HB 119

1
A bill to be entitled
2An act relating to motor vehicle personal injury
3protection insurance; providing a short title;
4providing legislative intent; amending s. 316.066,
5F.S.; revising provisions relating to the contents of
6written reports of motor vehicle crashes; authorizing
7the investigating officer to testify at trial or
8provide an affidavit concerning the content of the
9reports; amending s. 400.991, F.S.; requiring that an
10application for licensure as a mobile clinic include a
11statement regarding insurance fraud; amending s.
12627.730, F.S.; conforming a cross-reference; amending
13s. 627.731, F.S.; providing legislative intent with
14respect to the Florida Motor Vehicle No-Fault Law;
15amending s. 627.732, F.S.; defining the terms
16"claimant" and "no-fault law"; amending s. 627.736,
17F.S.; conforming a cross-reference; requiring certain
18entities providing medical services to document that
19they meet required criteria; revising requirements
20relating to the form that must be submitted by
21providers; requiring an entity or clinic to file a new
22form within a specified period after the date of a
23change of ownership; revising provisions relating to
24when payment for a benefit is due; providing that the
25time period for paying or denying a claim is tolled
26during the investigation of a fraudulent insurance
27act; specifying when benefits are not payable;
28providing that a claimant that violates certain
29provisions is not entitled to any payment, regardless
30of whether a portion of the claim may be legitimate;
31authorizing an insurer to recover payments and bring a
32cause of action to recover payments; forbidding a
33physician, hospital, clinic, or other medical
34institution that fails to comply with certain
35provisions from billing the injured person or the
36insured; providing that an insurer has a right to
37conduct reasonable investigations of claims;
38authorizing an insurer to require a claimant to
39provide certain records; revising the insurer's
40reimbursement limitation; deleting an obsolete
41provision; revising requirements relating to
42discovery; authorizing an insurer to conduct
43examinations of claimants under oath or sworn
44statement; requiring the provider to produce persons
45having the most knowledge in specified circumstances;
46providing that an insurer that requests an examination
47under oath without a reasonable basis is engaging in
48an unfair and deceptive trade practice; authorizing
49the insurer to conduct a physical review of the
50treatment location; authorizing an insurer to contract
51with a preferred provider network; authorizing an
52insurer to provide a premium discount to an insured
53who selects a preferred provider; authorizing an
54insurance policy not to pay for nonemergency services
55performed by a nonpreferred provider in specified
56circumstances; authorizing an insurer to contract with
57a health insurer in specified circumstances; amending
58ss. 324.021, 456.057, 627.7295, 627.733, 627.734,
59627.737, 627.7401, 627.7405, 627.7407, and 628.909,
60F.S.; conforming cross-references; reenacting s.
61817.234(7)(c), F.S., relating to false and fraudulent
62insurance claims, to incorporate the amendment of s.
63627.736, F.S., in a reference thereto; providing an
64effective date.
65
66Be 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
70Act."
71     (2)  FINDINGS AND INTENT.-The Legislature intends to
72balance the insured's interest in prompt payment of valid claims
73for insurance benefits under the no-fault law with the public's
74interest in reducing fraud, abuse, and overuse of the no-fault
75system. To that end, the Legislature intends that the
76investigation and prevention of fraudulent insurance acts in
77this state be enhanced, that additional sanctions for such acts
78be imposed, and that the no-fault law be revised to remove
79incentives for fraudulent insurance acts. The Legislature
80intends that the no-fault law be construed according to the
81plain language of the statutory provisions, which are designed
82to meet these goals.
83     (a)  The Legislature finds that:
84     1.  Motor vehicle insurance fraud remains a major problem
85for state consumers and insurers. According to the National
86Insurance Crime Bureau, in recent years this state has been
87among those states that have the highest number of fraudulent
88and questionable claims.
89     2.  The current regulatory process for health care clinics
90under part X of chapter 400, Florida Statutes, which was
91originally enacted to reduce motor vehicle insurance fraud, is
92not adequately preventing fraudulent insurance acts with respect
93to licensure exemptions and compliance with that part.
94     (b)  The Legislature intends that:
95     1.  Insurers properly investigate claims, and as such, this
96act clarifies that insurers are allowed to obtain examinations
97under oath and sworn statements from any claimant seeking no-
98fault insurance benefits and to request mental and physical
99examinations of persons seeking personal injury protection
100coverage or benefits.
101     2.  Any false, misleading, or otherwise fraudulent activity
102associated with a claim render the entire claim invalid. An
103insurer must be able to raise fraud as a defense to a claim for
104no-fault insurance benefits irrespective of any prior
105adjudication of guilt or determination of fraud by the
106Department of Financial Services.
107     3.  Insurers toll the payment or denial of a claim with
108respect to any portion of a claim for which the insurer has a
109reasonable belief that a fraudulent insurance act, as defined in
110s. 626.989 or s. 817.234, Florida Statutes, has been committed.
111     4.  Insurers discover the names of all passengers involved
112in a motor vehicle crash before paying claims or benefits
113pursuant to an insurance policy governed by the no-fault law. A
114rebuttable presumption must be established that a person was not
115involved in the event giving rise to the claim if that person's
116name does not appear on the police report.
117     Section 2.  Subsection (1) of section 316.066, Florida
118Statutes, is amended to read:
119     316.066  Written reports of crashes.-
120     (1)(a)  A Florida Traffic Crash Report, Long Form must is
121required to be completed and submitted to the department within
12210 days after completing an investigation is completed by the
123every law enforcement officer who in the regular course of duty
124investigates a motor vehicle crash that:
125     1.   Resulted in death of, or personal injury to, or any
126indication of complaints of pain or discomfort by any of the
127parties or passengers involved in the crash;
128     2.  Involved one or more passengers, other than the drivers
129of the vehicles, in any of the vehicles involved in the crash;
130or.
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,
136including all drivers and passengers.
137     4.  The names and addresses of witnesses.
138     5.  The name, badge number, and law enforcement agency of
139the officer investigating the crash.
140     6.  The names of the insurance companies for the respective
141parties involved in the crash.
142     7.  The names and addresses of all passengers in all
143vehicles involved in the crash, each clearly identified as being
144a passenger, including the identification of the vehicle in
145which each was a passenger.
146     (c)(b)  In every crash for which a Florida Traffic Crash
147Report, Long Form is not required by this section, the law
148enforcement officer may complete a short-form crash report or
149provide a driver exchange-of-information form to be completed by
150each party involved in the crash. The short-form report must
151include all of the items listed in subparagraphs (b)1.-6. Short-
152form crash reports prepared by the law enforcement officer shall
153be 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,
157including all drivers and passengers.
158     4.  The names and addresses of witnesses.
159     5.  The name, badge number, and law enforcement agency of
160the officer investigating the crash.
161     6.  The names of the insurance companies for the respective
162parties involved in the crash.
163     (d)(c)  Each party to the crash must provide the law
164enforcement officer with proof of insurance, which must be
165documented in the crash report. If a law enforcement officer
166submits a report on the crash, proof of insurance must be
167provided to the officer by each party involved in the crash. Any
168party who fails to provide the required information commits a
169noncriminal traffic infraction, punishable as a nonmoving
170violation as provided in chapter 318, unless the officer
171determines that due to injuries or other special circumstances
172such insurance information cannot be provided immediately. If
173the person provides the law enforcement agency, within 24 hours
174after the crash, proof of insurance that was valid at the time
175of the crash, the law enforcement agency may void the citation.
176     (e)(d)  The driver of a vehicle that was in any manner
177involved in a crash resulting in damage to any vehicle or other
178property in an amount of $500 or more which was not investigated
179by a law enforcement agency, shall, within 10 days after the
180crash, submit a written report of the crash to the department.
181The entity receiving the report may require witnesses of the
182crash to render reports and may require any driver of a vehicle
183involved in a crash of which a written report must be made to
184file supplemental written reports if the original report is
185deemed insufficient by the receiving entity.
186     (f)  The investigating law enforcement officer may testify
187at trial or provide a signed affidavit to confirm or supplement
188the information included on the long-form or short-form report.
189     (e)  Short-form crash reports prepared by law enforcement
190shall be maintained by the law enforcement officer's agency.
