Florida Senate - 2012                                     SB 254
       By Senator Bennett
       21-00032-12                                            2012254__
    1                        A bill to be entitled                      
    2         An act relating to motor vehicle personal injury
    3         protection insurance; amending s. 316.066, F.S.;
    4         revising provisions relating to the contents of
    5         written reports of motor vehicle crashes; authorizing
    6         the investigation officer to testify at trial or
    7         provide an affidavit concerning the content of the
    8         reports; amending s. 400.991, F.S.; requiring that an
    9         application for licensure as a mobile clinic include a
   10         statement regarding insurance fraud; amending s.
   11         627.730, F.S.; conforming a cross-reference; amending
   12         s. 627.731, F.S.; conforming provisions to changes
   13         made by the act; reordering and amending s. 627.732,
   14         F.S.; defining the term “no-fault law”; amending ss.
   15         627.733 and 627.734, F.S.; conforming provisions to
   16         changes made by the act; amending s. 627.736, F.S.;
   17         conforming provisions to changes made by the act;
   18         adding licensed acupuncturists to the list of
   19         practitioners authorized to provide, supervise, order,
   20         or prescribe services; providing that an insurer’s
   21         failure to send certain specification or explanation
   22         waives other grounds for rejecting an invalid claim;
   23         preempting local lien laws with respect to payment of
   24         benefits to medical providers; providing that a
   25         claimant that violates certain provisions is not
   26         entitled to any payment, regardless of whether a
   27         portion of the claim may be legitimate; revising the
   28         insurer’s reimbursement limitation; providing a limit
   29         on the amount of reimbursement if the insurance policy
   30         includes a schedule of charges; deleting a provision
   31         allowing charges for services provided before a
   32         certain date; authorizing the insurer to deny a claim
   33         if the provider does not submit a properly completed
   34         statement or bill within a certain time; specifying
   35         requirements for furnishing the insured with notice of
   36         the amount of covered loss; deleting an obsolete
   37         provision; requiring the provider to provide copies of
   38         the patient log within a certain time if requested by
   39         the insurer; providing that failure to maintain a
   40         patient log renders the treatment unlawful and
   41         noncompensable; revising requirements relating to
   42         discovery; requiring that the provider authorize the
   43         insurer to conduct a physical review of the treatment
   44         location under certain circumstances; authorizing an
   45         insurer to contract with a preferred provider;
   46         authorizing an insurer to provide a premium discount
   47         to an insured who selects a preferred provider;
   48         providing that an insured forfeits the premium
   49         discount if the insured uses nonemergency services
   50         performed by a nonpreferred provider in specified
   51         circumstances; authorizing an insurer to use a
   52         preferred provider network; revising requirements
   53         relating to demand letters in an action for benefits;
   54         specifying when a demand letter is defective; deleting
   55         obsolete provisions; authorizing a demand letter to be
   56         used to request the production of claim documents or
   57         other records from the insurer; amending ss. 627.737,
   58         627.7405, and 627.7407, F.S.; conforming provisions to
   59         changes made by the act; amending ss. 324.021,
   60         627.7295, 628.909, and 817.234, F.S.; conforming
   61         cross-references; providing an effective date.
   63  Be It Enacted by the Legislature of the State of Florida:
   65         Section 1. Subsection (1) of section 316.066, Florida
   66  Statutes, is amended to read:
   67         316.066 Written reports of crashes.—
   68         (1)(a) A Florida Traffic Crash Report, Long Form, must is
   69  required to be completed and submitted to the department within
   70  10 days after completing an investigation is completed by the
   71  every law enforcement officer who in the regular course of duty
   72  investigates a motor vehicle crash that:
   73         1. That resulted in death, or personal injury, or any
   74  indication of complaints of pain or discomfort by any of the
   75  parties or passengers involved in the crash;.
   76         2. That involved one or more passengers, other than the
   77  drivers of the vehicles, in any of the vehicles involved in the
   78  crash;
   79         3.2.That involved a violation of s. 316.061(1) or s.
   80  316.193; or
   81         4. In which a vehicle was rendered inoperative to a degree
   82  that required a wrecker to remove it from traffic, if the
   83  investigating officer determines such action to be appropriate.
   84         (b) In every crash for which a Florida Traffic Crash
   85  Report, Long Form, is not required by this section, the law
   86  enforcement officer may complete a short-form crash report or
   87  provide a driver exchange-of-information form to be completed by
   88  each party involved in the crash. Short-form crash reports
   89  prepared by the law enforcement officer shall be maintained by
   90  the officer’s agency.
   91         (c) The long-form and the short-form report must include:
   92         1. The date, time, and location of the crash.
   93         2. A description of the vehicles involved.
   94         3. The names and addresses of the parties involved,
   95  including all drivers and passengers.
   96         4. The identification of all passengers and the vehicle in
   97  which he or she was a passenger.
   98         5.4. The names and addresses of witnesses.
   99         6.5. The name, badge number, and law enforcement agency of
  100  the officer investigating the crash.
  101         7.6. The names of the insurance companies for the
  102  respective parties involved in the crash.
  103         (d)(c) Each party to the crash must provide the law
  104  enforcement officer with proof of insurance, which must be
  105  documented in the crash report. If a law enforcement officer
  106  submits a report on the crash, proof of insurance must be
  107  provided to the officer by each party involved in the crash. Any
  108  party who fails to provide the required information commits a
  109  noncriminal traffic infraction, punishable as a nonmoving
  110  violation as provided in chapter 318, unless the officer
  111  determines that due to injuries or other special circumstances
  112  such insurance information cannot be provided immediately. If
  113  the person provides the law enforcement agency, within 24 hours
  114  after the crash, proof of insurance that was valid at the time
  115  of the crash, the law enforcement agency may void the citation.
  116         (e)(d) The driver of a vehicle that was in any manner
  117  involved in a crash resulting in damage to any vehicle or other
  118  property in an amount of $500 or more which was not investigated
  119  by a law enforcement agency, shall, within 10 days after the
  120  crash, submit a written report of the crash to the department.
  121  The entity receiving the report may require witnesses of the
  122  crash to render reports and may require any driver of a vehicle
  123  involved in a crash of which a written report must be made to
  124  file supplemental written reports if the original report is
  125  deemed insufficient by the receiving entity.
  126         (e) Short-form crash reports prepared by law enforcement
  127  shall be maintained by the law enforcement officer’s agency.
  128         (f) The investigating law enforcement officer may testify
  129  at trial or provide a signed affidavit to confirm or supplement
  130  the information included on the long-form or short-form report.
  131         Section 2. Subsection (6) is added to section 400.991,
  132  Florida Statutes, to read:
  133         400.991 License requirements; background screenings;
  134  prohibitions.—
  135         (6) All forms that constitute part of the application for
  136  licensure or exemption from licensure under this part must
  137  contain the following statement:
  139         INSURANCE FRAUD NOTICE.—Submitting a false or
  140         fraudulent application or other document when applying
  141         for licensure as a health care clinic, when seeking an
  142         exemption from licensure as a health care clinic, or
  143         when demonstrating compliance with part X of chapter
  144         400, Florida Statutes, is a fraudulent insurance act,
  145         as defined in s. 626.989 or s. 817.234, Florida
  146         Statutes, subject to investigation by the Division of
  147         Insurance Fraud, and is grounds for discipline by the
  148         appropriate licensing board of the Department of
  149         Health.
  150         Section 3. Section 627.730, Florida Statutes, is amended to
  151  read:
  152         627.730 Florida Motor Vehicle No-Fault Law.—Sections
  153  627.730-627.7407 627.730-627.7405 may be cited and known as the
  154  “Florida Motor Vehicle No-Fault Law.”
  155         Section 4. Section 627.731, Florida Statutes, is amended to
  156  read:
  157         627.731 Purpose.—The purpose of the no-fault law ss.
  158  627.730-627.7405 is to provide for medical, surgical, funeral,
  159  and disability insurance benefits without regard to fault, and
  160  to require motor vehicle insurance securing such benefits, for
  161  motor vehicles required to be registered in this state and, with
  162  respect to motor vehicle accidents, a limitation on the right to
  163  claim damages for pain, suffering, mental anguish, and
  164  inconvenience.
  165         Section 5. Section 627.732, Florida Statutes, is reordered
  166  and amended to read:
  167         627.732 Definitions.—As used in the no-fault law ss.
  168  627.730-627.7405, the term:
  169         (1) “Broker” means any person not possessing a license
  170  under chapter 395, chapter 400, chapter 429, chapter 458,
  171  chapter 459, chapter 460, chapter 461, or chapter 641 who
  172  charges or receives compensation for any use of medical
  173  equipment and is not the 100 percent 100-percent owner or the
  174  100 percent 100-percent lessee of such equipment. For purposes
  175  of this section, such owner or lessee may be an individual, a
  176  corporation, a partnership, or any other entity and any of its
  177  100 percent-owned 100-percent-owned affiliates and subsidiaries.
