurance must be
  159  provided to the officer by each party involved in the crash. Any
  160  party who fails to provide the required information commits a
  161  noncriminal traffic infraction, punishable as a nonmoving
  162  violation as provided in chapter 318, unless the officer
  163  determines that due to injuries or other special circumstances
  164  such insurance information cannot be provided immediately. If
  165  the person provides the law enforcement agency, within 24 hours
  166  after the crash, proof of insurance that was valid at the time
  167  of the crash, the law enforcement agency may void the citation.
  168         (e)(d) The driver of a vehicle that was in any manner
  169  involved in a crash resulting in damage to any vehicle or other
  170  property in an amount of $500 or more, which crash was not
  171  investigated by a law enforcement agency, shall, within 10 days
  172  after the crash, submit a written report of the crash to the
  173  department or traffic records center. The entity receiving the
  174  report may require witnesses of the crash crashes to render
  175  reports and may require any driver of a vehicle involved in a
  176  crash of which a written report must be made as provided in this
  177  section to file supplemental written reports if whenever the
  178  original report is deemed insufficient by the receiving entity.
  179         (f) The investigating law enforcement officer may testify
  180  at trial or provide a signed affidavit to confirm or supplement
  181  the information included on the long-form or short-form report.
  182         (e)Short-form crash reports prepared by law enforcement
  183  shall be maintained by the law enforcement officer’s agency.
  184         Section 2. Subsection (6) is added to section 400.991,
  185  Florida Statutes, to read:
  186         400.991 License requirements; background screenings;
  187  prohibitions.—
  188         (6) All forms that constitute part of the application for
  189  licensure or exemption from licensure under this part must
  190  contain the following statement:
  192         INSURANCE FRAUD NOTICE.—Submitting a false,
  193         misleading, or fraudulent application or other
  194         document when applying for licensure as a health care
  195         clinic, when seeking an exemption from licensure as a
  196         health care clinic, or when demonstrating compliance
  197         with part X of chapter 400, Florida Statutes, is a
  198         fraudulent insurance act, as defined in s. 626.989,
  199         Florida Statutes, subject to investigation by the
  200         Division of Insurance Fraud, and is grounds for
  201         discipline by the appropriate licensing board of the
  202         Florida Department of Health.
  203         Section 3. Section 626.9894, Florida Statutes, is created
  204  to read:
  205         626.9894Motor vehicle insurance fraud direct-support
  206  organization.—
  207         (1) DEFINITIONS.—As used in this section, the term:
  208         (a) “Division” means the Division of Insurance Fraud of the
  209  Department of Financial Services.
  210         (b) “Motor vehicle insurance fraud” means any act defined
  211  as a “fraudulent insurance act” under s. 626.989, which relates
  212  to the coverage of motor vehicle insurance as described in part
  213  XI of chapter 627.
  214         (c) “Organization” means the direct-support organization
  215  established under this section.
  216         (2) ORGANIZATION ESTABLISHED.—The division may establish a
  217  direct-support organization, to be known as the “Fight Auto
  218  Fraud Fund,” whose sole purpose is to support the prosecution,
  219  investigation, and prevention of motor vehicle insurance fraud.
  220  The organization shall:
  221         (a) Be a not-for-profit corporation incorporated under
  222  chapter 617 and approved by the Department of State.
  223         (b) Be organized and operated to conduct programs and
  224  activities; to raise funds; to request and receive grants,
  225  gifts, and bequests of money; to acquire, receive, hold, invest,
  226  and administer, in its own name, securities, funds, objects of
  227  value, or other property, real or personal; and to make grants
  228  and expenditures to or for the direct or indirect benefit of the
  229  division, state attorneys’ offices, the statewide prosecutor,
  230  the Agency for Health Care Administration, and the Department of
  231  Health to the extent that such grants and expenditures are to be
  232  used exclusively to advance the purpose of prosecuting,
  233  investigating, or preventing motor vehicle insurance fraud.
  234  Grants and expenditures may include the cost of salaries or
  235  benefits of dedicated motor vehicle insurance fraud
  236  investigators, prosecutors, or support personnel if such grants
  237  and expenditures do not interfere with prosecutorial
  238  independence or otherwise create conflicts of interest which
  239  threaten the success of prosecutions.
  240         (c) Be determined by the division to operate in a manner
  241  that promotes the goals of laws relating to motor vehicle
  242  insurance fraud, that is in the best interest of the state, and
  243  that is in accordance with the adopted goals and mission of the
  244  division.
  245         (d) Use all of its grants and expenditures solely for the
  246  purpose of preventing and decreasing motor vehicle insurance
  247  fraud, and not for the purpose of lobbying as defined in s.
  248  11.045.
  249         (e) Be subject to an annual financial audit in accordance
  250  with s. 215.981.
  251         (3) CONTRACT.—The organization shall operate under written
  252  contract with the division. The contract must provide for:
  253         (a) Approval of the articles of incorporation and bylaws of
  254  the organization by the division.
  255         (b) Submission of an annual budget for the approval of the
  256  division.
  257         (c) Certification by the division that the direct-support
  258  organization is complying with the terms of the contract and in
  259  a manner consistent with the goals and purposes of the
  260  department and in the best interest of the state. Such
  261  certification must be made annually and reported in the official
  262  minutes of a meeting of the organization.
  263         (d) Allocation of funds to address motor vehicle insurance
  264  fraud.
  265         (e) Reversion of moneys and property held in trust by the
  266  organization for motor vehicle insurance fraud prosecution,
  267  investigation, and prevention to the division if the
  268  organization is no longer approved to operate for the department
  269  or if the organization ceases to exist, or to the state if the
  270  division ceases to exist.
  271         (f) Specific criteria to be used by the organization’s
  272  board of directors to evaluate the effectiveness of funding used
  273  to combat motor vehicle insurance fraud.
  274         (g) The fiscal year of the organization, which begins July
  275  1 of each year and ends June 30 of the following year.
  276         (h) Disclosure of the material provisions of the contract,
  277  and distinguishing between the department and the organization
  278  to donors of gifts, contributions, or bequests, including
  279  providing such disclosure on all promotional and fundraising
  280  publications.
  281         (4) BOARD OF DIRECTORS.—The board of directors of the
  282  organization shall consist of the following seven members:
  283         (a) The Chief Financial Officer, or designee, who shall
  284  serve as chair.
  285         (b) Two state attorneys appointed by the Attorney General.
  286         (c) Two representatives of motor vehicle insurers appointed
  287  by the Chief Financial Officer.
  288         (d) Two representatives of local law enforcement agencies,
  289  one of whom shall be appointed by the Chief Financial Officer,
  290  and one of whom shall be appointed by the Attorney General.
  292  The officer who appointed a member of the board may remove that
  293  member for cause. The term of office of an appointed member may
  294  not exceed 4 years and expires at the same time as the term of
  295  the officer who appointed him or her or at such earlier time as
  296  the person ceases to be qualified.
  297         (5) USE OF PROPERTY.—The department may authorize, without
  298  charge, appropriate use of fixed property and facilities of the
  299  division by the organization, subject to this subsection.
  300         (a) The department may prescribe any condition with which
  301  the organization must comply in order to use the division’s
  302  property or facilities.
  303         (b) The department may not authorize the use of the
  304  division’s property or facilities if the organization does not
  305  provide equal membership and employment opportunities to all
  306  persons regardless of race, religion, sex, age, or national
  307  origin.
  308         (c) The department shall adopt rules prescribing the
  309  procedures by which the organization is governed and any
  310  conditions with which the organization must comply to use the
  311  division’s property or facilities.
  312         (6) CONTRIBUTIONS.—Any contributions made by an insurer to
  313  the organization shall be allowed as appropriate business
  314  expenses for all regulatory purposes.
  315         (7) DEPOSITORY.—Any moneys received by the organization may
  316  be held in a separate depository account in the name of the
  317  organization and subject to the provisions of the contract with
  318  the division.
  319         (8) DIVISION’S RECEIPT OF PROCEEDS.—If the division
  320  receives proceeds from the organization, those proceeds shall be
  321  deposited into the Insurance Regulatory Trust Fund.
  322         Section 4. Subsection (3) is added to section 627.4137,
  323  Florida Statutes, to read:
  324         627.4137 Disclosure of certain information required.—
  325         (3)Any request made to a self-insured corporation pursuant
  326  to this section shall be sent by certified mail to the
  327  registered agent of the disclosing entity.
  328         Section 5. Section 627.730, Florida Statutes, is amended to
  329  read:
  330         627.730 Florida Motor Vehicle No-Fault Law.—Sections
  331  627.730-627.7407 627.730-627.7405 may be cited and known as the
  332  “Florida Motor Vehicle No-Fault Law.”
  333         Section 6. Section 627.731, Florida Statutes, is amended to
  334  read:
  335         627.731 Purpose; legislative intent.—The purpose of the no
  336  fault law ss. 627.730-627.7405 is to provide for medical,
  337  surgical, funeral, and disability insurance benefits without
  338  regard to fault, and to require motor vehicle insurance securing
  339  such benefits, for motor vehicles required to be registered in
  340  this state and, with respect to motor vehicle accidents, a
  341  limitation on the right to claim damages for pain, suffering,
  342  mental anguish, and inconvenience.
