HB 119

1	A bill to be entitled
2	An act relating to motor vehicle personal injury
3	protection insurance; providing a short title;
4	providing legislative intent; amending s. 316.066,
5	F.S.; revising provisions relating to the contents of
6	written reports of motor vehicle crashes; authorizing
7	the investigating officer to testify at trial or
8	provide an affidavit concerning the content of the
9	reports; amending s. 400.991, F.S.; requiring that an
10	application for licensure as a mobile clinic include a
11	statement regarding insurance fraud; amending s.
12	627.730, F.S.; conforming a cross-reference; amending
13	s. 627.731, F.S.; providing legislative intent with
14	respect to the Florida Motor Vehicle No-Fault Law;
15	amending s. 627.732, F.S.; defining the terms
16	"claimant" and "no-fault law"; amending s. 627.736,
17	F.S.; conforming a cross-reference; requiring certain
18	entities providing medical services to document that
19	they meet required criteria; revising requirements
20	relating to the form that must be submitted by
21	providers; requiring an entity or clinic to file a new
22	form within a specified period after the date of a
23	change of ownership; revising provisions relating to
24	when payment for a benefit is due; providing that the
25	time period for paying or denying a claim is tolled
26	during the investigation of a fraudulent insurance
27	act; specifying when benefits are not payable;
28	providing that a claimant that violates certain
29	provisions is not entitled to any payment, regardless
30	of whether a portion of the claim may be legitimate;
31	authorizing an insurer to recover payments and bring a
32	cause of action to recover payments; forbidding a
33	physician, hospital, clinic, or other medical
34	institution that fails to comply with certain
35	provisions from billing the injured person or the
36	insured; providing that an insurer has a right to
37	conduct reasonable investigations of claims;
38	authorizing an insurer to require a claimant to
39	provide certain records; revising the insurer's
40	reimbursement limitation; deleting an obsolete
41	provision; revising requirements relating to
42	discovery; authorizing an insurer to conduct
43	examinations of claimants under oath or sworn
44	statement; requiring the provider to produce persons
45	having the most knowledge in specified circumstances;
46	providing that an insurer that requests an examination
47	under oath without a reasonable basis is engaging in
48	an unfair and deceptive trade practice; authorizing
49	the insurer to conduct a physical review of the
50	treatment location; authorizing an insurer to contract
51	with a preferred provider network; authorizing an
52	insurer to provide a premium discount to an insured
53	who selects a preferred provider; authorizing an
54	insurance policy not to pay for nonemergency services
55	performed by a nonpreferred provider in specified
56	circumstances; authorizing an insurer to contract with
57	a health insurer in specified circumstances; amending
58	ss. 324.021, 456.057, 627.7295, 627.733, 627.734,
59	627.737, 627.7401, 627.7405, 627.7407, and 628.909,
60	F.S.; conforming cross-references; reenacting s.
61	817.234(7)(c), F.S., relating to false and fraudulent
62	insurance claims, to incorporate the amendment of s.
63	627.736, F.S., in a reference thereto; providing an
64	effective date.
65
66	Be It Enacted by the Legislature of the State of Florida:
67
68	Section 1.  (1)  SHORT TITLE.-This act may be cited as the
69	"Comprehensive Insurance Fraud Investigation and Prevention
70	Act."
71	(2)  FINDINGS AND INTENT.-The Legislature intends to
72	balance the insured's interest in prompt payment of valid claims
73	for insurance benefits under the no-fault law with the public's
74	interest in reducing fraud, abuse, and overuse of the no-fault
75	system. To that end, the Legislature intends that the
76	investigation and prevention of fraudulent insurance acts in
77	this state be enhanced, that additional sanctions for such acts
78	be imposed, and that the no-fault law be revised to remove
79	incentives for fraudulent insurance acts. The Legislature
80	intends that the no-fault law be construed according to the
81	plain language of the statutory provisions, which are designed
82	to meet these goals.
83	(a)  The Legislature finds that:
84	1.  Motor vehicle insurance fraud remains a major problem
85	for state consumers and insurers. According to the National
86	Insurance Crime Bureau, in recent years this state has been
87	among those states that have the highest number of fraudulent
88	and questionable claims.
89	2.  The current regulatory process for health care clinics
90	under part X of chapter 400, Florida Statutes, which was
91	originally enacted to reduce motor vehicle insurance fraud, is
92	not adequately preventing fraudulent insurance acts with respect
93	to licensure exemptions and compliance with that part.
94	(b)  The Legislature intends that:
95	1.  Insurers properly investigate claims, and as such, this
96	act clarifies that insurers are allowed to obtain examinations
97	under oath and sworn statements from any claimant seeking no-
98	fault insurance benefits and to request mental and physical
99	examinations of persons seeking personal injury protection
100	coverage or benefits.
101	2.  Any false, misleading, or otherwise fraudulent activity
102	associated with a claim render the entire claim invalid. An
103	insurer must be able to raise fraud as a defense to a claim for
104	no-fault insurance benefits irrespective of any prior
105	adjudication of guilt or determination of fraud by the
106	Department of Financial Services.
107	3.  Insurers toll the payment or denial of a claim with
108	respect to any portion of a claim for which the insurer has a
109	reasonable belief that a fraudulent insurance act, as defined in
110	s. 626.989 or s. 817.234, Florida Statutes, has been committed.
111	4.  Insurers discover the names of all passengers involved
112	in a motor vehicle crash before paying claims or benefits
113	pursuant to an insurance policy governed by the no-fault law. A
114	rebuttable presumption must be established that a person was not
115	involved in the event giving rise to the claim if that person's
116	name does not appear on the police report.
117	Section 2.  Subsection (1) of section 316.066, Florida
118	Statutes, is amended to read:
119	316.066  Written reports of crashes.-
120	(1)(a)  A Florida Traffic Crash Report, Long Form must is
121	required to be completed and submitted to the department within
122	10 days after completing an investigation is completed by the
123	every law enforcement officer who in the regular course of duty
124	investigates a motor vehicle crash that:
125	1.   Resulted in death of, or personal injury to, or any
126	indication of complaints of pain or discomfort by any of the
127	parties or passengers involved in the crash;
128	2.  Involved one or more passengers, other than the drivers
129	of the vehicles, in any of the vehicles involved in the crash;
130	or.
131	3.2.   Involved a violation of s. 316.061(1) or s. 316.193.
132	(b)  The long form must include:
133	1.  The date, time, and location of the crash.
134	2.  A description of the vehicles involved.
135	3.  The names and addresses of the parties involved,
136	including all drivers and passengers.
137	4.  The names and addresses of witnesses.
138	5.  The name, badge number, and law enforcement agency of
139	the officer investigating the crash.
140	6.  The names of the insurance companies for the respective
141	parties involved in the crash.
142	7.  The names and addresses of all passengers in all
143	vehicles involved in the crash, each clearly identified as being
144	a passenger, including the identification of the vehicle in
145	which each was a passenger.
146	(c)(b)  In every crash for which a Florida Traffic Crash
147	Report, Long Form is not required by this section, the law
148	enforcement officer may complete a short-form crash report or
149	provide a driver exchange-of-information form to be completed by
150	each party involved in the crash. The short-form report must
151	include all of the items listed in subparagraphs (b)1.-6. Short-
152	form crash reports prepared by the law enforcement officer shall
153	be maintained by the officer's agency.:
154	1.  The date, time, and location of the crash.
155	2.  A description of the vehicles involved.
156	3.  The names and addresses of the parties involved,
157	including all drivers and passengers.
158	4.  The names and addresses of witnesses.
159	5.  The name, badge number, and law enforcement agency of
160	the officer investigating the crash.
161	6.  The names of the insurance companies for the respective
162	parties involved in the crash.
163	(d)(c)  Each party to the crash must provide the law
164	enforcement officer with proof of insurance, which must be
165	documented in the crash report. If a law enforcement officer
166	submits a report on the crash, proof of insurance must be
167	provided to the officer by each party involved in the crash. Any
168	party who fails to provide the required information commits a
169	noncriminal traffic infraction, punishable as a nonmoving
170	violation as provided in chapter 318, unless the officer
171	determines that due to injuries or other special circumstances
172	such insurance information cannot be provided immediately. If
173	the person provides the law enforcement agency, within 24 hours
174	after the crash, proof of insurance that was valid at the time
175	of the crash, the law enforcement agency may void the citation.
176	(e)(d)  The driver of a vehicle that was in any manner
177	involved in a crash resulting in damage to any vehicle or other
178	property in an amount of $500 or more which was not investigated
179	by a law enforcement agency, shall, within 10 days after the
180	crash, submit a written report of the crash to the department.
181	The entity receiving the report may require witnesses of the
182	crash to render reports and may require any driver of a vehicle
183	involved in a crash of which a written report must be made to
184	file supplemental written reports if the original report is
185	deemed insufficient by the receiving entity.
186	(f)  The investigating law enforcement officer may testify
187	at trial or provide a signed affidavit to confirm or supplement
188	the information included on the long-form or short-form report.
189	(e)  Short-form crash reports prepared by law enforcement
190	shall be maintained by the law enforcement officer's agency.
