Bill Text: FL H1411 | 2011 | Regular Session | Comm Sub

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Bill Title: Motor Vehicle Personal Injury Protection Insurance

Spectrum: Slight Partisan Bill (Republican 6-1-1)

Status: (Introduced - Dead) 2011-05-07 - Indefinitely postponed and withdrawn from consideration [H1411 Detail]

Download: Florida-2011-H1411-Comm_Sub.html

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CS/HB 1411

1	A bill to be entitled
2	An act relating to motor vehicle personal injury
3	protection insurance; providing a short title; providing
4	legislative intent; amending s. 316.066, F.S.; revising
5	provisions relating to the contents of written reports of
6	motor vehicle crashes; authorizing the investigating
7	officer to testify at trial or provide an affidavit
8	concerning the content of the reports; amending s.
9	400.991, F.S.; requiring that an application for licensure
10	as a mobile clinic include a statement regarding insurance
11	fraud; amending s. 627.730, F.S.; conforming a cross-
12	reference; amending s. 627.731, F.S.; providing
13	legislative intent with respect to the Florida Motor
14	Vehicle No-Fault Law; amending s. 627.732, F.S.; defining
15	the terms "claimant" and "no-fault law"; amending s.
16	627.736, F.S.; conforming a cross-reference; requiring
17	certain entities providing medical services to document
18	that they meet required criteria; revising requirements
19	relating to the form that must be submitted by providers;
20	requiring an entity or clinic to file a new form within a
21	specified period after the date of a change of ownership;
22	revising provisions relating to when payment for a benefit
23	is due; providing that the time period for paying or
24	denying a claim is tolled during the investigation of a
25	fraudulent insurance act; specifying when benefits are not
26	payable; providing that a claimant that violates certain
27	provisions is not entitled to any payment, regardless of
28	whether a portion of the claim may be legitimate;
29	authorizing an insurer to recover payments and bring a
30	cause of action to recover payments; forbidding a
31	physician, hospital, clinic, or other medical institution
32	that fails to comply with certain provisions from billing
33	the injured person or the insured; providing that an
34	insurer has a right to conduct reasonable investigations
35	of claims; authorizing an insurer to require a claimant to
36	provide certain records; revising the insurer's
37	reimbursement limitation; deleting an obsolete provision;
38	revising requirements relating to discovery; authorizing
39	an insurer to conduct examinations of claimants under oath
40	or sworn statement; requiring the provider to produce
41	persons having the most knowledge in specified
42	circumstances; providing that an insurer that requests an
43	examination under oath without a reasonable basis is
44	engaging in an unfair and deceptive trade practice;
45	authorizing the insurer to conduct a physical review of
46	the treatment location; authorizing an insurer to contract
47	with a preferred provider network; authorizing an insurer
48	to provide a premium discount to an insured who selects a
49	preferred provider; authorizing an insurance policy not to
50	pay for nonemergency services performed by a nonpreferred
51	provider in specified circumstances; authorizing an
52	insurer to contract with a health insurer in specified
53	circumstances; amending s. 817.234, F.S.; conforming a
54	cross-reference; providing civil penalties for criminal
55	acts that result in the unlawful receipt of insurance
56	proceeds from a motor vehicle insurance contract; amending
57	ss. 324.021, 456.057, 627.7295, 627.733, 627.734, 627.737,
58	627.7401, 627.7405, 627.7407, and 628.909, F.S.;
59	conforming cross-references; providing an effective date.
60
61	Be It Enacted by the Legislature of the State of Florida:
62
63	Section 1.  (1)  SHORT TITLE.-This act may be cited as the
64	"Comprehensive Insurance Fraud Investigation and Prevention
65	Act."
66	(2)  FINDINGS AND INTENT.-The Legislature intends to
67	balance the insured's interest in prompt payment of valid claims
68	for insurance benefits under the no-fault law with the public's
69	interest in reducing fraud, abuse, and overuse of the no-fault
70	system. To that end, the Legislature intends that the
71	investigation and prevention of fraudulent insurance acts in
72	this state be enhanced, that additional sanctions for such acts
73	be imposed, and that the no-fault law be revised to remove
74	incentives for fraudulent insurance acts. The Legislature
75	intends that the no-fault law be construed according to the
76	plain language of the statutory provisions, which are designed
77	to meet these goals.
78	(a)  The Legislature finds that:
79	1.  Motor vehicle insurance fraud remains a major problem
80	for state consumers and insurers. According to the National
81	Insurance Crime Bureau, in recent years this state has been
82	among those states that have the highest number of fraudulent
83	and questionable claims.
84	2.  The current regulatory process for health care clinics
85	under part X of chapter 400, Florida Statutes, which was
86	originally enacted to reduce motor vehicle insurance fraud, is
87	not adequately preventing fraudulent insurance acts with respect
88	to licensure exemptions and compliance with that part.
89	(b)  The Legislature intends that:
90	1.  Insurers properly investigate claims, and as such, this
91	act clarifies that insurers are allowed to obtain examinations
92	under oath and sworn statements from any claimant seeking no-
93	fault insurance benefits and to request mental and physical
94	examinations of persons seeking personal injury protection
95	coverage or benefits.