  343         (1) The Legislature intends to balance the insured’s
  344  interest in prompt payment of valid claims for insurance
  345  benefits under the no-fault law with the public’s interest in
  346  reducing fraud, abuse, and overuse of the no-fault system. To
  347  that end, the Legislature intends that the investigation and
  348  prevention of fraudulent insurance acts in this state be
  349  enhanced, that additional sanctions for such acts be imposed,
  350  and that the no-fault law be revised to remove incentives for
  351  fraudulent insurance acts. The Legislature intends that the no
  352  fault law be construed according to the plain language of the
  353  statutory provisions, which are designed to meet these goals.
  354         (2) The Legislature finds that:
  355         (a) Automobile insurance fraud remains a major problem for
  356  state consumers and insurers. According to the National
  357  Insurance Crime Bureau, in recent years this state has been
  358  among those states that have the highest number of fraudulent
  359  and questionable claims.
  360         (b) The current regulatory process for health care clinics
  361  under part X of chapter 400, which was originally enacted to
  362  reduce automobile insurance fraud, is not adequately preventing
  363  fraudulent insurance acts with respect to licensure exemptions
  364  and compliance with that part.
  365         (3) The Legislature intends that:
  366         (a) The provisions, schedules, and procedures authorized
  367  under the no-fault law be implemented by the insurers offering
  368  policies pursuant to the no-fault law. These provisions,
  369  schedules, and procedures have full force and effect regardless
  370  of their express inclusion in an insurance policy, and an
  371  insurer is not required to amend its policy to implement and
  372  apply such provisions, schedules, or procedures.
  373         (b) Insurers properly investigate claims, and as such, be
  374  allowed to obtain examinations under oath and sworn statements
  375  from any claimant seeking no-fault insurance benefits, and to
  376  request mental and physical examinations of persons seeking
  377  personal injury protection coverage or benefits.
  378         (c) Any false, misleading, or otherwise fraudulent activity
  379  associated with a claim render the entire claim invalid. An
  380  insurer must be able to raise fraud as a defense to a claim for
  381  no-fault insurance benefits irrespective of any prior
  382  adjudication of guilt or determination of fraud by the
  383  Department of Financial Services.
  384         (d) Insurers toll the payment or denial of a claim, with
  385  respect to any portion of a claim for which the insurer has a
  386  reasonable belief that a fraudulent insurance act, as defined in
  387  s. 626.989, has been committed.
  388         (e) Insurers discover the names of all passengers involved
  389  in an automobile accident before paying claims or benefits
  390  pursuant to an insurance policy governed by the no-fault law. A
  391  rebuttable presumption must be established that a person was not
  392  involved in the event giving rise to the claim if that person’s
  393  name does not appear on the police report.
  394         (f) The insured’s interest in obtaining competent counsel
  395  must be balanced with the public’s interest in preventing a no
  396  fault system that encourages litigation by allowing for
  397  exorbitant attorney’s fees. Courts should limit attorney fee
  398  awards so as to eliminate the incentive for attorneys to
  399  manufacture unnecessary litigation.
  400         Section 7. Section 627.732, Florida Statutes, is reordered
  401  and amended to read:
  402         627.732 Definitions.—As used in the no-fault law ss.
  403  627.730-627.7405, the term:
  404         (1) “Broker” means any person not possessing a license
  405  under chapter 395, chapter 400, chapter 429, chapter 458,
  406  chapter 459, chapter 460, chapter 461, or chapter 641 who
  407  charges or receives compensation for any use of medical
  408  equipment and is not the 100-percent owner or the 100-percent
  409  lessee of such equipment. For purposes of this section, such
  410  owner or lessee may be an individual, a corporation, a
  411  partnership, or any other entity and any of its 100-percent
  412  owned affiliates and subsidiaries. For purposes of this
  413  subsection, the term “lessee” means a long-term lessee under a
  414  capital or operating lease, but does not include a part-time
  415  lessee. The term “broker” does not include a hospital or
  416  physician management company whose medical equipment is
  417  ancillary to the practices managed, a debt collection agency, or
  418  an entity that has contracted with the insurer to obtain a
  419  discounted rate for such services; or nor does the term include
  420  a management company that has contracted to provide general
  421  management services for a licensed physician or health care
  422  facility and whose compensation is not materially affected by
  423  the usage or frequency of usage of medical equipment or an
  424  entity that is 100-percent owned by one or more hospitals or
  425  physicians. The term “broker” does not include a person or
  426  entity that certifies, upon request of an insurer, that:
  427         (a) It is a clinic licensed under ss. 400.990-400.995;
  428         (b) It is a 100-percent owner of medical equipment; and
  429         (c) The owner’s only part-time lease of medical equipment
  430  for personal injury protection patients is on a temporary basis,
  431  not to exceed 30 days in a 12-month period, and such lease is
  432  solely for the purposes of necessary repair or maintenance of
  433  the 100-percent-owned medical equipment or pending the arrival
  434  and installation of the newly purchased or a replacement for the
  435  100-percent-owned medical equipment, or for patients for whom,
  436  because of physical size or claustrophobia, it is determined by
  437  the medical director or clinical director to be medically
  438  necessary that the test be performed in medical equipment that
  439  is open-style. The leased medical equipment may not cannot be
  440  used by patients who are not patients of the registered clinic
  441  for medical treatment of services. Any person or entity making a
  442  false certification under this subsection commits insurance
  443  fraud as defined in s. 817.234. However, the 30-day period
  444  provided in this paragraph may be extended for an additional 60
  445  days as applicable to magnetic resonance imaging equipment if
  446  the owner certifies that the extension otherwise complies with
  447  this paragraph.
  448         (9)(2) “Medically necessary” refers to a medical service or
  449  supply that a prudent physician would provide for the purpose of
  450  preventing, diagnosing, or treating an illness, injury, disease,
  451  or symptom in a manner that is:
  452         (a) In accordance with generally accepted standards of
  453  medical practice;
  454         (b) Clinically appropriate in terms of type, frequency,
  455  extent, site, and duration; and
  456         (c) Not primarily for the convenience of the patient,
  457  physician, or other health care provider.
  458         (10)(3) “Motor vehicle” means a any self-propelled vehicle
  459  with four or more wheels which is of a type both designed and
  460  required to be licensed for use on the highways of this state,
  461  and any trailer or semitrailer designed for use with such
  462  vehicle, and includes:
  463         (a) A “private passenger motor vehicle,” which is any motor
  464  vehicle that which is a sedan, station wagon, or jeep-type
  465  vehicle and, if not used primarily for occupational,
  466  professional, or business purposes, a motor vehicle of the
  467  pickup, panel, van, camper, or motor home type.
  468         (b) A “commercial motor vehicle,” which is any motor
  469  vehicle that which is not a private passenger motor vehicle.
  471  The term “motor vehicle” does not include a mobile home or any
  472  motor vehicle that which is used in mass transit, other than
  473  public school transportation, and designed to transport more
  474  than five passengers exclusive of the operator of the motor
  475  vehicle and that which is owned by a municipality, a transit
  476  authority, or a political subdivision of the state.
  477         (11)(4) “Named insured” means a person, usually the owner
  478  of a vehicle, identified in a policy by name as the insured
  479  under the policy.
  480         (12) “No-fault law” means the Florida Motor Vehicle No
  481  Fault Law codifed at ss. 627.730-627.7407.
  482         (13)(5) “Owner” means a person who holds the legal title to
  483  a motor vehicle; or, if in the event a motor vehicle is the
  484  subject of a security agreement or lease with an option to
  485  purchase with the debtor or lessee having the right to
  486  possession, then the debtor or lessee is shall be deemed the
  487  owner for the purposes of the no-fault law ss. 627.730-627.7405.
  488         (15)(6) “Relative residing in the same household” means a
  489  relative of any degree by blood or by marriage who usually makes
  490  her or his home in the same family unit, whether or not
  491  temporarily living elsewhere.
  492         (2)(7) “Certify” means to swear or attest to being true or
  493  represented in writing.
  494         (3) “Claimant” means the person, organization, or entity
  495  seeking benefits, including all assignees.
  496         (5)(8) “Immediate personal supervision,” as it relates to
  497  the performance of medical services by nonphysicians not in a
  498  hospital, means that an individual licensed to perform the
  499  medical service or provide the medical supplies must be present
  500  within the confines of the physical structure where the medical
  501  services are performed or where the medical supplies are
  502  provided such that the licensed individual can respond
  503  immediately to any emergencies if needed.
  504         (6)(9) “Incident,” with respect to services considered as
  505  incident to a physician’s professional service, for a physician
  506  licensed under chapter 458, chapter 459, chapter 460, or chapter
  507  461, if not furnished in a hospital, means such services that
  508  are must be an integral, even if incidental, part of a covered
  509  physician’s service.