191	Section 3.  Subsection (6) is added to section 400.991,
192	Florida Statutes, to read:
193	400.991  License requirements; background screenings;
194	prohibitions.-
195	(6)  All forms that constitute part of the application for
196	licensure or exemption from licensure under this part must
197	contain the following statement:
198
199	INSURANCE FRAUD NOTICE.-Submitting a false,
200	misleading, or fraudulent application or other
201	document when applying for licensure as a health care
202	clinic, when seeking an exemption from licensure as a
203	health care clinic, or when demonstrating compliance
204	with part X of chapter 400, Florida Statutes, is a
205	criminal act under s. 817.234, Florida Statutes, or a
206	fraudulent insurance act as defined in s. 626.989,
207	Florida Statutes, subject to investigation by the
208	Division of Insurance Fraud, and is grounds for
209	discipline by the appropriate licensing board of the
210	Florida Department of Health.
211	Section 4.  Section 627.730, Florida Statutes, is amended
212	to read:
213	627.730  Florida Motor Vehicle No-Fault Law.-Sections
214	627.730-627.7407 627.730-627.7405 may be cited and known as the
215	"Florida Motor Vehicle No-Fault Law."
216	Section 5.  Section 627.731, Florida Statutes, is amended
217	to read:
218	627.731  Purpose; legislative intent.-
219	(1)  The purpose of the no-fault law ss. 627.730-627.7405
220	is to provide for medical, surgical, funeral, and disability
221	insurance benefits without regard to fault, and to require motor
222	vehicle insurance securing such benefits, for motor vehicles
223	required to be registered in this state and, with respect to
224	motor vehicle accidents, a limitation on the right to claim
225	damages for pain, suffering, mental anguish, and inconvenience.
226	(2)  The Legislature intends that the provisions,
227	schedules, and procedures authorized under the no-fault law be
228	implemented by the insurers offering policies pursuant to the
229	no-fault law. These provisions, schedules, and procedures have
230	full force and effect regardless of their express inclusion in
231	an insurance policy, and an insurer is not required to amend its
232	policy to implement and apply such provisions, schedules, or
233	procedures.
234	Section 6.  Section 627.732, Florida Statutes, is amended
235	to read:
236	627.732  Definitions.-As used in the no-fault law ss.
237	627.730-627.7405, the term:
238	(1)  "Broker" means any person not possessing a license
239	under chapter 395, chapter 400, chapter 429, chapter 458,
240	chapter 459, chapter 460, chapter 461, or chapter 641 who
241	charges or receives compensation for any use of medical
242	equipment and is not the 100-percent owner or the 100-percent
243	lessee of such equipment. For purposes of this section, such
244	owner or lessee may be an individual, a corporation, a
245	partnership, or any other entity and any of its 100-percent-
246	owned affiliates and subsidiaries. For purposes of this
247	subsection, the term "lessee" means a long-term lessee under a
248	capital or operating lease, but does not include a part-time
249	lessee. The term "broker" does not include a hospital or
250	physician management company whose medical equipment is
251	ancillary to the practices managed, a debt collection agency, or
252	an entity that has contracted with the insurer to obtain a
253	discounted rate for such services; or nor does the term include
254	a management company that has contracted to provide general
255	management services for a licensed physician or health care
256	facility and whose compensation is not materially affected by
257	the usage or frequency of usage of medical equipment or an
258	entity that is 100-percent owned by one or more hospitals or
259	physicians. The term "broker" does not include a person or
260	entity that certifies, upon request of an insurer, that:
261	(a)  It is a clinic licensed under ss. 400.990-400.995;
262	(b)  It is a 100-percent owner of medical equipment; and
263	(c)  The owner's only part-time lease of medical equipment
264	for personal injury protection patients is on a temporary basis,
265	not to exceed 30 days in a 12-month period, and such lease is
266	solely for the purposes of necessary repair or maintenance of
267	the 100-percent-owned medical equipment or pending the arrival
268	and installation of the newly purchased or a replacement for the
269	100-percent-owned medical equipment, or for patients for whom,
270	because of physical size or claustrophobia, it is determined by
271	the medical director or clinical director to be medically
272	necessary that the test be performed in medical equipment that
273	is open-style. The leased medical equipment may not cannot be
274	used by patients who are not patients of the registered clinic
275	for medical treatment of services. Any person or entity making a
276	false certification under this subsection commits insurance
277	fraud as defined in s. 817.234. However, the 30-day period
278	provided in this paragraph may be extended for an additional 60
279	days as applicable to magnetic resonance imaging equipment if
280	the owner certifies that the extension otherwise complies with
281	this paragraph.
282	(2)(7)  "Certify" means to swear or attest to being true or
283	represented in writing.
284	(3)  "Claimant" means the person, organization, or entity
285	seeking benefits, including all assignees.
286	(4)(12)  "Hospital" means a facility that, at the time
287	services or treatment were rendered, was licensed under chapter
288	395.
289	(5)(8)  "Immediate personal supervision," as it relates to
290	the performance of medical services by nonphysicians not in a
291	hospital, means that an individual licensed to perform the
292	medical service or provide the medical supplies must be present
293	within the confines of the physical structure where the medical
294	services are performed or where the medical supplies are
295	provided such that the licensed individual can respond
296	immediately to any emergencies if needed.
297	(6)(9)  "Incident," with respect to services considered as
298	incident to a physician's professional service, for a physician
299	licensed under chapter 458, chapter 459, chapter 460, or chapter
300	461, if not furnished in a hospital, means such services that
301	are must be an integral, even if incidental, part of a covered
302	physician's service.
303	(7)(10)  "Knowingly" means that a person, with respect to
304	information, has actual knowledge of the information,; acts in
305	deliberate ignorance of the truth or falsity of the
306	information,; or acts in reckless disregard of the information.,
307	and Proof of specific intent to defraud is not required.
308	(8)(11)  "Lawful" or "lawfully" means in substantial
309	compliance with all relevant applicable criminal, civil, and
310	administrative requirements of state and federal law related to
311	the provision of medical services or treatment.
312	(9)(2)  "Medically necessary" refers to a medical service
313	or supply that a prudent physician would provide for the purpose
314	of preventing, diagnosing, or treating an illness, injury,
315	disease, or symptom in a manner that is:
316	(a)  In accordance with generally accepted standards of
317	medical practice;
318	(b)  Clinically appropriate in terms of type, frequency,
319	extent, site, and duration; and
320	(c)  Not primarily for the convenience of the patient,
321	physician, or other health care provider.
322	(10)(3)  "Motor vehicle" means a any self-propelled vehicle
323	with four or more wheels that which is of a type both designed
324	and required to be licensed for use on the highways of this
325	state, and any trailer or semitrailer designed for use with such
326	vehicle, and includes:
327	(a)  A "private passenger motor vehicle," which is any
328	motor vehicle that which is a sedan, station wagon, or jeep-type
329	vehicle and, if not used primarily for occupational,
330	professional, or business purposes, a motor vehicle of the
331	pickup, panel, van, camper, or motor home type.
332	(b)  A "commercial motor vehicle," which is any motor
333	vehicle that which is not a private passenger motor vehicle.
334
335	The term "motor vehicle" does not include a mobile home or any
336	motor vehicle that which is used in mass transit, other than
337	public school transportation, and designed to transport more
338	than five passengers exclusive of the operator of the motor
339	vehicle and that which is owned by a municipality, a transit
340	authority, or a political subdivision of the state.
341	(11)(4)  "Named insured" means a person, usually the owner
342	of a vehicle, identified in a policy by name as the insured
343	under the policy.
344	(12)  "No-fault law" means the Florida Motor Vehicle No-
345	Fault Law, ss. 627.730-627.7407.
346	(13)(5)  "Owner" means a person who holds the legal title
347	to a motor vehicle; or, if in the event a motor vehicle is the
348	subject of a security agreement or lease with an option to
349	purchase with the debtor or lessee having the right to
350	possession, then the debtor or lessee is shall be deemed the
351	owner for the purposes of the no-fault law ss. 627.730-627.7405.
352	(14)(13)  "Properly completed" means providing truthful,
353	substantially complete, and substantially accurate responses as
354	to all material elements of to each applicable request for
355	information or statement by a means that may lawfully be
356	provided and that complies with this section, or as agreed by
357	the parties.
358	(15)(6)  "Relative residing in the same household" means a
359	relative of any degree by blood or by marriage who usually makes
360	her or his home in the same family unit, whether or not
361	temporarily living elsewhere.
362	(16)(15)  "Unbundling" means submitting an action that
363	submits a billing code that is properly billed under one billing
364	code, but that has been separated into two or more billing
365	codes, and would result in payment greater than the in amount
366	that than would be paid using one billing code.
367	(17)(14)  "Upcoding" means submitting an action that
368	submits a billing code that would result in payment greater than
369	the in amount that than would be paid using a billing code that
370	accurately describes the services performed. The term does not
371	include an otherwise lawful bill by a magnetic resonance imaging
372	facility, which globally combines both technical and
373	professional components, if the amount of the global bill is not
374	more than the components if billed separately; however, payment
375	of such a bill constitutes payment in full for all components of
376	such service.