191     Section 3.  Subsection (6) is added to section 400.991,
192Florida Statutes, to read:
193     400.991  License requirements; background screenings;
194prohibitions.-
195     (6)  All forms that constitute part of the application for
196licensure or exemption from licensure under this part must
197contain the following statement:
198
199INSURANCE FRAUD NOTICE.-Submitting a false,
200misleading, or fraudulent application or other
201document when applying for licensure as a health care
202clinic, when seeking an exemption from licensure as a
203health care clinic, or when demonstrating compliance
204with part X of chapter 400, Florida Statutes, is a
205criminal act under s. 817.234, Florida Statutes, or a
206fraudulent insurance act as defined in s. 626.989,
207Florida Statutes, subject to investigation by the
208Division of Insurance Fraud, and is grounds for
209discipline by the appropriate licensing board of the
210Florida Department of Health.
211     Section 4.  Section 627.730, Florida Statutes, is amended
212to read:
213     627.730  Florida Motor Vehicle No-Fault Law.-Sections
214627.730-627.7407 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
217to read:
218     627.731  Purpose; legislative intent.-
219     (1)  The purpose of the no-fault law ss. 627.730-627.7405
220is to provide for medical, surgical, funeral, and disability
221insurance benefits without regard to fault, and to require motor
222vehicle insurance securing such benefits, for motor vehicles
223required to be registered in this state and, with respect to
224motor vehicle accidents, a limitation on the right to claim
225damages for pain, suffering, mental anguish, and inconvenience.
226     (2)  The Legislature intends that the provisions,
227schedules, and procedures authorized under the no-fault law be
228implemented by the insurers offering policies pursuant to the
229no-fault law. These provisions, schedules, and procedures have
230full force and effect regardless of their express inclusion in
231an insurance policy, and an insurer is not required to amend its
232policy to implement and apply such provisions, schedules, or
233procedures.
234     Section 6.  Section 627.732, Florida Statutes, is amended
235to read:
236     627.732  Definitions.-As used in the no-fault law ss.
237627.730-627.7405, the term:
238     (1)  "Broker" means any person not possessing a license
239under chapter 395, chapter 400, chapter 429, chapter 458,
240chapter 459, chapter 460, chapter 461, or chapter 641 who
241charges or receives compensation for any use of medical
242equipment and is not the 100-percent owner or the 100-percent
243lessee of such equipment. For purposes of this section, such
244owner or lessee may be an individual, a corporation, a
245partnership, or any other entity and any of its 100-percent-
246owned affiliates and subsidiaries. For purposes of this
247subsection, the term "lessee" means a long-term lessee under a
248capital or operating lease, but does not include a part-time
249lessee. The term "broker" does not include a hospital or
250physician management company whose medical equipment is
251ancillary to the practices managed, a debt collection agency, or
252an entity that has contracted with the insurer to obtain a
253discounted rate for such services; or nor does the term include
254a management company that has contracted to provide general
255management services for a licensed physician or health care
256facility and whose compensation is not materially affected by
257the usage or frequency of usage of medical equipment or an
258entity that is 100-percent owned by one or more hospitals or
259physicians. The term "broker" does not include a person or
260entity 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
264for personal injury protection patients is on a temporary basis,
265not to exceed 30 days in a 12-month period, and such lease is
266solely for the purposes of necessary repair or maintenance of
267the 100-percent-owned medical equipment or pending the arrival
268and installation of the newly purchased or a replacement for the
269100-percent-owned medical equipment, or for patients for whom,
270because of physical size or claustrophobia, it is determined by
271the medical director or clinical director to be medically
272necessary that the test be performed in medical equipment that
273is open-style. The leased medical equipment may not cannot be
274used by patients who are not patients of the registered clinic
275for medical treatment of services. Any person or entity making a
276false certification under this subsection commits insurance
277fraud as defined in s. 817.234. However, the 30-day period
278provided in this paragraph may be extended for an additional 60
279days as applicable to magnetic resonance imaging equipment if
280the owner certifies that the extension otherwise complies with
281this paragraph.
282     (2)(7)  "Certify" means to swear or attest to being true or
283represented in writing.
284     (3)  "Claimant" means the person, organization, or entity
285seeking benefits, including all assignees.
286     (4)(12)  "Hospital" means a facility that, at the time
287services or treatment were rendered, was licensed under chapter
288395.
289     (5)(8)  "Immediate personal supervision," as it relates to
290the performance of medical services by nonphysicians not in a
291hospital, means that an individual licensed to perform the
292medical service or provide the medical supplies must be present
293within the confines of the physical structure where the medical
294services are performed or where the medical supplies are
295provided such that the licensed individual can respond
296immediately to any emergencies if needed.
297     (6)(9)  "Incident," with respect to services considered as
298incident to a physician's professional service, for a physician
299licensed under chapter 458, chapter 459, chapter 460, or chapter
300461, if not furnished in a hospital, means such services that
301are must be an integral, even if incidental, part of a covered
302physician's service.
303     (7)(10)  "Knowingly" means that a person, with respect to
304information, has actual knowledge of the information,; acts in
305deliberate ignorance of the truth or falsity of the
306information,; or acts in reckless disregard of the information.,
307and Proof of specific intent to defraud is not required.
308     (8)(11)  "Lawful" or "lawfully" means in substantial
309compliance with all relevant applicable criminal, civil, and
310administrative requirements of state and federal law related to
311the provision of medical services or treatment.
312     (9)(2)  "Medically necessary" refers to a medical service
313or supply that a prudent physician would provide for the purpose
314of preventing, diagnosing, or treating an illness, injury,
315disease, or symptom in a manner that is:
316     (a)  In accordance with generally accepted standards of
317medical practice;
318     (b)  Clinically appropriate in terms of type, frequency,
319extent, site, and duration; and
320     (c)  Not primarily for the convenience of the patient,
321physician, or other health care provider.
322     (10)(3)  "Motor vehicle" means a any self-propelled vehicle
323with four or more wheels that which is of a type both designed
324and required to be licensed for use on the highways of this
325state, and any trailer or semitrailer designed for use with such
326vehicle, and includes:
327     (a)  A "private passenger motor vehicle," which is any
328motor vehicle that which is a sedan, station wagon, or jeep-type
329vehicle and, if not used primarily for occupational,
330professional, or business purposes, a motor vehicle of the
331pickup, panel, van, camper, or motor home type.
332     (b)  A "commercial motor vehicle," which is any motor
333vehicle that which is not a private passenger motor vehicle.
334
335The term "motor vehicle" does not include a mobile home or any
336motor vehicle that which is used in mass transit, other than
337public school transportation, and designed to transport more
338than five passengers exclusive of the operator of the motor
339vehicle and that which is owned by a municipality, a transit
340authority, or a political subdivision of the state.
341     (11)(4)  "Named insured" means a person, usually the owner
342of a vehicle, identified in a policy by name as the insured
343under the policy.
344     (12)  "No-fault law" means the Florida Motor Vehicle No-
345Fault Law, ss. 627.730-627.7407.
346     (13)(5)  "Owner" means a person who holds the legal title
347to a motor vehicle; or, if in the event a motor vehicle is the
348subject of a security agreement or lease with an option to
349purchase with the debtor or lessee having the right to
350possession, then the debtor or lessee is shall be deemed the
351owner for the purposes of the no-fault law ss. 627.730-627.7405.
352     (14)(13)  "Properly completed" means providing truthful,
353substantially complete, and substantially accurate responses as
354to all material elements of to each applicable request for
355information or statement by a means that may lawfully be
356provided and that complies with this section, or as agreed by
357the parties.
358     (15)(6)  "Relative residing in the same household" means a
359relative of any degree by blood or by marriage who usually makes
360her or his home in the same family unit, whether or not
361temporarily living elsewhere.
362     (16)(15)  "Unbundling" means submitting an action that
363submits a billing code that is properly billed under one billing
364code, but that has been separated into two or more billing
365codes, and would result in payment greater than the in amount
366that than would be paid using one billing code.
367     (17)(14)  "Upcoding" means submitting an action that
368submits a billing code that would result in payment greater than
369the in amount that than would be paid using a billing code that
370accurately describes the services performed. The term does not
371include an otherwise lawful bill by a magnetic resonance imaging
372facility, which globally combines both technical and
373professional components, if the amount of the global bill is not
374more than the components if billed separately; however, payment
375of such a bill constitutes payment in full for all components of
376such service.