  510         (7)(10) “Knowingly” means that a person, with respect to
  511  information, has actual knowledge of the information,; acts in
  512  deliberate ignorance of the truth or falsity of the
  513  information,; or acts in reckless disregard of the information.,
  514  and Proof of specific intent to defraud is not required.
  515         (8)(11) “Lawful” or “lawfully” means in substantial
  516  compliance with all relevant applicable criminal, civil, and
  517  administrative requirements of state and federal law related to
  518  the provision of medical services or treatment.
  519         (4)(12) “Hospital” means a facility that, at the time
  520  services or treatment were rendered, was licensed under chapter
  521  395.
  522         (14)(13) “Properly completed” means providing truthful,
  523  substantially complete, and substantially accurate responses as
  524  to all material elements of to each applicable request for
  525  information or statement by a means that may lawfully be
  526  provided and that complies with this section, or as agreed by
  527  the parties.
  528         (17)(14) “Upcoding” means submitting an action that submits
  529  a billing code that would result in payment greater in amount
  530  than would be paid using a billing code that accurately
  531  describes the services performed. The term does not include an
  532  otherwise lawful bill by a magnetic resonance imaging facility,
  533  which globally combines both technical and professional
  534  components, if the amount of the global bill is not more than
  535  the components if billed separately; however, payment of such a
  536  bill constitutes payment in full for all components of such
  537  service.
  538         (16)(15) “Unbundling” means submitting an action that
  539  submits a billing code that is properly billed under one billing
  540  code, but that has been separated into two or more billing
  541  codes, and would result in payment greater than the in amount
  542  that than would be paid using one billing code.
  543         Section 8. Subsections (1) and (4) of section 627.736,
  544  Florida Statutes, are amended, subsections (5) through (16) of
  545  that section are redesignated as subsections (6) through (17),
  546  respectively, a new subsection (5) is added to that section,
  547  present subsection (5), paragraph (b) of present subsection (6),
  548  paragraph (b) of present subsection (7), and present subsections
  549  (8), (9), and (10) of that section are amended, to read:
  550         627.736 Required personal injury protection benefits;
  551  exclusions; priority; claims.—
  552         (1) REQUIRED BENEFITS.—Every insurance policy complying
  553  with the security requirements of s. 627.733 must shall provide
  554  personal injury protection to the named insured, relatives
  555  residing in the same household, persons operating the insured
  556  motor vehicle, passengers in such motor vehicle, and other
  557  persons struck by such motor vehicle and suffering bodily injury
  558  while not an occupant of a self-propelled vehicle, subject to
  559  the provisions of subsection (2) and paragraph (4)(g) (4)(e), to
  560  a limit of $10,000 for loss sustained by any such person as a
  561  result of bodily injury, sickness, disease, or death arising out
  562  of the ownership, maintenance, or use of a motor vehicle as
  563  follows:
  564         (a) Medical benefits.—Eighty percent of all reasonable
  565  expenses, charged pursuant to subsection (6), for medically
  566  necessary medical, surgical, X-ray, dental, and rehabilitative
  567  services, including prosthetic devices, and for medically
  568  necessary ambulance, hospital, and nursing services. However,
  569  the medical benefits shall provide reimbursement only for such
  570  services and care that are lawfully provided, supervised,
  571  ordered, or prescribed by a physician licensed under chapter 458
  572  or chapter 459, a dentist licensed under chapter 466, or a
  573  chiropractic physician licensed under chapter 460 or that are
  574  provided by any of the following persons or entities:
  575         1. A hospital or ambulatory surgical center licensed under
  576  chapter 395.
  577         2. A person or entity licensed under part III of chapter
  578  401 which ss. 401.2101-401.45 that provides emergency
  579  transportation and treatment.
  580         3. An entity wholly owned by one or more physicians
  581  licensed under chapter 458 or chapter 459, chiropractic
  582  physicians licensed under chapter 460, or dentists licensed
  583  under chapter 466 or by such practitioner or practitioners and
  584  the spouse, parent, child, or sibling of such that practitioner
  585  or those practitioners.
  586         4. An entity wholly owned, directly or indirectly, by a
  587  hospital or hospitals.
  588         5. A health care clinic licensed under part X of chapter
  589  400 which ss. 400.990-400.995 that is:
  590         a. Accredited by the Joint Commission on Accreditation of
  591  Healthcare Organizations, the American Osteopathic Association,
  592  the Commission on Accreditation of Rehabilitation Facilities, or
  593  the Accreditation Association for Ambulatory Health Care, Inc.;
  594  or
  595         b. A health care clinic that:
  596         (I) Has a medical director licensed under chapter 458,
  597  chapter 459, or chapter 460;
  598         (II) Has been continuously licensed for more than 3 years
  599  or is a publicly traded corporation that issues securities
  600  traded on an exchange registered with the United States
  601  Securities and Exchange Commission as a national securities
  602  exchange; and
  603         (III) Provides at least four of the following medical
  604  specialties:
  605         (A) General medicine.
  606         (B) Radiography.
  607         (C) Orthopedic medicine.
  608         (D) Physical medicine.
  609         (E) Physical therapy.
  610         (F) Physical rehabilitation.
  611         (G) Prescribing or dispensing outpatient prescription
  612  medication.
  613         (H) Laboratory services.
  615  If any services under this paragraph are provided by an entity
  616  or clinic described in subparagraph 3., subparagraph 4., or
  617  subparagraph 5., the entity or clinic must provide the insurer
  618  at the initial submission of the claim with a form adopted by
  619  the Department of Financial Services which documents that the
  620  entity or clinic meets applicable criteria for such entity or
  621  clinic and includes a sworn statement or affidavit to that
  622  effect. Any change in ownership requires the filing of a new
  623  form within 10 days after the date of the change in ownership.
  624  The Financial Services Commission shall adopt by rule the form
  625  that must be used by an insurer and a health care provider
  626  specified in subparagraph 3., subparagraph 4., or subparagraph
  627  5. to document that the health care provider meets the criteria
  628  of this paragraph, which rule must include a requirement for a
  629  sworn statement or affidavit.
  630         (b) Disability benefits.—Sixty percent of any loss of gross
  631  income and loss of earning capacity per individual from
  632  inability to work proximately caused by the injury sustained by
  633  the injured person, plus all expenses reasonably incurred in
  634  obtaining from others ordinary and necessary services in lieu of
  635  those that, but for the injury, the injured person would have
  636  performed without income for the benefit of his or her
  637  household. All disability benefits payable under this provision
  638  must shall be paid at least not less than every 2 weeks.
  639         (c) Death benefits.—Death benefits equal to the lesser of
  640  $5,000 or the remainder of unused personal injury protection
  641  benefits per individual. The insurer may pay such benefits to
  642  the executor or administrator of the deceased, to any of the
  643  deceased’s relatives by blood, or legal adoption, or connection
  644  by marriage, or to any person appearing to the insurer to be
  645  equitably entitled thereto.
  647  Only insurers writing motor vehicle liability insurance in this
  648  state may provide the required benefits of this section, and no
  649  such insurers may not insurer shall require the purchase of any
  650  other motor vehicle coverage other than the purchase of property
  651  damage liability coverage as required by s. 627.7275 as a
  652  condition for providing such required benefits. Insurers may not
  653  require that property damage liability insurance in an amount
  654  greater than $10,000 be purchased in conjunction with personal
  655  injury protection. Such insurers shall make benefits and
  656  required property damage liability insurance coverage available
  657  through normal marketing channels. An Any insurer writing motor
  658  vehicle liability insurance in this state who fails to comply
  659  with such availability requirement as a general business
  660  practice violates shall be deemed to have violated part IX of
  661  chapter 626, and such violation constitutes shall constitute an
  662  unfair method of competition or an unfair or deceptive act or
  663  practice involving the business of insurance. An; and any such
  664  insurer committing such violation is shall be subject to the
  665  penalties afforded in such part, as well as those that are which
  666  may be afforded elsewhere in the insurance code.
  667         (4) BENEFITS; WHEN DUE.—Benefits due from an insurer under
  668  the no-fault law are ss. 627.730-627.7405 shall be primary,
  669  except that benefits received under any workers’ compensation
  670  law shall be credited against the benefits provided by
  671  subsection (1) and are shall be due and payable as loss accrues,
  672  upon the receipt of reasonable proof of such loss and the amount
  673  of expenses and loss incurred which are covered by the policy
  674  issued under the no-fault law ss. 627.730-627.7405. If When the
  675  Agency for Health Care Administration provides, pays, or becomes
  676  liable for medical assistance under the Medicaid program related
  677  to injury, sickness, disease, or death arising out of the
  678  ownership, maintenance, or use of a motor vehicle, the benefits
  679  are under ss. 627.730-627.7405 shall be subject to the
  680  provisions of the Medicaid program.
  681         (a) An insurer may require written notice to be given as
  682  soon as practicable after an accident involving a motor vehicle
  683  with respect to which the policy affords the security required
  684  by the no-fault law ss. 627.730-627.7405.
