HOUSE AMENDMENT Bill No. HB 27A
1	CHAMBER ACTION
2	Senate House
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12	Representative Seiler offered the following:
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14	Amendment
15	Remove line(s) 901-1675, and insert:
16	Section 8. Subsections (4), (5), (6), (7), (8), (10), and
17	(12) of section 627.736, Florida Statutes, are amended, present
18	subsection (13) is renumbered as subsection (14), and a new
19	subsection (13) is added to said section, to read:
20	627.736 Required personal injury protection benefits;
21	exclusions; priority; claims.--
22	(4) BENEFITS; WHEN DUE.--Benefits due from an insurer
23	under ss. 627.730-627.7405 shall be primary, except that
24	benefits received under any workers' compensation law shall be
25	credited against the benefits provided by subsection (1) and
26	shall be due and payable as loss accrues, upon receipt of
27	reasonable proof of such loss and the amount of expenses and
28	loss incurred which are covered by the policy issued under ss.
29	627.730-627.7405. When the Agency for Health Care Administration
30	provides, pays, or becomes liable for medical assistance under
31	the Medicaid program related to injury, sickness, disease, or
32	death arising out of the ownership, maintenance, or use of a
33	motor vehicle, benefits under ss. 627.730-627.7405 shall be
34	subject to the provisions of the Medicaid program.
35	(a) An insurer may require written notice to be given as
36	soon as practicable after an accident involving a motor vehicle
37	with respect to which the policy affords the security required
38	by ss. 627.730-627.7405.
39	(b) Personal injury protection insurance benefits paid
40	pursuant to this section shall be overdue if not paid within 30
41	days after the insurer is furnished written notice of the fact
42	of a covered loss and of the amount of same. If such written
43	notice is not furnished to the insurer as to the entire claim,
44	any partial amount supported by written notice is overdue if not
45	paid within 30 days after such written notice is furnished to
46	the insurer. Any part or all of the remainder of the claim that
47	is subsequently supported by written notice is overdue if not
48	paid within 30 days after such written notice is furnished to
49	the insurer. When an insurer pays only a portion of a claim or
50	rejects a claim, the insurer shall provide at the time of the
51	partial payment or rejection an itemized specification of each
52	item that the insurer had reduced, omitted, or declined to pay
53	and any information that the insurer desires the claimant to
54	consider related to the medical necessity of the denied
55	treatment or to explain the reasonableness of the reduced
56	charge, provided that this shall not limit the introduction of
57	evidence at trial; and the insurer shall include the name and
58	address of the person to whom the claimant should respond and a
59	claim number to be referenced in future correspondence.
60	However, notwithstanding the fact that written notice has been
61	furnished to the insurer, any payment shall not be deemed
62	overdue when the insurer has reasonable proof to establish that
63	the insurer is not responsible for the payment. For the purpose
64	of calculating the extent to which any benefits are overdue,
65	payment shall be treated as being made on the date a draft or
66	other valid instrument which is equivalent to payment was placed
67	in the United States mail in a properly addressed, postpaid
68	envelope or, if not so posted, on the date of delivery. This
69	paragraph does not preclude or limit the ability of the insurer
70	to assert that the claim was unrelated, was not medically
71	necessary, or was unreasonable or that the amount of the charge
72	was in excess of that permitted under, or in violation of,
73	subsection (5). Such assertion by the insurer may be made at any
74	time, including after payment of the claim or after the 30-day
75	time period for payment set forth in this paragraph.
76	(c) All overdue payments shall bear simple interest at the
77	rate established by the Comptrollerunder s. 55.03 or the rate
78	established in the insurance contract, whichever is greater, for
79	the year in which the payment became overdue, calculated from
80	the date the insurer was furnished with written notice of the
81	amount of covered loss. Interest shall be due at the time
82	payment of the overdue claim is made.
83	(d) The insurer of the owner of a motor vehicle shall pay
84	personal injury protection benefits for:
85	1. Accidental bodily injury sustained in this state by the
86	owner while occupying a motor vehicle, or while not an occupant
87	of a self-propelled vehicle if the injury is caused by physical
88	contact with a motor vehicle.
89	2. Accidental bodily injury sustained outside this state,
90	but within the United States of America or its territories or
91	possessions or Canada, by the owner while occupying the owner's
92	motor vehicle.
93	3. Accidental bodily injury sustained by a relative of the
94	owner residing in the same household, under the circumstances
95	described in subparagraph 1. or subparagraph 2., provided the
96	relative at the time of the accident is domiciled in the owner's
97	household and is not himself or herself the owner of a motor
98	vehicle with respect to which security is required under ss.
99	627.730-627.7405.
100	4. Accidental bodily injury sustained in this state by any
101	other person while occupying the owner's motor vehicle or, if a
102	resident of this state, while not an occupant of a self-
103	propelled vehicle, if the injury is caused by physical contact
104	with such motor vehicle, provided the injured person is not
105	himself or herself:
106	a. The owner of a motor vehicle with respect to which
107	security is required under ss. 627.730-627.7405; or
108	b. Entitled to personal injury benefits from the insurer
109	of the owner or owners of such a motor vehicle.