377     Section 7.  Subsections (1), (3), and (4) of section
378627.736, 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
381section, and present subsections (5), (6), (8), and (9),
382paragraph (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;
385exclusions; priority; claims.-
386     (1)  REQUIRED BENEFITS.-Every insurance policy complying
387with the security requirements of s. 627.733 must shall provide
388personal injury protection to the named insured, relatives
389residing in the same household, persons operating the insured
390motor vehicle, passengers in such motor vehicle, and other
391persons struck by such motor vehicle and suffering bodily injury
392while not an occupant of a self-propelled vehicle, subject to
393the provisions of subsection (2) and paragraph (4)(g) (4)(e), to
394a limit of $10,000 for loss sustained by any such person as a
395result of bodily injury, sickness, disease, or death arising out
396of the ownership, maintenance, or use of a motor vehicle as
397follows:
398     (a)  Medical benefits.-Eighty percent of all reasonable
399expenses for medically necessary medical, surgical, X-ray,
400dental, and rehabilitative services, including prosthetic
401devices, and for medically necessary ambulance, hospital, and
402nursing services. However, the medical benefits shall provide
403reimbursement only for such services and care that are lawfully
404provided, supervised, ordered, or prescribed by a physician
405licensed under chapter 458 or chapter 459, a dentist licensed
406under chapter 466, or a chiropractic physician licensed under
407chapter 460 or that are provided by any of the following persons
408or entities:
409     1.  A hospital or ambulatory surgical center licensed under
410chapter 395.
411     2.  A person or entity licensed under part III of chapter
412401 that ss. 401.2101-401.45 that provides emergency
413transportation and treatment.
414     3.  An entity wholly owned by one or more physicians
415licensed under chapter 458 or chapter 459, chiropractic
416physicians licensed under chapter 460, or dentists licensed
417under chapter 466 or by such practitioner or practitioners and
418the spouses, parents, children, or siblings spouse, parent,
419child, or sibling of such that practitioner or those
420practitioners.
421     4.  An entity wholly owned, directly or indirectly, by a
422hospital or hospitals.
423     5.  A health care clinic licensed under part X of chapter
424400 ss. 400.990-400.995 that is:
425     a.  Accredited by the Joint Commission on Accreditation of
426Healthcare Organizations, the American Osteopathic Association,
427the Commission on Accreditation of Rehabilitation Facilities, or
428the Accreditation Association for Ambulatory Health Care, Inc.;
429or
430     b.  A health care clinic that:
431     (I)  Has a medical director licensed under chapter 458,
432chapter 459, or chapter 460;
433     (II)  Has been continuously licensed for more than 3 years
434or is a publicly traded corporation that issues securities
435traded on an exchange registered with the United States
436Securities and Exchange Commission as a national securities
437exchange; and
438     (III)  Provides at least four of the following medical
439specialties:
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
447medication.
448     (H)  Laboratory services.
449
450If any services under this paragraph are provided by an entity
451or clinic described in subparagraph 3., subparagraph 4., or
452subparagraph 5., the entity or clinic must provide the insurer
453at the initial submission of the claim with a form adopted by
454the Department of Financial Services that documents that the
455entity or clinic meets applicable criteria for such entity or
456clinic and includes a sworn statement or affidavit to that
457effect. Any change in ownership requires the filing of a new
458form within 10 days after the date of the change in ownership.
459The Financial Services Commission shall adopt by rule the form
460that must be used by an insurer and a health care provider
461specified in subparagraph 3., subparagraph 4., or subparagraph
4625. to document that the health care provider meets the criteria
463of this paragraph, which rule must include a requirement for a
464sworn statement or affidavit.
465     (b)  Disability benefits.-Sixty percent of any loss of
466gross income and loss of earning capacity per individual from
467inability to work proximately caused by the injury sustained by
468the injured person, plus all expenses reasonably incurred in
469obtaining from others ordinary and necessary services in lieu of
470those that, but for the injury, the injured person would have
471performed without income for the benefit of his or her
472household. All disability benefits payable under this paragraph
473must provision shall be paid at least not less than every 2
474weeks.
475     (c)  Death benefits.-Death benefits equal to the lesser of
476$5,000 or the remainder of unused personal injury protection
477benefits per individual. The insurer may pay such benefits to
478the executor or administrator of the deceased, to any of the
479deceased's relatives by blood, or legal adoption, or connection
480by marriage, or to any person appearing to the insurer to be
481equitably entitled thereto.
482
483Only insurers writing motor vehicle liability insurance in this
484state may provide the required benefits of this section, and no
485such insurers may not insurer shall require the purchase of any
486other motor vehicle coverage other than the purchase of property
487damage liability coverage as required by s. 627.7275 as a
488condition for providing such required benefits. Insurers may not
489require that property damage liability insurance in an amount
490greater than $10,000 be purchased in conjunction with personal
491injury protection. Such insurers shall make benefits and
492required property damage liability insurance coverage available
493through normal marketing channels. An Any insurer writing motor
494vehicle liability insurance in this state who fails to comply
495with such availability requirement as a general business
496practice violates shall be deemed to have violated part IX of
497chapter 626, and such violation constitutes shall constitute an
498unfair method of competition or an unfair or deceptive act or
499practice involving the business of insurance. An; and any such
500insurer committing such violation is shall be subject to the
501penalties afforded in such part, as well as those that are which
502may be afforded elsewhere in the insurance code.
503     (3)  INSURED'S RIGHTS TO RECOVERY OF SPECIAL DAMAGES IN
504TORT CLAIMS.-An No insurer shall not have a lien on any recovery
505in tort by judgment, settlement, or otherwise for personal
506injury protection benefits, whether suit has been filed or
507settlement has been reached without suit. An injured party who
508is entitled to bring suit under the no-fault law provisions of
509ss. 627.730-627.7405, or his or her legal representative, shall
510have no right to recover any damages for which personal injury
511protection benefits are paid or payable. The plaintiff may prove
512all of his or her special damages notwithstanding this
513limitation, but if special damages are introduced in evidence,
514the trier of facts, whether judge or jury, shall not award
515damages for personal injury protection benefits paid or payable.
516In all cases in which a jury is required to fix damages, the
517court shall instruct the jury that the plaintiff shall not
518recover such special damages for personal injury protection
519benefits paid or payable.
520     (4)  BENEFITS; WHEN DUE.-Benefits due from an insurer under
521the no-fault law are ss. 627.730-627.7405 shall be primary,
522except that benefits received under any workers' compensation
523law shall be credited against the benefits provided by
524subsection (1) and are shall be due and payable as loss accrues,
525upon the receipt of reasonable proof of such loss and the amount
526of expenses and loss incurred that which are covered by the
527policy issued under the no-fault law ss. 627.730-627.7405. If
528When the Agency for Health Care Administration provides, pays,
529or becomes liable for medical assistance under the Medicaid
530program related to injury, sickness, disease, or death arising
531out of the ownership, maintenance, or use of a motor vehicle,
532the benefits are under ss. 627.730-627.7405 shall be subject to
533the provisions of the Medicaid program.
534     (a)  An insurer may require written notice to be given as
535soon as practicable after an accident involving a motor vehicle
536with respect to which the policy affords the security required
537by the no-fault law ss. 627.730-627.7405.
538     (b)  Personal injury protection insurance benefits paid
539pursuant to this section are shall be overdue if not paid within
54030 days after the insurer is furnished written notice of the
541fact of a covered loss and of the amount of same. If such
542written notice is not furnished to the insurer as to the entire
543claim, any partial amount supported by written notice is overdue
544if not paid within 30 days after such written notice is
545furnished to the insurer. Any part or all of the remainder of
546the claim that is subsequently supported by written notice is
547overdue if not paid within 30 days after such written notice is
548furnished to the insurer.
549     (c)  If When an insurer pays only a portion of a claim or
550rejects a claim, the insurer shall provide at the time of the
551partial payment or rejection an itemized specification of each
552item that the insurer had reduced, omitted, or declined to pay
553and any information that the insurer desires the claimant to
554consider related to the medical necessity of the denied
555treatment or to explain the reasonableness of the reduced
556charge, provided that this does shall not limit the introduction
557of evidence at trial.; and The insurer must shall include the
558name and address of the person to whom the claimant should
559respond and a claim number to be referenced in future
560correspondence.
561     (d)  A However, notwithstanding the fact that written
562notice has been furnished to the insurer, Any payment is shall
563not be deemed overdue if when the insurer has reasonable proof
564to establish that the insurer is not responsible for the
565payment. For the purpose of calculating the extent to which any
566benefits are overdue, payment shall be treated as being made on
567the date a draft or other valid instrument which is equivalent
568to payment was placed in the United States mail in a properly
569addressed, postpaid envelope or, if not so posted, on the date
570of delivery. This paragraph does not preclude or limit the
571ability of the insurer to assert that the claim is was
572unrelated, was not medically necessary, or was unreasonable, or
573submitted that the amount of the charge was in excess of that
574permitted under, or in violation of, subsection (6) (5). Such
575assertion by the insurer may be made at any time, including
576after payment of the claim or after the 30-day time period for
577payment set forth in this paragraph (b). The 30-day period for
578payment or denial is tolled with respect to any portion of a
579claim for which the insurer has a reasonable belief that a
580fraudulent insurance act as defined in s. 626.989 has been
581committed while the insurer investigates such act. The insurer
582must notify the claimant in writing that it is investigating a
583fraudulent insurance act within 30 days after the date it has a
584reasonable belief that such act has been committed. The insurer
585must pay or deny the claim, in full or in part, within 120 days
586after the date the written notice of the fact of a covered loss
587and of the amount of the loss was provided to the insurer.