  178  For purposes of this subsection, the term “lessee” means a long
  179  term lessee under a capital or operating lease, but does not
  180  include a part-time lessee. The term “broker” does not include a
  181  hospital or physician management company whose medical equipment
  182  is ancillary to the practices managed, a debt collection agency,
  183  or an entity that has contracted with the insurer to obtain a
  184  discounted rate for such services; or nor does the term include
  185  a management company that has contracted to provide general
  186  management services for a licensed physician or health care
  187  facility and whose compensation is not materially affected by
  188  the usage or frequency of usage of medical equipment or an
  189  entity that is 100 percent 100-percent owned by one or more
  190  hospitals or physicians. The term “broker” does not include a
  191  person or entity that certifies, upon request of an insurer,
  192  that:
  193         (a) It is a clinic licensed under ss. 400.990-400.995;
  194         (b) It is a 100 percent 100-percent owner of medical
  195  equipment; and
  196         (c) The owner’s only part-time lease of medical equipment
  197  for personal injury protection patients is on a temporary basis,
  198  not to exceed 30 days in a 12-month period, and such lease is
  199  solely for the purposes of necessary repair or maintenance of
  200  the 100 percent-owned 100-percent-owned medical equipment or
  201  pending the arrival and installation of the newly purchased or a
  202  replacement for the 100 percent-owned 100-percent-owned medical
  203  equipment, or for patients for whom, because of physical size or
  204  claustrophobia, it is determined by the medical director or
  205  clinical director to be medically necessary that the test be
  206  performed in medical equipment that is open-style. The leased
  207  medical equipment may not cannot be used by patients who are not
  208  patients of the registered clinic for medical treatment of
  209  services. Any person or entity making a false certification
  210  under this subsection commits insurance fraud as defined in s.
  211  817.234. However, the 30-day period provided in this paragraph
  212  may be extended for an additional 60 days as applicable to
  213  magnetic resonance imaging equipment if the owner certifies that
  214  the extension otherwise complies with this paragraph.
  215         (8)(2) “Medically necessary” refers to a medical service or
  216  supply that a prudent physician would provide for the purpose of
  217  preventing, diagnosing, or treating an illness, injury, disease,
  218  or symptom in a manner that is:
  219         (a) In accordance with generally accepted standards of
  220  medical practice;
  221         (b) Clinically appropriate in terms of type, frequency,
  222  extent, site, and duration; and
  223         (c) Not primarily for the convenience of the patient,
  224  physician, or other health care provider.
  225         (9)(3) “Motor vehicle” means a any self-propelled vehicle
  226  with four or more wheels which is of a type both designed and
  227  required to be licensed for use on the highways of this state,
  228  and any trailer or semitrailer designed for use with such
  229  vehicle, and includes:
  230         (a) A “private passenger motor vehicle,” which is any motor
  231  vehicle that which is a sedan, station wagon, or jeep-type
  232  vehicle and, if not used primarily for occupational,
  233  professional, or business purposes, a motor vehicle of the
  234  pickup, panel, van, camper, or motor home type.
  235         (b) A “commercial motor vehicle,” which is any motor
  236  vehicle that which is not a private passenger motor vehicle.
  238  The term “motor vehicle” does not include a mobile home or any
  239  motor vehicle that which is used in mass transit, other than
  240  public school transportation, and designed to transport more
  241  than five passengers exclusive of the operator of the motor
  242  vehicle and that which is owned by a municipality, a transit
  243  authority, or a political subdivision of the state.
  244         (10)(4) “Named insured” means a person, usually the owner
  245  of a vehicle, identified in a policy by name as the insured
  246  under the policy.
  247         (11) “No-fault law” means the Florida Motor Vehicle No
  248  Fault Law codified at ss. 627.730-627.7407.
  249         (12)(5) “Owner” means a person who holds the legal title to
  250  a motor vehicle; or, if in the event a motor vehicle is the
  251  subject of a security agreement or lease with an option to
  252  purchase with the debtor or lessee having the right to
  253  possession, then the debtor or lessee is shall be deemed the
  254  owner for the purposes of the no-fault law ss. 627.730-627.7405.
  255         (14)(6) “Relative residing in the same household” means a
  256  relative of any degree by blood or by marriage who usually makes
  257  her or his home in the same family unit, whether or not
  258  temporarily living elsewhere.
  259         (2)(7) “Certify” means to swear or attest to being true or
  260  represented in writing.
  261         (4)(8) “Immediate personal supervision,” as it relates to
  262  the performance of medical services by nonphysicians not in a
  263  hospital, means that an individual licensed to perform the
  264  medical service or provide the medical supplies must be present
  265  within the confines of the physical structure where the medical
  266  services are performed or where the medical supplies are
  267  provided such that the licensed individual can respond
  268  immediately to any emergencies if needed.
  269         (5)(9) “Incident,” with respect to services considered as
  270  incident to a physician’s professional service, for a physician
  271  licensed under chapter 458, chapter 459, chapter 460, or chapter
  272  461, if not furnished in a hospital, means such services that
  273  are must be an integral, even if incidental, part of a covered
  274  physician’s service.
  275         (6)(10) “Knowingly” means that a person, with respect to
  276  information, has actual knowledge of the information,; acts in
  277  deliberate ignorance of the truth or falsity of the
  278  information,; or acts in reckless disregard of the information.,
  279  and Proof of specific intent to defraud is not required.
  280         (7)(11) “Lawful” or “lawfully” means in substantial
  281  compliance with all relevant applicable criminal, civil, and
  282  administrative requirements of state and federal law related to
  283  the provision of medical services or treatment.
  284         (3)(12) “Hospital” means a facility that, at the time
  285  services or treatment was were rendered, was licensed under
  286  chapter 395.
  287         (13)(13) “Properly completed” means providing truthful,
  288  substantially complete, and substantially accurate responses as
  289  to all material elements of to each applicable request for
  290  information or statement by a means that may lawfully be
  291  provided and that complies with this section, or as agreed by
  292  the parties.
  293         (16)(14) “Upcoding” means submitting an action that submits
  294  a billing code that would result in payment greater in amount
  295  than would be paid using a billing code that accurately
  296  describes the services performed. The term does not include an
  297  otherwise lawful bill by a magnetic resonance imaging facility,
  298  which globally combines both technical and professional
  299  components, if the amount of the global bill is not more than
  300  the components if billed separately; however, payment of such a
  301  bill constitutes payment in full for all components of such
  302  service.
  303         (15) “Unbundling” means submitting an action that submits a
  304  billing code that is properly billed under one billing code, but
  305  that has been separated into two or more billing codes, and
  306  would result in payment greater than the in amount that than
  307  would be paid using one billing code.
  308         Section 6. Subsections (3) and (4) of section 627.733,
  309  Florida Statutes, are amended to read:
  310         627.733 Required security.—
  311         (3) Such security shall be provided:
  312         (a) By an insurance policy delivered or issued for delivery
  313  in this state by an authorized or eligible motor vehicle
  314  liability insurer which provides the benefits and exemptions
  315  contained under the no-fault law in ss. 627.730-627.7405. Any
  316  policy of insurance represented or sold as providing the
  317  security required hereunder shall be deemed to provide insurance
  318  for the payment of the required benefits; or
  319         (b) By any other method authorized by s. 324.031(2), (3),
  320  or (4) and approved by the Department of Highway Safety and
  321  Motor Vehicles as affording security equivalent to that afforded
  322  by a policy of insurance or by self-insuring as authorized by s.
  323  768.28(16). The person filing such security has shall have all
  324  of the obligations and rights of an insurer under the no-fault
  325  law ss. 627.730-627.7405.
  326         (4) An owner of a motor vehicle with respect to which
  327  security is required by this section who fails to have such
  328  security in effect at the time of an accident has shall have no
  329  immunity from tort liability, but is shall be personally liable
  330  for the payment of benefits under s. 627.736. With respect to
  331  such benefits, such an owner has shall have all of the rights
  332  and obligations of an insurer under the no-fault law ss.
  333  627.730-627.7405.
  334         Section 7. Section 627.734, Florida Statutes, is amended to
  335  read:
  336         627.734 Proof of security; security requirements;
  337  penalties.—
  338         (1) The provisions of chapter 324 which pertain to the
  339  method of giving and maintaining proof of financial
  340  responsibility and which govern and define a motor vehicle
  341  liability policy shall apply to filing and maintaining proof of
  342  security required under the no-fault law by ss. 627.730
  343  627.7405.