377	Section 7.  Subsections (1), (3), and (4) of section
378	627.736, Florida Statutes, are amended, subsections (5) through
379	(16) of that section are renumbered as subsections (6) through
380	(17), respectively, a new subsection (5) is added to that
381	section, and present subsections (5), (6), (8), and (9),
382	paragraph (b) of present subsection (7), and present subsection
383	(16) of that section are amended, to read:
384	627.736  Required personal injury protection benefits;
385	exclusions; priority; claims.-
386	(1)  REQUIRED BENEFITS.-Every insurance policy complying
387	with the security requirements of s. 627.733 must shall provide
388	personal injury protection to the named insured, relatives
389	residing in the same household, persons operating the insured
390	motor vehicle, passengers in such motor vehicle, and other
391	persons struck by such motor vehicle and suffering bodily injury
392	while not an occupant of a self-propelled vehicle, subject to
393	the provisions of subsection (2) and paragraph (4)(g) (4)(e), to
394	a limit of $10,000 for loss sustained by any such person as a
395	result of bodily injury, sickness, disease, or death arising out
396	of the ownership, maintenance, or use of a motor vehicle as
397	follows:
398	(a)  Medical benefits.-Eighty percent of all reasonable
399	expenses for medically necessary medical, surgical, X-ray,
400	dental, and rehabilitative services, including prosthetic
401	devices, and for medically necessary ambulance, hospital, and
402	nursing services. However, the medical benefits shall provide
403	reimbursement only for such services and care that are lawfully
404	provided, supervised, ordered, or prescribed by a physician
405	licensed under chapter 458 or chapter 459, a dentist licensed
406	under chapter 466, or a chiropractic physician licensed under
407	chapter 460 or that are provided by any of the following persons
408	or entities:
409	1.  A hospital or ambulatory surgical center licensed under
410	chapter 395.
411	2.  A person or entity licensed under part III of chapter
412	401 that ss. 401.2101-401.45 that provides emergency
413	transportation and treatment.
414	3.  An entity wholly owned by one or more physicians
415	licensed under chapter 458 or chapter 459, chiropractic
416	physicians licensed under chapter 460, or dentists licensed
417	under chapter 466 or by such practitioner or practitioners and
418	the spouses, parents, children, or siblings spouse, parent,
419	child, or sibling of such that practitioner or those
420	practitioners.
421	4.  An entity wholly owned, directly or indirectly, by a
422	hospital or hospitals.
423	5.  A health care clinic licensed under part X of chapter
424	400 ss. 400.990-400.995 that is:
425	a.  Accredited by the Joint Commission on Accreditation of
426	Healthcare Organizations, the American Osteopathic Association,
427	the Commission on Accreditation of Rehabilitation Facilities, or
428	the Accreditation Association for Ambulatory Health Care, Inc.;
429	or
430	b.  A health care clinic that:
431	(I)  Has a medical director licensed under chapter 458,
432	chapter 459, or chapter 460;
433	(II)  Has been continuously licensed for more than 3 years
434	or is a publicly traded corporation that issues securities
435	traded on an exchange registered with the United States
436	Securities and Exchange Commission as a national securities
437	exchange; and
438	(III)  Provides at least four of the following medical
439	specialties:
440	(A)  General medicine.
441	(B)  Radiography.
442	(C)  Orthopedic medicine.
443	(D)  Physical medicine.
444	(E)  Physical therapy.
445	(F)  Physical rehabilitation.
446	(G)  Prescribing or dispensing outpatient prescription
447	medication.
448	(H)  Laboratory services.
449
450	If any services under this paragraph are provided by an entity
451	or clinic described in subparagraph 3., subparagraph 4., or
452	subparagraph 5., the entity or clinic must provide the insurer
453	at the initial submission of the claim with a form adopted by
454	the Department of Financial Services that documents that the
455	entity or clinic meets applicable criteria for such entity or
456	clinic and includes a sworn statement or affidavit to that
457	effect. Any change in ownership requires the filing of a new
458	form within 10 days after the date of the change in ownership.
459	The Financial Services Commission shall adopt by rule the form
460	that must be used by an insurer and a health care provider
461	specified in subparagraph 3., subparagraph 4., or subparagraph
462	5. to document that the health care provider meets the criteria
463	of this paragraph, which rule must include a requirement for a
464	sworn statement or affidavit.
465	(b)  Disability benefits.-Sixty percent of any loss of
466	gross income and loss of earning capacity per individual from
467	inability to work proximately caused by the injury sustained by
468	the injured person, plus all expenses reasonably incurred in
469	obtaining from others ordinary and necessary services in lieu of
470	those that, but for the injury, the injured person would have
471	performed without income for the benefit of his or her
472	household. All disability benefits payable under this paragraph
473	must provision shall be paid at least not less than every 2
474	weeks.
475	(c)  Death benefits.-Death benefits equal to the lesser of
476	$5,000 or the remainder of unused personal injury protection
477	benefits per individual. The insurer may pay such benefits to
478	the executor or administrator of the deceased, to any of the
479	deceased's relatives by blood, or legal adoption, or connection
480	by marriage, or to any person appearing to the insurer to be
481	equitably entitled thereto.
482
483	Only insurers writing motor vehicle liability insurance in this
484	state may provide the required benefits of this section, and no
485	such insurers may not insurer shall require the purchase of any
486	other motor vehicle coverage other than the purchase of property
487	damage liability coverage as required by s. 627.7275 as a
488	condition for providing such required benefits. Insurers may not
489	require that property damage liability insurance in an amount
490	greater than $10,000 be purchased in conjunction with personal
491	injury protection. Such insurers shall make benefits and
492	required property damage liability insurance coverage available
493	through normal marketing channels. An Any insurer writing motor
494	vehicle liability insurance in this state who fails to comply
495	with such availability requirement as a general business
496	practice violates shall be deemed to have violated part IX of
497	chapter 626, and such violation constitutes shall constitute an
498	unfair method of competition or an unfair or deceptive act or
499	practice involving the business of insurance. An; and any such
500	insurer committing such violation is shall be subject to the
501	penalties afforded in such part, as well as those that are which
502	may be afforded elsewhere in the insurance code.
503	(3)  INSURED'S RIGHTS TO RECOVERY OF SPECIAL DAMAGES IN
504	TORT CLAIMS.-An No insurer shall not have a lien on any recovery
505	in tort by judgment, settlement, or otherwise for personal
506	injury protection benefits, whether suit has been filed or
507	settlement has been reached without suit. An injured party who
508	is entitled to bring suit under the no-fault law provisions of
509	ss. 627.730-627.7405, or his or her legal representative, shall
510	have no right to recover any damages for which personal injury
511	protection benefits are paid or payable. The plaintiff may prove
512	all of his or her special damages notwithstanding this
513	limitation, but if special damages are introduced in evidence,
514	the trier of facts, whether judge or jury, shall not award
515	damages for personal injury protection benefits paid or payable.
516	In all cases in which a jury is required to fix damages, the
517	court shall instruct the jury that the plaintiff shall not
518	recover such special damages for personal injury protection
519	benefits paid or payable.
520	(4)  BENEFITS; WHEN DUE.-Benefits due from an insurer under
521	the no-fault law are ss. 627.730-627.7405 shall be primary,
522	except that benefits received under any workers' compensation
523	law shall be credited against the benefits provided by
524	subsection (1) and are shall be due and payable as loss accrues,
525	upon the receipt of reasonable proof of such loss and the amount
526	of expenses and loss incurred that which are covered by the
527	policy issued under the no-fault law ss. 627.730-627.7405. If
528	When the Agency for Health Care Administration provides, pays,
529	or becomes liable for medical assistance under the Medicaid
530	program related to injury, sickness, disease, or death arising
531	out of the ownership, maintenance, or use of a motor vehicle,
532	the benefits are under ss. 627.730-627.7405 shall be subject to
533	the provisions of the Medicaid program.
534	(a)  An insurer may require written notice to be given as
535	soon as practicable after an accident involving a motor vehicle
536	with respect to which the policy affords the security required
537	by the no-fault law ss. 627.730-627.7405.
538	(b)  Personal injury protection insurance benefits paid
539	pursuant to this section are shall be overdue if not paid within
540	30 days after the insurer is furnished written notice of the
541	fact of a covered loss and of the amount of same. If such
542	written notice is not furnished to the insurer as to the entire
543	claim, any partial amount supported by written notice is overdue
544	if not paid within 30 days after such written notice is
545	furnished to the insurer. Any part or all of the remainder of
546	the claim that is subsequently supported by written notice is
547	overdue if not paid within 30 days after such written notice is
548	furnished to the insurer.
549	(c)  If When an insurer pays only a portion of a claim or
550	rejects a claim, the insurer shall provide at the time of the
551	partial payment or rejection an itemized specification of each
552	item that the insurer had reduced, omitted, or declined to pay
553	and any information that the insurer desires the claimant to
554	consider related to the medical necessity of the denied
555	treatment or to explain the reasonableness of the reduced
556	charge, provided that this does shall not limit the introduction
557	of evidence at trial.; and The insurer must shall include the
558	name and address of the person to whom the claimant should
559	respond and a claim number to be referenced in future
560	correspondence.