  685         (b) Personal injury protection insurance benefits paid
  686  pursuant to this section are shall be overdue if not paid within
  687  30 days after the insurer is furnished written notice of the
  688  fact of a covered loss and of the amount of same. If such
  689  written notice is not furnished to the insurer as to the entire
  690  claim, any partial amount supported by written notice is overdue
  691  if not paid within 30 days after such written notice is
  692  furnished to the insurer. Any part or all of the remainder of
  693  the claim that is subsequently supported by written notice is
  694  overdue if not paid within 30 days after such written notice is
  695  furnished to the insurer.
  696         (c) If When an insurer pays only a portion of a claim or
  697  rejects a claim, the insurer shall provide at the time of the
  698  partial payment or rejection an itemized specification of each
  699  item that the insurer had reduced, omitted, or declined to pay
  700  and any information that the insurer desires the claimant to
  701  consider related to the medical necessity of the denied
  702  treatment or to explain the reasonableness of the reduced
  703  charge, provided that this does shall not limit the introduction
  704  of evidence at trial.; and The insurer must shall include the
  705  name and address of the person to whom the claimant should
  706  respond and a claim number to be referenced in future
  707  correspondence. An insurer’s failure to send an itemized
  708  specification or explanation of benefits does not waive any
  709  ground for rejecting an invalid claim.
  710         (d)A However, notwithstanding the fact that written notice
  711  has been furnished to the insurer, Any payment is shall not be
  712  deemed overdue if when the insurer has reasonable proof to
  713  establish that the insurer is not responsible for the payment.
  714  An insurer may define “reasonable proof” in its policy and may
  715  request information that will aid it in its investigation of a
  716  claim. An insurer may obtain evidence and assert any ground for
  717  adjustment or rejection of a For the purpose of calculating the
  718  extent to which any benefits are overdue, payment shall be
  719  treated as being made on the date a draft or other valid
  720  instrument which is equivalent to payment was placed in the
  721  United States mail in a properly addressed, postpaid envelope
  722  or, if not so posted, on the date of delivery. This paragraph
  723  does not preclude or limit the ability of the insurer to assert
  724  that the claim that is was unrelated, was not medically
  725  necessary, or was unreasonable, or submitted that the amount of
  726  the charge was in excess of that permitted under, or in
  727  violation of, subsection (6) (5). Such assertion by the insurer
  728  may be made at any time, including after payment of the claim,
  729  or after the 30-day time period for payment set forth in this
  730  paragraph (b), or after the filing of a lawsuit. The 30-day
  731  period for payment is tolled while the insurer investigates a
  732  fraudulent insurance act, as defined in s. 626.989, with respect
  733  to any portion of a claim for which the insurer has a reasonable
  734  belief that a fraudulent insurance act has been committed. The
  735  insurer must notify the claimant in writing that it is
  736  investigating a fraudulent insurance act within 30 days after
  737  the date it has a reasonable belief that such act has been
  738  committed. The insurer must pay or deny the claim, in full or in
  739  part, within 120 days after the date the written notice of the
  740  fact of a covered loss and of the amount of the loss was
  741  provided to the insurer.
  742         (e)(c) Upon receiving notice of an accident that is
  743  potentially covered by personal injury protection benefits, the
  744  insurer must reserve $5,000 of personal injury protection
  745  benefits for payment to physicians licensed under chapter 458 or
  746  chapter 459 or dentists licensed under chapter 466 who provide
  747  emergency services and care, as defined in s. 395.002(9), or who
  748  provide hospital inpatient care. The amount required to be held
  749  in reserve may be used only to pay claims from such physicians
  750  or dentists until 30 days after the date the insurer receives
  751  notice of the accident. After the 30-day period, any amount of
  752  the reserve for which the insurer has not received notice of
  753  such a claim from a physician or dentist who provided emergency
  754  services and care or who provided hospital inpatient care may
  755  then be used by the insurer to pay other claims. The time
  756  periods specified in paragraph (b) for required payment of
  757  personal injury protection benefits are shall be tolled for the
  758  period of time that an insurer is required by this paragraph to
  759  hold payment of a claim that is not from a physician or dentist
  760  who provided emergency services and care or who provided
  761  hospital inpatient care to the extent that the personal injury
  762  protection benefits not held in reserve are insufficient to pay
  763  the claim. This paragraph does not require an insurer to
  764  establish a claim reserve for insurance accounting purposes.
  765         (f)(d) All overdue payments shall bear simple interest at
  766  the rate established under s. 55.03 or the rate established in
  767  the insurance contract, whichever is greater, for the year in
  768  which the payment became overdue, calculated from the date the
  769  insurer was furnished with written notice of the amount of
  770  covered loss. Interest is shall be due at the time payment of
  771  the overdue claim is made.
  772         (g)(e) The insurer of the owner of a motor vehicle shall
  773  pay personal injury protection benefits for:
  774         1. Accidental bodily injury sustained in this state by the
  775  owner while occupying a motor vehicle, or while not an occupant
  776  of a self-propelled vehicle if the injury is caused by physical
  777  contact with a motor vehicle.
  778         2. Accidental bodily injury sustained outside this state,
  779  but within the United States of America or its territories or
  780  possessions or Canada, by the owner while occupying the owner’s
  781  motor vehicle.
  782         3. Accidental bodily injury sustained by a relative of the
  783  owner residing in the same household, under the circumstances
  784  described in subparagraph 1. or subparagraph 2. if, provided the
  785  relative at the time of the accident is domiciled in the owner’s
  786  household and is not himself or herself the owner of a motor
  787  vehicle with respect to which security is required under the no
  788  fault law ss. 627.730-627.7405.
  789         4. Accidental bodily injury sustained in this state by any
  790  other person while occupying the owner’s motor vehicle or, if a
  791  resident of this state, while not an occupant of a self
  792  propelled vehicle, if the injury is caused by physical contact
  793  with such motor vehicle if, provided the injured person is not
  794  himself or herself:
  795         a. The owner of a motor vehicle with respect to which
  796  security is required under the no-fault law ss. 627.730
  797  627.7405; or
  798         b. Entitled to personal injury benefits from the insurer of
  799  the owner or owners of such a motor vehicle.
  800         (h)(f) If two or more insurers are liable to pay personal
  801  injury protection benefits for the same injury to any one
  802  person, the maximum payable is shall be as specified in
  803  subsection (1), and any insurer paying the benefits is shall be
  804  entitled to recover from each of the other insurers an equitable
  805  pro rata share of the benefits paid and expenses incurred in
  806  processing the claim.
  807         (i)(g) It is a violation of the insurance code for an
  808  insurer to fail to timely provide benefits as required by this
  809  section with such frequency as to constitute a general business
  810  practice.
  811         (j)(h) Benefits are shall not be due or payable to or on
  812  the behalf of an insured, claimant, medical provider, or
  813  attorney who: person if that person has
  814         1. Submits a false or misleading statement, document,
  815  record, or bill;
  816         2. Submits false or misleading information; or
  817         3. Has otherwise committed or attempted to commit a
  818  fraudulent insurance act as defined in s. 626.989.
  820  A claimant that violates this paragraph is not entitled to any
  821  personal injury protection benefits or payment for any bills and
  822  services, regardless of whether a portion of the claim may be
  823  legitimate.
  824         (k) Notwithstanding any remedies afforded by law, the
  825  insurer may recover from a claimant that has violated paragraph
  826  (j) any sums previously paid to the claimant and may bring any
  827  available common law and statutory causes of action. An insured,
  828  claimant, medical provider, or attorney has committed, by a
  829  material act or omission, any insurance fraud relating to
  830  personal injury protection coverage under his or her policy or a
  831  claim for attorney’s fees, if the fraud is admitted to in a
  832  sworn statement by the insured or if it is established in a
  833  court of competent jurisdiction. Any insurance fraud voids shall
  834  void all coverage arising from the claim and all claims for
  835  attorney’s fees related to such fraud under the personal injury
  836  protection coverage of the insured person who committed the
  837  fraud, irrespective of whether a portion of the insured person’s
  838  claim may be legitimate, and any benefits or attorney’s fees
  839  paid before prior to the discovery of the insured person’s
  840  insurance fraud is shall be recoverable by the insurer from the
  841  person who committed insurance fraud in their entirety. The
  842  prevailing party is entitled to its costs and attorney’s fees in
  843  any action in which it prevails in an insurer’s action to
  844  enforce its right of recovery under this paragraph. This
  845  paragraph does not preclude or limit an insurer’s right to deny
  846  a claim based on other evidence of fraud or affect an insurer’s
  847  right to plead and prove a claim or defense of fraud under
  848  common law. If a physician, hospital, clinic, or other medical
  849  institution violates paragraph (j), the injured party is not
  850  liable for, and the physician, hospital, clinic, or other
  851  medical institution may not bill the insured for, charges that
  852  are unpaid because of failure to comply with paragraph (j). Any
  853  agreement requiring the injured person or insured to pay for
  854  such charges is unenforceable.