  344         (2) Any person who:
  345         (a) Gives information required in a report or otherwise as
  346  provided under the no-fault law for in ss. 627.730-627.7405,
  347  knowing or having reason to believe that such information is
  348  false;
  349         (b) Forges or, without authority, signs any evidence of
  350  proof of security; or
  351         (c) Files, or offers for filing, any such evidence of
  352  proof, knowing or having reason to believe that it is forged or
  353  signed without authority,
  355  commits is guilty of a misdemeanor of the first degree,
  356  punishable as provided in s. 775.082 or s. 775.083.
  357         Section 8. Subsections (1), (4), and (5), paragraph (b) of
  358  subsection (6), and subsections (8), (9), and (10) of section
  359  627.736, Florida Statutes, are amended to read:
  360         627.736 Required personal injury protection benefits;
  361  exclusions; priority; claims.—
  362         (1) REQUIRED BENEFITS.—Every insurance policy complying
  363  with the security requirements of s. 627.733 must shall provide
  364  personal injury protection to the named insured, relatives
  365  residing in the same household, persons operating the insured
  366  motor vehicle, passengers in such motor vehicle, and other
  367  persons struck by such motor vehicle and suffering bodily injury
  368  while not an occupant of a self-propelled vehicle, subject to
  369  the provisions of subsection (2) and paragraph (4)(g) (4)(e), to
  370  a limit of $10,000 for loss sustained by any such person as a
  371  result of bodily injury, sickness, disease, or death arising out
  372  of the ownership, maintenance, or use of a motor vehicle as
  373  follows:
  374         (a) Medical benefits.—Eighty percent of all reasonable
  375  expenses, charged pursuant to subsection (5) for medically
  376  necessary medical, surgical, X-ray, dental, and rehabilitative
  377  services, including prosthetic devices; for, and medically
  378  necessary ambulance, hospital, and nursing services; and for
  379  reasonable transportation services to such services. However,
  380  the medical benefits shall provide reimbursement only for such
  381  services and care that are lawfully provided, supervised,
  382  ordered, or prescribed by a physician licensed under chapter 458
  383  or chapter 459, a dentist licensed under chapter 466, or a
  384  chiropractic physician licensed under chapter 460, or an
  385  acupuncturist licensed under chapter 457 pursuant to his or her
  386  scope of practice, or that are provided by any of the following
  387  persons or entities:
  388         1. A hospital or ambulatory surgical center licensed under
  389  chapter 395.
  390         2. A person or entity licensed under part III of chapter
  391  401 which ss. 401.2101-401.45 that provides emergency
  392  transportation and treatment.
  393         3. An entity wholly owned by one or more physicians
  394  licensed under chapter 458 or chapter 459, chiropractic
  395  physicians licensed under chapter 460, or dentists licensed
  396  under chapter 466 or by such practitioner or practitioners and
  397  the spouse, parent, child, or sibling of such that practitioner
  398  or those practitioners.
  399         4. An entity wholly owned, directly or indirectly, by a
  400  hospital or hospitals.
  401         5. A health care clinic licensed under part X of chapter
  402  400 which ss. 400.990-400.995 that is:
  403         a. A health care clinic that is accredited by the Joint
  404  Commission on Accreditation of Healthcare Organizations, the
  405  American Osteopathic Association, the Commission on
  406  Accreditation of Rehabilitation Facilities, or the Accreditation
  407  Association for Ambulatory Health Care, Inc.; or
  408         b. A health care clinic that:
  409         (I) Has a medical director licensed under chapter 458,
  410  chapter 459, or chapter 460;
  411         (II) Has been continuously licensed for more than 3 years
  412  or is a publicly traded corporation that issues securities
  413  traded on an exchange registered with the United States
  414  Securities and Exchange Commission as a national securities
  415  exchange; and
  416         (III) Provides at least four of the following medical
  417  specialties:
  418         (A) General medicine.
  419         (B) Radiography.
  420         (C) Orthopedic medicine.
  421         (D) Physical medicine.
  422         (E) Physical therapy.
  423         (F) Physical rehabilitation.
  424         (G) Prescribing or dispensing outpatient prescription
  425  medication.
  426         (H) Laboratory services.
  428  The Financial Services Commission shall adopt by rule the form
  429  that must be used by an insurer and a health care provider
  430  specified in subparagraph 3., subparagraph 4., or subparagraph
  431  5. to document that the health care provider meets the criteria
  432  of this paragraph, which rule must include a requirement for a
  433  sworn statement or affidavit.
  434         (b) Disability benefits.—Sixty percent of any loss of gross
  435  income and loss of earning capacity per individual from
  436  inability to work proximately caused by the injury sustained by
  437  the injured person, plus all expenses reasonably incurred in
  438  obtaining from others ordinary and necessary services in lieu of
  439  those that, but for the injury, the injured person would have
  440  performed without income for the benefit of his or her
  441  household. All disability benefits payable under this provision
  442  must shall be paid at least not less than every 2 weeks.
  443         (c) Death benefits.—Death benefits equal to the lesser of
  444  $5,000 or the remainder of unused personal injury protection
  445  benefits per individual. The insurer may pay such benefits to
  446  the executor or administrator of the deceased, to any of the
  447  deceased’s relatives by blood, or legal adoption, or connection
  448  by marriage, or to any person appearing to the insurer to be
  449  equitably entitled thereto.
  451  Only insurers writing motor vehicle liability insurance in this
  452  state may provide the required benefits of this section, and no
  453  such insurers may not insurer shall require the purchase of any
  454  other motor vehicle coverage other than the purchase of property
  455  damage liability coverage as required by s. 627.7275 as a
  456  condition for providing such required benefits. Insurers may not
  457  require that property damage liability insurance in an amount
  458  greater than $10,000 be purchased in conjunction with personal
  459  injury protection. Such insurers shall make benefits and
  460  required property damage liability insurance coverage available
  461  through normal marketing channels. An Any insurer writing motor
  462  vehicle liability insurance in this state who fails to comply
  463  with such availability requirement as a general business
  464  practice violates shall be deemed to have violated part IX of
  465  chapter 626, and such violation constitutes shall constitute an
  466  unfair method of competition or an unfair or deceptive act or
  467  practice involving the business of insurance. An; and any such
  468  insurer committing such violation is shall be subject to the
  469  penalties afforded in such part, as well as those that are which
  470  may be afforded elsewhere in the insurance code.
  471         (4) BENEFITS; WHEN DUE.—Benefits due from an insurer under
  472  the no-fault law are ss. 627.730-627.7405 shall be primary,
  473  except that benefits received under any workers’ compensation
  474  law shall be credited against the benefits provided by
  475  subsection (1) and are shall be due and payable as loss accrues,
  476  upon the receipt of reasonable proof of such loss and the amount
  477  of expenses and loss incurred which are covered by the policy
  478  issued under the no-fault law ss. 627.730-627.7405. If When the
  479  Agency for Health Care Administration provides, pays, or becomes
  480  liable for medical assistance under the Medicaid program related
  481  to injury, sickness, disease, or death arising out of the
  482  ownership, maintenance, or use of a motor vehicle, the benefits
  483  are under ss. 627.730-627.7405 shall be subject to the
  484  provisions of the Medicaid program.
  485         (a) An insurer may require written notice to be given as
  486  soon as practicable after an accident involving a motor vehicle
  487  with respect to which the policy affords the security required
  488  by the no-fault law ss. 627.730-627.7405.
  489         (b) Personal injury protection insurance benefits paid
  490  pursuant to this section are shall be overdue if not paid within
  491  30 days after the insurer is furnished written notice of the
  492  fact of a covered loss and of the amount of same. If such
  493  written notice is not furnished to the insurer as to the entire
  494  claim, any partial amount supported by written notice is overdue
  495  if not paid within 30 days after the such written notice is
  496  furnished to the insurer. Any part or all of the remainder of
  497  the claim that is subsequently supported by written notice is
  498  overdue if not paid within 30 days after such written notice is
  499  furnished to the insurer. For the purpose of calculating the
  500  extent to which benefits are overdue, payment shall be
  501  considered made on the date a draft or other valid instrument
  502  that is equivalent to payment is placed in the United States
  503  mail in a properly addressed, postpaid envelope, or, if not so
  504  posted, on the date of delivery.
  505         (c) If When an insurer pays only a portion of a claim or
  506  rejects a claim, the insurer shall provide at the time of the
  507  partial payment or rejection an itemized specification of each
  508  item that the insurer had reduced, omitted, or declined to pay
  509  and any information that the insurer desires the claimant to
  510  consider related to the medical necessity of the denied
  511  treatment or to explain the reasonableness of the reduced
  512  charge, if provided that this does shall not limit the
  513  introduction of evidence at trial.; and The insurer must shall
  514  include the name and address of the person to whom the claimant
  515  should respond, and a claim number to be referenced in future
  516  correspondence, and a detailed description of the amount paid
  517  for each date of service. The insurer’s failure to include an
  518  itemized specification or explanation of benefits waives other
  519  grounds for rejecting an invalid claim.