96	2.  Any false, misleading, or otherwise fraudulent activity
97	associated with a claim render the entire claim invalid. An
98	insurer must be able to raise fraud as a defense to a claim for
99	no-fault insurance benefits irrespective of any prior
100	adjudication of guilt or determination of fraud by the
101	Department of Financial Services.
102	3.  Insurers toll the payment or denial of a claim with
103	respect to any portion of a claim for which the insurer has a
104	reasonable belief that a fraudulent insurance act, as defined in
105	s. 626.989 or s. 817.234, Florida Statutes, has been committed.
106	4.  Insurers discover the names of all passengers involved
107	in a motor vehicle crash before paying claims or benefits
108	pursuant to an insurance policy governed by the no-fault law. A
109	rebuttable presumption must be established that a person was not
110	involved in the event giving rise to the claim if that person's
111	name does not appear on the police report.
112	Section 2.  Subsection (1) of section 316.066, Florida
113	Statutes, is amended to read:
114	316.066  Written reports of crashes.-
115	(1)(a)  A Florida Traffic Crash Report, Long Form, must is
116	required to be completed and submitted to the department within
117	10 days after completing an investigation is completed by the
118	every law enforcement officer who in the regular course of duty
119	investigates a motor vehicle crash:
120	1.  That resulted in death of, or personal injury to, or
121	any indication of complaints of pain or discomfort by any of the
122	parties or passengers involved in the crash;
123	2.  That involved one or more passengers, other than the
124	drivers of the vehicles, in any of the vehicles involved in the
125	crash;.
126	3.2.  That involved a violation of s. 316.061(1) or s.
127	316.193; or.
128	4.3.  In which a vehicle was rendered inoperative to a
129	degree that required a wrecker to remove it from traffic, if
130	such action is appropriate, in the officer's discretion.
131	(b)  The long form must include:
132	1.  The date, time, and location of the crash.
133	2.  A description of the vehicles involved.
134	3.  The names and addresses of the parties involved.
135	4.  The names and addresses of witnesses.
136	5.  The name, badge number, and law enforcement agency of
137	the officer investigating the crash.
138	6.  The names of the insurance companies for the respective
139	parties involved in the crash.
140	7.  The names and addresses of all passengers in all
141	vehicles involved in the crash, each clearly identified as being
142	a passenger, including the identification of the vehicle in
143	which each was a passenger.
144	(c)(b)  In every crash for which a Florida Traffic Crash
145	Report, Long Form, is not required by this section, the law
146	enforcement officer may complete a short-form crash report or
147	provide a short-form crash report to be completed by each party
148	involved in the crash. The short-form report must include all of
149	the items listed in subparagraphs (b)1.-6. Short-form crash
150	reports prepared by the law enforcement officer shall be
151	maintained by the officer's agency.:
152	1.  The date, time, and location of the crash.
153	2.  A description of the vehicles involved.
154	3.  The names and addresses of the parties involved.
155	4.  The names and addresses of witnesses.
156	5.  The name, badge number, and law enforcement agency of
157	the officer investigating the crash.
158	6.  The names of the insurance companies for the respective
159	parties involved in the crash.
160	(d)(c)  Each party to the crash must shall provide the law
161	enforcement officer with proof of insurance, which must to be
162	included in the crash report. If a law enforcement officer
163	submits a report on the accident, proof of insurance must be
164	provided to the officer by each party involved in the crash. Any
165	party who fails to provide the required information commits a
166	noncriminal traffic infraction, punishable as a nonmoving
167	violation as provided in chapter 318, unless the officer
168	determines that due to injuries or other special circumstances
169	such insurance information cannot be provided immediately. If
170	the person provides the law enforcement agency, within 24 hours
171	after the crash, proof of insurance that was valid at the time
172	of the crash, the law enforcement agency may void the citation.
173	(e)(d)  The driver of a vehicle that was in any manner
174	involved in a crash resulting in damage to any vehicle or other
175	property in an amount of $500 or more, which crash was not
176	investigated by a law enforcement agency, shall, within 10 days
177	after the crash, submit a written report of the crash to the
178	department or traffic records center. The entity receiving the
179	report may require witnesses of the crash crashes to render
180	reports and may require any driver of a vehicle involved in the
181	a crash of which a written report must be made as provided in
182	this section to file supplemental written reports if whenever
183	the original report is deemed insufficient by the receiving
184	entity.
185	(f)  The investigating law enforcement officer may testify
186	at trial or provide a signed affidavit to confirm or supplement
187	the information included on the long-form or short-form report.
188	(e)  Short-form crash reports prepared by law enforcement
189	shall be maintained by the law enforcement officer's agency.
190	Section 3.  Subsection (6) is added to section 400.991,
191	Florida Statutes, to read:
192	400.991  License requirements; background screenings;
193	prohibitions.-
194	(6)  All forms that constitute part of the application for
195	licensure or exemption from licensure under this part must
196	contain the following statement:
197
198	INSURANCE FRAUD NOTICE.-Submitting a false,
199	misleading, or fraudulent application or other
200	document when applying for licensure as a health care
201	clinic, when seeking an exemption from licensure as a
202	health care clinic, or when demonstrating compliance
203	with part X of chapter 400, Florida Statutes, is a
204	criminal act under s. 817.234, Florida Statutes, or a
205	fraudulent insurance act as defined in s. 626.989,
206	Florida Statutes, subject to investigation by the
207	Division of Insurance Fraud, and is grounds for
208	discipline by the appropriate licensing board of the
209	Florida Department of Health.
210	Section 4.  Section 627.730, Florida Statutes, is amended
211	to read:
212	627.730  Florida Motor Vehicle No-Fault Law.-Sections
213	627.730-627.7407 627.730-627.7405 may be cited and known as the
214	"Florida Motor Vehicle No-Fault Law."