561	(d)  A However, notwithstanding the fact that written
562	notice has been furnished to the insurer, Any payment is shall
563	not be deemed overdue if when the insurer has reasonable proof
564	to establish that the insurer is not responsible for the
565	payment. For the purpose of calculating the extent to which any
566	benefits are overdue, payment shall be treated as being made on
567	the date a draft or other valid instrument which is equivalent
568	to payment was placed in the United States mail in a properly
569	addressed, postpaid envelope or, if not so posted, on the date
570	of delivery. This paragraph does not preclude or limit the
571	ability of the insurer to assert that the claim is was
572	unrelated, was not medically necessary, or was unreasonable, or
573	submitted that the amount of the charge was in excess of that
574	permitted under, or in violation of, subsection (6) (5). Such
575	assertion by the insurer may be made at any time, including
576	after payment of the claim or after the 30-day time period for
577	payment set forth in this paragraph (b). The 30-day period for
578	payment or denial is tolled with respect to any portion of a
579	claim for which the insurer has a reasonable belief that a
580	fraudulent insurance act as defined in s. 626.989 has been
581	committed while the insurer investigates such act. The insurer
582	must notify the claimant in writing that it is investigating a
583	fraudulent insurance act within 30 days after the date it has a
584	reasonable belief that such act has been committed. The insurer
585	must pay or deny the claim, in full or in part, within 120 days
586	after the date the written notice of the fact of a covered loss
587	and of the amount of the loss was provided to the insurer.
588	(e)(c)  Upon receiving notice of an accident that is
589	potentially covered by personal injury protection benefits, the
590	insurer must reserve $5,000 of personal injury protection
591	benefits for payment to physicians licensed under chapter 458 or
592	chapter 459 or dentists licensed under chapter 466 who provide
593	emergency services and care, as defined in s. 395.002(9), or who
594	provide hospital inpatient care. The amount required to be held
595	in reserve may be used only to pay claims from such physicians
596	or dentists until 30 days after the date the insurer receives
597	notice of the accident. After the 30-day period, any amount of
598	the reserve for which the insurer has not received notice of
599	such a claim from a physician or dentist who provided emergency
600	services and care or who provided hospital inpatient care may
601	then be used by the insurer to pay other claims. The time
602	periods specified in paragraph (b) for required payment of
603	personal injury protection benefits are shall be tolled for the
604	period of time that an insurer is required by this paragraph to
605	hold payment of a claim that is not from a physician or dentist
606	who provided emergency services and care or who provided
607	hospital inpatient care to the extent that the personal injury
608	protection benefits not held in reserve are insufficient to pay
609	the claim. This paragraph does not require an insurer to
610	establish a claim reserve for insurance accounting purposes.
611	(f)(d)  All overdue payments shall bear simple interest at
612	the rate established under s. 55.03 or the rate established in
613	the insurance contract, whichever is greater, for the year in
614	which the payment became overdue, calculated from the date the
615	insurer was furnished with written notice of the amount of
616	covered loss. Interest is shall be due at the time payment of
617	the overdue claim is made.
618	(g)(e)  The insurer of the owner of a motor vehicle shall
619	pay personal injury protection benefits for:
620	1.  Accidental bodily injury sustained in this state by the
621	owner while occupying a motor vehicle, or while not an occupant
622	of a self-propelled vehicle if the injury is caused by physical
623	contact with a motor vehicle.
624	2.  Accidental bodily injury sustained outside this state,
625	but within the United States of America or its territories or
626	possessions or Canada, by the owner while occupying the owner's
627	motor vehicle.
628	3.  Accidental bodily injury sustained by a relative of the
629	owner residing in the same household, under the circumstances
630	described in subparagraph 1. or subparagraph 2. if, provided the
631	relative at the time of the accident is domiciled in the owner's
632	household and is not himself or herself the owner of a motor
633	vehicle with respect to which security is required under the no-
634	fault law ss. 627.730-627.7405.
635	4.  Accidental bodily injury sustained in this state by any
636	other person while occupying the owner's motor vehicle or, if a
637	resident of this state, while not an occupant of a self-
638	propelled vehicle, if the injury is caused by physical contact
639	with such motor vehicle and if, provided the injured person is
640	not himself or herself:
641	a.  The owner of a motor vehicle with respect to which
642	security is required under the no-fault law ss. 627.730-
643	627.7405; or
644	b.  Entitled to personal injury benefits from the insurer
645	of the owner or owners of such a motor vehicle.
646	(h)(f)  If two or more insurers are liable to pay personal
647	injury protection benefits for the same injury to any one
648	person, the maximum payable is shall be as specified in
649	subsection (1), and any insurer paying the benefits is shall be
650	entitled to recover from each of the other insurers an equitable
651	pro rata share of the benefits paid and expenses incurred in
652	processing the claim.
653	(i)(g)  It is a violation of the insurance code for an
654	insurer to fail to timely provide benefits as required by this
655	section with such frequency as to constitute a general business
656	practice.
657	(j)(h)  Benefits are shall not be due or payable to or on
658	the behalf of a claimant who: an insured person if that person
659	has
660	1.  Submits a false or misleading statement, document,
661	record, or bill;
662	2.  Submits any other false or misleading information; or
663	3.  Has otherwise committed or attempted to commit a
664	fraudulent insurance act as defined in s. 626.989.
665
666	A claimant who violates this paragraph is not entitled to any
667	personal injury protection benefits or payment for any bills and
668	services, regardless of whether a portion of the claim may be
669	legitimate.
670	(k)  Notwithstanding any remedies afforded by law, the
671	insurer may recover from a claimant who has violated paragraph
672	(j) any sums previously paid to the claimant and may bring any
673	available common law and statutory causes of action committed,
674	by a material act or omission, any insurance fraud relating to
675	personal injury protection coverage under his or her policy, if
676	the fraud is admitted to in a sworn statement by the insured or
677	if it is established in a court of competent jurisdiction. If a
678	physician, hospital, clinic, or other medical institution
679	violates paragraph (j), the injured party is not liable for, and
680	the physician, hospital, clinic, or other medical institution
681	may not bill the insured for, charges that are unpaid because of
682	failure to comply with paragraph (j). Any agreement requiring
683	the injured person or insured to pay for such charges is
684	unenforceable. Any insurance fraud shall void all coverage
685	arising from the claim related to such fraud under the personal
686	injury protection coverage of the insured person who committed
687	the fraud, irrespective of whether a portion of the insured
688	person's claim may be legitimate, and any benefits paid prior to
689	the discovery of the insured person's insurance fraud shall be
690	recoverable by the insurer from the person who committed
691	insurance fraud in their entirety. The prevailing party is
692	entitled to its costs and attorney's fees in any action in which
693	it prevails in an insurer's action to enforce its right of
694	recovery under this paragraph.
695	(5)  INSURER INVESTIGATIONS.-An insurer has the right and
696	duty to conduct a reasonable investigation of a claim. In the
697	course of the investigation, the insurer may require the
698	insured, claimant, or medical provider to provide copies of the
699	treatment and examination records so that the insurer can
700	provide such records to a physician for a records review. A
701	records review need not be based on a physical examination and
702	may be obtained at any time, including after reduction or denial
703	of the claim. The 30-day period for payment under paragraph
704	(4)(b) is tolled from the date the insurer sends its request for
705	treatment records to the date that the insurer receives the
706	treatment records. The claim may be denied or reduced if the
707	medical provider fails to keep adequate records such that the
708	insurer is unable to obtain a records review.
709	(6)(5)  CHARGES FOR TREATMENT OF INJURED PERSONS.-
710	(a)1.  Any physician, hospital, clinic, or other person or
711	institution lawfully rendering treatment to an injured person
712	for a bodily injury covered by personal injury protection
713	insurance may charge the insurer and injured party only an a
714	reasonable amount pursuant to this section for the services and
715	supplies rendered, and the insurer providing such coverage may
716	pay for such charges directly to such person or institution
717	lawfully rendering such treatment, if the insured receiving such
718	treatment or his or her guardian has countersigned the properly
719	completed invoice, bill, or claim form approved by the office
720	upon which such charges are to be paid for as having actually
721	been rendered, to the best knowledge of the insured or his or
722	her guardian. In no event, However, may such a charge may not
723	exceed be in excess of the amount the person or institution
724	customarily charges for like services or supplies. When
725	determining With respect to a determination of whether a charge
726	for a particular service, treatment, or otherwise is reasonable,
727	consideration may be given to evidence of usual and customary
728	charges and payments accepted by the provider involved in the
729	dispute, and reimbursement levels in the community and various
730	federal and state medical fee schedules applicable to automobile
731	and other insurance coverages, and other information relevant to
732	the reasonableness of the reimbursement for the service,
733	treatment, or supply.
734	1.2.  The insurer may limit reimbursement to 80 percent of
735	the following schedule of maximum charges:
736	a.  For emergency transport and treatment by providers
737	licensed under chapter 401, 200 percent of Medicare.
738	b.  For emergency services and care provided by a hospital
739	licensed under chapter 395, 75 percent of the hospital's usual
740	and customary charges.
741	c.  For emergency services and care as defined by s.
742	395.002(9) provided in a facility licensed under chapter 395
743	rendered by a physician or dentist, and related hospital
744	inpatient services rendered by a physician or dentist, the usual
745	and customary charges in the community.
746	d.  For hospital inpatient services, other than emergency
747	services and care, 200 percent of the Medicare Part A
748	prospective payment applicable to the specific hospital
749	providing the inpatient services.