  520         (d)However, Notwithstanding the fact that written notice
  521  has been furnished to the insurer, any payment is shall not be
  522  deemed overdue if when the insurer has reasonable proof to
  523  establish that the insurer is not responsible for the payment.
  524  For the purpose of calculating the extent to which any benefits
  525  are overdue, payment shall be treated as being made on the date
  526  a draft or other valid instrument which is equivalent to payment
  527  was placed in the United States mail in a properly addressed,
  528  postpaid envelope or, if not so posted, on the date of delivery.
  529  This paragraph does not preclude or limit the ability of the
  530  insurer to assert that the claim was unrelated, was not
  531  medically necessary, or was unreasonable, or that the amount of
  532  the charge was in excess of that permitted under, or in
  533  violation of, subsection (5). Such assertion by the insurer may
  534  be made at any time, including after payment of the claim or
  535  after the 30-day time period for payment set forth in this
  536  paragraph (b).
  537         (e)(c)Notwithstanding any local lien law, upon receiving
  538  notice of an accident that is potentially covered by personal
  539  injury protection benefits, the insurer must reserve $5,000 of
  540  personal injury protection benefits for payment to physicians
  541  licensed under chapter 458 or chapter 459 or dentists licensed
  542  under chapter 466 who provide emergency services and care, as
  543  defined in s. 395.002(9), or who provide hospital inpatient
  544  care. The amount required to be held in reserve may be used only
  545  to pay claims from such physicians or dentists until 30 days
  546  after the date the insurer receives notice of the accident.
  547  After the 30-day period, any amount of the reserve for which the
  548  insurer has not received notice of such a claim from a physician
  549  or dentist who provided emergency services and care or who
  550  provided hospital inpatient care may then be used by the insurer
  551  to pay other claims. The time periods specified in paragraph (b)
  552  for required payment of personal injury protection benefits are
  553  shall be tolled for the period of time that an insurer is
  554  required by this paragraph to hold payment of a claim that is
  555  not from a physician or dentist who provided emergency services
  556  and care or who provided hospital inpatient care to the extent
  557  that the personal injury protection benefits not held in reserve
  558  are insufficient to pay the claim. This paragraph does not
  559  require an insurer to establish a claim reserve for insurance
  560  accounting purposes.
  561         (f)(d) All overdue payments shall bear simple interest at
  562  the rate established under s. 55.03 or the rate established in
  563  the insurance contract, whichever is greater, for the year in
  564  which the payment became overdue, calculated from the date the
  565  insurer was furnished with written notice of the amount of
  566  covered loss. Interest is shall be due at the time payment of
  567  the overdue claim is made.
  568         (g)(e) The insurer of the owner of a motor vehicle shall
  569  pay personal injury protection benefits for:
  570         1. Accidental bodily injury sustained in this state by the
  571  owner while occupying a motor vehicle, or while not an occupant
  572  of a self-propelled vehicle if the injury is caused by physical
  573  contact with a motor vehicle.
  574         2. Accidental bodily injury sustained outside this state,
  575  but within the United States of America or its territories or
  576  possessions or Canada, by the owner while occupying the owner’s
  577  motor vehicle.
  578         3. Accidental bodily injury sustained by a relative of the
  579  owner residing in the same household, under the circumstances
  580  described in subparagraph 1. or subparagraph 2. if, provided the
  581  relative at the time of the accident is domiciled in the owner’s
  582  household and is not himself or herself the owner of a motor
  583  vehicle with respect to which security is required under the no
  584  fault law ss. 627.730-627.7405.
  585         4. Accidental bodily injury sustained in this state by any
  586  other person while occupying the owner’s motor vehicle or, if a
  587  resident of this state, while not an occupant of a self
  588  propelled vehicle, if the injury is caused by physical contact
  589  with such motor vehicle and if, provided the injured person is
  590  not himself or herself:
  591         a. The owner of a motor vehicle with respect to which
  592  security is required under the no-fault law ss. 627.730
  593  627.7405; or
  594         b. Entitled to personal injury benefits from the insurer of
  595  the owner or owners of such a motor vehicle.
  596         (h)(f) If two or more insurers are liable to pay personal
  597  injury protection benefits for the same injury to any one
  598  person, the maximum payable is shall be as specified in
  599  subsection (1), and any insurer paying the benefits is shall be
  600  entitled to recover from each of the other insurers an equitable
  601  pro rata share of the benefits paid and expenses incurred in
  602  processing the claim.
  603         (i)(g) It is a violation of the insurance code for an
  604  insurer to fail to timely provide benefits as required by this
  605  section with such frequency as to constitute a general business
  606  practice.
  607         (j)(h) Benefits are shall not be due or payable to a
  608  claimant who knowingly: or on the behalf of an insured person if
  609  that person has
  610         1. Submits a fraudulent statement, document, record, or
  611  bill;
  612         2. Submits fraudulent information; or
  613         3. Has otherwise committed or attempted to commit a
  614  fraudulent insurance act as defined in s. 626.989.
  616  A claimant that violates this paragraph is not entitled to any
  617  personal injury protection benefit or payment for any bill and
  618  service, regardless of whether a portion of the claim may be
  619  legitimate. However, a claimant that does not violate this
  620  paragraph may not be denied benefits solely due to a violation
  621  by another claimant.
  622         (k) A claimant has violated paragraph (j) committed, by a
  623  material act or omission, any insurance fraud relating to
  624  personal injury protection coverage under his or her policy, if
  625  the fraud is admitted to in a sworn statement by the insured or
  626  if it is established in a court of competent jurisdiction. Any
  627  insurance fraud voids shall void all coverage arising from the
  628  claim related to such fraud under the personal injury protection
  629  coverage of the claimant insured person who committed the fraud,
  630  irrespective of whether a portion of the insured person’s claim
  631  may be legitimate, and any benefits paid before prior to the
  632  discovery of the insured person’s insurance fraud is shall be
  633  recoverable in their entirety by the insurer from the claimant
  634  person who committed insurance fraud in their entirety. The
  635  prevailing party is entitled to its costs and attorney’s fees in
  636  any action in which it prevails in an insurer’s action to
  637  enforce its right of recovery under this paragraph.
  639         (a)1. Any physician, hospital, clinic, or other person or
  640  institution lawfully rendering treatment to an injured person
  641  for a bodily injury covered by personal injury protection
  642  insurance may charge the insurer and injured party only a
  643  reasonable amount pursuant to this section for the services and
  644  supplies rendered, and the insurer providing such coverage may
  645  pay for such charges directly to the such person or institution
  646  lawfully rendering such treatment, if the insured receiving such
  647  treatment or his or her guardian has countersigned the properly
  648  completed invoice, bill, or claim form approved by the office
  649  upon which such charges are to be paid for as having actually
  650  been rendered, to the best knowledge of the insured or his or
  651  her guardian. In no event, However, may such charges may not
  652  exceed a charge be in excess of the amount the person or
  653  institution customarily charges for like services or supplies.
  654  In determining With respect to a determination of whether a
  655  charge for a particular service, treatment, or otherwise is
  656  reasonable, consideration may be given to evidence of usual and
  657  customary charges and payments accepted by the provider involved
  658  in the dispute, and reimbursement levels in the community, and
  659  various federal and state medical fee schedules applicable to
  660  automobile and other insurance coverages, and other information
  661  relevant to the reasonableness of the reimbursement for the
  662  service, treatment, or supply.
  663         1.2. The insurer may limit reimbursement to not less than
  664  80 percent of the following schedule of maximum charges:
  665         a. For emergency transport and treatment by providers
  666  licensed under chapter 401, 200 percent of Medicare.
  667         b. For emergency services and care provided by a hospital
  668  licensed under chapter 395, 75 percent of the hospital’s usual
  669  and customary charges.
  670         c. For emergency services and care as defined by s.
  671  395.002(9) provided in a facility licensed under chapter 395
  672  rendered by a physician or dentist, and related hospital
  673  inpatient services rendered by a physician or dentist, the usual
  674  and customary charges in the community.
  675         d. For hospital inpatient services, other than emergency
  676  services and care, 200 percent of the Medicare Part A
  677  prospective payment applicable to the specific hospital
  678  providing the inpatient services.
  679         e. For hospital outpatient services, other than emergency
  680  services and care, 200 percent of the Medicare Part A Ambulatory
  681  Payment Classification for the specific hospital providing the
  682  outpatient services.