215	Section 5.  Section 627.731, Florida Statutes, is amended
216	to read:
217	627.731  Purpose; legislative intent.-
218	(1)  The purpose of the no-fault law ss. 627.730-627.7405
219	is to provide for medical, surgical, funeral, and disability
220	insurance benefits without regard to fault, and to require motor
221	vehicle insurance securing such benefits, for motor vehicles
222	required to be registered in this state and, with respect to
223	motor vehicle accidents, a limitation on the right to claim
224	damages for pain, suffering, mental anguish, and inconvenience.
225	(2)  The Legislature intends that the provisions,
226	schedules, and procedures authorized under the no-fault law be
227	implemented by the insurers offering policies pursuant to the
228	no-fault law. These provisions, schedules, and procedures have
229	full force and effect regardless of their express inclusion in
230	an insurance policy, and an insurer is not required to amend its
231	policy to implement and apply such provisions, schedules, or
232	procedures.
233	Section 6.  Section 627.732, Florida Statutes, is amended
234	to read:
235	627.732  Definitions.-As used in the no-fault law ss.
236	627.730-627.7405, the term:
237	(1)  "Broker" means any person not possessing a license
238	under chapter 395, chapter 400, chapter 429, chapter 458,
239	chapter 459, chapter 460, chapter 461, or chapter 641 who
240	charges or receives compensation for any use of medical
241	equipment and is not the 100-percent owner or the 100-percent
242	lessee of such equipment. For purposes of this section, such
243	owner or lessee may be an individual, a corporation, a
244	partnership, or any other entity and any of its 100-percent-
245	owned affiliates and subsidiaries. For purposes of this
246	subsection, the term "lessee" means a long-term lessee under a
247	capital or operating lease, but does not include a part-time
248	lessee. The term "broker" does not include a hospital or
249	physician management company whose medical equipment is
250	ancillary to the practices managed, a debt collection agency, or
251	an entity that has contracted with the insurer to obtain a
252	discounted rate for such services; or nor does the term include
253	a management company that has contracted to provide general
254	management services for a licensed physician or health care
255	facility and whose compensation is not materially affected by
256	the usage or frequency of usage of medical equipment or an
257	entity that is 100-percent owned by one or more hospitals or
258	physicians. The term "broker" does not include a person or
259	entity that certifies, upon request of an insurer, that:
260	(a)  It is a clinic licensed under ss. 400.990-400.995;
261	(b)  It is a 100-percent owner of medical equipment; and
262	(c)  The owner's only part-time lease of medical equipment
263	for personal injury protection patients is on a temporary basis,
264	not to exceed 30 days in a 12-month period, and such lease is
265	solely for the purposes of necessary repair or maintenance of
266	the 100-percent-owned medical equipment or pending the arrival
267	and installation of the newly purchased or a replacement for the
268	100-percent-owned medical equipment, or for patients for whom,
269	because of physical size or claustrophobia, it is determined by
270	the medical director or clinical director to be medically
271	necessary that the test be performed in medical equipment that
272	is open-style. The leased medical equipment may not cannot be
273	used by patients who are not patients of the registered clinic
274	for medical treatment of services. Any person or entity making a
275	false certification under this subsection commits insurance
276	fraud as defined in s. 817.234. However, the 30-day period
277	provided in this paragraph may be extended for an additional 60
278	days as applicable to magnetic resonance imaging equipment if
279	the owner certifies that the extension otherwise complies with
280	this paragraph.
281	(2)(7)  "Certify" means to swear or attest to being true or
282	represented in writing.
283	(3)  "Claimant" means the person, organization, or entity
284	seeking benefits, including all assignees.
285	(4)(12)  "Hospital" means a facility that, at the time
286	services or treatment were rendered, was licensed under chapter
287	395.
288	(5)(8)  "Immediate personal supervision," as it relates to
289	the performance of medical services by nonphysicians not in a
290	hospital, means that an individual licensed to perform the
291	medical service or provide the medical supplies must be present
292	within the confines of the physical structure where the medical
293	services are performed or where the medical supplies are
294	provided such that the licensed individual can respond
295	immediately to any emergencies if needed.
296	(6)(9)  "Incident," with respect to services considered as
297	incident to a physician's professional service, for a physician
298	licensed under chapter 458, chapter 459, chapter 460, or chapter
299	461, if not furnished in a hospital, means such services that
300	are must be an integral, even if incidental, part of a covered
301	physician's service.
302	(7)(10)  "Knowingly" means that a person, with respect to
303	information, has actual knowledge of the information,; acts in
304	deliberate ignorance of the truth or falsity of the
305	information,; or acts in reckless disregard of the information.,
306	and Proof of specific intent to defraud is not required.