750	e.  For hospital outpatient services, other than emergency
751	services and care, 200 percent of the Medicare Part A Ambulatory
752	Payment Classification for the specific hospital providing the
753	outpatient services.
754	f.  For all other medical services, supplies, and care, 200
755	percent of the allowable amount under the participating
756	physicians schedule of Medicare Part B. However, if such
757	services, supplies, or care is not reimbursable under Medicare
758	Part B, the insurer may limit reimbursement to 80 percent of the
759	maximum reimbursable allowance under workers' compensation, as
760	determined under s. 440.13 and rules adopted thereunder which
761	are in effect at the time such services, supplies, or care is
762	provided. Services, supplies, or care that is not reimbursable
763	under Medicare or workers' compensation is not required to be
764	reimbursed by the insurer.
765	2.3.  For purposes of subparagraph 1. 2., the applicable
766	fee schedule or payment limitation under Medicare is the fee
767	schedule or payment limitation in effect on January 1 of the
768	year in which at the time the services, supplies, or care was
769	rendered and for the area in which such services were rendered,
770	notwithstanding any subsequent changes made to such fee schedule
771	or payment limitation, except that it may not be less than the
772	allowable amount under the participating physicians schedule of
773	Medicare Part B for 2007 for medical services, supplies, and
774	care subject to Medicare Part B.
775	3.4.  Subparagraph 1. 2. does not allow the insurer to
776	apply any limitation on the number of treatments or other
777	utilization limits that apply under Medicare or workers'
778	compensation. An insurer that applies the allowable payment
779	limitations of subparagraph 1. 2. must reimburse a provider who
780	lawfully provided care or treatment under the scope of his or
781	her license, regardless of whether such provider is would be
782	entitled to reimbursement under Medicare due to restrictions or
783	limitations on the types or discipline of health care providers
784	who may be reimbursed for particular procedures or procedure
785	codes.
786	4.5.  If an insurer limits payment as authorized by
787	subparagraph 1. 2., the person providing such services,
788	supplies, or care may not bill or attempt to collect from the
789	insured any amount in excess of such limits, except for amounts
790	that are not covered by the insured's personal injury protection
791	coverage due to the coinsurance amount or maximum policy limits.
792	(b)1.  An insurer or insured is not required to pay a claim
793	or charges:
794	a.  Made by a broker or by a person making a claim on
795	behalf of a broker;
796	b.  For any service or treatment that was not lawful at the
797	time rendered;
798	c.  To any person who knowingly submits a false or
799	misleading statement relating to the claim or charges;
800	d.  With respect to a bill or statement that does not
801	substantially meet the applicable requirements of paragraphs (c)
802	and paragraph (d);
803	e.  For any treatment or service that is upcoded, or that
804	is unbundled if when such treatment or services should be
805	bundled, in accordance with paragraph (d). To facilitate prompt
806	payment of lawful services, an insurer may change codes that it
807	determines to have been improperly or incorrectly upcoded or
808	unbundled, and may make payment based on the changed codes,
809	without affecting the right of the provider to dispute the
810	change by the insurer if, provided that before doing so, the
811	insurer contacts must contact the health care provider and
812	discusses discuss the reasons for the insurer's change and the
813	health care provider's reason for the coding, or makes make a
814	reasonable good faith effort to do so, as documented in the
815	insurer's file; and
816	f.  For medical services or treatment billed by a physician
817	and not provided in a hospital unless such services are rendered
818	by the physician or are incident to his or her professional
819	services and are included on the physician's bill, including
820	documentation verifying that the physician is responsible for
821	the medical services that were rendered and billed.
822	2.  The Department of Health, in consultation with the
823	appropriate professional licensing boards, shall adopt, by rule,
824	a list of diagnostic tests deemed not to be medically necessary
825	for use in the treatment of persons sustaining bodily injury
826	covered by personal injury protection benefits under this
827	section. The initial list shall be adopted by January 1, 2004,
828	and shall be revised from time to time as determined by the
829	Department of Health, in consultation with the respective
830	professional licensing boards. Inclusion of a test on the list
831	must of invalid diagnostic tests shall be based on lack of
832	demonstrated medical value and a level of general acceptance by
833	the relevant provider community and may shall not be dependent
834	for results entirely upon subjective patient response.
835	Notwithstanding its inclusion on a fee schedule in this
836	subsection, an insurer or insured is not required to pay any
837	charges or reimburse claims for any invalid diagnostic test as
838	determined by the Department of Health.
839	(c)1.  With respect to any treatment or service, other than
840	medical services billed by a hospital or other provider for
841	emergency services as defined in s. 395.002 or inpatient
842	services rendered at a hospital-owned facility, the statement of
843	charges must be furnished to the insurer by the provider and may
844	not include, and the insurer is not required to pay, charges for
845	treatment or services rendered more than 35 days before the
846	postmark date or electronic transmission date of the statement,
847	except for past due amounts previously billed on a timely basis
848	under this paragraph, and except that, if the provider submits
849	to the insurer a notice of initiation of treatment within 21
850	days after its first examination or treatment of the claimant,
851	the statement may include charges for treatment or services
852	rendered up to, but not more than, 75 days before the postmark
853	date of the statement. The injured party is not liable for, and
854	the provider may shall not bill the injured party for, charges
855	that are unpaid because of the provider's failure to comply with
856	this paragraph. Any agreement requiring the injured person or
857	insured to pay for such charges is unenforceable.
858	1.2.  If, however, the insured fails to furnish the
859	provider with the correct name and address of the insured's
860	personal injury protection insurer, the provider has 35 days
861	from the date the provider obtains the correct information to
862	furnish the insurer with a statement of the charges. The insurer
863	is not required to pay for such charges unless the provider
864	includes with the statement documentary evidence that was
865	provided by the insured during the 35-day period demonstrating
866	that the provider reasonably relied on erroneous information
867	from the insured and either:
868	a.  A denial letter from the incorrect insurer; or
869	b.  Proof of mailing, which may include an affidavit under
870	penalty of perjury, reflecting timely mailing to the incorrect
871	address or insurer.
872	2.3.  For emergency services and care as defined in s.
873	395.002 rendered in a hospital emergency department or for
874	transport and treatment rendered by an ambulance provider
875	licensed pursuant to part III of chapter 401, the provider is
876	not required to furnish the statement of charges within the time
877	periods established by this paragraph,; and the insurer is shall
878	not be considered to have been furnished with notice of the
879	amount of covered loss for purposes of paragraph (4)(b) until it
880	receives a statement complying with paragraph (d), or copy
881	thereof, which specifically identifies the place of service to
882	be a hospital emergency department or an ambulance in accordance
883	with billing standards recognized by the Centers for Medicare
884	and Medicaid Services (CMS) Health Care Finance Administration.
885	3.4.  Each notice of the insured's rights under s. 627.7401
886	must include the following statement in type no smaller than 12
887	points:
888
889	BILLING REQUIREMENTS.-Florida Statutes provide that
890	with respect to any treatment or services, other than
891	certain hospital and emergency services, the statement
892	of charges furnished to the insurer by the provider
893	may not include, and the insurer and the injured party
894	are not required to pay, charges for treatment or
895	services rendered more than 35 days before the
896	postmark date of the statement, except for past due
897	amounts previously billed on a timely basis, and
898	except that, if the provider submits to the insurer a
899	notice of initiation of treatment within 21 days after
900	its first examination or treatment of the claimant,
901	the first billing cycle statement may include charges
902	for treatment or services rendered up to, but not more
903	than, 75 days before the postmark date of the
904	statement.
905
906	(d)  All statements and bills for medical services rendered
907	by any physician, hospital, clinic, or other person or
908	institution shall be submitted to the insurer on a properly
909	completed Centers for Medicare and Medicaid Services (CMS) 1500
910	form, UB 92 forms, or any other standard form approved by the
911	office or adopted by the commission for purposes of this
912	paragraph. All billings for such services rendered by providers
913	must shall, to the extent applicable, follow the Physicians'
914	Current Procedural Terminology (CPT) or Healthcare Correct
915	Procedural Coding System (HCPCS), or ICD-9 in effect for the
916	year in which services are rendered and comply with the Centers
917	for Medicare and Medicaid Services (CMS) 1500 form instructions
918	and the American Medical Association Current Procedural
919	Terminology (CPT) Editorial Panel and Healthcare Correct
920	Procedural Coding System (HCPCS). All providers other than
921	hospitals shall include on the applicable claim form the
922	professional license number of the provider in the line or space
923	provided for "Signature of Physician or Supplier, Including
924	Degrees or Credentials." In determining compliance with
925	applicable CPT and HCPCS coding, guidance shall be provided by
926	the Physicians' Current Procedural Terminology (CPT) or the
927	Healthcare Correct Procedural Coding System (HCPCS) in effect
928	for the year in which services were rendered, the Office of the
929	Inspector General (OIG), Physicians Compliance Guidelines, and
930	other authoritative treatises designated by rule by the Agency
931	for Health Care Administration. A No statement of medical
932	services may not include charges for medical services of a
933	person or entity that performed such services without possessing
934	the valid licenses required to perform such services. For
935	purposes of paragraph (4)(b), an insurer is shall not be
936	considered to have been furnished with notice of the amount of
937	covered loss or medical bills due unless the statements or bills
938	comply with this paragraph, and unless the statements or bills
939	are properly completed in their entirety as to all material
940	provisions, with all relevant information being provided
941	therein.