  683         f. For all other medical services, supplies, and care, 200
  684  percent of the allowable amount under the participating
  685  physicians schedule of Medicare Part B. For all other supplies
  686  and care, including durable medical equipment and care and
  687  services rendered by ambulatory surgical centers and clinical
  688  laboratories, 200 percent of the allowable amount under Medicare
  689  Part B. However, if such services, supplies, or care is not
  690  reimbursable under Medicare Part B, the insurer may limit
  691  reimbursement to 80 percent of the maximum reimbursable
  692  allowance under workers’ compensation, as determined under s.
  693  440.13 and rules adopted thereunder which are in effect at the
  694  time such services, supplies, or care is provided. Services,
  695  supplies, or care that is not reimbursable under Medicare or
  696  workers’ compensation is not required to be reimbursed by the
  697  insurer.
  698         2.3. For purposes of subparagraph 1. 2., the applicable fee
  699  schedule or payment limitation under Medicare is the fee
  700  schedule or payment limitation in effect at the time the
  701  services, supplies, or care was rendered and for the area in
  702  which such services were rendered, except that it may not be
  703  less than the allowable amount under the participating
  704  physicians schedule of Medicare Part B for 2007 for medical
  705  services, supplies, and care subject to Medicare Part B.
  706         3.4. Subparagraph 1. 2. does not allow the insurer to apply
  707  any limitation on the number of treatments or other utilization
  708  limits that apply under Medicare or workers’ compensation. An
  709  insurer that applies the allowable payment limitations of
  710  subparagraph 1. 2. must reimburse a provider who lawfully
  711  provided care or treatment under the scope of his or her
  712  license, regardless of whether such provider is would be
  713  entitled to reimbursement under Medicare due to restrictions or
  714  limitations on the types or discipline of health care providers
  715  who may be reimbursed for particular procedures or procedure
  716  codes.
  717         4.5. If an insurer limits payment as authorized by
  718  subparagraph 1. 2., the person providing such services,
  719  supplies, or care may not bill or attempt to collect from the
  720  insured any amount in excess of such limits, except for amounts
  721  that are not covered by the insured’s personal injury protection
  722  coverage due to the coinsurance amount or maximum policy limits.
  723         5. Effective July 1, 2012, an insurer may limit
  724  reimbursement pursuant to this paragraph only if the insurance
  725  policy includes the schedule of charges specified in this
  726  paragraph.
  727         (b)1. An insurer or insured is not required to pay a claim
  728  or charges:
  729         a. Made by a broker or by a person making a claim on behalf
  730  of a broker;
  731         b. For any service or treatment that was not lawful at the
  732  time rendered;
  733         c. To any person who knowingly submits a false or
  734  misleading statement relating to the claim or charges;
  735         d. With respect to a bill or statement that does not
  736  substantially meet the applicable requirements of paragraphs
  737  (c), paragraph (d), and (e);
  738         e. For any treatment or service that is upcoded, or that is
  739  unbundled if when such treatment or services should be bundled,
  740  in accordance with paragraph (d). To facilitate prompt payment
  741  of lawful services, an insurer may change codes that it
  742  determines to have been improperly or incorrectly upcoded or
  743  unbundled, and may make payment based on the changed codes,
  744  without affecting the right of the provider to dispute the
  745  change by the insurer if, provided that before doing so, the
  746  insurer contacts must contact the health care provider and
  747  discusses discuss the reasons for the insurer’s change and the
  748  health care provider’s reason for the coding, or makes make a
  749  reasonable good faith effort to do so, as documented in the
  750  insurer’s file; or and
  751         f. For medical services or treatment billed by a physician
  752  and not provided in a hospital unless such services are rendered
  753  by the physician or are incident to his or her professional
  754  services and are included on the physician’s bill, including
  755  documentation verifying that the physician is responsible for
  756  the medical services that were rendered and billed.
  757         2. The Department of Health, in consultation with the
  758  appropriate professional licensing boards, shall adopt, by rule,
  759  a list of diagnostic tests deemed not to be medically necessary
  760  for use in the treatment of persons sustaining bodily injury
  761  covered by personal injury protection benefits under this
  762  section. The initial list shall be adopted by January 1, 2004,
  763  and shall be revised from time to time as determined by the
  764  Department of Health, in consultation with the respective
  765  professional licensing boards. Inclusion of a test on the list
  766  must of invalid diagnostic tests shall be based on lack of
  767  demonstrated medical value and a level of general acceptance by
  768  the relevant provider community and may shall not be dependent
  769  for results entirely upon subjective patient response.
  770  Notwithstanding its inclusion on a fee schedule in this
  771  subsection, an insurer or insured is not required to pay any
  772  charges or reimburse claims for any invalid diagnostic test as
  773  determined by the Department of Health.
  774         (c)1. With respect to any treatment or service, other than
  775  medical services billed by a hospital or other provider for
  776  emergency services as defined in s. 395.002 or inpatient
  777  services rendered at a hospital-owned facility, the statement of
  778  charges must be furnished to the insurer by the provider and may
  779  not include, and the insurer is not required to pay, charges for
  780  treatment or services rendered more than 35 days before the
  781  postmark date or electronic transmission date of the statement,
  782  except for past due amounts previously billed on a timely basis
  783  under this paragraph, and except that, if the provider submits
  784  to the insurer a notice of initiation of treatment within 21
  785  days after its first examination or treatment of the claimant,
  786  the statement may include charges for treatment or services
  787  rendered up to, but not more than, 75 days before the postmark
  788  date of the statement. The injured party is not liable for, and
  789  the provider may shall not bill the injured party for, charges
  790  that are unpaid because of the provider’s failure to comply with
  791  this paragraph. Any agreement requiring the injured person or
  792  insured to pay for such charges is unenforceable.
  793         1.2. If, however, the insured fails to furnish the provider
  794  with the correct name and address of the insured’s personal
  795  injury protection insurer, the provider has 35 days from the
  796  date the provider obtains the correct information to furnish the
  797  insurer with a statement of the charges. The insurer is not
  798  required to pay for such charges unless the provider includes
  799  with the statement documentary evidence that was provided by the
  800  insured during the 35-day period demonstrating that the provider
  801  reasonably relied on erroneous information from the insured and
  802  either:
  803         a. A denial letter from the incorrect insurer; or
  804         b. Proof of mailing, which may include an affidavit under
  805  penalty of perjury, reflecting timely mailing to the incorrect
  806  address or insurer.
  807         2.3. For emergency services and care as defined in s.
  808  395.002 rendered in a hospital emergency department or for
  809  transport and treatment rendered by an ambulance provider
  810  licensed pursuant to part III of chapter 401, the provider is
  811  not required to furnish the statement of charges within the time
  812  periods established by this paragraph,; and the insurer is shall
  813  not be considered to have been furnished with notice of the
  814  amount of covered loss for purposes of paragraph (4)(b) until it
  815  receives a statement complying with paragraph (d), or copy
  816  thereof, which specifically identifies the place of service to
  817  be a hospital emergency department or an ambulance in accordance
  818  with billing standards recognized by the Centers for Medicare
  819  and Medicaid Services Health Care Finance Administration.
  820         3.4. Each notice of the insured’s rights under s. 627.7401
  821  must include the following statement in type no smaller than 12
  822  points:
  824         BILLING REQUIREMENTS.—Florida Statutes provide that
  825         with respect to any treatment or services, other than
  826         certain hospital and emergency services, the statement
  827         of charges furnished to the insurer by the provider
  828         may not include, and the insurer and the injured party
  829         are not required to pay, charges for treatment or
  830         services rendered more than 35 days before the
  831         postmark date of the statement, except for past due
  832         amounts previously billed on a timely basis, and
  833         except that, if the provider submits to the insurer a
  834         notice of initiation of treatment within 21 days after
  835         its first examination or treatment of the claimant,
  836         the first billing cycle statement may include charges
  837         for treatment or services rendered up to, but not more
  838         than, 75 days before the postmark date of the
  839         statement.