307	(8)(11)  "Lawful" or "lawfully" means in substantial
308	compliance with all relevant applicable criminal, civil, and
309	administrative requirements of state and federal law related to
310	the provision of medical services or treatment.
311	(9)(2)  "Medically necessary" refers to a medical service
312	or supply that a prudent physician would provide for the purpose
313	of preventing, diagnosing, or treating an illness, injury,
314	disease, or symptom in a manner that is:
315	(a)  In accordance with generally accepted standards of
316	medical practice;
317	(b)  Clinically appropriate in terms of type, frequency,
318	extent, site, and duration; and
319	(c)  Not primarily for the convenience of the patient,
320	physician, or other health care provider.
321	(10)(3)  "Motor vehicle" means a any self-propelled vehicle
322	with four or more wheels that which is of a type both designed
323	and required to be licensed for use on the highways of this
324	state, and any trailer or semitrailer designed for use with such
325	vehicle, and includes:
326	(a)  A "private passenger motor vehicle," which is any
327	motor vehicle that which is a sedan, station wagon, or jeep-type
328	vehicle and, if not used primarily for occupational,
329	professional, or business purposes, a motor vehicle of the
330	pickup, panel, van, camper, or motor home type.
331	(b)  A "commercial motor vehicle," which is any motor
332	vehicle that which is not a private passenger motor vehicle.
333
334	The term "motor vehicle" does not include a mobile home or any
335	motor vehicle that which is used in mass transit, other than
336	public school transportation, and designed to transport more
337	than five passengers exclusive of the operator of the motor
338	vehicle and that which is owned by a municipality, a transit
339	authority, or a political subdivision of the state.
340	(11)(4)  "Named insured" means a person, usually the owner
341	of a vehicle, identified in a policy by name as the insured
342	under the policy.
343	(12)  "No-fault law" means the Florida Motor Vehicle No-
344	Fault Law, ss. 627.730-627.7407.
345	(13)(5)  "Owner" means a person who holds the legal title
346	to a motor vehicle; or, if in the event a motor vehicle is the
347	subject of a security agreement or lease with an option to
348	purchase with the debtor or lessee having the right to
349	possession, then the debtor or lessee is shall be deemed the
350	owner for the purposes of the no-fault law ss. 627.730-627.7405.
351	(14)(13)  "Properly completed" means providing truthful,
352	substantially complete, and substantially accurate responses as
353	to all material elements of to each applicable request for
354	information or statement by a means that may lawfully be
355	provided and that complies with this section, or as agreed by
356	the parties.
357	(15)(6)  "Relative residing in the same household" means a
358	relative of any degree by blood or by marriage who usually makes
359	her or his home in the same family unit, whether or not
360	temporarily living elsewhere.
361	(16)(15)  "Unbundling" means submitting an action that
362	submits a billing code that is properly billed under one billing
363	code, but that has been separated into two or more billing
364	codes, and would result in payment greater than the in amount
365	that than would be paid using one billing code.
366	(17)(14)  "Upcoding" means submitting an action that
367	submits a billing code that would result in payment greater than
368	the in amount that than would be paid using a billing code that
369	accurately describes the services performed. The term does not
370	include an otherwise lawful bill by a magnetic resonance imaging
371	facility, which globally combines both technical and
372	professional components, if the amount of the global bill is not
373	more than the components if billed separately; however, payment
374	of such a bill constitutes payment in full for all components of
375	such service.
376	Section 7.  Subsections (1), (3), and (4) of section
377	627.736, Florida Statutes, are amended, subsections (5) through
378	(16) of that section are renumbered as subsections (6) through
379	(17), respectively, a new subsection (5) is added to that
380	section, and present subsections (5), (6), (8), and (9),
381	paragraph (b) of present subsection (7), and present subsection
382	(16) of that section are amended, to read:
383	627.736  Required personal injury protection benefits;
384	exclusions; priority; claims.-
385	(1)  REQUIRED BENEFITS.-Every insurance policy complying
386	with the security requirements of s. 627.733 must shall provide
387	personal injury protection to the named insured, relatives
388	residing in the same household, persons operating the insured
389	motor vehicle, passengers in such motor vehicle, and other
390	persons struck by such motor vehicle and suffering bodily injury
391	while not an occupant of a self-propelled vehicle, subject to
392	the provisions of subsection (2) and paragraph (4)(g) (4)(e), to
393	a limit of $10,000 for loss sustained by any such person as a
394	result of bodily injury, sickness, disease, or death arising out
395	of the ownership, maintenance, or use of a motor vehicle as
396	follows:
397	(a)  Medical benefits.-Eighty percent of all reasonable
398	expenses for medically necessary medical, surgical, X-ray,
399	dental, and rehabilitative services, including prosthetic
400	devices, and for medically necessary ambulance, hospital, and
401	nursing services. However, the medical benefits shall provide
402	reimbursement only for such services and care that are lawfully
403	provided, supervised, ordered, or prescribed by a physician
404	licensed under chapter 458 or chapter 459, a dentist licensed
405	under chapter 466, or a chiropractic physician licensed under
406	chapter 460 or that are provided by any of the following persons
407	or entities:
408	1.  A hospital or ambulatory surgical center licensed under
409	chapter 395.
410	2.  A person or entity licensed under part III of chapter
411	401 that ss. 401.2101-401.45 that provides emergency
412	transportation and treatment.