588     (e)(c)  Upon receiving notice of an accident that is
589potentially covered by personal injury protection benefits, the
590insurer must reserve $5,000 of personal injury protection
591benefits for payment to physicians licensed under chapter 458 or
592chapter 459 or dentists licensed under chapter 466 who provide
593emergency services and care, as defined in s. 395.002(9), or who
594provide hospital inpatient care. The amount required to be held
595in reserve may be used only to pay claims from such physicians
596or dentists until 30 days after the date the insurer receives
597notice of the accident. After the 30-day period, any amount of
598the reserve for which the insurer has not received notice of
599such a claim from a physician or dentist who provided emergency
600services and care or who provided hospital inpatient care may
601then be used by the insurer to pay other claims. The time
602periods specified in paragraph (b) for required payment of
603personal injury protection benefits are shall be tolled for the
604period of time that an insurer is required by this paragraph to
605hold payment of a claim that is not from a physician or dentist
606who provided emergency services and care or who provided
607hospital inpatient care to the extent that the personal injury
608protection benefits not held in reserve are insufficient to pay
609the claim. This paragraph does not require an insurer to
610establish a claim reserve for insurance accounting purposes.
611     (f)(d)  All overdue payments shall bear simple interest at
612the rate established under s. 55.03 or the rate established in
613the insurance contract, whichever is greater, for the year in
614which the payment became overdue, calculated from the date the
615insurer was furnished with written notice of the amount of
616covered loss. Interest is shall be due at the time payment of
617the overdue claim is made.
618     (g)(e)  The insurer of the owner of a motor vehicle shall
619pay personal injury protection benefits for:
620     1.  Accidental bodily injury sustained in this state by the
621owner while occupying a motor vehicle, or while not an occupant
622of a self-propelled vehicle if the injury is caused by physical
623contact with a motor vehicle.
624     2.  Accidental bodily injury sustained outside this state,
625but within the United States of America or its territories or
626possessions or Canada, by the owner while occupying the owner's
627motor vehicle.
628     3.  Accidental bodily injury sustained by a relative of the
629owner residing in the same household, under the circumstances
630described in subparagraph 1. or subparagraph 2. if, provided the
631relative at the time of the accident is domiciled in the owner's
632household and is not himself or herself the owner of a motor
633vehicle with respect to which security is required under the no-
634fault law ss. 627.730-627.7405.
635     4.  Accidental bodily injury sustained in this state by any
636other person while occupying the owner's motor vehicle or, if a
637resident of this state, while not an occupant of a self-
638propelled vehicle, if the injury is caused by physical contact
639with such motor vehicle and if, provided the injured person is
640not himself or herself:
641     a.  The owner of a motor vehicle with respect to which
642security is required under the no-fault law ss. 627.730-
643627.7405; or
644     b.  Entitled to personal injury benefits from the insurer
645of the owner or owners of such a motor vehicle.
646     (h)(f)  If two or more insurers are liable to pay personal
647injury protection benefits for the same injury to any one
648person, the maximum payable is shall be as specified in
649subsection (1), and any insurer paying the benefits is shall be
650entitled to recover from each of the other insurers an equitable
651pro rata share of the benefits paid and expenses incurred in
652processing the claim.
653     (i)(g)  It is a violation of the insurance code for an
654insurer to fail to timely provide benefits as required by this
655section with such frequency as to constitute a general business
656practice.
657     (j)(h)  Benefits are shall not be due or payable to or on
658the behalf of a claimant who: an insured person if that person
659has
660     1.  Submits a false or misleading statement, document,
661record, or bill;
662     2.  Submits any other false or misleading information; or
663     3.  Has otherwise committed or attempted to commit a
664fraudulent insurance act as defined in s. 626.989.
665
666A claimant who violates this paragraph is not entitled to any
667personal injury protection benefits or payment for any bills and
668services, regardless of whether a portion of the claim may be
669legitimate.
670     (k)  Notwithstanding any remedies afforded by law, the
671insurer may recover from a claimant who has violated paragraph
672(j) any sums previously paid to the claimant and may bring any
673available common law and statutory causes of action committed,
674by a material act or omission, any insurance fraud relating to
675personal injury protection coverage under his or her policy, if
676the fraud is admitted to in a sworn statement by the insured or
677if it is established in a court of competent jurisdiction. If a
678physician, hospital, clinic, or other medical institution
679violates paragraph (j), the injured party is not liable for, and
680the physician, hospital, clinic, or other medical institution
681may not bill the insured for, charges that are unpaid because of
682failure to comply with paragraph (j). Any agreement requiring
683the injured person or insured to pay for such charges is
684unenforceable. Any insurance fraud shall void all coverage
685arising from the claim related to such fraud under the personal
686injury protection coverage of the insured person who committed
687the fraud, irrespective of whether a portion of the insured
688person's claim may be legitimate, and any benefits paid prior to
689the discovery of the insured person's insurance fraud shall be
690recoverable by the insurer from the person who committed
691insurance fraud in their entirety. The prevailing party is
692entitled to its costs and attorney's fees in any action in which
693it prevails in an insurer's action to enforce its right of
694recovery under this paragraph.
695     (5)  INSURER INVESTIGATIONS.-An insurer has the right and
696duty to conduct a reasonable investigation of a claim. In the
697course of the investigation, the insurer may require the
698insured, claimant, or medical provider to provide copies of the
699treatment and examination records so that the insurer can
700provide such records to a physician for a records review. A
701records review need not be based on a physical examination and
702may be obtained at any time, including after reduction or denial
703of the claim. The 30-day period for payment under paragraph
704(4)(b) is tolled from the date the insurer sends its request for
705treatment records to the date that the insurer receives the
706treatment records. The claim may be denied or reduced if the
707medical provider fails to keep adequate records such that the
708insurer 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
711institution lawfully rendering treatment to an injured person
712for a bodily injury covered by personal injury protection
713insurance may charge the insurer and injured party only an a
714reasonable amount pursuant to this section for the services and
715supplies rendered, and the insurer providing such coverage may
716pay for such charges directly to such person or institution
717lawfully rendering such treatment, if the insured receiving such
718treatment or his or her guardian has countersigned the properly
719completed invoice, bill, or claim form approved by the office
720upon which such charges are to be paid for as having actually
721been rendered, to the best knowledge of the insured or his or
722her guardian. In no event, However, may such a charge may not
723exceed be in excess of the amount the person or institution
724customarily charges for like services or supplies. When
725determining With respect to a determination of whether a charge
726for a particular service, treatment, or otherwise is reasonable,
727consideration may be given to evidence of usual and customary
728charges and payments accepted by the provider involved in the
729dispute, and reimbursement levels in the community and various
730federal and state medical fee schedules applicable to automobile
731and other insurance coverages, and other information relevant to
732the reasonableness of the reimbursement for the service,
733treatment, or supply.
734     1.2.  The insurer may limit reimbursement to 80 percent of
735the following schedule of maximum charges:
736     a.  For emergency transport and treatment by providers
737licensed under chapter 401, 200 percent of Medicare.
738     b.  For emergency services and care provided by a hospital
739licensed under chapter 395, 75 percent of the hospital's usual
740and customary charges.
741     c.  For emergency services and care as defined by s.
742395.002(9) provided in a facility licensed under chapter 395
743rendered by a physician or dentist, and related hospital
744inpatient services rendered by a physician or dentist, the usual
745and customary charges in the community.
746     d.  For hospital inpatient services, other than emergency
747services and care, 200 percent of the Medicare Part A
748prospective payment applicable to the specific hospital
749providing the inpatient services.
750     e.  For hospital outpatient services, other than emergency
751services and care, 200 percent of the Medicare Part A Ambulatory
752Payment Classification for the specific hospital providing the
753outpatient services.