  841         (d) All statements and bills for medical services rendered
  842  by any physician, hospital, clinic, or other person or
  843  institution shall be submitted to the insurer on a properly
  844  completed Centers for Medicare and Medicaid Services (CMS) 1500
  845  form, UB 92 forms, or any other standard form approved by the
  846  office or adopted by the commission for purposes of this
  847  paragraph. All billings for such services rendered by providers
  848  must shall, to the extent applicable, follow the Physicians’
  849  Current Procedural Terminology (CPT) or Healthcare Correct
  850  Procedural Coding System (HCPCS), or ICD-9 in effect for the
  851  year in which services are rendered and comply with the Centers
  852  for Medicare and Medicaid Services (CMS) 1500 form instructions
  853  and the American Medical Association Current Procedural
  854  Terminology (CPT) Editorial Panel and Healthcare Correct
  855  Procedural Coding System (HCPCS). All providers other than
  856  hospitals shall include on the applicable claim form the
  857  professional license number of the provider in the line or space
  858  provided for “Signature of Physician or Supplier, Including
  859  Degrees or Credentials.” In determining compliance with
  860  applicable CPT and HCPCS coding, guidance shall be provided by
  861  the Physicians’ Current Procedural Terminology (CPT) or the
  862  Healthcare Correct Procedural Coding System (HCPCS) in effect
  863  for the year in which services were rendered, the Office of the
  864  Inspector General (OIG), Physicians Compliance Guidelines, and
  865  other authoritative treatises designated by rule by the Agency
  866  for Health Care Administration. A No statement of medical
  867  services may not include charges for medical services of a
  868  person or entity that performed such services without possessing
  869  the valid licenses required to perform such services. For
  870  purposes of paragraph (4)(b), an insurer is shall not be
  871  considered to have been furnished with notice of the amount of
  872  covered loss or medical bills due unless the statements or bills
  873  comply with this paragraph, and unless the statements or bills
  874  are comply with this paragraph, and unless the statements or
  875  bills are properly completed in their entirety as to all
  876  material provisions, with all relevant information being
  877  provided therein. If an insurer denies a claim within 30 days
  878  after receipt due to the provider’s failure to submit a
  879  substantially completed statement or bill, the insurer shall
  880  notify the provider as to the provisions that were improperly
  881  completed, and the provider shall have 120 days after the
  882  receipt of such notice to submit a substantially completed
  883  statement or bill. If the provider fails to comply with this
  884  requirement, the insurer is not required to pay for the billed
  885  services.
  886         (e)1. At the initial treatment or service provided, each
  887  physician, other licensed professional, clinic, or other medical
  888  institution providing medical services upon which a claim for
  889  personal injury protection benefits is based shall require an
  890  insured person, or his or her guardian, to execute a disclosure
  891  and acknowledgment form, which reflects at a minimum that:
  892         a. The insured, or his or her guardian, must countersign
  893  the form attesting to the fact that the services set forth
  894  therein were actually rendered. Listing common medical
  895  abbreviations, commonly accepted CPT codes, or other common
  896  coding on the disclosure and acknowledgment form satisfies this
  897  requirement;
  898         b. The insured, or his or her guardian, has both the right
  899  and affirmative duty to confirm that the services were actually
  900  rendered;
  901         c. The insured, or his or her guardian, was not solicited
  902  by any person to seek any services from the medical provider;
  903         d. The physician, other licensed professional, clinic, or
  904  other medical institution rendering services for which payment
  905  is being claimed explained the services to the insured or his or
  906  her guardian; and
  907         e. If the insured notifies the insurer in writing of a
  908  billing error, the insured may be entitled to a certain
  909  percentage of a reduction in the amounts paid by the insured’s
  910  motor vehicle insurer.
  911         2. The physician, other licensed professional, clinic, or
  912  other medical institution rendering services for which payment
  913  is being claimed has the affirmative duty to explain the
  914  services rendered to the insured, or his or her guardian, so
  915  that the insured, or his or her guardian, countersigns the form
  916  with informed consent.
  917         3. Countersignature by the insured, or his or her guardian,
  918  is not required for the reading of diagnostic tests or other
  919  services that are of such a nature that they are not required to
  920  be performed in the presence of the insured.
  921         4. The licensed medical professional rendering treatment
  922  for which payment is being claimed must sign, by his or her own
  923  hand, the form complying with this paragraph.
  924         5. An insurer is not considered to have been furnished with
  925  notice of the amount of a covered loss or medical bills unless
  926  the original completed disclosure and acknowledgment form is
  927  shall be furnished to the insurer pursuant to paragraph (4)(b)
  928  and sub-subparagraph 1.a. The disclosure and acknowledgement
  929  form may not be electronically furnished. A disclosure and
  930  acknowledgement form that does not substantially meet the
  931  minimum requirements of sub-subparagraph 1.a. does not provide
  932  an insurer with notice of the amount of a covered loss or
  933  medical bills due.
  934         6. This disclosure and acknowledgment form is not required
  935  for services billed by a provider for emergency services as
  936  defined in s. 395.002, for emergency services and care as
  937  defined in s. 395.002 rendered in a hospital emergency
  938  department, or for transport and treatment rendered by an
  939  ambulance provider licensed pursuant to part III of chapter 401.
  940         7. The Financial Services Commission shall adopt, by rule,
  941  a standard disclosure and acknowledgment form to that shall be
  942  used to fulfill the requirements of this paragraph, effective 90
  943  days after such form is adopted and becomes final. The
  944  commission shall adopt a proposed rule by October 1, 2003. Until
  945  the rule is final, the provider may use a form of its own which
  946  otherwise complies with the requirements of this paragraph.
  947         8. As used in this paragraph, the term “countersigned” or
  948  “countersignature” means a second or verifying signature, as on
  949  a previously signed document, and is not satisfied by the
  950  statement “signature on file” or any similar statement.
  951         9. The requirements of this paragraph apply only with
  952  respect to the initial treatment or service of the insured by a
  953  provider. For subsequent treatments or service, the provider
  954  must maintain a patient log signed by the patient, in
  955  chronological order by date of service, that is consistent with
  956  the services being rendered to the patient as claimed. Listing
  957  commonly accepted CPT codes or other common coding on the
  958  patient log satisfies this requirement. The provider must
  959  provide copies of the patient log to the insurer within 30 days
  960  after receiving a written request from the insurer. Failure to
  961  maintain a substantially complete patient log renders the
  962  treatment unlawful and noncompensable. The requirements of this
  963  subparagraph for maintaining a patient log signed by the patient
  964  may be met by a hospital that maintains medical records as
  965  required by s. 395.3025 and applicable rules and makes such
  966  records available to the insurer upon request.
  967         (f) Upon written notification by any person, an insurer
  968  shall investigate any claim of improper billing by a physician
  969  or other medical provider. The insurer shall determine if the
  970  insured was properly billed for only those services and
  971  treatments that the insured actually received. If the insurer
  972  determines that the insured has been improperly billed, the
  973  insurer shall notify the insured, the person making the written
  974  notification, and the provider of its findings and shall reduce
  975  the amount of payment to the provider by the amount determined
  976  to be improperly billed. If a reduction is made due to a such
  977  written notification by any person, the insurer shall pay to the
  978  person 20 percent of the amount of the reduction, up to $500. If
  979  the provider is arrested due to the improper billing, then the
  980  insurer shall pay to the person 40 percent of the amount of the
  981  reduction, up to $500.
  982         (g) An insurer may not systematically downcode with the
  983  intent to deny reimbursement otherwise due. Such action
  984  constitutes a material misrepresentation under s.
  985  626.9541(1)(i)2.
  987         (b) Every physician, hospital, clinic, or other medical
  988  institution providing, before or after bodily injury upon which
  989  a claim for personal injury protection insurance benefits is
  990  based, any products, services, or accommodations in relation to
  991  that or any other injury, or in relation to a condition claimed
  992  to be connected with that or any other injury, shall, if
  993  requested to do so by the insurer against whom the claim has
  994  been made, allow the insurer or the insurer’s representative to
  995  conduct an onsite physical review and examination of the
  996  treatment location, treatment apparatuses, diagnostic devices,
  997  and any other medical equipment used for the services rendered
  998  within a reasonable time after the insurer’s request, and
  999  furnish forthwith a written report of the history, condition,
 1000  treatment, dates, and costs of such treatment of the injured
 1001  person and why the items identified by the insurer were
 1002  reasonable in amount and medically necessary, together with a
 1003  sworn statement that the treatment or services rendered were
 1004  reasonable and necessary with respect to the bodily injury
 1005  sustained and identifying which portion of the expenses for such
 1006  treatment or services was incurred as a result of such bodily
 1007  injury, and produce forthwith, and allow permit the inspection
 1008  and copying of, his or her or its records regarding such
 1009  history, condition, treatment, dates, and costs of treatment if;
 1010  provided that this does shall not limit the introduction of
 1011  evidence at trial. Such sworn statement must shall read as
 1012  follows: “Under penalty of perjury, I declare that I have read
 1013  the foregoing, and the facts alleged are true, to the best of my
 1014  knowledge and belief.” A No cause of action for violation of the
 1015  physician-patient privilege or invasion of the right of privacy
 1016  may not be brought shall be permitted against any physician,
 1017  hospital, clinic, or other medical institution complying with
 1018  the provisions of this section. The person requesting such
 1019  records and such sworn statement shall pay all reasonable costs
 1020  connected therewith. If an insurer makes a written request for
 1021  documentation or information under this paragraph within 30 days
 1022  after having received notice of the amount of a covered loss
 1023  under paragraph (4)(a), the amount or the partial amount that
 1024  which is the subject of the insurer’s inquiry is shall become
 1025  overdue if the insurer does not pay in accordance with paragraph
 1026  (4)(b) or within 10 days after the insurer’s receipt of the
 1027  requested documentation or information, whichever occurs later.