413	3.  An entity wholly owned by one or more physicians
414	licensed under chapter 458 or chapter 459, chiropractic
415	physicians licensed under chapter 460, or dentists licensed
416	under chapter 466 or by such practitioner or practitioners and
417	the spouses, parents, children, or siblings spouse, parent,
418	child, or sibling of such that practitioner or those
419	practitioners.
420	4.  An entity wholly owned, directly or indirectly, by a
421	hospital or hospitals.
422	5.  A health care clinic licensed under part X of chapter
423	400 ss. 400.990-400.995 that is:
424	a.  Accredited by the Joint Commission on Accreditation of
425	Healthcare Organizations, the American Osteopathic Association,
426	the Commission on Accreditation of Rehabilitation Facilities, or
427	the Accreditation Association for Ambulatory Health Care, Inc.;
428	or
429	b.  A health care clinic that:
430	(I)  Has a medical director licensed under chapter 458,
431	chapter 459, or chapter 460;
432	(II)  Has been continuously licensed for more than 3 years
433	or is a publicly traded corporation that issues securities
434	traded on an exchange registered with the United States
435	Securities and Exchange Commission as a national securities
436	exchange; and
437	(III)  Provides at least four of the following medical
438	specialties:
439	(A)  General medicine.
440	(B)  Radiography.
441	(C)  Orthopedic medicine.
442	(D)  Physical medicine.
443	(E)  Physical therapy.
444	(F)  Physical rehabilitation.
445	(G)  Prescribing or dispensing outpatient prescription
446	medication.
447	(H)  Laboratory services.
448
449	If any services under this paragraph are provided by an entity
450	or clinic described in subparagraph 3., subparagraph 4., or
451	subparagraph 5., the entity or clinic must provide the insurer
452	at the initial submission of the claim with a form adopted by
453	the Department of Financial Services that documents that the
454	entity or clinic meets applicable criteria for such entity or
455	clinic and includes a sworn statement or affidavit to that
456	effect. Any change in ownership requires the filing of a new
457	form within 10 days after the date of the change in ownership.
458	The Financial Services Commission shall adopt by rule the form
459	that must be used by an insurer and a health care provider
460	specified in subparagraph 3., subparagraph 4., or subparagraph
461	5. to document that the health care provider meets the criteria
462	of this paragraph, which rule must include a requirement for a
463	sworn statement or affidavit.
464	(b)  Disability benefits.-Sixty percent of any loss of
465	gross income and loss of earning capacity per individual from
466	inability to work proximately caused by the injury sustained by
467	the injured person, plus all expenses reasonably incurred in
468	obtaining from others ordinary and necessary services in lieu of
469	those that, but for the injury, the injured person would have
470	performed without income for the benefit of his or her
471	household. All disability benefits payable under this paragraph
472	must provision shall be paid at least not less than every 2
473	weeks.
474	(c)  Death benefits.-Death benefits equal to the lesser of
475	$5,000 or the remainder of unused personal injury protection
476	benefits per individual. The insurer may pay such benefits to
477	the executor or administrator of the deceased, to any of the
478	deceased's relatives by blood, or legal adoption, or connection
479	by marriage, or to any person appearing to the insurer to be
480	equitably entitled thereto.
481
482	Only insurers writing motor vehicle liability insurance in this
483	state may provide the required benefits of this section, and no
484	such insurers may not insurer shall require the purchase of any
485	other motor vehicle coverage other than the purchase of property
486	damage liability coverage as required by s. 627.7275 as a
487	condition for providing such required benefits. Insurers may not
488	require that property damage liability insurance in an amount
489	greater than $10,000 be purchased in conjunction with personal
490	injury protection. Such insurers shall make benefits and
491	required property damage liability insurance coverage available
492	through normal marketing channels. An Any insurer writing motor
493	vehicle liability insurance in this state who fails to comply
494	with such availability requirement as a general business
495	practice violates shall be deemed to have violated part IX of
496	chapter 626, and such violation constitutes shall constitute an
497	unfair method of competition or an unfair or deceptive act or
498	practice involving the business of insurance. An; and any such
499	insurer committing such violation is shall be subject to the
500	penalties afforded in such part, as well as those that are which
501	may be afforded elsewhere in the insurance code.
502	(3)  INSURED'S RIGHTS TO RECOVERY OF SPECIAL DAMAGES IN
503	TORT CLAIMS.-An No insurer shall not have a lien on any recovery
504	in tort by judgment, settlement, or otherwise for personal
505	injury protection benefits, whether suit has been filed or
506	settlement has been reached without suit. An injured party who
507	is entitled to bring suit under the no-fault law provisions of
508	ss. 627.730-627.7405, or his or her legal representative, shall
509	have no right to recover any damages for which personal injury
510	protection benefits are paid or payable. The plaintiff may prove
511	all of his or her special damages notwithstanding this
512	limitation, but if special damages are introduced in evidence,
513	the trier of facts, whether judge or jury, shall not award
514	damages for personal injury protection benefits paid or payable.
515	In all cases in which a jury is required to fix damages, the
516	court shall instruct the jury that the plaintiff shall not
517	recover such special damages for personal injury protection
518	benefits paid or payable.