754     f.  For all other medical services, supplies, and care, 200
755percent of the allowable amount under the participating
756physicians schedule of Medicare Part B. However, if such
757services, supplies, or care is not reimbursable under Medicare
758Part B, the insurer may limit reimbursement to 80 percent of the
759maximum reimbursable allowance under workers' compensation, as
760determined under s. 440.13 and rules adopted thereunder which
761are in effect at the time such services, supplies, or care is
762provided. Services, supplies, or care that is not reimbursable
763under Medicare or workers' compensation is not required to be
764reimbursed by the insurer.
765     2.3.  For purposes of subparagraph 1. 2., the applicable
766fee schedule or payment limitation under Medicare is the fee
767schedule or payment limitation in effect on January 1 of the
768year in which at the time the services, supplies, or care was
769rendered and for the area in which such services were rendered,
770notwithstanding any subsequent changes made to such fee schedule
771or payment limitation, except that it may not be less than the
772allowable amount under the participating physicians schedule of
773Medicare Part B for 2007 for medical services, supplies, and
774care subject to Medicare Part B.
775     3.4.  Subparagraph 1. 2. does not allow the insurer to
776apply any limitation on the number of treatments or other
777utilization limits that apply under Medicare or workers'
778compensation. An insurer that applies the allowable payment
779limitations of subparagraph 1. 2. must reimburse a provider who
780lawfully provided care or treatment under the scope of his or
781her license, regardless of whether such provider is would be
782entitled to reimbursement under Medicare due to restrictions or
783limitations on the types or discipline of health care providers
784who may be reimbursed for particular procedures or procedure
785codes.
786     4.5.  If an insurer limits payment as authorized by
787subparagraph 1. 2., the person providing such services,
788supplies, or care may not bill or attempt to collect from the
789insured any amount in excess of such limits, except for amounts
790that are not covered by the insured's personal injury protection
791coverage due to the coinsurance amount or maximum policy limits.
792     (b)1.  An insurer or insured is not required to pay a claim
793or charges:
794     a.  Made by a broker or by a person making a claim on
795behalf of a broker;
796     b.  For any service or treatment that was not lawful at the
797time rendered;
798     c.  To any person who knowingly submits a false or
799misleading statement relating to the claim or charges;
800     d.  With respect to a bill or statement that does not
801substantially meet the applicable requirements of paragraphs (c)
802and paragraph (d);
803     e.  For any treatment or service that is upcoded, or that
804is unbundled if when such treatment or services should be
805bundled, in accordance with paragraph (d). To facilitate prompt
806payment of lawful services, an insurer may change codes that it
807determines to have been improperly or incorrectly upcoded or
808unbundled, and may make payment based on the changed codes,
809without affecting the right of the provider to dispute the
810change by the insurer if, provided that before doing so, the
811insurer contacts must contact the health care provider and
812discusses discuss the reasons for the insurer's change and the
813health care provider's reason for the coding, or makes make a
814reasonable good faith effort to do so, as documented in the
815insurer's file; and
816     f.  For medical services or treatment billed by a physician
817and not provided in a hospital unless such services are rendered
818by the physician or are incident to his or her professional
819services and are included on the physician's bill, including
820documentation verifying that the physician is responsible for
821the medical services that were rendered and billed.
822     2.  The Department of Health, in consultation with the
823appropriate professional licensing boards, shall adopt, by rule,
824a list of diagnostic tests deemed not to be medically necessary
825for use in the treatment of persons sustaining bodily injury
826covered by personal injury protection benefits under this
827section. The initial list shall be adopted by January 1, 2004,
828and shall be revised from time to time as determined by the
829Department of Health, in consultation with the respective
830professional licensing boards. Inclusion of a test on the list
831must of invalid diagnostic tests shall be based on lack of
832demonstrated medical value and a level of general acceptance by
833the relevant provider community and may shall not be dependent
834for results entirely upon subjective patient response.
835Notwithstanding its inclusion on a fee schedule in this
836subsection, an insurer or insured is not required to pay any
837charges or reimburse claims for any invalid diagnostic test as
838determined by the Department of Health.
839     (c)1.  With respect to any treatment or service, other than
840medical services billed by a hospital or other provider for
841emergency services as defined in s. 395.002 or inpatient
842services rendered at a hospital-owned facility, the statement of
843charges must be furnished to the insurer by the provider and may
844not include, and the insurer is not required to pay, charges for
845treatment or services rendered more than 35 days before the
846postmark date or electronic transmission date of the statement,
847except for past due amounts previously billed on a timely basis
848under this paragraph, and except that, if the provider submits
849to the insurer a notice of initiation of treatment within 21
850days after its first examination or treatment of the claimant,
851the statement may include charges for treatment or services
852rendered up to, but not more than, 75 days before the postmark
853date of the statement. The injured party is not liable for, and
854the provider may shall not bill the injured party for, charges
855that are unpaid because of the provider's failure to comply with
856this paragraph. Any agreement requiring the injured person or
857insured to pay for such charges is unenforceable.
858     1.2.  If, however, the insured fails to furnish the
859provider with the correct name and address of the insured's
860personal injury protection insurer, the provider has 35 days
861from the date the provider obtains the correct information to
862furnish the insurer with a statement of the charges. The insurer
863is not required to pay for such charges unless the provider
864includes with the statement documentary evidence that was
865provided by the insured during the 35-day period demonstrating
866that the provider reasonably relied on erroneous information
867from 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
870penalty of perjury, reflecting timely mailing to the incorrect
871address or insurer.
872     2.3.  For emergency services and care as defined in s.
873395.002 rendered in a hospital emergency department or for
874transport and treatment rendered by an ambulance provider
875licensed pursuant to part III of chapter 401, the provider is
876not required to furnish the statement of charges within the time
877periods established by this paragraph,; and the insurer is shall
878not be considered to have been furnished with notice of the
879amount of covered loss for purposes of paragraph (4)(b) until it
880receives a statement complying with paragraph (d), or copy
881thereof, which specifically identifies the place of service to
882be a hospital emergency department or an ambulance in accordance
883with billing standards recognized by the Centers for Medicare
884and Medicaid Services (CMS) Health Care Finance Administration.
885     3.4.  Each notice of the insured's rights under s. 627.7401
886must include the following statement in type no smaller than 12
887points:
888
889BILLING REQUIREMENTS.-Florida Statutes provide that
890with respect to any treatment or services, other than
891certain hospital and emergency services, the statement
892of charges furnished to the insurer by the provider
893may not include, and the insurer and the injured party
894are not required to pay, charges for treatment or
895services rendered more than 35 days before the
896postmark date of the statement, except for past due
897amounts previously billed on a timely basis, and
898except that, if the provider submits to the insurer a
899notice of initiation of treatment within 21 days after
900its first examination or treatment of the claimant,
901the first billing cycle statement may include charges
902for treatment or services rendered up to, but not more
903than, 75 days before the postmark date of the
904statement.
905
906     (d)  All statements and bills for medical services rendered
907by any physician, hospital, clinic, or other person or
908institution shall be submitted to the insurer on a properly
909completed Centers for Medicare and Medicaid Services (CMS) 1500
910form, UB 92 forms, or any other standard form approved by the
911office or adopted by the commission for purposes of this
912paragraph. All billings for such services rendered by providers
913must shall, to the extent applicable, follow the Physicians'
914Current Procedural Terminology (CPT) or Healthcare Correct
915Procedural Coding System (HCPCS), or ICD-9 in effect for the
916year in which services are rendered and comply with the Centers
917for Medicare and Medicaid Services (CMS) 1500 form instructions
918and the American Medical Association Current Procedural
919Terminology (CPT) Editorial Panel and Healthcare Correct
920Procedural Coding System (HCPCS). All providers other than
921hospitals shall include on the applicable claim form the
922professional license number of the provider in the line or space
923provided for "Signature of Physician or Supplier, Including
924Degrees or Credentials." In determining compliance with
925applicable CPT and HCPCS coding, guidance shall be provided by
926the Physicians' Current Procedural Terminology (CPT) or the
927Healthcare Correct Procedural Coding System (HCPCS) in effect
928for the year in which services were rendered, the Office of the
929Inspector General (OIG), Physicians Compliance Guidelines, and
930other authoritative treatises designated by rule by the Agency
931for Health Care Administration. A No statement of medical
932services may not include charges for medical services of a
933person or entity that performed such services without possessing
934the valid licenses required to perform such services. For
935purposes of paragraph (4)(b), an insurer is shall not be
936considered to have been furnished with notice of the amount of
937covered loss or medical bills due unless the statements or bills
938comply with this paragraph, and unless the statements or bills
939are properly completed in their entirety as to all material
940provisions, with all relevant information being provided
941therein.