942	(e)1.  At the initial treatment or service provided, each
943	physician, other licensed professional, clinic, or other medical
944	institution providing medical services upon which a claim for
945	personal injury protection benefits is based shall require an
946	insured person, or his or her guardian, to execute a disclosure
947	and acknowledgment form, which reflects at a minimum that:
948	a.  The insured, or his or her guardian, must countersign
949	the form attesting to the fact that the services set forth
950	therein were actually rendered;
951	b.  The insured, or his or her guardian, has both the right
952	and affirmative duty to confirm that the services were actually
953	rendered;
954	c.  The insured, or his or her guardian, was not solicited
955	by any person to seek any services from the medical provider;
956	d.  The physician, other licensed professional, clinic, or
957	other medical institution rendering services for which payment
958	is being claimed explained the services to the insured or his or
959	her guardian; and
960	e.  If the insured notifies the insurer in writing of a
961	billing error, the insured may be entitled to a certain
962	percentage of a reduction in the amounts paid by the insured's
963	motor vehicle insurer.
964	2.  The physician, other licensed professional, clinic, or
965	other medical institution rendering services for which payment
966	is being claimed has the affirmative duty to explain the
967	services rendered to the insured, or his or her guardian, so
968	that the insured, or his or her guardian, countersigns the form
969	with informed consent.
970	3.  Countersignature by the insured, or his or her
971	guardian, is not required for the reading of diagnostic tests or
972	other services that are of such a nature that they are not
973	required to be performed in the presence of the insured.
974	4.  The licensed medical professional rendering treatment
975	for which payment is being claimed must sign, by his or her own
976	hand, the form complying with this paragraph.
977	5.  The original completed disclosure and acknowledgment
978	form is shall be furnished to the insurer pursuant to paragraph
979	(4)(b) and may not be electronically furnished.
980	6.  This disclosure and acknowledgment form is not required
981	for services billed by a provider for emergency services as
982	defined in s. 395.002, for emergency services and care as
983	defined in s. 395.002 rendered in a hospital emergency
984	department, or for transport and treatment rendered by an
985	ambulance provider licensed pursuant to part III of chapter 401.
986	7.  The Financial Services Commission shall adopt, by rule,
987	a standard disclosure and acknowledgment form to that shall be
988	used to fulfill the requirements of this paragraph, effective 90
989	days after such form is adopted and becomes final. The
990	commission shall adopt a proposed rule by October 1, 2003. Until
991	the rule is final, the provider may use a form of its own which
992	otherwise complies with the requirements of this paragraph.
993	8.  As used in this paragraph, the term "countersigned" or
994	"countersignature" means a second or verifying signature, as on
995	a previously signed document, and is not satisfied by the
996	statement "signature on file" or any similar statement.
997	9.  The requirements of this paragraph apply only with
998	respect to the initial treatment or service of the insured by a
999	provider. For subsequent treatments or service, the provider
1000	must maintain a patient log signed by the patient, in
1001	chronological order by date of service, that is consistent with
1002	the services being rendered to the patient as claimed. The
1003	requirements of this subparagraph for maintaining a patient log
1004	signed by the patient may be met by a hospital that maintains
1005	medical records as required by s. 395.3025 and applicable rules
1006	and makes such records available to the insurer upon request.
1007	(f)  Upon written notification by any person, an insurer
1008	shall investigate any claim of improper billing by a physician
1009	or other medical provider. The insurer shall determine if the
1010	insured was properly billed for only those services and
1011	treatments that the insured actually received. If the insurer
1012	determines that the insured has been improperly billed, the
1013	insurer shall notify the insured, the person making the written
1014	notification, and the provider of its findings and shall reduce
1015	the amount of payment to the provider by the amount determined
1016	to be improperly billed. If a reduction is made due to such
1017	written notification by any person, the insurer shall pay to the
1018	person 20 percent of the amount of the reduction, up to $500. If
1019	the provider is arrested due to the improper billing, then the
1020	insurer shall pay to the person 40 percent of the amount of the
1021	reduction, up to $500.
1022	(g)  An insurer may not systematically downcode with the
1023	intent to deny reimbursement otherwise due. Such action
1024	constitutes a material misrepresentation under s.
1025	626.9541(1)(i)2.
1026	(7)(6)  DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
1027	DISPUTES.-
1028	(a)  An insurer may require a claimant to submit to an
1029	examination under oath or sworn statement as often as reasonably
1030	requested by an insurer and at any reasonable location
1031	designated by the insurer. Submission to an examination under
1032	oath or sworn statement is a condition precedent to recovery or
1033	filing suit. The insurer is not liable for benefits under the
1034	no-fault law if the claimant fails to fully and truthfully
1035	answer all questions asked or violates any provision of
1036	paragraph (4)(j).
1037	1.  The insurer may conduct the examination outside the
1038	presence of any other person seeking coverage.
1039	2.  If an insurer requests an examination of a claimant
1040	that is in a hospital, clinic, or other medical institution,
1041	such claimant shall produce the persons with the most knowledge
1042	relating to the issues set forth by the insurer in the notice of
1043	examination.
1044	3.  The claimant must provide the insurer at the
1045	examination with all documents, papers, receipts, invoices,
1046	bills, records, or other tangible items requested by the
1047	insurer.
1048	4.  The examination may be recorded by audio, video, or
1049	court report or any combination thereof. The claimant may record
1050	the examination at the claimant's expense.
1051	5.  The claimant may have an attorney present at the
1052	examination at the claimant's expense.
1053	6.  An insurer that unreasonably requests an examination
1054	without a reasonable basis as a general business practice is
1055	engaging in an unfair insurance trade practice pursuant to s.
1056	626.9541.
1057	(a)  Every employer shall, if a request is made by an
1058	insurer providing personal injury protection benefits under ss.
1059	627.730-627.7405 against whom a claim has been made, furnish
1060	forthwith, in a form approved by the office, a sworn statement
1061	of the earnings, since the time of the bodily injury and for a
1062	reasonable period before the injury, of the person upon whose
1063	injury the claim is based.
1064	(b)  Every physician, hospital, clinic, or other medical
1065	institution providing, before or after bodily injury upon which
1066	a claim for personal injury protection insurance benefits is
1067	based, any products, services, or accommodations in relation to
1068	that or any other injury, or in relation to a condition claimed
1069	to be connected with that or any other injury, shall, if
1070	requested to do so by the insurer against whom the claim has
1071	been made, permit the insurer or the insurer's representative to
1072	conduct an onsite physical review and examination of the
1073	treatment location, treatment apparatuses, diagnostic devices,
1074	and any other medical equipment used for the services rendered
1075	within 10 days after the insurer's request and furnish forthwith
1076	a written report of the history, condition, treatment, dates,
1077	and costs of such treatment of the injured person and why the
1078	items identified by the insurer were reasonable in amount and
1079	medically necessary, together with a sworn statement that the
1080	treatment or services rendered were reasonable and necessary
1081	with respect to the bodily injury sustained and identifying
1082	which portion of the expenses for such treatment or services was
1083	incurred as a result of such bodily injury, and produce
1084	forthwith, and permit the inspection and copying of, his or her
1085	or its records regarding such history, condition, treatment,
1086	dates, and costs of treatment if; provided that this does shall
1087	not limit the introduction of evidence at trial. Such sworn
1088	statement must shall read as follows: "Under penalty of perjury,
1089	I declare that I have read the foregoing, and the facts alleged
1090	are true, to the best of my knowledge and belief." A No cause of
1091	action for violation of the physician-patient privilege or
1092	invasion of the right of privacy may not be brought shall be
1093	permitted against any physician, hospital, clinic, or other
1094	medical institution complying with the provisions of this
1095	section. The person requesting such records and such sworn
1096	statement shall pay all reasonable costs connected therewith. If
1097	an insurer makes a written request for documentation or
1098	information under this paragraph within 30 days after having
1099	received notice of the amount of a covered loss under paragraph
1100	(4)(a), the amount or the partial amount that which is the
1101	subject of the insurer's inquiry is shall become overdue if the
1102	insurer does not pay in accordance with paragraph (4)(b) or
1103	within 10 days after the insurer's receipt of the requested
1104	documentation or information, whichever occurs later. For
1105	purposes of this paragraph, the term "receipt" includes, but is
1106	not limited to, inspection and copying pursuant to this
1107	paragraph. An Any insurer that requests documentation or
1108	information pertaining to reasonableness of charges or medical
1109	necessity under this paragraph without a reasonable basis for
1110	such requests as a general business practice is engaging in an
1111	unfair trade practice under the insurance code.
1112	(c)  If a request is made by an insurer, an employer must
1113	furnish, in a form approved by the office, a sworn statement of
1114	the earnings of the person upon whose injury a claim is based
1115	since the time of the bodily injury and for a reasonable period
1116	before the injury.
1117	(d)(c)  If there is a In the event of any dispute regarding
1118	an insurer's right to discovery of facts under this section, the
1119	insurer may petition the a court of competent jurisdiction to
1120	enter an order permitting such discovery. The order may be made
1121	only on motion for good cause shown and upon notice to all
1122	persons having an interest, and must it shall specify the time,
1123	place, manner, conditions, and scope of the discovery. The Such
1124	court may, in order to protect against annoyance, embarrassment,
1125	or oppression, as justice requires, enter an order refusing
1126	discovery or specifying conditions of discovery and may order
1127	payments of costs and expenses of the proceeding, including
1128	reasonable fees for the appearance of attorneys at the
1129	proceedings, as justice requires.