110	(e) If two or more insurers are liable to pay personal
111	injury protection benefits for the same injury to any one
112	person, the maximum payable shall be as specified in subsection
113	(1), and any insurer paying the benefits shall be entitled to
114	recover from each of the other insurers an equitable pro rata
115	share of the benefits paid and expenses incurred in processing
116	the claim.
117	(f) It is a violation of the insurance code for an insurer
118	to fail to timely provide benefits as required by this section
119	with such frequency as to constitute a general business
120	practice.
121	(g) Benefits shall not be due or payable to or on the
122	behalf of an insured person if that person has committed, by a
123	material act or omission, any insurance fraud relating to
124	personal injury protection coverage under his or her policy, if
125	the fraud is admitted to in a sworn statement by the insured or
126	if it is established in a court of competent jurisdiction. Any
127	insurance fraud shall void all coverage arising from the claim
128	related to such fraud under the personal injury protection
129	coverage of the insured person who committed the fraud,
130	irrespective of whether a portion of the insured person's claim
131	may be legitimate, and any benefits paid prior to the discovery
132	of the insured person's insurance fraud shall be recoverable by
133	the insurer from the person who committed insurance fraud in
134	their entirety. The prevailing party is entitled to its costs
135	and attorney's fees in any action in which it prevails in an
136	insurer's action to enforce its right of recovery under this
137	paragraph.
138	(5) CHARGES FOR TREATMENT OF INJURED PERSONS.--
139	(a) Any physician, hospital, clinic, or other person or
140	institution lawfully rendering treatment to an injured person
141	for a bodily injury covered by personal injury protection
142	insurance may charge the insurer and injured partyonly a
143	reasonable amount pursuant to this sectionfor the services and
144	supplies rendered, and the insurer providing such coverage may
145	pay for such charges directly to such person or institution
146	lawfully rendering such treatment, if the insured receiving such
147	treatment or his or her guardian has countersigned the properly
148	completedinvoice, bill, or claim form approved by the
149	Department of Insurance upon which such charges are to be paid
150	for as having actually been rendered, to the best knowledge of
151	the insured or his or her guardian. In no event, however, may
152	such a charge be in excess of the amount the person or
153	institution customarily charges for like services or supplies in
154	cases involving no insurance. With respect to a determination of
155	whether a charge for a particular service, treatment, or
156	otherwise is reasonable, consideration may be given to evidence
157	of usual and customary charges and payments accepted by the
158	provider involved in the dispute, and reimbursement levels in
159	the community and various federal and state medical fee
160	schedules applicable to automobile and other insurance
161	coverages, and other information relevant to the reasonableness
162	of the reimbursement for the service, treatment, or supply.
163	(b)1. An insurer or insured is not required to pay a claim
164	or charges:
165	a.Made by a broker or by a person making a claim on
166	behalf of a broker;
167	b. For any service or treatment that was not lawful at the
168	time rendered;
169	c. To any person who knowingly submits a false or
170	misleading statement relating to the claim or charges;
171	d. With respect to a bill or statement that does not
172	substantially meet the applicable requirements of paragraph (d);
173	e. For any treatment or service that is upcoded, or that
174	is unbundled when such treatment or services should be bundled,
175	in accordance with paragraph (d). To facilitate prompt payment
176	of lawful services, an insurer may change codes that it
177	determines to have been improperly or incorrectly upcoded or
178	unbundled, and may make payment based on the changed codes,
179	without affecting the right of the provider to dispute the
180	change by the insurer, provided that before doing so, the
181	insurer must contact the health care provider and discuss the
182	reasons for the insurer's change and the health care provider's
183	reason for the coding, or make a reasonable good-faith effort to
184	do so, as documented in the insurer's file; and
185	f. For medical services or treatment billed by a physician
186	and not provided in a hospital unless such services are rendered
187	by the physician or are incident to his or her professional
188	services and are included on the physician's bill, including
189	documentation verifying that the physician is responsible for
190	the medical services that were rendered and billed.
191	2. Charges for medically necessary cephalic thermograms,
192	peripheral thermograms, spinal ultrasounds, extremity
193	ultrasounds, video fluoroscopy, and surface electromyography
194	shall not exceed the maximum reimbursement allowance for such
195	procedures as set forth in the applicable fee schedule or other
196	payment methodology established pursuant to s. 440.13.