  855         (5) INSURER INVESTIGATIONS.—An insurer has the right and
  856  duty to conduct a reasonable investigation of a claim. In the
  857  course of the insurer’s investigation of a claim:
  858         (a) The insurer may require the insured, claimant, or
  859  medical provider to provide copies of the treatment and
  860  examination records so that the insurer can provide such records
  861  to a physician for a records review. A records review need not
  862  be based on a physical examination and may be obtained at any
  863  time, including after reduction or denial of the claim. The 30
  864  day period for payment under paragraph (4)(b) is tolled from the
  865  date the insurer sends its request for treatment records to the
  866  date that the insurer receives the treatment records. The claim
  867  may be denied or reduced if the medical provider fails to keep
  868  adequate records such that the insurer is unable to obtain a
  869  records review.
  870         (b) An insurer’s choice of physician is not limited by the
  871  physician’s area of practice or licensing chapter.
  872         (c) An insurer may deny benefits if the insured, claimant,
  873  or medical provider fails to comply with this subsection.
  874         (d) An insurer may deny benefits if the insured, claimant,
  875  or medical provider fails to cooperate in the insurer’s
  876  investigation.
  877         (e) An insurer may deny benefits if the insured, claimant,
  878  or medical provider commits a fraud or material
  879  misrepresentation.
  880         (f) The claimant may not file suit unless and until it
  881  complies with this subsection.
  883         (a)1. Any physician, hospital, clinic, or other person or
  884  institution lawfully rendering treatment to an injured person
  885  for a bodily injury covered by personal injury protection
  886  insurance may charge the insurer and injured party only a
  887  reasonable amount pursuant to this section for the services and
  888  supplies rendered, and the insurer providing such coverage may
  889  pay for such charges directly to such person or institution
  890  lawfully rendering such treatment, if the insured receiving such
  891  treatment or his or her guardian has countersigned the properly
  892  completed invoice, bill, or claim form approved by the office
  893  upon which such charges are to be paid for as having actually
  894  been rendered, to the best knowledge of the insured or his or
  895  her guardian. In no event, However, may such a charge may not
  896  exceed be in excess of the amount the person or institution
  897  customarily charges for like services or supplies. When
  898  determining With respect to a determination of whether a charge
  899  for a particular service, treatment, or otherwise is reasonable,
  900  consideration may be given to evidence of usual and customary
  901  charges and payments accepted by the provider involved in the
  902  dispute, and reimbursement levels in the community and various
  903  federal and state medical fee schedules applicable to automobile
  904  and other insurance coverages, and other information relevant to
  905  the reasonableness of the reimbursement for the service,
  906  treatment, or supply.
  907         1.2. The insurer may limit reimbursement to 80 percent of
  908  the following schedule of maximum charges:
  909         a. For emergency transport and treatment by providers
  910  licensed under chapter 401, 200 percent of Medicare.
  911         b. For emergency services and care provided by a hospital
  912  licensed under chapter 395, 75 percent of the hospital’s usual
  913  and customary charges.
  914         c. For emergency services and care as defined by s.
  915  395.002(9) provided in a facility licensed under chapter 395
  916  rendered by a physician or dentist, and related hospital
  917  inpatient services rendered by a physician or dentist, the usual
  918  and customary charges in the community.
  919         d. For hospital inpatient services, other than emergency
  920  services and care, 200 percent of the Medicare Part A
  921  prospective payment applicable to the specific hospital
  922  providing the inpatient services.
  923         e. For hospital outpatient services, other than emergency
  924  services and care, 200 percent of the Medicare Part A Ambulatory
  925  Payment Classification for the specific hospital providing the
  926  outpatient services.
  927         f. For all other medical services, supplies, and care, 200
  928  percent of the allowable amount under the participating
  929  physicians schedule of Medicare Part B. However, if such
  930  services, supplies, or care is not reimbursable under Medicare
  931  Part B, the insurer may limit reimbursement to 80 percent of the
  932  maximum reimbursable allowance under workers’ compensation, as
  933  determined under s. 440.13 and rules adopted thereunder which
  934  are in effect at the time such services, supplies, or care is
  935  provided. Services, supplies, or care that is not reimbursable
  936  under Medicare or workers’ compensation is not required to be
  937  reimbursed by the insurer.
  938         2.3. For purposes of subparagraph 1. 2., the applicable fee
  939  schedule or payment limitation under Medicare is the fee
  940  schedule or payment limitation in effect on January 1 of the
  941  year in which at the time the services, supplies, or care was
  942  rendered and for the area in which such services were rendered,
  943  notwithstanding any subsequent changes made to such fee schedule
  944  or payment limitation, except that it may not be less than the
  945  allowable amount under the participating physicians schedule of
  946  Medicare Part B for 2007 for medical services, supplies, and
  947  care subject to Medicare Part B.
  948         3.4. Subparagraph 1. 2. does not allow the insurer to apply
  949  any limitation on the number of treatments or other utilization
  950  limits that apply under Medicare or workers’ compensation. An
  951  insurer that applies the allowable payment limitations of
  952  subparagraph 1. 2. must reimburse a provider who lawfully
  953  provided care or treatment under the scope of his or her
  954  license, regardless of whether such provider is would be
  955  entitled to reimbursement under Medicare due to restrictions or
  956  limitations on the types or discipline of health care providers
  957  who may be reimbursed for particular procedures or procedure
  958  codes.
  959         4.5. If an insurer limits payment as authorized by
  960  subparagraph 1. 2., the person providing such services,
  961  supplies, or care may not bill or attempt to collect from the
  962  insured any amount in excess of such limits, except for amounts
  963  that are not covered by the insured’s personal injury protection
  964  coverage due to the coinsurance amount or maximum policy limits.
  965         (b)1. An insurer or insured is not required to pay a claim
  966  or charges:
  967         a. Made by a broker or by a person making a claim on behalf
  968  of a broker;
  969         b. For any service or treatment that was not lawful at the
  970  time rendered;
  971         c. To any person who knowingly submits a false or
  972  misleading statement relating to the claim or charges;
  973         d. With respect to a bill or statement that does not
  974  substantially meet the applicable requirements of paragraphs
  975  (c), paragraph (d), and (e);
  976         e. If the insured has not countersigned the billing forms
  977  and patient logs. As used in this sub-subparagraph, the term
  978  “countersigned” means a second or verifying signature, as on a
  979  previously signed document, and is not satisfied by the
  980  statement “signature on file” or any similar statement;
  981         f.e. For any treatment or service that is upcoded, or that
  982  is unbundled if when such treatment or services should be
  983  bundled, in accordance with paragraph (d). To facilitate prompt
  984  payment of lawful services, an insurer may change codes that it
  985  determines to have been improperly or incorrectly upcoded or
  986  unbundled, and may make payment based on the changed codes,
  987  without affecting the right of the provider to dispute the
  988  change by the insurer if, provided that before doing so, the
  989  insurer contacts must contact the health care provider and
  990  discusses discuss the reasons for the insurer’s change and the
  991  health care provider’s reason for the coding, or makes make a
  992  reasonable good faith effort to do so, as documented in the
  993  insurer’s file; and
  994         g.f. For medical services or treatment billed by a
  995  physician and not provided in a hospital unless such services
  996  are rendered by the physician or are incident to his or her
  997  professional services and are included on the physician’s bill,
  998  including documentation verifying that the physician is
  999  responsible for the medical services that were rendered and
 1000  billed.
 1001         2. The Department of Health, in consultation with the
 1002  appropriate professional licensing boards, shall adopt, by rule,
 1003  a list of diagnostic tests deemed not to be medically necessary
 1004  for use in the treatment of persons sustaining bodily injury
 1005  covered by personal injury protection benefits under this
 1006  section. The initial list shall be adopted by January 1, 2004,
 1007  and shall be revised from time to time as determined by the
 1008  Department of Health, in consultation with the respective
 1009  professional licensing boards. Inclusion of a test on the list
 1010  must of invalid diagnostic tests shall be based on lack of
 1011  demonstrated medical value and a level of general acceptance by
 1012  the relevant provider community and may shall not be dependent
 1013  for results entirely upon subjective patient response.
 1014  Notwithstanding its inclusion on a fee schedule in this
 1015  subsection, an insurer or insured is not required to pay any
 1016  charges or reimburse claims for any invalid diagnostic test as
 1017  determined by the Department of Health.
 1018         (c)1. With respect to any treatment or service, other than
 1019  medical services billed by a hospital or other provider for
 1020  emergency services as defined in s. 395.002 or inpatient
 1021  services rendered at a hospital-owned facility, the statement of
 1022  charges must be furnished to the insurer by the provider and may
 1023  not include, and the insurer is not required to pay, charges for
 1024  treatment or services rendered more than 35 days before the
 1025  postmark date or electronic transmission date of the statement,
 1026  except for past due amounts previously billed on a timely basis
 1027  under this paragraph, and except that, if the provider submits
 1028  to the insurer a notice of initiation of treatment within 21
 1029  days after its first examination or treatment of the claimant,
 1030  the statement may include charges for treatment or services
 1031  rendered up to, but not more than, 75 days before the postmark
 1032  date of the statement. The injured party is not liable for, and
 1033  the provider may shall not bill the injured party for, charges
 1034  that are unpaid because of the provider’s failure to comply with
 1035  this paragraph. Any agreement requiring the injured person or
 1036  insured to pay for such charges is unenforceable.