519	(4)  BENEFITS; WHEN DUE.-Benefits due from an insurer under
520	the no-fault law are ss. 627.730-627.7405 shall be primary,
521	except that benefits received under any workers' compensation
522	law shall be credited against the benefits provided by
523	subsection (1) and are shall be due and payable as loss accrues,
524	upon the receipt of reasonable proof of such loss and the amount
525	of expenses and loss incurred that which are covered by the
526	policy issued under the no-fault law ss. 627.730-627.7405. If
527	When the Agency for Health Care Administration provides, pays,
528	or becomes liable for medical assistance under the Medicaid
529	program related to injury, sickness, disease, or death arising
530	out of the ownership, maintenance, or use of a motor vehicle,
531	the benefits are under ss. 627.730-627.7405 shall be subject to
532	the provisions of the Medicaid program.
533	(a)  An insurer may require written notice to be given as
534	soon as practicable after an accident involving a motor vehicle
535	with respect to which the policy affords the security required
536	by the no-fault law ss. 627.730-627.7405.
537	(b)  Personal injury protection insurance benefits paid
538	pursuant to this section are shall be overdue if not paid within
539	30 days after the insurer is furnished written notice of the
540	fact of a covered loss and of the amount of same. If such
541	written notice is not furnished to the insurer as to the entire
542	claim, any partial amount supported by written notice is overdue
543	if not paid within 30 days after such written notice is
544	furnished to the insurer. Any part or all of the remainder of
545	the claim that is subsequently supported by written notice is
546	overdue if not paid within 30 days after such written notice is
547	furnished to the insurer.
548	(c)  If When an insurer pays only a portion of a claim or
549	rejects a claim, the insurer shall provide at the time of the
550	partial payment or rejection an itemized specification of each
551	item that the insurer had reduced, omitted, or declined to pay
552	and any information that the insurer desires the claimant to
553	consider related to the medical necessity of the denied
554	treatment or to explain the reasonableness of the reduced
555	charge, provided that this does shall not limit the introduction
556	of evidence at trial.; and The insurer must shall include the
557	name and address of the person to whom the claimant should
558	respond and a claim number to be referenced in future
559	correspondence.
560	(d)  A However, notwithstanding the fact that written
561	notice has been furnished to the insurer, Any payment is shall
562	not be deemed overdue if when the insurer has reasonable proof
563	to establish that the insurer is not responsible for the
564	payment. For the purpose of calculating the extent to which any
565	benefits are overdue, payment shall be treated as being made on
566	the date a draft or other valid instrument which is equivalent
567	to payment was placed in the United States mail in a properly
568	addressed, postpaid envelope or, if not so posted, on the date
569	of delivery. This paragraph does not preclude or limit the
570	ability of the insurer to assert that the claim is was
571	unrelated, was not medically necessary, or was unreasonable, or
572	submitted that the amount of the charge was in excess of that
573	permitted under, or in violation of, subsection (6) (5). Such
574	assertion by the insurer may be made at any time, including
575	after payment of the claim or after the 30-day time period for
576	payment set forth in this paragraph (b). The 30-day period for
577	payment or denial is tolled with respect to any portion of a
578	claim for which the insurer has a reasonable belief that a
579	fraudulent insurance act as defined in s. 626.989 has been
580	committed while the insurer investigates such act. The insurer
581	must notify the claimant in writing that it is investigating a
582	fraudulent insurance act within 30 days after the date it has a
583	reasonable belief that such act has been committed. The insurer
584	must pay or deny the claim, in full or in part, within 120 days
585	after the date the written notice of the fact of a covered loss
586	and of the amount of the loss was provided to the insurer.
587	(e)(c)  Upon receiving notice of an accident that is
588	potentially covered by personal injury protection benefits, the
589	insurer must reserve $5,000 of personal injury protection
590	benefits for payment to physicians licensed under chapter 458 or
591	chapter 459 or dentists licensed under chapter 466 who provide
592	emergency services and care, as defined in s. 395.002(9), or who
593	provide hospital inpatient care. The amount required to be held
594	in reserve may be used only to pay claims from such physicians
595	or dentists until 30 days after the date the insurer receives
596	notice of the accident. After the 30-day period, any amount of
597	the reserve for which the insurer has not received notice of
598	such a claim from a physician or dentist who provided emergency
599	services and care or who provided hospital inpatient care may
600	then be used by the insurer to pay other claims. The time
601	periods specified in paragraph (b) for required payment of
602	personal injury protection benefits are shall be tolled for the
603	period of time that an insurer is required by this paragraph to
604	hold payment of a claim that is not from a physician or dentist
605	who provided emergency services and care or who provided
606	hospital inpatient care to the extent that the personal injury
607	protection benefits not held in reserve are insufficient to pay
608	the claim. This paragraph does not require an insurer to
609	establish a claim reserve for insurance accounting purposes.
610	(f)(d)  All overdue payments shall bear simple interest at
611	the rate established under s. 55.03 or the rate established in
612	the insurance contract, whichever is greater, for the year in
613	which the payment became overdue, calculated from the date the
614	insurer was furnished with written notice of the amount of
615	covered loss. Interest is shall be due at the time payment of
616	the overdue claim is made.