197	3. Allowable amounts that may be charged to a personal
198	injury protection insurance insurer and insured for medically
199	necessary nerve conduction testing when done in conjunction with
200	a needle electromyography procedure and both are performed and
201	billed solely by a physician licensed under chapter 458, chapter
202	459, chapter 460, or chapter 461 who is also certified by the
203	American Board of Electrodiagnostic Medicine or by a board
204	recognized by the American Board of Medical Specialties or the
205	American Osteopathic Association or who holds diplomate status
206	with the American Chiropractic Neurology Board or its
207	predecessors shall not exceed 200 percent of the allowable
208	amount under the participating physician fee schedule of
209	Medicare Part B for year 2001, for the area in which the
210	treatment was rendered, adjusted annually on August 1 to reflect
211	the prior calendar year's changes in the annual Medical Care
212	Item of the Consumer Price Index for All Urban Consumers in the
213	South Region as determined by the Bureau of Labor Statistics of
214	the United States Department of Laborby an additional amount
215	equal to the medical Consumer Price Index for Florida.
216	4. Allowable amounts that may be charged to a personal
217	injury protection insurance insurer and insured for medically
218	necessary nerve conduction testing that does not meet the
219	requirements of subparagraph 3. shall not exceed the applicable
220	fee schedule or other payment methodology established pursuant
221	to s. 440.13.
222	5. Effective upon this act becoming a law and before
223	November 1, 2001, allowable amounts that may be charged to a
224	personal injury protection insurance insurer and insured for
225	magnetic resonance imaging services shall not exceed 200 percent
226	of the allowable amount under Medicare Part B for year 2001, for
227	the area in which the treatment was rendered. Beginning November
228	1, 2001, allowable amounts that may be charged to a personal
229	injury protection insurance insurer and insured for magnetic
230	resonance imaging services shall not exceed 175 percent of the
231	allowable amount under the participating physician fee schedule
232	ofMedicare Part B for year 2001, for the area in which the
233	treatment was rendered, adjusted annually on August 1 to reflect
234	the prior calendar year’s changes in the annual Medical Care
235	Item of the Consumer Price Index for All Urban Consumers in the
236	South Region as determined by the Bureau of Labor Statistics of
237	the United States Department of Laborby an additional amount
238	equal to the medical Consumer Price Index for Florida, except
239	that allowable amounts that may be charged to a personal injury
240	protection insurance insurer and insured for magnetic resonance
241	imaging services provided in facilities accredited by the
242	American College of Radiology or the Joint Commission on
243	Accreditation of Healthcare Organizations shall not exceed 200
244	percent of the allowable amount under the participating
245	physician fee schedule ofMedicare Part B for year 2001, for the
246	area in which the treatment was rendered, adjusted annually on
247	August 1to reflect the prior calendar year’s changes in the
248	annual Medical Care Item of the Consumer Price Index for All
249	Urban Consumers in the South Region as determined by the Bureau
250	of Labor Statistics of the United States Department of Labor by
251	an additional amount equal to the medical Consumer Price Index
252	for Florida. This paragraph does not apply to charges for
253	magnetic resonance imaging services and nerve conduction testing
254	for inpatients and emergency services and care as defined in
255	chapter 395 rendered by facilities licensed under chapter 395.
256	6. The Department of Health, in consultation with the
257	appropriate professional licensing boards, shall adopt, by rule,
258	a list of diagnostic tests deemed not to be medically necessary
259	for use in the treatment of persons sustaining bodily injury
260	covered by personal injury protection benefits under this
261	section. The initial list shall be adopted by January 1, 2004,
262	and shall be revised from time to time as determined by the
263	Department of Health, in consultation with the respective
264	professional licensing boards. Inclusion of a test on the list
265	of invalid diagnostic tests shall be based on lack of
266	demonstrated medical value and a level of general acceptance by
267	the relevant provider community and shall not be dependent for
268	results entirely upon subjective patient response.
269	Notwithstanding its inclusion on a fee schedule in this
270	subsection, an insurer or insured is not required to pay any
271	charges or reimburse claims for any invalid diagnostic test as
272	determined by the Department of Health.
273	(c)1.With respect to any treatment or service, other than
274	medical services billed by a hospital or other provider for
275	emergency services as defined in s. 395.002 or inpatient
276	services rendered at a hospital-owned facility, the statement of
277	charges must be furnished to the insurer by the provider and may
278	not include, and the insurer is not required to pay, charges for
279	treatment or services rendered more than 35 days before the
280	postmark date of the statement, except for past due amounts
281	previously billed on a timely basis under this paragraph, and
282	except that, if the provider submits to the insurer a notice of
283	initiation of treatment within 21 days after its first
284	examination or treatment of the claimant, the statement may
285	include charges for treatment or services rendered up to, but
286	not more than, 75 days before the postmark date of the
287	statement. The injured party is not liable for, and the provider
288	shall not bill the injured party for, charges that are unpaid
289	because of the provider's failure to comply with this paragraph.
290	Any agreement requiring the injured person or insured to pay for
291	such charges is unenforceable.
292	2.If, however, the insured fails to furnish the provider
293	with the correct name and address of the insured's personal
294	injury protection insurer, the provider has 35 days from the
295	date the provider obtains the correct information to furnish the
296	insurer with a statement of the charges. The insurer is not
297	required to pay for such charges unless the provider includes
298	with the statement documentary evidence that was provided by the
299	insured during the 35-day period demonstrating that the provider
300	reasonably relied on erroneous information from the insured and
301	either:
302	a.1.A denial letter from the incorrect insurer; or
303	b.2.Proof of mailing, which may include an affidavit
304	under penalty of perjury, reflecting timely mailing to the
305	incorrect address or insurer.