942     (e)1.  At the initial treatment or service provided, each
943physician, other licensed professional, clinic, or other medical
944institution providing medical services upon which a claim for
945personal injury protection benefits is based shall require an
946insured person, or his or her guardian, to execute a disclosure
947and acknowledgment form, which reflects at a minimum that:
948     a.  The insured, or his or her guardian, must countersign
949the form attesting to the fact that the services set forth
950therein were actually rendered;
951     b.  The insured, or his or her guardian, has both the right
952and affirmative duty to confirm that the services were actually
953rendered;
954     c.  The insured, or his or her guardian, was not solicited
955by any person to seek any services from the medical provider;
956     d.  The physician, other licensed professional, clinic, or
957other medical institution rendering services for which payment
958is being claimed explained the services to the insured or his or
959her guardian; and
960     e.  If the insured notifies the insurer in writing of a
961billing error, the insured may be entitled to a certain
962percentage of a reduction in the amounts paid by the insured's
963motor vehicle insurer.
964     2.  The physician, other licensed professional, clinic, or
965other medical institution rendering services for which payment
966is being claimed has the affirmative duty to explain the
967services rendered to the insured, or his or her guardian, so
968that the insured, or his or her guardian, countersigns the form
969with informed consent.
970     3.  Countersignature by the insured, or his or her
971guardian, is not required for the reading of diagnostic tests or
972other services that are of such a nature that they are not
973required to be performed in the presence of the insured.
974     4.  The licensed medical professional rendering treatment
975for which payment is being claimed must sign, by his or her own
976hand, the form complying with this paragraph.
977     5.  The original completed disclosure and acknowledgment
978form 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
981for services billed by a provider for emergency services as
982defined in s. 395.002, for emergency services and care as
983defined in s. 395.002 rendered in a hospital emergency
984department, or for transport and treatment rendered by an
985ambulance provider licensed pursuant to part III of chapter 401.
986     7.  The Financial Services Commission shall adopt, by rule,
987a standard disclosure and acknowledgment form to that shall be
988used to fulfill the requirements of this paragraph, effective 90
989days after such form is adopted and becomes final. The
990commission shall adopt a proposed rule by October 1, 2003. Until
991the rule is final, the provider may use a form of its own which
992otherwise 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
995a previously signed document, and is not satisfied by the
996statement "signature on file" or any similar statement.
997     9.  The requirements of this paragraph apply only with
998respect to the initial treatment or service of the insured by a
999provider. For subsequent treatments or service, the provider
1000must maintain a patient log signed by the patient, in
1001chronological order by date of service, that is consistent with
1002the services being rendered to the patient as claimed. The
1003requirements of this subparagraph for maintaining a patient log
1004signed by the patient may be met by a hospital that maintains
1005medical records as required by s. 395.3025 and applicable rules
1006and makes such records available to the insurer upon request.
1007     (f)  Upon written notification by any person, an insurer
1008shall investigate any claim of improper billing by a physician
1009or other medical provider. The insurer shall determine if the
1010insured was properly billed for only those services and
1011treatments that the insured actually received. If the insurer
1012determines that the insured has been improperly billed, the
1013insurer shall notify the insured, the person making the written
1014notification, and the provider of its findings and shall reduce
1015the amount of payment to the provider by the amount determined
1016to be improperly billed. If a reduction is made due to such
1017written notification by any person, the insurer shall pay to the
1018person 20 percent of the amount of the reduction, up to $500. If
1019the provider is arrested due to the improper billing, then the
1020insurer shall pay to the person 40 percent of the amount of the
1021reduction, up to $500.
1022     (g)  An insurer may not systematically downcode with the
1023intent to deny reimbursement otherwise due. Such action
1024constitutes a material misrepresentation under s.
1025626.9541(1)(i)2.
1026     (7)(6)  DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
1027DISPUTES.-
1028     (a)  An insurer may require a claimant to submit to an
1029examination under oath or sworn statement as often as reasonably
1030requested by an insurer and at any reasonable location
1031designated by the insurer. Submission to an examination under
1032oath or sworn statement is a condition precedent to recovery or
1033filing suit. The insurer is not liable for benefits under the
1034no-fault law if the claimant fails to fully and truthfully
1035answer all questions asked or violates any provision of
1036paragraph (4)(j).
1037     1.  The insurer may conduct the examination outside the
1038presence of any other person seeking coverage.
1039     2.  If an insurer requests an examination of a claimant
1040that is in a hospital, clinic, or other medical institution,
1041such claimant shall produce the persons with the most knowledge
1042relating to the issues set forth by the insurer in the notice of
1043examination.
1044     3.  The claimant must provide the insurer at the
1045examination with all documents, papers, receipts, invoices,
1046bills, records, or other tangible items requested by the
1047insurer.
1048     4.  The examination may be recorded by audio, video, or
1049court report or any combination thereof. The claimant may record
1050the examination at the claimant's expense.
1051     5.  The claimant may have an attorney present at the
1052examination at the claimant's expense.
1053     6.  An insurer that unreasonably requests an examination
1054without a reasonable basis as a general business practice is
1055engaging in an unfair insurance trade practice pursuant to s.
1056626.9541.
1057     (a)  Every employer shall, if a request is made by an
1058insurer providing personal injury protection benefits under ss.
1059627.730-627.7405 against whom a claim has been made, furnish
1060forthwith, in a form approved by the office, a sworn statement
1061of the earnings, since the time of the bodily injury and for a
1062reasonable period before the injury, of the person upon whose
1063injury the claim is based.
1064     (b)  Every physician, hospital, clinic, or other medical
1065institution providing, before or after bodily injury upon which
1066a claim for personal injury protection insurance benefits is
1067based, any products, services, or accommodations in relation to
1068that or any other injury, or in relation to a condition claimed
1069to be connected with that or any other injury, shall, if
1070requested to do so by the insurer against whom the claim has
1071been made, permit the insurer or the insurer's representative to
1072conduct an onsite physical review and examination of the
1073treatment location, treatment apparatuses, diagnostic devices,
1074and any other medical equipment used for the services rendered
1075within 10 days after the insurer's request and furnish forthwith
1076a written report of the history, condition, treatment, dates,
1077and costs of such treatment of the injured person and why the
1078items identified by the insurer were reasonable in amount and
1079medically necessary, together with a sworn statement that the
1080treatment or services rendered were reasonable and necessary
1081with respect to the bodily injury sustained and identifying
1082which portion of the expenses for such treatment or services was
1083incurred as a result of such bodily injury, and produce
1084forthwith, and permit the inspection and copying of, his or her
1085or its records regarding such history, condition, treatment,
1086dates, and costs of treatment if; provided that this does shall
1087not limit the introduction of evidence at trial. Such sworn
1088statement must shall read as follows: "Under penalty of perjury,
1089I declare that I have read the foregoing, and the facts alleged
1090are true, to the best of my knowledge and belief." A No cause of
1091action for violation of the physician-patient privilege or
1092invasion of the right of privacy may not be brought shall be
1093permitted against any physician, hospital, clinic, or other
1094medical institution complying with the provisions of this
1095section. The person requesting such records and such sworn
1096statement shall pay all reasonable costs connected therewith. If
1097an insurer makes a written request for documentation or
1098information under this paragraph within 30 days after having
1099received notice of the amount of a covered loss under paragraph
1100(4)(a), the amount or the partial amount that which is the
1101subject of the insurer's inquiry is shall become overdue if the
1102insurer does not pay in accordance with paragraph (4)(b) or
1103within 10 days after the insurer's receipt of the requested
1104documentation or information, whichever occurs later. For
1105purposes of this paragraph, the term "receipt" includes, but is
1106not limited to, inspection and copying pursuant to this
1107paragraph. An Any insurer that requests documentation or
1108information pertaining to reasonableness of charges or medical
1109necessity under this paragraph without a reasonable basis for
1110such requests as a general business practice is engaging in an
1111unfair trade practice under the insurance code.
1112     (c)  If a request is made by an insurer, an employer must
1113furnish, in a form approved by the office, a sworn statement of
1114the earnings of the person upon whose injury a claim is based
1115since the time of the bodily injury and for a reasonable period
1116before the injury.