 1028  As used in For purposes of this paragraph, the term “receipt”
 1029  includes, but is not limited to, inspection and copying pursuant
 1030  to this paragraph. An Any insurer that requests documentation or
 1031  information pertaining to reasonableness of charges or medical
 1032  necessity under this paragraph without a reasonable basis for
 1033  such requests as a general business practice is engaging in an
 1034  unfair trade practice under the insurance code.
 1036  With respect to any dispute under the provisions of ss. 627.730
 1037  627.7405 between the insured and the insurer under the no-fault
 1038  law, or between an assignee of an insured’s rights and the
 1039  insurer, the provisions of s. 627.428 shall apply, except as
 1040  provided in subsections (10) and (15).
 1041         (9) PREFERRED PROVIDERS.—An insurer may negotiate and enter
 1042  into contracts with preferred licensed health care providers for
 1043  the benefits described in this section, referred to in this
 1044  section as “preferred providers,” which include shall include
 1045  health care providers licensed under chapter 457, chapter
 1046  chapters 458, chapter 459, chapter 460, chapter 461, or chapter
 1047  and 463.
 1048         (a) The insurer may provide an option to an insured to use
 1049  a preferred provider at the time of purchase of the policy for
 1050  personal injury protection benefits, if the requirements of this
 1051  subsection are met. If the insured elects to use a provider who
 1052  is not a preferred provider, whether the insured purchased a
 1053  preferred provider policy or a nonpreferred provider policy, the
 1054  medical benefits provided by the insurer must shall be as
 1055  required by this section.
 1056         (b) If the insured elects the to use a provider who is a
 1057  preferred provider option, the insurer may pay medical benefits
 1058  in excess of the benefits required by this section and may waive
 1059  or lower the amount of any deductible that applies to such
 1060  medical benefits. As an alternative, or in addition to such
 1061  benefits, waiver, or reduction, the insurer may provide an
 1062  actuarially appropriate premium discount as specified in an
 1063  approved rate filing to an insured who selects the preferred
 1064  provider option. If the preferred provider option provides a
 1065  premium discount, the insured forfeits the premium discount
 1066  effective on the date that the insured elects to use a provider
 1067  who is not a preferred provider and who renders nonemergency
 1068  services, unless there is no member of the preferred provider
 1069  network located within 15 miles of the insured’s place of
 1070  residence whose scope of practice includes the required
 1071  services, or unless the nonemergency services are rendered in
 1072  the emergency room of a hospital licensed under chapter 395. If
 1073  the insurer offers a preferred provider policy to a policyholder
 1074  or applicant, it must also offer a nonpreferred provider policy.
 1075         (c) The insurer shall provide each insured policyholder
 1076  with a current roster of preferred providers in the county in
 1077  which the insured resides at the time of purchasing purchase of
 1078  such policy, and shall make such list available for public
 1079  inspection during regular business hours at the insurer’s
 1080  principal office of the insurer within the state. The insurer
 1081  may contract with a health insurer to use an existing preferred
 1082  provider network to implement the preferred provider option. All
 1083  providers and entities that are eligible to receive
 1084  reimbursement pursuant to paragraph (1)(a) may provide services
 1085  through a preferred provider network. Any other arrangement is
 1086  subject to the approval of the Office of Insurance Regulation.
 1087         (10) DEMAND LETTER.—
 1088         (a) As a condition precedent to filing any action for
 1089  benefits under this section, the claimant filing suit must
 1090  provide the insurer must be provided with written notice of an
 1091  intent to initiate litigation. Such notice may not be sent until
 1092  the claim is overdue, including any additional time the insurer
 1093  has to pay the claim pursuant to paragraph (4)(b). A premature
 1094  demand letter is defective and cannot be cured unless the court
 1095  first abates the action or the claimant first voluntarily
 1096  dismisses the action.
 1097         (b) The notice required notice must shall state that it is
 1098  a “demand letter under s. 627.736(10)” and shall state with
 1099  specificity:
 1100         1. The name of the insured upon which such benefits are
 1101  being sought, including a copy of the assignment giving rights
 1102  to the claimant if the claimant is not the insured.
 1103         2. The claim number or policy number upon which such claim
 1104  was originally submitted to the insurer.
 1105         3. To the extent applicable, the name of any medical
 1106  provider who rendered to an insured the treatment, services,
 1107  accommodations, or supplies that form the basis of such claim;
 1108  and an itemized statement specifying each exact amount, the date
 1109  of treatment, service, or accommodation, and the type of benefit
 1110  claimed to be due. A completed form satisfying the requirements
 1111  of paragraph (5)(d) or the lost-wage statement previously
 1112  submitted may be used as the itemized statement. To the extent
 1113  that the demand involves an insurer’s withdrawal of payment
 1114  under paragraph (7)(a) for future treatment not yet rendered,
 1115  the claimant shall attach a copy of the insurer’s notice
 1116  withdrawing such payment and an itemized statement of the type,
 1117  frequency, and duration of future treatment claimed to be
 1118  reasonable and medically necessary.
 1119         (c) Each notice required by this subsection must be
 1120  delivered to the insurer by United States certified or
 1121  registered mail, return receipt requested. Such postal costs
 1122  shall be reimbursed by the insurer if so requested by the
 1123  claimant in the notice, when the insurer pays the claim. Such
 1124  notice must be sent to the person and address specified by the
 1125  insurer for the purposes of receiving notices under this
 1126  subsection. Each licensed insurer, whether domestic, foreign, or
 1127  alien, shall file with the office designation of the name and
 1128  address of the person to whom notices must pursuant to this
 1129  subsection shall be sent which the office shall make available
 1130  on its Internet website. The name and address on file with the
 1131  office pursuant to s. 624.422 shall be deemed the authorized
 1132  representative to accept notice pursuant to this subsection if
 1133  in the event no other designation has been made.
 1134         (d) If, within 30 days after receipt of notice by the
 1135  insurer, the overdue claim specified in the notice is paid by
 1136  the insurer together with applicable interest and a penalty of
 1137  10 percent of the overdue amount paid by the insurer, subject to
 1138  a maximum penalty of $250, no action may be brought against the
 1139  insurer. If the demand involves an insurer’s withdrawal of
 1140  payment under paragraph (7)(a) for future treatment not yet
 1141  rendered, no action may be brought against the insurer if,
 1142  within 30 days after its receipt of the notice, the insurer
 1143  mails to the person filing the notice a written statement of the
 1144  insurer’s agreement to pay for such treatment in accordance with
 1145  the notice and to pay a penalty of 10 percent, subject to a
 1146  maximum penalty of $250, when it pays for such future treatment
 1147  in accordance with the requirements of this section. To the
 1148  extent the insurer determines not to pay any amount demanded,
 1149  the penalty is shall not be payable in any subsequent action.
 1150  For purposes of this subsection, payment or the insurer’s
 1151  agreement is shall be treated as being made on the date a draft
 1152  or other valid instrument that is equivalent to payment, or the
 1153  insurer’s written statement of agreement, is placed in the
 1154  United States mail in a properly addressed, postpaid envelope,
 1155  or if not so posted, on the date of delivery. The insurer is not
 1156  obligated to pay any attorney’s fees if the insurer pays the
 1157  claim or mails its agreement to pay for future treatment within
 1158  the time prescribed by this subsection.
 1159         (e) The applicable statute of limitation for an action
 1160  under this section shall be tolled for a period of 30 business
 1161  days by the mailing of the notice required by this subsection.
 1162         (f)A demand letter that does not substantially meet the
 1163  minimum requirements set forth in this subsection is defective.
 1164  A defective demand letter cannot be cured unless the court first
 1165  abates the action or the claimant first voluntarily dismisses
 1166  the action.
 1167         (g)(f)An Any insurer making a general business practice of
 1168  not paying valid claims until receipt of the notice required by
 1169  this subsection is engaging in an unfair trade practice under
 1170  the insurance code.
 1171         (h) A demand letter may be used to request the production
 1172  of claim documents or other records from the insurer. The
 1173  insurer’s reply must be made within 30 days after receipt of
 1174  such request.