306	3.For emergency services and care as defined in s.
307	395.002 rendered in a hospital emergency department or for
308	transport and treatment rendered by an ambulance provider
309	licensed pursuant to part III of chapter 401, the provider is
310	not required to furnish the statement of charges within the time
311	periods established by this paragraph; and the insurer shall not
312	be considered to have been furnished with notice of the amount
313	of covered loss for purposes of paragraph (4)(b) until it
314	receives a statement complying with paragraph (d)(e), or copy
315	thereof, which specifically identifies the place of service to
316	be a hospital emergency department or an ambulance in accordance
317	with billing standards recognized by the Health Care Finance
318	Administration.
319	4.Each notice of insured's rights under s. 627.7401 must
320	include the following statement in type no smaller than 12
321	points:
322	BILLING REQUIREMENTS.--Florida Statutes provide that with
323	respect to any treatment or services, other than certain
324	hospital and emergency services, the statement of charges
325	furnished to the insurer by the provider may not include, and
326	the insurer and the injured party are not required to pay,
327	charges for treatment or services rendered more than 35 days
328	before the postmark date of the statement, except for past
329	due amounts previously billed on a timely basis, and except
330	that, if the provider submits to the insurer a notice of
331	initiation of treatment within 21 days after its first
332	examination or treatment of the claimant, the statement may
333	include charges for treatment or services rendered up to, but
334	not more than, 75 days before the postmark date of the
335	statement.
336	(d) Every insurer shall include a provision in its policy
337	for personal injury protection benefits for binding arbitration
338	of any claims dispute involving medical benefits arising between
339	the insurer and any person providing medical services or
340	supplies if that person has agreed to accept assignment of
341	personal injury protection benefits. The provision shall specify
342	that the provisions of chapter 682 relating to arbitration shall
343	apply. The prevailing party shall be entitled to attorney's
344	fees and costs. For purposes of the award of attorney's fees and
345	costs, the prevailing party shall be determined as follows:
346	1. When the amount of personal injury protection benefits
347	determined by arbitration exceeds the sum of the amount offered
348	by the insurer at arbitration plus 50 percent of the difference
349	between the amount of the claim asserted by the claimant at
350	arbitration and the amount offered by the insurer at
351	arbitration, the claimant is the prevailing party.
352	2. When the amount of personal injury protection benefits
353	determined by arbitration is less than the sum of the amount
354	offered by the insurer at arbitration plus 50 percent of the
355	difference between the amount of the claim asserted by the
356	claimant at arbitration and the amount offered by the insurer at
357	arbitration, the insurer is the prevailing party.
358	3. When neither subparagraph 1. nor subparagraph 2.
359	applies, there is no prevailing party. For purposes of this
360	paragraph, the amount of the offer or claim at arbitration is
361	the amount of the last written offer or claim made at least 30
362	days prior to the arbitration.
363	4. In the demand for arbitration, the party requesting
364	arbitration must include a statement specifically identifying
365	the issues for arbitration for each examination or treatment in
366	dispute. The other party must subsequently issue a statement
367	specifying any other examinations or treatment and any other
368	issues that it intends to raise in the arbitration. The parties
369	may amend their statements up to 30 days prior to arbitration,
370	provided that arbitration shall be limited to those identified
371	issues and neither party may add additional issues during
372	arbitration.
373	(d)(e)All statements and bills for medical services
374	rendered by any physician, hospital, clinic, or other person or
375	institution shall be submitted to the insurer on a properly
376	completed Centers for Medicare and Medicaid Services (CMS)
377	Health Care Finance Administration1500 form, UB 92 forms, or
378	any other standard form approved by the department for purposes
379	of this paragraph. All billings for such services rendered by
380	providersshall, to the extent applicable, follow the
381	Physicians' Current Procedural Terminology (CPT) or Healthcare
382	Correct Procedural Coding System (HCPCS), or ICD-9 in effect for
383	the year in which services are rendered and comply with the
384	Centers for Medicare and Medicaid Services (CMS) 1500 form
385	instructions and the American Medical Association Current
386	Procedural Terminology (CPT) Editorial Panel and Healthcare
387	Correct Procedural Coding System (HCPCS). All providers other
388	than hospitals shall include on the applicable claim form the
389	professional license number of the provider in the line or space
390	provided for "Signature of Physician or Supplier, Including
391	Degrees or Credentials." In determining compliance with
392	applicable CPT and HCPCS coding, guidance shall be provided by
393	the Physicians' Current Procedural Terminology (CPT) or the
394	Healthcare Correct Procedural Coding System (HCPCS) in effect
395	for the year in which services were rendered, the Office of the
396	Inspector General (OIG), Physicians Compliance Guidelines, and
397	other authoritative treatises designated by rule by the Agency
398	for Health Care Administration.No statement of medical services
399	may include charges for medical services of a person or entity
400	that performed such services without possessing the valid
401	licenses required to perform such services. For purposes of
402	paragraph (4)(b), an insurer shall not be considered to have
403	been furnished with notice of the amount of covered loss or
404	medical bills due unless the statements or bills comply with
405	this paragraph, and unless the statements or bills are properly
406	completed in their entirety as to all material provisions, with
407	all relevant information being provided therein.