1117     (d)(c)  If there is a In the event of any dispute regarding
1118an insurer's right to discovery of facts under this section, the
1119insurer may petition the a court of competent jurisdiction to
1120enter an order permitting such discovery. The order may be made
1121only on motion for good cause shown and upon notice to all
1122persons having an interest, and must it shall specify the time,
1123place, manner, conditions, and scope of the discovery. The Such
1124court may, in order to protect against annoyance, embarrassment,
1125or oppression, as justice requires, enter an order refusing
1126discovery or specifying conditions of discovery and may order
1127payments of costs and expenses of the proceeding, including
1128reasonable fees for the appearance of attorneys at the
1129proceedings, as justice requires.
1130     (8)(7)  MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON;
1131REPORTS.-
1132     (b)  If requested by the person examined, a party causing
1133an examination to be made shall deliver to him or her a copy of
1134every written report concerning the examination rendered by an
1135examining physician, at least one of which reports must set out
1136the examining physician's findings and conclusions in detail.
1137After such request and delivery, the party causing the
1138examination to be made is entitled, upon request, to receive
1139from the person examined every written report available to him
1140or her or his or her representative concerning any examination,
1141previously or thereafter made, of the same mental or physical
1142condition. By requesting and obtaining a report of the
1143examination so ordered, or by taking the deposition of the
1144examiner, the person examined waives any privilege he or she may
1145have, in relation to the claim for benefits, regarding the
1146testimony of every other person who has examined, or may
1147thereafter examine, him or her in respect to the same mental or
1148physical condition. If a person unreasonably refuses to submit
1149to an examination, the personal injury protection carrier is no
1150longer liable for subsequent personal injury protection benefits
1151incurred after the date of the first request for examination.
1152Failure to appear for an examination raises a rebuttable
1153presumption that such failure was unreasonable. Submission to an
1154examination is a condition precedent to the recovery of
1155benefits.
1156     (9)(8)  APPLICABILITY OF PROVISION REGULATING ATTORNEY'S
1157FEES.-With respect to any dispute under the provisions of ss.
1158627.730-627.7405 between the insured and the insurer under the
1159no-fault law, or between an assignee of an insured's rights and
1160the insurer, the provisions of s. 627.428 applies shall apply,
1161except as provided in subsections (11) and (16) (10) and (15).
1162     (10)(9)  PREFERRED PROVIDERS.-An insurer may negotiate and
1163enter into contracts with preferred licensed health care
1164providers for the benefits described in this section, referred
1165to in this section as "preferred providers," which shall include
1166health care providers licensed under chapter chapters 458,
1167chapter 459, chapter 460, chapter 461, or chapter and 463.
1168     (a)  The insurer may provide an option to an insured to use
1169a preferred provider at the time of purchase of the policy for
1170personal injury protection benefits, if the requirements of this
1171subsection are met. However, if the insurer offers a preferred
1172provider option, it must also offer a nonpreferred provider
1173policy. If the insured elects to use a provider who is not a
1174preferred provider, whether the insured purchased a preferred
1175provider policy or a nonpreferred provider policy, the medical
1176benefits provided by the insurer shall be as required by this
1177section.
1178     (b)  If the insured elects the to use a provider who is a
1179preferred provider option, the insurer may pay medical benefits
1180in excess of the benefits required by this section and may waive
1181or lower the amount of any deductible that applies to such
1182medical benefits. As an alternative, or in addition to such
1183benefits, waiver, or reduction, the insurer may provide an
1184actuarially appropriate premium discount as specified in an
1185approved rate filing to an insured who selects the preferred
1186provider option. If the preferred provider option provides a
1187premium discount, the policy may provide that charges for
1188nonemergency services provided within this state are payable
1189only if performed by members of the preferred provider network
1190unless there is no member of the preferred provider network
1191located within 15 miles of the insured's place of residence
1192whose scope of practice includes the required services. If the
1193insurer offers a preferred provider policy to a policyholder or
1194applicant, it must also offer a nonpreferred provider policy.
1195     (c)  The insurer shall provide each insured policyholder
1196with a current roster of preferred providers in the county in
1197which the insured resides at the time of purchasing purchase of
1198such policy, and shall make such list available for public
1199inspection during regular business hours at the insurer's
1200principal office of the insurer within the state. The insurer
1201may contract with another health insurer for the right to use an
1202existing preferred provider network to implement the preferred
1203provider option. Any other arrangement is subject to the
1204approval of the Office of Insurance Regulation.
1205     (17)(16)  SECURE ELECTRONIC DATA TRANSFER.-If all parties
1206mutually and expressly agree, a notice, documentation,
1207transmission, or communication of any kind required or
1208authorized under the no-fault law ss. 627.730-627.7405 may be
1209transmitted electronically if it is transmitted by secure
1210electronic data transfer that is consistent with state and
1211federal privacy and security laws.
1212     Section 8.  Subsection (1) of section 324.021, Florida
1213Statutes, is amended to read:
1214     324.021  Definitions; minimum insurance required.-The
1215following words and phrases when used in this chapter shall, for
1216the purpose of this chapter, have the meanings respectively
1217ascribed to them in this section, except in those instances
1218where the context clearly indicates a different meaning:
1219     (1)  MOTOR VEHICLE.-Every self-propelled vehicle that which
1220is designed and required to be licensed for use upon a highway,
1221including trailers and semitrailers designed for use with such
1222vehicles, except traction engines, road rollers, farm tractors,
1223power shovels, and well drillers, and every vehicle that which
1224is propelled by electric power obtained from overhead wires but
1225not operated upon rails, but not including any bicycle or moped.
1226However, the term does "motor vehicle" shall not include a any
1227motor vehicle as defined in s. 627.732(3) if when the owner of
1228such vehicle has complied with the no-fault law requirements of
1229ss. 627.730-627.7405, inclusive, unless the provisions of s.
1230324.051 apply; and, in such case, the applicable proof of
1231insurance provisions of s. 320.02 apply.
1232     Section 9.  Paragraph (k) of subsection (2) of section
1233456.057, Florida Statutes, is amended to read:
1234     456.057  Ownership and control of patient records; report
1235or 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
1238employer" do not include any of the following persons or
1239entities; furthermore, the following persons or entities are not
1240authorized to acquire or own medical records, but are authorized
1241under the confidentiality and disclosure requirements of this
1242section to maintain those documents required by the part or
1243chapter under which they are licensed or regulated:
1244     (k)  Persons or entities practicing under s. 627.736(8)
1245627.736(7).
1246     Section 10.  Subsection (7) of section 627.7295, Florida
1247Statutes, is amended to read:
1248     627.7295  Motor vehicle insurance contracts.-
1249     (7)  A policy of private passenger motor vehicle insurance
1250or a binder for such a policy may be initially issued in this
1251state only if, before the effective date of such binder or
1252policy, the insurer or agent has collected from the insured an
1253amount equal to 2 months' premium. An insurer, agent, or premium
1254finance company may not, directly or indirectly, take any action
1255resulting in the insured having paid from the insured's own
1256funds an amount less than the 2 months' premium required by this
1257subsection. This subsection applies without regard to whether
1258the premium is financed by a premium finance company or is paid
1259pursuant to a periodic payment plan of an insurer or an
1260insurance agent. This subsection does not apply if an insured or
1261member of the insured's family is renewing or replacing a policy
1262or a binder for such policy written by the same insurer or a
1263member of the same insurer group. This subsection does not apply
1264to an insurer that issues private passenger motor vehicle
1265coverage primarily to active duty or former military personnel
1266or their dependents. This subsection does not apply if all
1267policy payments are paid pursuant to a payroll deduction plan or
1268an automatic electronic funds transfer payment plan from the
1269policyholder. This subsection and subsection (4) do not apply if
1270all policy payments to an insurer are paid pursuant to an
1271automatic electronic funds transfer payment plan from an agent,
1272a managing general agent, or a premium finance company and if
1273the policy includes, at a minimum, personal injury protection
1274pursuant to ss. 627.730-627.7407 627.730-627.7405; motor vehicle
1275property damage liability pursuant to s. 627.7275; and bodily
1276injury liability in at least the amount of $10,000 because of
1277bodily injury to, or death of, one person in any one accident
1278and in the amount of $20,000 because of bodily injury to, or
1279death of, two or more persons in any one accident. This
1280subsection and subsection (4) do not apply if an insured has had
1281a policy in effect for at least 6 months, the insured's agent is
1282terminated by the insurer that issued the policy, and the
1283insured obtains coverage on the policy's renewal date with a new
1284company through the terminated agent.
1285     Section 11.  Subsections (3) and (4) of section 627.733,
1286Florida 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
1290delivery in this state by an authorized or eligible motor
1291vehicle liability insurer which provides the benefits and
1292exemptions contained in the no-fault law ss. 627.730-627.7405.