 1037         1.2. If, however, the insured fails to furnish the provider
 1038  with the correct name and address of the insured’s personal
 1039  injury protection insurer, the provider has 35 days from the
 1040  date the provider obtains the correct information to furnish the
 1041  insurer with a statement of the charges. The insurer is not
 1042  required to pay for such charges unless the provider includes
 1043  with the statement documentary evidence that was provided by the
 1044  insured during the 35-day period demonstrating that the provider
 1045  reasonably relied on erroneous information from the insured and
 1046  either:
 1047         a. A denial letter from the incorrect insurer; or
 1048         b. Proof of mailing, which may include an affidavit under
 1049  penalty of perjury, reflecting timely mailing to the incorrect
 1050  address or insurer.
 1051         2.3. For emergency services and care as defined in s.
 1052  395.002 rendered in a hospital emergency department or for
 1053  transport and treatment rendered by an ambulance provider
 1054  licensed pursuant to part III of chapter 401, the provider is
 1055  not required to furnish the statement of charges within the time
 1056  periods established by this paragraph,; and the insurer is shall
 1057  not be considered to have been furnished with notice of the
 1058  amount of covered loss for purposes of paragraph (4)(b) until it
 1059  receives a statement complying with paragraph (d), or copy
 1060  thereof, which specifically identifies the place of service to
 1061  be a hospital emergency department or an ambulance in accordance
 1062  with billing standards recognized by the Centers for Medicare
 1063  and Medicaid Services Health Care Finance Administration.
 1064         3.4. Each notice of the insured’s rights under s. 627.7401
 1065  must include the following statement in type no smaller than 12
 1066  points:
 1068         BILLING REQUIREMENTS.—Florida Statutes provide that
 1069         with respect to any treatment or services, other than
 1070         certain hospital and emergency services, the statement
 1071         of charges furnished to the insurer by the provider
 1072         may not include, and the insurer and the injured party
 1073         are not required to pay, charges for treatment or
 1074         services rendered more than 35 days before the
 1075         postmark date of the statement, except for past due
 1076         amounts previously billed on a timely basis, and
 1077         except that, if the provider submits to the insurer a
 1078         notice of initiation of treatment within 21 days after
 1079         its first examination or treatment of the claimant,
 1080         the first billing cycle statement may include charges
 1081         for treatment or services rendered up to, but not more
 1082         than, 75 days before the postmark date of the
 1083         statement.
 1085         (d) All statements and bills for medical services rendered
 1086  by any physician, hospital, clinic, or other person or
 1087  institution shall be submitted to the insurer on a properly
 1088  completed Centers for Medicare and Medicaid Services (CMS) 1500
 1089  form, UB 92 forms, or any other standard form approved by the
 1090  office or adopted by the commission for purposes of this
 1091  paragraph. All billings for such services rendered by providers
 1092  must shall, to the extent applicable, follow the Physicians’
 1093  Current Procedural Terminology (CPT) or Healthcare Correct
 1094  Procedural Coding System (HCPCS), or ICD-9 in effect for the
 1095  year in which services are rendered and comply with the Centers
 1096  for Medicare and Medicaid Services (CMS) 1500 form instructions
 1097  and the American Medical Association Current Procedural
 1098  Terminology (CPT) Editorial Panel and Healthcare Correct
 1099  Procedural Coding System (HCPCS). All providers other than
 1100  hospitals shall include on the applicable claim form the
 1101  professional license number of the provider in the line or space
 1102  provided for “Signature of Physician or Supplier, Including
 1103  Degrees or Credentials.” In determining compliance with
 1104  applicable CPT and HCPCS coding, guidance shall be provided by
 1105  the Physicians’ Current Procedural Terminology (CPT) or the
 1106  Healthcare Correct Procedural Coding System (HCPCS) in effect
 1107  for the year in which services were rendered, the Office of the
 1108  Inspector General (OIG), Physicians Compliance Guidelines, and
 1109  other authoritative treatises designated by rule by the Agency
 1110  for Health Care Administration. A No statement of medical
 1111  services may not include charges for medical services of a
 1112  person or entity that performed such services without possessing
 1113  the valid licenses required to perform such services. For
 1114  purposes of paragraph (4)(b), an insurer is shall not be
 1115  considered to have been furnished with notice of the amount of
 1116  covered loss or medical bills due unless the statements or bills
 1117  are submitted on an approved form, follow the foregoing coding
 1118  requirements, and contain the professional license number of the
 1119  provider. The remaining portions of the statements and bills
 1120  must be comply with this paragraph, and unless the statements or
 1121  bills are properly completed in their entirety as to all
 1122  material provisions, with all relevant information being
 1123  provided therein.
 1124         (e)1. At the initial treatment or service provided, each
 1125  physician, other licensed professional, clinic, or other medical
 1126  institution providing medical services upon which a claim for
 1127  personal injury protection benefits is based shall require an
 1128  insured person, or his or her guardian, to execute a disclosure
 1129  and acknowledgment form, which reflects at a minimum that:
 1130         a. The insured, or his or her guardian, must countersign
 1131  the form attesting to the fact that the services set forth
 1132  therein were actually rendered. The services shall be described
 1133  and listed on the disclosure and acknowledgement form in words
 1134  readable by the insured. If the insured cannot read, the
 1135  provider should verify, under penalty of perjury, that the
 1136  services listed on the form were verbally explained to the
 1137  insured before the insured signs the form. Listing CPT codes or
 1138  other coding on the disclosure and acknowledgment form does not
 1139  satisfy this requirement;
 1140         b. The insured, or his or her guardian, has both the right
 1141  and affirmative duty to confirm that the services were actually
 1142  rendered;
 1143         c. The insured, or his or her guardian, was not solicited
 1144  by any person to seek any services from the medical provider;
 1145         d. The physician, other licensed professional, clinic, or
 1146  other medical institution rendering services for which payment
 1147  is being claimed explained the services to the insured or his or
 1148  her guardian; and
 1149         e. If the insured notifies the insurer in writing of a
 1150  billing error, the insured may be entitled to a certain
 1151  percentage of a reduction in the amounts paid by the insured’s
 1152  motor vehicle insurer.
 1153         2. The physician, other licensed professional, clinic, or
 1154  other medical institution rendering services for which payment
 1155  is being claimed has the affirmative duty to explain the
 1156  services rendered to the insured, or his or her guardian, so
 1157  that the insured, or his or her guardian, countersigns the form
 1158  with informed consent.
 1159         3. Countersignature by the insured, or his or her guardian,
 1160  is not required for the reading of diagnostic tests or other
 1161  services that are of such a nature that they are not required to
 1162  be performed in the presence of the insured.
 1163         4. The licensed medical professional rendering treatment
 1164  for which payment is being claimed must sign, by his or her own
 1165  hand, the form complying with this paragraph.
 1166         5. An insurer is not considered to have been furnished with
 1167  notice of the amount of a covered loss or medical bills unless
 1168  the original completed disclosure and acknowledgment form is
 1169  shall be furnished to the insurer pursuant to paragraph (4)(b)
 1170  and sub-subparagraph 1.e. The disclosure and acknowledgement
 1171  form may not be electronically furnished. A disclosure and
 1172  acknowledgement form that does not meet the minimum requirements
 1173  of sub-subparagraph 1.a. does not provide an insurer with notice
 1174  of the amount of a covered loss or medical bills due.
 1175         6. This disclosure and acknowledgment form is not required
 1176  for services billed by a provider for emergency services as
 1177  defined in s. 395.002, for emergency services and care as
 1178  defined in s. 395.002 rendered in a hospital emergency
 1179  department, or for transport and treatment rendered by an
 1180  ambulance provider licensed pursuant to part III of chapter 401.
 1181         7. The Financial Services Commission shall adopt, by rule,
 1182  a standard disclosure and acknowledgment form to that shall be
 1183  used to fulfill the requirements of this paragraph, effective 90
 1184  days after such form is adopted and becomes final. The
 1185  commission shall adopt a proposed rule by October 1, 2003. Until
 1186  the rule is final, the provider may use a form of its own which
 1187  otherwise complies with the requirements of this paragraph.
 1188         8. As used in this paragraph, the term “countersigned” or
 1189  “countersignature” means a second or verifying signature, as on
 1190  a previously signed document, and is not satisfied by the
 1191  statement “signature on file” or any similar statement.
 1192         9. The requirements of this paragraph apply only with
 1193  respect to the initial treatment or service of the insured by a
 1194  provider. For subsequent treatments or service, the provider
 1195  must maintain a patient log signed by the patient, in
 1196  chronological order by date of service, which describes the
 1197  treatment rendered in a language readable by the insured that is
 1198  consistent with the services being rendered to the patient as
 1199  claimed. Listing CPT codes or other coding on the patient log
 1200  does not satisfy this requirement. The provider must provide
 1201  copies of the patient log to the insurer within 30 days after
 1202  receiving a written request from the insurer. Failure to
 1203  maintain a patient log renders the treatment unlawful and
 1204  noncompensable. The requirements of this subparagraph for
 1205  maintaining a patient log signed by the patient may be met by a
 1206  hospital that maintains medical records as required by s.