408	(e)1. At the initial treatment or service provided, each
409	physician, other licensed professional, clinic, or other medical
410	institution providing medical services upon which a claim for
411	personal injury protection benefits is based shall require an
412	insured person, or his or her guardian, to execute a disclosure
413	and acknowledgment form, which reflects at a minimum that:
414	a. The insured, or his or her guardian, must countersign
415	the form attesting to the fact that the services set forth
416	therein were actually rendered;
417	b. The insured, or his or her guardian, has both the right
418	and affirmative duty to confirm that the services were actually
419	rendered;
420	c. The insured, or his or her guardian, was not solicited
421	by any person to seek any services from the medical provider;
422	d. That the physician, other licensed professional,
423	clinic, or other medical institution rendering services for
424	which payment is being claimed explained the services to the
425	insured or his or her guardian; and
426	e. If the insured notifies the insurer in writing of a
427	billing error, the insured may be entitled to a certain
428	percentage of a reduction in the amounts paid by the insured's
429	motor vehicle insurer.
430	2. The physician, other licensed professional, clinic, or
431	other medical institution rendering services for which payment
432	is being claimed has the affirmative duty to explain the
433	services rendered to the insured, or his or her guardian, so
434	that the insured, or his or her guardian, countersigns the form
435	with informed consent.
436	3. Countersignature by the insured, or his or her
437	guardian, is not required for the reading of diagnostic tests or
438	other services that are of such a nature that they are not
439	required to be performed in the presence of the insured.
440	4. The licensed medical professional rendering treatment
441	for which payment is being claimed must sign, by his or her own
442	hand, the form complying with this paragraph.
443	5. The original completed disclosure and acknowledgement
444	form shall be furnished to the insurer pursuant to paragraph
445	(4)(b) and may not be electronically furnished.
446	6. This disclosure and acknowledgement form is not
447	required for services billed by a provider for emergency
448	services as defined in s. 395.002, for emergency services and
449	care as defined in s. 395.002 rendered in a hospital emergency
450	department, or for transport and treatment rendered by an
451	ambulance provider licensed pursuant to part III of chapter 401.
452	7. The Financial Services Commission shall adopt, by rule,
453	a standard disclosure and acknowledgment form that shall be used
454	to fulfill the requirements of this paragraph, effective 90 days
455	after such form is adopted and becomes final. The commission
456	shall adopt a proposed rule by October 1, 2003. Until the rule
457	is final, the provider may use a form of its own which otherwise
458	complies with the requirements of this paragraph.
459	8. As used in this paragraph, "countersigned" means a
460	second or verifying signature, as on a previously signed
461	document, and is not satisfied by the statement "signature on
462	file" or any similar statement.
463	9. The requirements of this paragraph apply only with
464	respect to the initial treatment or service of the insured by a
465	provider. For subsequent treatments or service, the provider
466	must maintain a patient log signed by the patient, in
467	chronological order by date of service, that is consistent with
468	the services being rendered to the patient as claimed.
469	(f) Upon written notification by any person, an insurer
470	shall investigate any claim of improper billing by a physician
471	or other medical provider. The insurer shall determine if the
472	insured was properly billed for only those services and
473	treatments that the insured actually received. If the insurer
474	determines that the insured has been improperly billed, the
475	insurer shall notify the insured, the person making the written
476	notification and the provider of its findings and shall reduce
477	the amount of payment to the provider by the amount determined
478	to be improperly billed. If a reduction is made due to such
479	written notification by any person, the insurer shall pay to the
480	person 20 percent of the amount of the reduction, up to $500. If
481	the provider is arrested due to the improper billing, then the
482	insurer shall pay to the person 40 percent of the amount of the
483	reduction, up to $500.
484	(h) An insurer may not systematically downcode with the
485	intent to deny reimbursement otherwise due. Such action
486	constitutes a material misrepresentation under s.
487	626.9541(1)(i)2.
488	(6) DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
489	DISPUTES.--
490	(a) Every employer shall, if a request is made by an
491	insurer providing personal injury protection benefits under ss.
492	627.730-627.7405 against whom a claim has been made, furnish
493	forthwith, in a form approved by the department, a sworn
494	statement of the earnings, since the time of the bodily injury
495	and for a reasonable period before the injury, of the person
496	upon whose injury the claim is based.