 1175         Section 9. Section 627.737, Florida Statutes, is amended to
 1176  read:
 1177         627.737 Tort exemption; limitation on right to damages;
 1178  punitive damages.—
 1179         (1) Every owner, registrant, operator, or occupant of a
 1180  motor vehicle with respect to which security has been provided
 1181  as required under the no-fault law by ss. 627.730-627.7405, and
 1182  every person or organization legally responsible for her or his
 1183  acts or omissions, is hereby exempted from tort liability for
 1184  damages because of bodily injury, sickness, or disease arising
 1185  out of the ownership, operation, maintenance, or use of such
 1186  motor vehicle in this state to the extent that the benefits
 1187  described in s. 627.736(1) are payable for such injury, or would
 1188  be payable but for any exclusion authorized by the no-fault law
 1189  ss. 627.730-627.7405, under any insurance policy or other method
 1190  of security complying with the requirements of s. 627.733, or by
 1191  an owner personally liable under s. 627.733 for the payment of
 1192  such benefits, unless a person is entitled to maintain an action
 1193  for pain, suffering, mental anguish, and inconvenience for such
 1194  injury under the provisions of subsection (2).
 1195         (2) In any action of tort brought against the owner,
 1196  registrant, operator, or occupant of a motor vehicle with
 1197  respect to which security has been provided as required by the
 1198  no-fault law ss. 627.730-627.7405, or against any person or
 1199  organization legally responsible for her or his acts or
 1200  omissions, a plaintiff may recover damages in tort for pain,
 1201  suffering, mental anguish, and inconvenience because of bodily
 1202  injury, sickness, or disease arising out of the ownership,
 1203  maintenance, operation, or use of such motor vehicle only if in
 1204  the event that the injury or disease consists in whole or in
 1205  part of:
 1206         (a) Significant and permanent loss of an important bodily
 1207  function.
 1208         (b) Permanent injury within a reasonable degree of medical
 1209  probability, other than scarring or disfigurement.
 1210         (c) Significant and permanent scarring or disfigurement.
 1211         (d) Death.
 1212         (3) If When a defendant, in a proceeding brought pursuant
 1213  to the no-fault law ss. 627.730-627.7405, questions whether the
 1214  plaintiff has met the requirements of subsection (2), then the
 1215  defendant may file an appropriate motion with the court, and the
 1216  court shall, on a one-time basis only, 30 days before the date
 1217  set for the trial or the pretrial hearing, whichever occurs is
 1218  first, by examining the pleadings and the evidence before it,
 1219  ascertain whether the plaintiff will be able to submit some
 1220  evidence that the plaintiff will meet the requirements of
 1221  subsection (2). If the court finds that the plaintiff will not
 1222  be able to submit such evidence, then the court shall dismiss
 1223  the plaintiff’s claim without prejudice.
 1224         (4) In any action brought against an automobile liability
 1225  insurer for damages in excess of its policy limits, a no claim
 1226  for punitive damages is not shall be allowed.
 1227         Section 10. Section 627.7405, Florida Statutes, is amended
 1228  to read:
 1229         627.7405 Insurers’ right of reimbursement.—Notwithstanding
 1230  any other provisions of the no-fault law ss. 627.730-627.7405,
 1231  any insurer providing personal injury protection benefits on a
 1232  private passenger motor vehicle shall have, to the extent of any
 1233  personal injury protection benefits paid to any person as a
 1234  benefit arising out of such private passenger motor vehicle
 1235  insurance, has a right of reimbursement against the owner or the
 1236  insurer of the owner of a commercial motor vehicle, if the
 1237  benefits paid result from such person having been an occupant of
 1238  the commercial motor vehicle or having been struck by the
 1239  commercial motor vehicle while not an occupant of any self
 1240  propelled vehicle.
 1241         Section 11. Subsection (1) of section 627.7407, Florida
 1242  Statutes, is amended to read:
 1243         627.7407 Application of the Florida Motor Vehicle No-Fault
 1244  Law.—
 1245         (1) Any person subject to the requirements of ss. 627.730
 1246  627.7405, the Florida Motor Vehicle No-Fault Law, as revived and
 1247  amended by chapter 2007-324, Laws of Florida this act, must
 1248  maintain security for personal injury protection as required by
 1249  the Florida Motor Vehicle no-fault law, as revived and amended
 1250  by this act, beginning on January 1, 2008.
 1251         Section 12. Subsection (1) of section 324.021, Florida
 1252  Statutes, is amended to read:
 1253         324.021 Definitions; minimum insurance required.—The
 1254  following words and phrases when used in this chapter shall, for
 1255  the purpose of this chapter, have the meanings respectively
 1256  ascribed to them in this section, except in those instances
 1257  where the context clearly indicates a different meaning:
 1258         (1) MOTOR VEHICLE.—Every self-propelled vehicle that which
 1259  is designed and required to be licensed for use upon a highway,
 1260  including trailers and semitrailers designed for use with such
 1261  vehicles, except traction engines, road rollers, farm tractors,
 1262  power shovels, and well drillers, and every vehicle that which
 1263  is propelled by electric power obtained from overhead wires but
 1264  not operated upon rails, but not including any bicycle or moped.
 1265  However, the term does “motor vehicle” shall not include a any
 1266  motor vehicle as defined in s. 627.732 if s. 627.732(3) when the
 1267  owner of such vehicle has complied with the Florida Motor
 1268  Vehicle No-Fault Law requirements of ss. 627.730-627.7405,
 1269  inclusive, unless the provisions of s. 324.051 apply; and, in
 1270  such case, the applicable proof of insurance provisions of s.
 1271  320.02 apply.
 1272         Section 13. Subsection (7) of section 627.7295, Florida
 1273  Statutes, is amended to read:
 1274         627.7295 Motor vehicle insurance contracts.—
 1275         (7) A policy of private passenger motor vehicle insurance
 1276  or a binder for such a policy may be initially issued in this
 1277  state only if, before the effective date of such binder or
 1278  policy, the insurer or agent has collected from the insured an
 1279  amount equal to 2 months’ premium. An insurer, agent, or premium
 1280  finance company may not, directly or indirectly, take any action
 1281  resulting in the insured having paid from the insured’s own
 1282  funds an amount less than the 2 months’ premium required by this
 1283  subsection.
 1284         (a) This subsection applies without regard to whether the
 1285  premium is financed by a premium finance company or is paid
 1286  pursuant to a periodic payment plan of an insurer or an
 1287  insurance agent.
 1288         (b) This subsection does not apply:
 1289         1. If an insured or member of the insured’s family is
 1290  renewing or replacing a policy or a binder for such policy
 1291  written by the same insurer or a member of the same insurer
 1292  group;.
 1293         2.This subsection does not apply To an insurer that issues
 1294  private passenger motor vehicle coverage primarily to active
 1295  duty or former military personnel or their dependents; or.
 1296         3.This subsection does not apply If all policy payments
 1297  are paid pursuant to a payroll deduction plan or an automatic
 1298  electronic funds transfer payment plan from the policyholder.
 1299         (c) This subsection and subsection (4) do not apply if:
 1300         1. All policy payments to an insurer are paid pursuant to
 1301  an automatic electronic funds transfer payment plan from an
 1302  agent, a managing general agent, or a premium finance company
 1303  and if the policy includes, at a minimum, personal injury
 1304  protection pursuant to the Florida Motor Vehicle No-Fault Law
 1305  ss. 627.730-627.7405; motor vehicle property damage liability
 1306  pursuant to s. 627.7275; and bodily injury liability in at least
 1307  the amount of $10,000 because of bodily injury to, or death of,
 1308  one person in any one accident and in the amount of $20,000
 1309  because of bodily injury to, or death of, two or more persons in
 1310  any one accident; or.
 1311         2.This subsection and subsection (4) do not apply if An
 1312  insured has had a policy in effect for at least 6 months, the
 1313  insured’s agent is terminated by the insurer that issued the
 1314  policy, and the insured obtains coverage on the policy’s renewal
 1315  date with a new company through the terminated agent.
 1316         Section 14. Paragraph (d) of subsection (3) of section
 1317  628.909, Florida Statutes, is amended to read:
 1318         628.909 Applicability of other laws.—
 1319         (3) The following provisions of the Florida Insurance Code
 1320  shall apply to industrial insured captive insurers to the extent
 1321  that such provisions are not inconsistent with this part:
 1322         (d) Sections 627.730-627.7407 if 627.730-627.7405 when no
 1323  fault coverage is provided.
 1324         Section 15. Paragraph (c) of subsection (7) of section
 1325  817.234, Florida Statutes, is amended to read:
 1326         817.234 False and fraudulent insurance claims.—
 1327         (7)
 1328         (c) An insurer, or any person acting at the direction of or
 1329  on behalf of an insurer, may not change an opinion in a mental
 1330  or physical report prepared under s. 627.736(7) 627.736(8) or
 1331  direct the physician preparing the report to change such
 1332  opinion; however, this provision does not preclude the insurer
 1333  from calling to the attention of the physician errors of fact in
 1334  the report based upon information in the claim file. Any person
 1335  who violates this paragraph commits a felony of the third
 1336  degree, punishable as provided in s. 775.082, s. 775.083, or s.
 1337  775.084.
 1338         Section 16. This act shall take effect July 1, 2012.