617	(g)(e)  The insurer of the owner of a motor vehicle shall
618	pay personal injury protection benefits for:
619	1.  Accidental bodily injury sustained in this state by the
620	owner while occupying a motor vehicle, or while not an occupant
621	of a self-propelled vehicle if the injury is caused by physical
622	contact with a motor vehicle.
623	2.  Accidental bodily injury sustained outside this state,
624	but within the United States of America or its territories or
625	possessions or Canada, by the owner while occupying the owner's
626	motor vehicle.
627	3.  Accidental bodily injury sustained by a relative of the
628	owner residing in the same household, under the circumstances
629	described in subparagraph 1. or subparagraph 2. if, provided the
630	relative at the time of the accident is domiciled in the owner's
631	household and is not himself or herself the owner of a motor
632	vehicle with respect to which security is required under the no-
633	fault law ss. 627.730-627.7405.
634	4.  Accidental bodily injury sustained in this state by any
635	other person while occupying the owner's motor vehicle or, if a
636	resident of this state, while not an occupant of a self-
637	propelled vehicle, if the injury is caused by physical contact
638	with such motor vehicle and if, provided the injured person is
639	not himself or herself:
640	a.  The owner of a motor vehicle with respect to which
641	security is required under the no-fault law ss. 627.730-
642	627.7405; or
643	b.  Entitled to personal injury benefits from the insurer
644	of the owner or owners of such a motor vehicle.
645	(h)(f)  If two or more insurers are liable to pay personal
646	injury protection benefits for the same injury to any one
647	person, the maximum payable is shall be as specified in
648	subsection (1), and any insurer paying the benefits is shall be
649	entitled to recover from each of the other insurers an equitable
650	pro rata share of the benefits paid and expenses incurred in
651	processing the claim.
652	(i)(g)  It is a violation of the insurance code for an
653	insurer to fail to timely provide benefits as required by this
654	section with such frequency as to constitute a general business
655	practice.
656	(j)(h)  Benefits are shall not be due or payable to or on
657	the behalf of a claimant who: an insured person if that person
658	has
659	1.  Submits a false or misleading statement, document,
660	record, or bill;
661	2.  Submits any other false or misleading information; or
662	3.  Has otherwise committed or attempted to commit a
663	fraudulent insurance act as defined in s. 626.989.
664
665	A claimant who violates this paragraph is not entitled to any
666	personal injury protection benefits or payment for any bills and
667	services, regardless of whether a portion of the claim may be
668	legitimate.
669	(k)  Notwithstanding any remedies afforded by law, the
670	insurer may recover from a claimant who has violated paragraph
671	(j) any sums previously paid to the claimant and may bring any
672	available common law and statutory causes of action committed,
673	by a material act or omission, any insurance fraud relating to
674	personal injury protection coverage under his or her policy, if
675	the fraud is admitted to in a sworn statement by the insured or
676	if it is established in a court of competent jurisdiction. If a
677	physician, hospital, clinic, or other medical institution
678	violates paragraph (j), the injured party is not liable for, and
679	the physician, hospital, clinic, or other medical institution
680	may not bill the insured for, charges that are unpaid because of
681	failure to comply with paragraph (j). Any agreement requiring
682	the injured person or insured to pay for such charges is
683	unenforceable. Any insurance fraud shall void all coverage
684	arising from the claim related to such fraud under the personal
685	injury protection coverage of the insured person who committed
686	the fraud, irrespective of whether a portion of the insured
687	person's claim may be legitimate, and any benefits paid prior to
688	the discovery of the insured person's insurance fraud shall be
689	recoverable by the insurer from the person who committed
690	insurance fraud in their entirety. The prevailing party is
691	entitled to its costs and attorney's fees in any action in which
692	it prevails in an insurer's action to enforce its right of
693	recovery under this paragraph.
694	(5)  INSURER INVESTIGATIONS.-An insurer has the right and
695	duty to conduct a reasonable investigation of a claim. In the
696	course of the investigation, the insurer may require the
697	insured, claimant, or medical provider to provide copies of the
698	treatment and examination records so that the insurer can
699	provide such records to a physician for a records review. A
700	records review need not be based on a physical examination and
701	may be obtained at any time, including after reduction or denial
702	of the claim. The 30-day period for payment under paragraph
703	(4)(b) is tolled from the date the insurer sends its request for
704	treatment records to the date that the insurer receives the
705	treatment records. The claim may be denied or reduced if the
706	medical provider fails to keep adequate records such that the
707	insurer is unable to obtain a records review.
708	(6)(5)  CHARGES FOR TREATMENT OF INJURED PERSONS.-
709	(a)1.  Any physician, hospital, clinic, or other person or
710	institution lawfully rendering treatment to an injured person
711	for a bodily injury covered by personal injury protection
712	insurance may charge the insurer and injured party only an a
713	reasonable amount pursuant to this section for the services and
714	supplies rendered, and the insurer providing such coverage may
715	pay for such charges directly to such person or institution
716	lawfully rendering such treatment, if the insured receiving such
717	treatment or his or her guardian has countersigned the properly
718	completed invoice, bill, or claim form approved by the office
719	upon which such charges are to be paid for as having actually
720	been rendered, to the best knowledge of the insured or his or
721	her guardian. In no event, However, may such a charge may not
722	exceed be in excess of the amount the person or institution
723	customarily charges for like services or supplies. When
724	determining With respect to a determination of whether a charge
725	for a particular service, treatment, or otherwise is reasonable,
726	consideration may be given to evidence of usual and customary
727	charges and payments accepted by the provider involved in the
728	dispute, and reimbursement levels in the community and various
729	federal and state medical fee schedules applicable to automobile
730	and other insurance coverages, and other information relevant to
731	the reasonableness of the reimbursement for the service,
732	treatment, or supply.