497	(b) Every physician, hospital, clinic, or other medical
498	institution providing, before or after bodily injury upon which
499	a claim for personal injury protection insurance benefits is
500	based, any products, services, or accommodations in relation to
501	that or any other injury, or in relation to a condition claimed
502	to be connected with that or any other injury, shall, if
503	requested to do so by the insurer against whom the claim has
504	been made, furnish forthwith a written report of the history,
505	condition, treatment, dates, and costs of such treatment of the
506	injured person and why the items identified by the insurer were
507	reasonable in amount and medically necessary, together with a
508	sworn statement that the treatment or services rendered were
509	reasonable and necessary with respect to the bodily injury
510	sustained and identifying which portion of the expenses for such
511	treatment or services was incurred as a result of such bodily
512	injury, and produce forthwith, and permit the inspection and
513	copying of, his or her or its records regarding such history,
514	condition, treatment, dates, and costs of treatment; provided
515	that this shall not limit the introduction of evidence at trial.
516	Such sworn statement shall read as follows: "Under penalty of
517	perjury, I declare that I have read the foregoing, and the facts
518	alleged are true, to the best of my knowledge and belief." No
519	cause of action for violation of the physician-patient privilege
520	or invasion of the right of privacy shall be permitted against
521	any physician, hospital, clinic, or other medical institution
522	complying with the provisions of this section. The person
523	requesting such records and such sworn statement shall pay all
524	reasonable costs connected therewith. If an insurer makes a
525	written request for documentation or information under this
526	paragraph within 30 days after having received notice of the
527	amount of a covered loss under paragraph (4)(a), the amount or
528	the partial amount which is the subject of the insurer's inquiry
529	shall become overdue if the insurer does not pay in accordance
530	with paragraph(4)(b) or within 10 days after the insurer's
531	receipt of the requested documentation or information, whichever
532	occurs later. For purposes of this paragraph, the term "receipt"
533	includes, but is not limited to, inspection and copying pursuant
534	to this paragraph. Any insurer that requests documentation or
535	information pertaining to reasonableness of charges or medical
536	necessity under this paragraph without a reasonable basis for
537	such requests as a general business practice is engaging in an
538	unfair trade practice under the insurance code.
539	(c) In the event of any dispute regarding an insurer's
540	right to discovery of facts under this sectionabout an injured
541	person's earnings or about his or her history, condition, or
542	treatment, or the dates and costs of such treatment, the insurer
543	may petition a court of competent jurisdiction to enter an order
544	permitting such discovery. The order may be made only on motion
545	for good cause shown and upon notice to all persons having an
546	interest, and it shall specify the time, place, manner,
547	conditions, and scope of the discovery. Such court may, in order
548	to protect against annoyance, embarrassment, or oppression, as
549	justice requires, enter an order refusing discovery or
550	specifying conditions of discovery and may order payments of
551	costs and expenses of the proceeding, including reasonable fees
552	for the appearance of attorneys at the proceedings, as justice
553	requires.
554	(d) The injured person shall be furnished, upon request, a
555	copy of all information obtained by the insurer under the
556	provisions of this section, and shall pay a reasonable charge,
557	if required by the insurer.
558	(e) Notice to an insurer of the existence of a claim shall
559	not be unreasonably withheld by an insured.
560	(7) MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON;
561	REPORTS.--
562	(a) Whenever the mental or physical condition of an
563	injured person covered by personal injury protection is material
564	to any claim that has been or may be made for past or future
565	personal injury protection insurance benefits, such person
566	shall, upon the request of an insurer, submit to mental or
567	physical examination by a physician or physicians. The costs of
568	any examinations requested by an insurer shall be borne entirely
569	by the insurer. Such examination shall be conducted within the
570	municipality where the insured is receiving treatment, or in a
571	location reasonably accessible to the insured, which, for
572	purposes of this paragraph, means any location within the
573	municipality in which the insured resides, or any location
574	within 10 miles by road of the insured's residence, provided
575	such location is within the county in which the insured resides.
576	If the examination is to be conducted in a location reasonably
577	accessible to the insured, and if there is no qualified
578	physician to conduct the examination in a location reasonably
579	accessible to the insured, then such examination shall be
580	conducted in an area of the closest proximity to the insured's
581	residence. Personal protection insurers are authorized to
582	include reasonable provisions in personal injury protection
583	insurance policies for mental and physical examination of those
584	claiming personal injury protection insurance benefits. An
585	insurer may not withdraw payment of a treating physician without
586	the consent of the injured person covered by the personal injury
587	protection, unless the insurer first obtains a valid report by a
588	Floridaphysician licensed under the same chapter as the
589	treating physician whose treatment authorization is sought to be
590	withdrawn, stating that treatment was not reasonable, related,
591	or necessary. A valid report is one that is prepared and signed
592	by the physician examining the injured person or reviewing the
593	treatment records of the injured person and is factually
594	supported by the examination and treatment records if reviewed
595	and that has not been modified by anyone other than the
596	physician. The physician preparing the report must be in active
597	practice, unless the physician is physically disabled. Active
598	practice means that during the 3 years immediately preceding the
599	date of the physical examination or review of the treatment
600	records the physician must have devoted professional time to the
601	active clinical practice of evaluation, diagnosis, or treatment
602	of medical conditions or to the instruction of students in an
603	accredited health professional school or accredited residency
604	program or a clinical research program that is affiliated with
605	an accredited health professional school or teaching hospital or
606	accredited residency program. The physician preparing a report
607	at the request of an insurer and physicians rendering expert
608	opinions on behalf of persons claiming medical benefits for
609	personal injury protection, or on behalf of an insured through
610	an attorney or another entity, shall maintain, for at least 3
611	years, copies of all examination reports as medical records and
612	shall maintain, for at least 3 years, records of all payments
613	for the examinations and reports. Neither an insurer nor any
614	person acting at the direction of or on behalf of an insurer may
615	materially change an opinion in a report prepared under this
616	paragraph or direct the physician preparing the report to change
617	such opinion. The denial of a payment as the result of such a
618	changed opinion constitutes a material misrepresentation under
619	s. 626.9541(1)(i)2.; however, this provision does not preclude
620	the insurer from calling to the attention of the physician
621	errors of fact in the report based upon information in the claim
622	file.