1130	(8)(7)  MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON;
1131	REPORTS.-
1132	(b)  If requested by the person examined, a party causing
1133	an examination to be made shall deliver to him or her a copy of
1134	every written report concerning the examination rendered by an
1135	examining physician, at least one of which reports must set out
1136	the examining physician's findings and conclusions in detail.
1137	After such request and delivery, the party causing the
1138	examination to be made is entitled, upon request, to receive
1139	from the person examined every written report available to him
1140	or her or his or her representative concerning any examination,
1141	previously or thereafter made, of the same mental or physical
1142	condition. By requesting and obtaining a report of the
1143	examination so ordered, or by taking the deposition of the
1144	examiner, the person examined waives any privilege he or she may
1145	have, in relation to the claim for benefits, regarding the
1146	testimony of every other person who has examined, or may
1147	thereafter examine, him or her in respect to the same mental or
1148	physical condition. If a person unreasonably refuses to submit
1149	to an examination, the personal injury protection carrier is no
1150	longer liable for subsequent personal injury protection benefits
1151	incurred after the date of the first request for examination.
1152	Failure to appear for an examination raises a rebuttable
1153	presumption that such failure was unreasonable. Submission to an
1154	examination is a condition precedent to the recovery of
1155	benefits.
1156	(9)(8)  APPLICABILITY OF PROVISION REGULATING ATTORNEY'S
1157	FEES.-With respect to any dispute under the provisions of ss.
1158	627.730-627.7405 between the insured and the insurer under the
1159	no-fault law, or between an assignee of an insured's rights and
1160	the insurer, the provisions of s. 627.428 applies shall apply,
1161	except as provided in subsections (11) and (16) (10) and (15).
1162	(10)(9)  PREFERRED PROVIDERS.-An insurer may negotiate and
1163	enter into contracts with preferred licensed health care
1164	providers for the benefits described in this section, referred
1165	to in this section as "preferred providers," which shall include
1166	health care providers licensed under chapter chapters 458,
1167	chapter 459, chapter 460, chapter 461, or chapter and 463.
1168	(a)  The insurer may provide an option to an insured to use
1169	a preferred provider at the time of purchase of the policy for
1170	personal injury protection benefits, if the requirements of this
1171	subsection are met. However, if the insurer offers a preferred
1172	provider option, it must also offer a nonpreferred provider
1173	policy. If the insured elects to use a provider who is not a
1174	preferred provider, whether the insured purchased a preferred
1175	provider policy or a nonpreferred provider policy, the medical
1176	benefits provided by the insurer shall be as required by this
1177	section.
1178	(b)  If the insured elects the to use a provider who is a
1179	preferred provider option, the insurer may pay medical benefits
1180	in excess of the benefits required by this section and may waive
1181	or lower the amount of any deductible that applies to such
1182	medical benefits. As an alternative, or in addition to such
1183	benefits, waiver, or reduction, the insurer may provide an
1184	actuarially appropriate premium discount as specified in an
1185	approved rate filing to an insured who selects the preferred
1186	provider option. If the preferred provider option provides a
1187	premium discount, the policy may provide that charges for
1188	nonemergency services provided within this state are payable
1189	only if performed by members of the preferred provider network
1190	unless there is no member of the preferred provider network
1191	located within 15 miles of the insured's place of residence
1192	whose scope of practice includes the required services. If the
1193	insurer offers a preferred provider policy to a policyholder or
1194	applicant, it must also offer a nonpreferred provider policy.
1195	(c)  The insurer shall provide each insured policyholder
1196	with a current roster of preferred providers in the county in
1197	which the insured resides at the time of purchasing purchase of
1198	such policy, and shall make such list available for public
1199	inspection during regular business hours at the insurer's
1200	principal office of the insurer within the state. The insurer
1201	may contract with another health insurer for the right to use an
1202	existing preferred provider network to implement the preferred
1203	provider option. Any other arrangement is subject to the
1204	approval of the Office of Insurance Regulation.
1205	(17)(16)  SECURE ELECTRONIC DATA TRANSFER.-If all parties
1206	mutually and expressly agree, a notice, documentation,
1207	transmission, or communication of any kind required or
1208	authorized under the no-fault law ss. 627.730-627.7405 may be
1209	transmitted electronically if it is transmitted by secure
1210	electronic data transfer that is consistent with state and
1211	federal privacy and security laws.
1212	Section 8.  Subsection (1) of section 324.021, Florida
1213	Statutes, is amended to read:
1214	324.021  Definitions; minimum insurance required.-The
1215	following words and phrases when used in this chapter shall, for
1216	the purpose of this chapter, have the meanings respectively
1217	ascribed to them in this section, except in those instances
1218	where the context clearly indicates a different meaning:
1219	(1)  MOTOR VEHICLE.-Every self-propelled vehicle that which
1220	is designed and required to be licensed for use upon a highway,
1221	including trailers and semitrailers designed for use with such
1222	vehicles, except traction engines, road rollers, farm tractors,
1223	power shovels, and well drillers, and every vehicle that which
1224	is propelled by electric power obtained from overhead wires but
1225	not operated upon rails, but not including any bicycle or moped.
1226	However, the term does "motor vehicle" shall not include a any
1227	motor vehicle as defined in s. 627.732(3) if when the owner of
1228	such vehicle has complied with the no-fault law requirements of
1229	ss. 627.730-627.7405, inclusive, unless the provisions of s.
1230	324.051 apply; and, in such case, the applicable proof of
1231	insurance provisions of s. 320.02 apply.
1232	Section 9.  Paragraph (k) of subsection (2) of section
1233	456.057, Florida Statutes, is amended to read:
1234	456.057  Ownership and control of patient records; report
1235	or copies of records to be furnished.-
1236	(2)  As used in this section, the terms "records owner,"
1237	"health care practitioner," and "health care practitioner's
1238	employer" do not include any of the following persons or
1239	entities; furthermore, the following persons or entities are not
1240	authorized to acquire or own medical records, but are authorized
1241	under the confidentiality and disclosure requirements of this
1242	section to maintain those documents required by the part or
1243	chapter under which they are licensed or regulated:
1244	(k)  Persons or entities practicing under s. 627.736(8)
1245	627.736(7).
1246	Section 10.  Subsection (7) of section 627.7295, Florida
1247	Statutes, is amended to read:
1248	627.7295  Motor vehicle insurance contracts.-
1249	(7)  A policy of private passenger motor vehicle insurance
1250	or a binder for such a policy may be initially issued in this
1251	state only if, before the effective date of such binder or
1252	policy, the insurer or agent has collected from the insured an
1253	amount equal to 2 months' premium. An insurer, agent, or premium
1254	finance company may not, directly or indirectly, take any action
1255	resulting in the insured having paid from the insured's own
1256	funds an amount less than the 2 months' premium required by this
1257	subsection. This subsection applies without regard to whether
1258	the premium is financed by a premium finance company or is paid
1259	pursuant to a periodic payment plan of an insurer or an
1260	insurance agent. This subsection does not apply if an insured or
1261	member of the insured's family is renewing or replacing a policy
1262	or a binder for such policy written by the same insurer or a
1263	member of the same insurer group. This subsection does not apply
1264	to an insurer that issues private passenger motor vehicle
1265	coverage primarily to active duty or former military personnel
1266	or their dependents. This subsection does not apply if all
1267	policy payments are paid pursuant to a payroll deduction plan or
1268	an automatic electronic funds transfer payment plan from the
1269	policyholder. This subsection and subsection (4) do not apply if
1270	all policy payments to an insurer are paid pursuant to an
1271	automatic electronic funds transfer payment plan from an agent,
1272	a managing general agent, or a premium finance company and if
1273	the policy includes, at a minimum, personal injury protection
1274	pursuant to ss. 627.730-627.7407 627.730-627.7405; motor vehicle
1275	property damage liability pursuant to s. 627.7275; and bodily
1276	injury liability in at least the amount of $10,000 because of
1277	bodily injury to, or death of, one person in any one accident
1278	and in the amount of $20,000 because of bodily injury to, or
1279	death of, two or more persons in any one accident. This
1280	subsection and subsection (4) do not apply if an insured has had
1281	a policy in effect for at least 6 months, the insured's agent is
1282	terminated by the insurer that issued the policy, and the
1283	insured obtains coverage on the policy's renewal date with a new
1284	company through the terminated agent.
1285	Section 11.  Subsections (3) and (4) of section 627.733,
1286	Florida Statutes, are amended to read:
1287	627.733  Required security.-
1288	(3)  Such security shall be provided:
1289	(a)  By an insurance policy delivered or issued for
1290	delivery in this state by an authorized or eligible motor
1291	vehicle liability insurer which provides the benefits and
1292	exemptions contained in the no-fault law ss. 627.730-627.7405.