 1207  395.3025 and applicable rules and makes such records available
 1208  to the insurer upon request.
 1209         (f) Upon written notification by any person, an insurer
 1210  shall investigate any claim of improper billing by a physician
 1211  or other medical provider. The insurer shall determine if the
 1212  insured was properly billed for only those services and
 1213  treatments that the insured actually received. If the insurer
 1214  determines that the insured has been improperly billed, the
 1215  insurer shall notify the insured, the person making the written
 1216  notification, and the provider of its findings and shall reduce
 1217  the amount of payment to the provider by the amount determined
 1218  to be improperly billed. If a reduction is made due to such
 1219  written notification by any person, the insurer shall pay to the
 1220  person 20 percent of the amount of the reduction, up to $500. If
 1221  the provider is arrested due to the improper billing, then the
 1222  insurer shall pay to the person 40 percent of the amount of the
 1223  reduction, up to $500.
 1224         (g) An insurer may not systematically downcode with the
 1225  intent to deny reimbursement otherwise due. Such action
 1226  constitutes a material misrepresentation under s.
 1227  626.9541(1)(i)2.
 1229  DISPUTES.—
 1230         (b) Every physician, hospital, clinic, or other medical
 1231  institution providing, before or after bodily injury upon which
 1232  a claim for personal injury protection insurance benefits is
 1233  based, any products, services, or accommodations in relation to
 1234  that or any other injury, or in relation to a condition claimed
 1235  to be connected with that or any other injury, shall, if
 1236  requested to do so by the insurer against whom the claim has
 1237  been made, permit the insurer or the insurer’s representative to
 1238  conduct an onsite physical review and examination of the
 1239  treatment location, treatment apparatuses, diagnostic devices,
 1240  and any other medical equipment used for the services rendered
 1241  within 10 days after the insurer’s request, and furnish
 1242  forthwith a written report of the history, condition, treatment,
 1243  dates, and costs of such treatment of the injured person and why
 1244  the items identified by the insurer were reasonable in amount
 1245  and medically necessary, together with a sworn statement that
 1246  the treatment or services rendered were reasonable and necessary
 1247  with respect to the bodily injury sustained and identifying
 1248  which portion of the expenses for such treatment or services was
 1249  incurred as a result of such bodily injury, and produce
 1250  forthwith, and permit the inspection and copying of, his or her
 1251  or its records regarding such history, condition, treatment,
 1252  dates, and costs of treatment if; provided that this does shall
 1253  not limit the introduction of evidence at trial. Such sworn
 1254  statement must shall read as follows: “Under penalty of perjury,
 1255  I declare that I have read the foregoing, and the facts alleged
 1256  are true, to the best of my knowledge and belief.” A No cause of
 1257  action for violation of the physician-patient privilege or
 1258  invasion of the right of privacy may not be brought shall be
 1259  permitted against any physician, hospital, clinic, or other
 1260  medical institution complying with the provisions of this
 1261  section. The person requesting such records and such sworn
 1262  statement shall pay all reasonable costs connected therewith. If
 1263  an insurer makes a written request for documentation or
 1264  information under this paragraph within 30 days after having
 1265  received notice of the amount of a covered loss under paragraph
 1266  (4)(a), the amount or the partial amount that which is the
 1267  subject of the insurer’s inquiry is shall become overdue if the
 1268  insurer does not pay in accordance with paragraph (4)(b) or
 1269  within 10 days after the insurer’s receipt of the requested
 1270  documentation or information, whichever occurs later. For
 1271  purposes of this paragraph, the term “receipt” includes, but is
 1272  not limited to, inspection and copying pursuant to this
 1273  paragraph. An Any insurer that requests documentation or
 1274  information pertaining to reasonableness of charges or medical
 1275  necessity under this paragraph without a reasonable basis for
 1276  such requests as a general business practice is engaging in an
 1277  unfair trade practice under the insurance code. If an insured
 1278  seeking to recover benefits pursuant to the no-fault law assigns
 1279  the contractual right to those benefits or payment to any person
 1280  or entity, the assignee must comply with the terms of the
 1281  policy, and both the insured and the assignee are obligated to
 1282  cooperate under the policy, including, but not limited to,
 1283  submitting to examinations under oath. Compliance with this
 1284  paragraph is a condition precedent to recovery of benefits
 1285  pursuant to the no-fault law. If an insurer requests an
 1286  examination under oath of a medical provider, the provider must
 1287  produce the persons having the most knowledge of the issues
 1288  identified by the insurer in the request for examination. All
 1289  claimants must produce and provide for inspection all documents
 1290  requested by the insurer which are reasonably obtainable by the
 1291  claimants. Examinations under oath may be recorded by audio,
 1292  video, court reporter, or any combination thereof. An insurer
 1293  that, as a general practice, requests examinations under oath
 1294  without a reasonable basis is engaging in an unfair and
 1295  deceptive trade practice.
 1297  REPORTS.—
 1298         (b) If requested by the person examined, a party causing an
 1299  examination to be made shall deliver to him or her a copy of
 1300  every written report concerning the examination rendered by an
 1301  examining physician, at least one of which reports must set out
 1302  the examining physician’s findings and conclusions in detail.
 1303  After such request and delivery, the party causing the
 1304  examination to be made is entitled, upon request, to receive
 1305  from the person examined every written report available to him
 1306  or her or his or her representative concerning any examination,
 1307  previously or thereafter made, of the same mental or physical
 1308  condition. By requesting and obtaining a report of the
 1309  examination so ordered, or by taking the deposition of the
 1310  examiner, the person examined waives any privilege he or she may
 1311  have, in relation to the claim for benefits, regarding the
 1312  testimony of every other person who has examined, or may
 1313  thereafter examine, him or her in respect to the same mental or
 1314  physical condition. If a person unreasonably refuses to submit
 1315  to an examination, the personal injury protection carrier is no
 1316  longer liable for subsequent personal injury protection benefits
 1317  incurred after the date of the first request for examination.
 1318  Failure to appear for an examination raises a rebuttable
 1319  presumption that such failure was unreasonable. Submission to an
 1320  examination is a condition precedent to the recovery of
 1321  benefits.
 1323  FEES.—With respect to any dispute under the provisions of ss.
 1324  627.730-627.7405 between the insured and the insurer under the
 1325  no-fault law, or between an assignee of an insured’s rights and
 1326  the insurer, the provisions of s. 627.428 shall apply, except as
 1327  provided in subsections (11) and (16) (10) and (15).
 1328         (10)(9)PREFERRED PROVIDERS.—An insurer may negotiate and
 1329  enter into contracts with preferred licensed health care
 1330  providers for the benefits described in this section, referred
 1331  to in this section as “preferred providers,” which include shall
 1332  include health care providers licensed under chapter chapters
 1333  458, chapter 459, chapter 460, chapter 461, or chapter and 463.
 1334         (a) The insurer may provide an option to an insured to use
 1335  a preferred provider at the time of purchase of the policy for
 1336  personal injury protection benefits, if the requirements of this
 1337  subsection are met. However, if the insurer offers a preferred
 1338  provider option, it must also offer a nonpreferred provider
 1339  policy. If the insured elects to use a provider who is not a
 1340  preferred provider, whether the insured purchased a preferred
 1341  provider policy or a nonpreferred provider policy, the medical
 1342  benefits provided by the insurer shall be as required by this
 1343  section.
 1344         (b) If the insured elects the to use a provider who is a
 1345  preferred provider option, the insurer may pay medical benefits
 1346  in excess of the benefits required by this section and may waive
 1347  or lower the amount of any deductible that applies to such
 1348  medical benefits. As an alternative, or in addition to such
 1349  benefits, waiver, or reduction, the insurer may provide an
 1350  actuarially appropriate premium discount as specified in an
 1351  approved rate filing to an insured who selects the preferred
 1352  provider option. If the preferred provider option provides a
 1353  premium discount, the policy may provide that charges for
 1354  nonemergency services provided within this state are payable
 1355  only if performed by members of the preferred provider network
 1356  unless there is no member of the preferred provider network
 1357  located within 15 miles of the insured’s place of residence
 1358  whose scope of practice includes the required services. If the
 1359  insurer offers a preferred provider policy to a policyholder or
 1360  applicant, it must also offer a nonpreferred provider policy.
 1361         (c) The insurer shall provide each insured policyholder
 1362  with a current roster of preferred providers in the county in
 1363  which the insured resides at the time of purchasing purchase of
 1364  such policy, and shall make such list available for public
 1365  inspection during regular business hours at the insurer’s
 1366  principal office of the insurer within the state. The insurer
 1367  may contract with a health insurer for the right to use an
 1368  existing preferred provider network to implement the preferred
 1369  provider option. Any other arrangement is subject to the
 1370  approval of the Office of Insurance Regulation.