623	(b) If requested by the person examined, a party causing
624	an examination to be made shall deliver to him or her a copy of
625	every written report concerning the examination rendered by an
626	examining physician, at least one of which reports must set out
627	the examining physician's findings and conclusions in detail.
628	After such request and delivery, the party causing the
629	examination to be made is entitled, upon request, to receive
630	from the person examined every written report available to him
631	or her or his or her representative concerning any examination,
632	previously or thereafter made, of the same mental or physical
633	condition. By requesting and obtaining a report of the
634	examination so ordered, or by taking the deposition of the
635	examiner, the person examined waives any privilege he or she may
636	have, in relation to the claim for benefits, regarding the
637	testimony of every other person who has examined, or may
638	thereafter examine, him or her in respect to the same mental or
639	physical condition. If a person unreasonably refuses to submit
640	to an examination, the personal injury protection carrier is no
641	longer liable for subsequent personal injury protection
642	benefits.
643	(8) APPLICABILITY OF PROVISION REGULATING ATTORNEY'S
644	FEES.--With respect to any dispute under the provisions of ss.
645	627.730-627.7405 between the insured and the insurer, or between
646	an assignee of an insured's rights and the insurer, the
647	provisions of s. 627.428 shall apply, except as provided in
648	subsection (11).
649	(10) An insurer may negotiate and enter into contracts
650	with licensed health care providers for the benefits described
651	in this section, referred to in this section as "preferred
652	providers," which shall include health care providers licensed
653	under chapters 458, 459, 460, 461, and 463. The insurer may
654	provide an option to an insured to use a preferred provider at
655	the time of purchase of the policy for personal injury
656	protection benefits, if the requirements of this subsection are
657	met. If the insured elects to use a provider who is not a
658	preferred provider, whether the insured purchased a preferred
659	provider policy or a nonpreferred provider policy, the medical
660	benefits provided by the insurer shall be as required by this
661	section. If the insured elects to use a provider who is a
662	preferred provider, the insurer may pay medical benefits in
663	excess of the benefits required by this section and may waive or
664	lower the amount of any deductible that applies to such medical
665	benefits. If the insurer offers a preferred provider policy to a
666	policyholder or applicant, it must also offer a nonpreferred
667	provider policy. The insurer shall provide each policyholder
668	with a current roster of preferred providers in the county in
669	which the insured resides at the time of purchase of such
670	policy, and shall make such list available for public inspection
671	during regular business hours at the principal office of the
672	insurer within the state.
673	(12) CIVIL ACTION FOR INSURANCE FRAUD.--An insurer shall
674	have a cause of action against any person convicted of, or who,
675	regardless of adjudication of guilt, pleads guilty or nolo
676	contendere to insurance fraud under s. 817.234, patient
677	brokering under s. 817.505, or kickbacks under s. 456.054,
678	associated with a claim for personal injury protection benefits
679	in accordance with this section. An insurer prevailing in an
680	action brought under this subsection may recover compensatory,
681	consequential, and punitive damages subject to the requirements
682	and limitations of part II of chapter 768, and attorney's fees
683	and costs incurred in litigating a cause of action against any
684	person convicted of, or who, regardless of adjudication of
685	guilt, pleads guilty or nolo contendere to insurance fraud under
686	s. 817.234, patient brokering under s. 817.505, or kickbacks
687	under s. 456.054, associated with a claim for personal injury
688	protection benefits in accordance with this section.
689	(13) If the Financial Services Commission determines that
690	the cost savings under personal injury protection insurance
691	benefits paid by insurers have been realized due to the
692	provisions of this act, prior legislative reforms, or other
693	factors, the commission may increase the minimum $10,000 benefit
694	coverage requirement. In establishing the amount of such
695	increase, the commission must determine that the additional
696	premium for such coverage is approximately equal to the premium
697	cost savings that have been realized for the personal injury
698	protection coverage with limits of $10,000.