1293	Any policy of insurance represented or sold as providing the
1294	security required hereunder shall be deemed to provide insurance
1295	for the payment of the required benefits; or
1296	(b)  By any other method authorized by s. 324.031(2), (3),
1297	or (4) and approved by the Department of Highway Safety and
1298	Motor Vehicles as affording security equivalent to that afforded
1299	by a policy of insurance or by self-insuring as authorized by s.
1300	768.28(16). The person filing such security shall have all of
1301	the obligations and rights of an insurer under the no-fault law
1302	ss. 627.730-627.7405.
1303	(4)  An owner of a motor vehicle with respect to which
1304	security is required by this section who fails to have such
1305	security in effect at the time of an accident shall have no
1306	immunity from tort liability, but shall be personally liable for
1307	the payment of benefits under s. 627.736. With respect to such
1308	benefits, such an owner shall have all of the rights and
1309	obligations of an insurer under the no-fault law ss. 627.730-
1310	627.7405.
1311	Section 12.  Section 627.734, Florida Statutes, is amended
1312	to read:
1313	627.734  Proof of security; security requirements;
1314	penalties.-
1315	(1)  The provisions of chapter 324 that which pertain to
1316	the method of giving and maintaining proof of financial
1317	responsibility and that which govern and define a motor vehicle
1318	liability policy shall apply to filing and maintaining proof of
1319	security required by the no-fault law ss. 627.730-627.7405.
1320	(2)  Any person who:
1321	(a)  Gives information required in a report or otherwise as
1322	provided for in the no-fault law ss. 627.730-627.7405, knowing
1323	or having reason to believe that such information is false;
1324	(b)  Forges or, without authority, signs any evidence of
1325	proof of security; or
1326	(c)  Files, or offers for filing, any such evidence of
1327	proof, knowing or having reason to believe that it is forged or
1328	signed without authority,
1329
1330	commits is guilty of a misdemeanor of the first degree,
1331	punishable as provided in s. 775.082 or s. 775.083.
1332	Section 13.  Subsections (1), (2), and (3) of section
1333	627.737, Florida Statutes, are amended to read:
1334	627.737  Tort exemption; limitation on right to damages;
1335	punitive damages.-
1336	(1)  Every owner, registrant, operator, or occupant of a
1337	motor vehicle with respect to which security has been provided
1338	as required by the no-fault law ss. 627.730-627.7405, and every
1339	person or organization legally responsible for her or his acts
1340	or omissions, is hereby exempted from tort liability for damages
1341	because of bodily injury, sickness, or disease arising out of
1342	the ownership, operation, maintenance, or use of such motor
1343	vehicle in this state to the extent that the benefits described
1344	in s. 627.736(1) are payable for such injury, or would be
1345	payable but for any exclusion authorized by the no-fault law ss.
1346	627.730-627.7405, under any insurance policy or other method of
1347	security complying with the requirements of s. 627.733, or by an
1348	owner personally liable under s. 627.733 for the payment of such
1349	benefits, unless a person is entitled to maintain an action for
1350	pain, suffering, mental anguish, and inconvenience for such
1351	injury under the provisions of subsection (2).
1352	(2)  In any action of tort brought against the owner,
1353	registrant, operator, or occupant of a motor vehicle with
1354	respect to which security has been provided as required by the
1355	no-fault law ss. 627.730-627.7405, or against any person or
1356	organization legally responsible for her or his acts or
1357	omissions, a plaintiff may recover damages in tort for pain,
1358	suffering, mental anguish, and inconvenience because of bodily
1359	injury, sickness, or disease arising out of the ownership,
1360	maintenance, operation, or use of such motor vehicle only in the
1361	event that the injury or disease consists in whole or in part
1362	of:
1363	(a)  Significant and permanent loss of an important bodily
1364	function.
1365	(b)  Permanent injury within a reasonable degree of medical
1366	probability, other than scarring or disfigurement.
1367	(c)  Significant and permanent scarring or disfigurement.
1368	(d)  Death.
1369	(3)  When a defendant, in a proceeding brought pursuant to
1370	the no-fault law ss. 627.730-627.7405, questions whether the
1371	plaintiff has met the requirements of subsection (2), then the
1372	defendant may file an appropriate motion with the court, and the
1373	court shall, on a one-time basis only, 30 days before the date
1374	set for the trial or the pretrial hearing, whichever is first,
1375	by examining the pleadings and the evidence before it, ascertain
1376	whether the plaintiff will be able to submit some evidence that
1377	the plaintiff will meet the requirements of subsection (2). If
1378	the court finds that the plaintiff will not be able to submit
1379	such evidence, then the court shall dismiss the plaintiff's
1380	claim without prejudice.
1381	Section 14.  Subsection (1) of section 627.7401, Florida
1382	Statutes, is amended to read:
1383	627.7401  Notification of insured's rights.-
1384	(1)  The commission, by rule, shall adopt a form for the
1385	notification of insureds of their right to receive personal
1386	injury protection benefits under the Florida Motor Vehicle no-
1387	fault law. Such notice shall include:
1388	(a)  A description of the benefits provided by personal
1389	injury protection, including, but not limited to, the specific
1390	types of services for which medical benefits are paid,
1391	disability benefits, death benefits, significant exclusions from
1392	and limitations on personal injury protection benefits, when
1393	payments are due, how benefits are coordinated with other
1394	insurance benefits that the insured may have, penalties and
1395	interest that may be imposed on insurers for failure to make
1396	timely payments of benefits, and rights of parties regarding
1397	disputes as to benefits.
1398	(b)  An advisory informing insureds that:
1399	1.  Pursuant to s. 626.9892, the Department of Financial
1400	Services may pay rewards of up to $25,000 to persons providing
1401	information leading to the arrest and conviction of persons
1402	committing crimes investigated by the Division of Insurance
1403	Fraud arising from violations of s. 440.105, s. 624.15, s.
1404	626.9541, s. 626.989, or s. 817.234.
1405	2.  Pursuant to s. 627.736(6)(e)1. 627.736(5)(e)1., if the
1406	insured notifies the insurer of a billing error, the insured may
1407	be entitled to a certain percentage of a reduction in the amount
1408	paid by the insured's motor vehicle insurer.
1409	(c)  A notice that solicitation of a person injured in a
1410	motor vehicle crash for purposes of filing personal injury
1411	protection or tort claims could be a violation of s. 817.234, s
1412	817.505, or the rules regulating The Florida Bar and should be
1413	immediately reported to the Division of Insurance Fraud if such
1414	conduct has taken place.
1415	Section 15.  Section 627.7405, Florida Statutes, is amended
1416	to read:
1417	627.7405  Insurers' right of reimbursement.-Notwithstanding
1418	any other provisions of the no-fault law ss. 627.730-627.7405,
1419	any insurer providing personal injury protection benefits on a
1420	private passenger motor vehicle has shall have, to the extent of
1421	any personal injury protection benefits paid to any person as a
1422	benefit arising out of such private passenger motor vehicle
1423	insurance, a right of reimbursement against the owner or the
1424	insurer of the owner of a commercial motor vehicle, if the
1425	benefits paid result from such person having been an occupant of
1426	the commercial motor vehicle or having been struck by the
1427	commercial motor vehicle while not an occupant of any self-
1428	propelled vehicle.
1429	Section 16.  Subsection (1) of section 627.7407, Florida
1430	Statutes, is amended to read:
1431	627.7407  Application of the Florida Motor Vehicle No-Fault
1432	Law.-
1433	(1)  Any person subject to the requirements of ss. 627.730-
1434	627.7405, the Florida Motor Vehicle No-Fault Law, as revived and
1435	amended by this act, must maintain security for personal injury
1436	protection as required by the Florida Motor Vehicle No-Fault
1437	Law, as revived and amended by this act, beginning on January 1,
1438	2008.
1439	Section 17.  Paragraph (d) of subsection (2) and paragraph
1440	(d) of subsection (3) of section 628.909, Florida Statutes, are
1441	amended to read:
1442	628.909  Applicability of other laws.-
1443	(2)  The following provisions of the Florida Insurance Code
1444	shall apply to captive insurers who are not industrial insured
1445	captive insurers to the extent that such provisions are not
1446	inconsistent with this part:
1447	(d)  Sections 627.730-627.7407 627.730-627.7405, when no-
1448	fault coverage is provided.
1449	(3)  The following provisions of the Florida Insurance Code
1450	shall apply to industrial insured captive insurers to the extent
1451	that such provisions are not inconsistent with this part:
1452	(d)  Sections 627.730-627.7407 627.730-627.7405 when no-
1453	fault coverage is provided.
1454	Section 18.  For the purpose of incorporating the amendment
1455	made by this act to section 627.736, Florida Statutes, in a
1456	reference thereto, paragraph (c) of subsection (7) of section
1457	817.234, Florida Statutes, is reenacted to read:
1458	817.234  False and fraudulent insurance claims.-
1459	(7)
1460	(c)  An insurer, or any person acting at the direction of
1461	or on behalf of an insurer, may not change an opinion in a
1462	mental or physical report prepared under s. 627.736(8) or direct
1463	the physician preparing the report to change such opinion;
1464	however, this provision does not preclude the insurer from
1465	calling to the attention of the physician errors of fact in the
1466	report based upon information in the claim file. Any person who
1467	violates this paragraph commits a felony of the third degree,
1468	punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
1469	Section 19.  This act shall take effect July 1, 2012.

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