 1371         (11)(10) DEMAND LETTER.—
 1372         (a) As a condition precedent to filing any action for
 1373  benefits under this section, the claimant filing suit must
 1374  provide the insurer must be provided with written notice of an
 1375  intent to initiate litigation. Such notice may not be sent until
 1376  the claim is overdue, including any additional time the insurer
 1377  has to pay the claim pursuant to paragraph (4)(b). A premature
 1378  demand letter is defective and cannot be cured unless the court
 1379  first abates the action or the claimant first voluntarily
 1380  dismisses the action.
 1381         (b) The notice required notice must shall state that it is
 1382  a “demand letter under s. 627.736(10)” and shall state with
 1383  specificity:
 1384         1. The name of the insured upon which such benefits are
 1385  being sought, including a copy of the assignment giving rights
 1386  to the claimant if the claimant is not the insured.
 1387         2. The claim number or policy number upon which such claim
 1388  was originally submitted to the insurer.
 1389         3. To the extent applicable, the name of any medical
 1390  provider who rendered to an insured the treatment, services,
 1391  accommodations, or supplies that form the basis of such claim;
 1392  and an itemized statement specifying each exact amount, the date
 1393  of treatment, service, or accommodation, and the type of benefit
 1394  claimed to be due. A completed form satisfying the requirements
 1395  of paragraph (6)(5)(d) or the lost-wage statement previously
 1396  submitted may be used as the itemized statement. To the extent
 1397  that the demand involves an insurer’s withdrawal of payment
 1398  under paragraph (7)(a) for future treatment not yet rendered,
 1399  the claimant shall attach a copy of the insurer’s notice
 1400  withdrawing such payment and an itemized statement of the type,
 1401  frequency, and duration of future treatment claimed to be
 1402  reasonable and medically necessary.
 1403         (c) Each notice required by this subsection must be
 1404  delivered to the insurer by United States certified or
 1405  registered mail, return receipt requested. Such postal costs
 1406  shall be reimbursed by the insurer if so requested by the
 1407  claimant in the notice, when the insurer pays the claim. Such
 1408  notice must be sent to the person and address specified by the
 1409  insurer for the purposes of receiving notices under this
 1410  subsection. Each licensed insurer, whether domestic, foreign, or
 1411  alien, shall file with the office designation of the name and
 1412  address of the person to whom notices must pursuant to this
 1413  subsection shall be sent which the office shall make available
 1414  on its Internet website. The name and address on file with the
 1415  office pursuant to s. 624.422 shall be deemed the authorized
 1416  representative to accept notice pursuant to this subsection if
 1417  in the event no other designation has been made.
 1418         (d) If, within 30 days after receipt of notice by the
 1419  insurer, the overdue claim specified in the notice is paid by
 1420  the insurer together with applicable interest and a penalty of
 1421  10 percent of the overdue amount paid by the insurer, subject to
 1422  a maximum penalty of $250, no action may be brought against the
 1423  insurer. If the demand involves an insurer’s withdrawal of
 1424  payment under paragraph (7)(a) for future treatment not yet
 1425  rendered, no action may be brought against the insurer if,
 1426  within 30 days after its receipt of the notice, the insurer
 1427  mails to the person filing the notice a written statement of the
 1428  insurer’s agreement to pay for such treatment in accordance with
 1429  the notice and to pay a penalty of 10 percent, subject to a
 1430  maximum penalty of $250, when it pays for such future treatment
 1431  in accordance with the requirements of this section. To the
 1432  extent the insurer determines not to pay any amount demanded,
 1433  the penalty is shall not be payable in any subsequent action.
 1434  For purposes of this subsection, payment or the insurer’s
 1435  agreement is shall be treated as being made on the date a draft
 1436  or other valid instrument that is equivalent to payment, or the
 1437  insurer’s written statement of agreement, is placed in the
 1438  United States mail in a properly addressed, postpaid envelope,
 1439  or if not so posted, on the date of delivery. The insurer is not
 1440  obligated to pay any attorney’s fees if the insurer pays the
 1441  claim or mails its agreement to pay for future treatment within
 1442  the time prescribed by this subsection.
 1443         (e) The applicable statute of limitation for an action
 1444  under this section shall be tolled for a period of 30 business
 1445  days by the mailing of the notice required by this subsection.
 1446         (f)A demand letter that does not meet the minimum
 1447  requirements set forth in this subsection or that is sent during
 1448  the pendency of the lawsuit is defective. A defective demand
 1449  letter cannot be cured unless the court first abates the action
 1450  or the claimant first voluntarily dismisses the action. If the
 1451  insurer pays the benefits during abatement or dismissal, the
 1452  insurer is not liable for attorney’s fees.
 1453         (g)(f)An Any insurer making a general business practice of
 1454  not paying valid claims until receipt of the notice required by
 1455  this subsection is engaging in an unfair trade practice under
 1456  the insurance code.
 1457         (h) If the insurer pays in response to a demand letter and
 1458  the claimant disputes the amount paid, the claimant must send a
 1459  second demand letter by certified or registered mail stating the
 1460  exact amount that the claimant believes the insurer owes and why
 1461  the claimant believes the amount paid is incorrect. The insurer
 1462  has an additional 10 days after receipt of the second letter to
 1463  issue any additional payment that is owed. The purpose of this
 1464  provision is to avoid unnecessary litigation over miscalculated
 1465  payments.
 1466         (i) Demand letters may not be used to request the
 1467  production of claim documents or other records from the insurer.
 1468         Section 9. Subsection (1) of section 324.021, Florida
 1469  Statutes, is amended to read:
 1470         324.021 Definitions; minimum insurance required.—The
 1471  following words and phrases when used in this chapter shall, for
 1472  the purpose of this chapter, have the meanings respectively
 1473  ascribed to them in this section, except in those instances
 1474  where the context clearly indicates a different meaning:
 1475         (1) MOTOR VEHICLE.—Every self-propelled vehicle that which
 1476  is designed and required to be licensed for use upon a highway,
 1477  including trailers and semitrailers designed for use with such
 1478  vehicles, except traction engines, road rollers, farm tractors,
 1479  power shovels, and well drillers, and every vehicle that which
 1480  is propelled by electric power obtained from overhead wires but
 1481  not operated upon rails, but not including any bicycle or moped.
 1482  However, the term does “motor vehicle” shall not include a any
 1483  motor vehicle as defined in s. 627.732(3) if when the owner of
 1484  such vehicle has complied with the no-fault law requirements of
 1485  ss. 627.730-627.7405, inclusive, unless the provisions of s.
 1486  324.051 apply; and, in such case, the applicable proof of
 1487  insurance provisions of s. 320.02 apply.
 1488         Section 10. Paragraph (k) of subsection (2) of section
 1489  456.057, Florida Statutes, is amended to read:
 1490         456.057 Ownership and control of patient records; report or
 1491  copies of records to be furnished.—
 1492         (2) As used in this section, the terms “records owner,”
 1493  “health care practitioner,” and “health care practitioner’s
 1494  employer” do not include any of the following persons or
 1495  entities; furthermore, the following persons or entities are not
 1496  authorized to acquire or own medical records, but are authorized
 1497  under the confidentiality and disclosure requirements of this
 1498  section to maintain those documents required by the part or
 1499  chapter under which they are licensed or regulated:
 1500         (k) Persons or entities practicing under s. 627.736(8)
 1501  627.736(7).
 1502         Section 11. Paragraph (b) of subsection (1) of section
 1503  627.7401, Florida Statutes, is amended to read:
 1504         627.7401 Notification of insured’s rights.—
 1505         (1) The commission, by rule, shall adopt a form for the
 1506  notification of insureds of their right to receive personal
 1507  injury protection benefits under the Florida Motor Vehicle no
 1508  fault law. Such notice shall include:
 1509         (b) An advisory informing insureds that:
 1510         1. Pursuant to s. 626.9892, the Department of Financial
 1511  Services may pay rewards of up to $25,000 to persons providing
 1512  information leading to the arrest and conviction of persons
 1513  committing crimes investigated by the Division of Insurance
 1514  Fraud arising from violations of s. 440.105, s. 624.15, s.
 1515  626.9541, s. 626.989, or s. 817.234.
 1516         2. Pursuant to s. 627.736(6)(e)1. 627.736(5)(e)1., if the
 1517  insured notifies the insurer of a billing error, the insured may
 1518  be entitled to a certain percentage of a reduction in the amount
 1519  paid by the insured’s motor vehicle insurer.
 1520         Section 12. Paragraph (c) of subsection (7) of section
 1521  817.234, Florida Statutes, is amended to read:
 1522         817.234 False and fraudulent insurance claims.—
 1523         (7)
 1524         (c) An insurer, or any person acting at the direction of or
 1525  on behalf of an insurer, may not change an opinion in a mental
 1526  or physical report prepared under s. 627.736(8) 627.736(7) or
 1527  direct the physician preparing the report to change such
 1528  opinion; however, this provision does not preclude the insurer
 1529  from calling to the attention of the physician errors of fact in
 1530  the report based upon information in the claim file. Any person
 1531  who violates this paragraph commits a felony of the third
 1532  degree, punishable as provided in s. 775.082, s. 775.083, or s.
 1533  775.084.
 1534         Section 13. This act shall take effect July 1, 2011.