699	Section 9. Effective October 1, 2003, subsection (11) of
700	section 627.736, Florida Statutes, is amended to read:
701	627.736 Required personal injury protection benefits;
702	exclusions; priority; claims.--
703	(11) DEMAND LETTER.--
704	(a) As a condition precedent to filing any action for an
705	overdue claim for benefits under this sectionparagraph(4)(b),
706	the insurer must be provided with written notice of an intent to
707	initiate litigation; provided, however, that, except with regard
708	to a claim or amended claim or judgment for interest only which
709	was not paid or was incorrectly calculated, such notice is not
710	required for an overdue claim that the insurer has denied or
711	reduced, nor is such notice required if the insurer has been
712	provided documentation or information at the insurer's request
713	pursuant to subsection (6). Such notice may not be sent until
714	the claim is overdue, including any additional time the insurer
715	has to pay the claim pursuant to paragraph (4)(b).
716	(b) The notice required shall state that it is a "demand
717	letter under s. 627.736(11)" and shall state with specificity:
718	1. The name of the insured upon which such benefits are
719	being sought, including a copy of the assignment giving rights
720	to the claimant if the claimant is not the insured.
721	2. The claim number or policy number upon which such claim
722	was originally submitted to the insurer.
723	3. To the extent applicable, the name of any medical
724	provider who rendered to an insured the treatment, services,
725	accommodations, or supplies that form the basis of such claim;
726	and an itemized statement specifying each exact amount, the date
727	of treatment, service, or accommodation, and the type of benefit
728	claimed to be due. A completed form satisfying the requirements
729	of paragraph (5)(d) or the lost-wage statement previously
730	submittedHealth Care Finance Administration 1500 form, UB 92,
731	or successor forms approved by the Secretary of the United
732	States Department of Health and Human Servicesmay be used as
733	the itemized statement. To the extent that the demand involves
734	an insurer's withdrawal of payment under paragraph (7)(a) for
735	future treatment not yet rendered, the claimant shall attach a
736	copy of the insurer's notice withdrawing such payment and an
737	itemized statement of the type, frequency, and duration of
738	future treatment claimed to be reasonable and medically
739	necessary.
740	(c) Each notice required by this subsectionsectionmust
741	be delivered to the insurer by United States certified or
742	registered mail, return receipt requested. Such postal costs
743	shall be reimbursed by the insurer if so requested by the
744	claimantprovider in the notice, when the insurer pays the
745	overdueclaim. Such notice must be sent to the person and
746	address specified by the insurer for the purposes of receiving
747	notices under this subsectionsection, on the document denying
748	or reducing the amount asserted by the filer to be overdue. Each
749	licensed insurer, whether domestic, foreign, or alien, shallmay
750	file with the officedepartmentdesignation of the name and
751	address of the person to whom notices pursuant to this
752	subsectionsection shall be sent which the office shall make
753	available on its Internet websitewhen such document does not
754	specify the name and address to whom the notices under this
755	section are to be sent or when there is no such document. The
756	name and address on file with the officedepartmentpursuant to
757	s. 624.422 shall be deemed the authorized representative to
758	accept notice pursuant to this subsectionsectionin the event
759	no other designation has been made.
760	(d) If, within 157 businessdays after receipt of notice
761	by the insurer, the overdue claim specified in the notice is
762	paid by the insurer together with applicable interest and a
763	penalty of 10 percent of the overdue amount paid by the insurer,
764	subject to a maximum penalty of $250, no action for nonpayment
765	or late payment may be brought against the insurer. If the
766	demand involves an insurer's withdrawal of payment under
767	paragraph (7)(a) for future treatment not yet rendered, no
768	action may be brought against the insurer if, within 15 days
769	after its receipt of the notice, the insurer mails to the person
770	filing the notice a written statement of the insurer's agreement
771	to pay for such treatment in accordance with the notice and to
772	pay a penalty of 10 percent, subject to a maximum penalty of
773	$250, when it pays for such future treatment in accordance with
774	the requirements of this section.To the extent the insurer
775	determines not to pay anythe overdue amount demanded, the
776	penalty shall not be payable in any subsequent action for
777	nonpayment or late payment. For purposes of this subsection,
778	payment or the insurer's agreementshall be treated as being
779	made on the date a draft or other valid instrument that is
780	equivalent to payment, or the insurer's written statement of
781	agreement,is placed in the United States mail in a properly
782	addressed, postpaid envelope, or if not so posted, on the date
783	of delivery. The insurer shall not be obligated to pay any
784	attorney's fees if the insurer pays the claim or mails its
785	agreement to pay for future treatmentwithin the time prescribed
786	by this subsection.
787	(e) The applicable statute of limitation for an action
788	under this section shall be tolled for a period of 15 business
789	days by the mailing of the notice required by this subsection.
790	(f) Any insurer making a general business practice of not
791	paying valid claims until receipt of the notice required by this
792	subsectionsectionis engaging in an unfair trade practice under
793	the insurance code.