1293Any policy of insurance represented or sold as providing the
1294security required hereunder shall be deemed to provide insurance
1295for the payment of the required benefits; or
1296     (b)  By any other method authorized by s. 324.031(2), (3),
1297or (4) and approved by the Department of Highway Safety and
1298Motor Vehicles as affording security equivalent to that afforded
1299by a policy of insurance or by self-insuring as authorized by s.
1300768.28(16). The person filing such security shall have all of
1301the obligations and rights of an insurer under the no-fault law
1302ss. 627.730-627.7405.
1303     (4)  An owner of a motor vehicle with respect to which
1304security is required by this section who fails to have such
1305security in effect at the time of an accident shall have no
1306immunity from tort liability, but shall be personally liable for
1307the payment of benefits under s. 627.736. With respect to such
1308benefits, such an owner shall have all of the rights and
1309obligations of an insurer under the no-fault law ss. 627.730-
1310627.7405.
1311     Section 12.  Section 627.734, Florida Statutes, is amended
1312to read:
1313     627.734  Proof of security; security requirements;
1314penalties.-
1315     (1)  The provisions of chapter 324 that which pertain to
1316the method of giving and maintaining proof of financial
1317responsibility and that which govern and define a motor vehicle
1318liability policy shall apply to filing and maintaining proof of
1319security 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
1322provided for in the no-fault law ss. 627.730-627.7405, knowing
1323or having reason to believe that such information is false;
1324     (b)  Forges or, without authority, signs any evidence of
1325proof of security; or
1326     (c)  Files, or offers for filing, any such evidence of
1327proof, knowing or having reason to believe that it is forged or
1328signed without authority,
1329
1330commits is guilty of a misdemeanor of the first degree,
1331punishable as provided in s. 775.082 or s. 775.083.
1332     Section 13.  Subsections (1), (2), and (3) of section
1333627.737, Florida Statutes, are amended to read:
1334     627.737  Tort exemption; limitation on right to damages;
1335punitive damages.-
1336     (1)  Every owner, registrant, operator, or occupant of a
1337motor vehicle with respect to which security has been provided
1338as required by the no-fault law ss. 627.730-627.7405, and every
1339person or organization legally responsible for her or his acts
1340or omissions, is hereby exempted from tort liability for damages
1341because of bodily injury, sickness, or disease arising out of
1342the ownership, operation, maintenance, or use of such motor
1343vehicle in this state to the extent that the benefits described
1344in s. 627.736(1) are payable for such injury, or would be
1345payable but for any exclusion authorized by the no-fault law ss.
1346627.730-627.7405, under any insurance policy or other method of
1347security complying with the requirements of s. 627.733, or by an
1348owner personally liable under s. 627.733 for the payment of such
1349benefits, unless a person is entitled to maintain an action for
1350pain, suffering, mental anguish, and inconvenience for such
1351injury under the provisions of subsection (2).
1352     (2)  In any action of tort brought against the owner,
1353registrant, operator, or occupant of a motor vehicle with
1354respect to which security has been provided as required by the
1355no-fault law ss. 627.730-627.7405, or against any person or
1356organization legally responsible for her or his acts or
1357omissions, a plaintiff may recover damages in tort for pain,
1358suffering, mental anguish, and inconvenience because of bodily
1359injury, sickness, or disease arising out of the ownership,
1360maintenance, operation, or use of such motor vehicle only in the
1361event that the injury or disease consists in whole or in part
1362of:
1363     (a)  Significant and permanent loss of an important bodily
1364function.
1365     (b)  Permanent injury within a reasonable degree of medical
1366probability, 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
1370the no-fault law ss. 627.730-627.7405, questions whether the
1371plaintiff has met the requirements of subsection (2), then the
1372defendant may file an appropriate motion with the court, and the
1373court shall, on a one-time basis only, 30 days before the date
1374set for the trial or the pretrial hearing, whichever is first,
1375by examining the pleadings and the evidence before it, ascertain
1376whether the plaintiff will be able to submit some evidence that
1377the plaintiff will meet the requirements of subsection (2). If
1378the court finds that the plaintiff will not be able to submit
1379such evidence, then the court shall dismiss the plaintiff's
1380claim without prejudice.
1381     Section 14.  Subsection (1) of section 627.7401, Florida
1382Statutes, is amended to read:
1383     627.7401  Notification of insured's rights.-
1384     (1)  The commission, by rule, shall adopt a form for the
1385notification of insureds of their right to receive personal
1386injury protection benefits under the Florida Motor Vehicle no-
1387fault law. Such notice shall include:
1388     (a)  A description of the benefits provided by personal
1389injury protection, including, but not limited to, the specific
1390types of services for which medical benefits are paid,
1391disability benefits, death benefits, significant exclusions from
1392and limitations on personal injury protection benefits, when
1393payments are due, how benefits are coordinated with other
1394insurance benefits that the insured may have, penalties and
1395interest that may be imposed on insurers for failure to make
1396timely payments of benefits, and rights of parties regarding
1397disputes as to benefits.
1398     (b)  An advisory informing insureds that:
1399     1.  Pursuant to s. 626.9892, the Department of Financial
1400Services may pay rewards of up to $25,000 to persons providing
1401information leading to the arrest and conviction of persons
1402committing crimes investigated by the Division of Insurance
1403Fraud arising from violations of s. 440.105, s. 624.15, s.
1404626.9541, s. 626.989, or s. 817.234.
1405     2.  Pursuant to s. 627.736(6)(e)1. 627.736(5)(e)1., if the
1406insured notifies the insurer of a billing error, the insured may
1407be entitled to a certain percentage of a reduction in the amount
1408paid by the insured's motor vehicle insurer.
1409     (c)  A notice that solicitation of a person injured in a
1410motor vehicle crash for purposes of filing personal injury
1411protection or tort claims could be a violation of s. 817.234, s
1412817.505, or the rules regulating The Florida Bar and should be
1413immediately reported to the Division of Insurance Fraud if such
1414conduct has taken place.
1415     Section 15.  Section 627.7405, Florida Statutes, is amended
1416to read:
1417     627.7405  Insurers' right of reimbursement.-Notwithstanding
1418any other provisions of the no-fault law ss. 627.730-627.7405,
1419any insurer providing personal injury protection benefits on a
1420private passenger motor vehicle has shall have, to the extent of
1421any personal injury protection benefits paid to any person as a
1422benefit arising out of such private passenger motor vehicle
1423insurance, a right of reimbursement against the owner or the
1424insurer of the owner of a commercial motor vehicle, if the
1425benefits paid result from such person having been an occupant of
1426the commercial motor vehicle or having been struck by the
1427commercial motor vehicle while not an occupant of any self-
1428propelled vehicle.
1429     Section 16.  Subsection (1) of section 627.7407, Florida
1430Statutes, is amended to read:
1431     627.7407  Application of the Florida Motor Vehicle No-Fault
1432Law.-
1433     (1)  Any person subject to the requirements of ss. 627.730-
1434627.7405, the Florida Motor Vehicle No-Fault Law, as revived and
1435amended by this act, must maintain security for personal injury
1436protection as required by the Florida Motor Vehicle No-Fault
1437Law, as revived and amended by this act, beginning on January 1,
14382008.
1439     Section 17.  Paragraph (d) of subsection (2) and paragraph
1440(d) of subsection (3) of section 628.909, Florida Statutes, are
1441amended to read:
1442     628.909  Applicability of other laws.-
1443     (2)  The following provisions of the Florida Insurance Code
1444shall apply to captive insurers who are not industrial insured
1445captive insurers to the extent that such provisions are not
1446inconsistent with this part:
1447     (d)  Sections 627.730-627.7407 627.730-627.7405, when no-
1448fault coverage is provided.
1449     (3)  The following provisions of the Florida Insurance Code
1450shall apply to industrial insured captive insurers to the extent
1451that such provisions are not inconsistent with this part:
1452     (d)  Sections 627.730-627.7407 627.730-627.7405 when no-
1453fault coverage is provided.
1454     Section 18.  For the purpose of incorporating the amendment
1455made by this act to section 627.736, Florida Statutes, in a
1456reference thereto, paragraph (c) of subsection (7) of section
1457817.234, 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
1461or on behalf of an insurer, may not change an opinion in a
1462mental or physical report prepared under s. 627.736(8) or direct
1463the physician preparing the report to change such opinion;
1464however, this provision does not preclude the insurer from
1465calling to the attention of the physician errors of fact in the
1466report based upon information in the claim file. Any person who
1467violates this paragraph commits a felony of the third degree,
1468punishable 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.