733	1.2.  The insurer may limit reimbursement to 80 percent of
734	the following schedule of maximum charges:
735	a.  For emergency transport and treatment by providers
736	licensed under chapter 401, 200 percent of Medicare.
737	b.  For emergency services and care provided by a hospital
738	licensed under chapter 395, 75 percent of the hospital's usual
739	and customary charges.
740	c.  For emergency services and care as defined by s.
741	395.002(9) provided in a facility licensed under chapter 395
742	rendered by a physician or dentist, and related hospital
743	inpatient services rendered by a physician or dentist, the usual
744	and customary charges in the community.
745	d.  For hospital inpatient services, other than emergency
746	services and care, 200 percent of the Medicare Part A
747	prospective payment applicable to the specific hospital
748	providing the inpatient services.
749	e.  For hospital outpatient services, other than emergency
750	services and care, 200 percent of the Medicare Part A Ambulatory
751	Payment Classification for the specific hospital providing the
752	outpatient services.
753	f.  For all other medical services, supplies, and care, 200
754	percent of the allowable amount under the participating
755	physicians schedule of Medicare Part B. However, if such
756	services, supplies, or care is not reimbursable under Medicare
757	Part B, the insurer may limit reimbursement to 80 percent of the
758	maximum reimbursable allowance under workers' compensation, as
759	determined under s. 440.13 and rules adopted thereunder which
760	are in effect at the time such services, supplies, or care is
761	provided. Services, supplies, or care that is not reimbursable
762	under Medicare or workers' compensation is not required to be
763	reimbursed by the insurer.
764	2.3.  For purposes of subparagraph 1. 2., the applicable
765	fee schedule or payment limitation under Medicare is the fee
766	schedule or payment limitation in effect on January 1 of the
767	year in which at the time the services, supplies, or care was
768	rendered and for the area in which such services were rendered,
769	notwithstanding any subsequent changes made to such fee schedule
770	or payment limitation, except that it may not be less than the
771	allowable amount under the participating physicians schedule of
772	Medicare Part B for 2007 for medical services, supplies, and
773	care subject to Medicare Part B.
774	3.4.  Subparagraph 1. 2. does not allow the insurer to
775	apply any limitation on the number of treatments or other
776	utilization limits that apply under Medicare or workers'
777	compensation. An insurer that applies the allowable payment
778	limitations of subparagraph 1. 2. must reimburse a provider who
779	lawfully provided care or treatment under the scope of his or
780	her license, regardless of whether such provider is would be
781	entitled to reimbursement under Medicare due to restrictions or
782	limitations on the types or discipline of health care providers
783	who may be reimbursed for particular procedures or procedure
784	codes.
785	4.5.  If an insurer limits payment as authorized by
786	subparagraph 1. 2., the person providing such services,
787	supplies, or care may not bill or attempt to collect from the
788	insured any amount in excess of such limits, except for amounts
789	that are not covered by the insured's personal injury protection
790	coverage due to the coinsurance amount or maximum policy limits.
791	(b)1.  An insurer or insured is not required to pay a claim
792	or charges:
793	a.  Made by a broker or by a person making a claim on
794	behalf of a broker;
795	b.  For any service or treatment that was not lawful at the
796	time rendered;
797	c.  To any person who knowingly submits a false or
798	misleading statement relating to the claim or charges;
799	d.  With respect to a bill or statement that does not
800	substantially meet the applicable requirements of paragraphs (c)
801	and paragraph (d);
802	e.  For any treatment or service that is upcoded, or that
803	is unbundled if when such treatment or services should be
804	bundled, in accordance with paragraph (d). To facilitate prompt
805	payment of lawful services, an insurer may change codes that it
806	determines to have been improperly or incorrectly upcoded or
807	unbundled, and may make payment based on the changed codes,
808	without affecting the right of the provider to dispute the
809	change by the insurer if, provided that before doing so, the
810	insurer contacts must contact the health care provider and
811	discusses discuss the reasons for the insurer's change and the
812	health care provider's reason for the coding, or makes make a
813	reasonable good faith effort to do so, as documented in the
814	insurer's file; and
815	f.  For medical services or treatment billed by a physician
816	and not provided in a hospital unless such services are rendered
817	by the physician or are incident to his or her professional
818	services and are included on the physician's bill, including
819	documentation verifying that the physician is responsible for
820	the medical services that were rendered and billed.
821	2.  The Department of Health, in consultation with the
822	appropriate professional licensing boards, shall adopt, by rule,
823	a list of diagnostic tests deemed not to be medically necessary
824	for use in the treatment of persons sustaining bodily injury
825	covered by personal injury protection benefits under this
826	section. The initial list shall be adopted by January 1, 2004,
827	and shall be revised from time to time as determined by the
828	Department of Health, in consultation with the respective
829	professional licensing boards. Inclusion of a test on the list
830	must of invalid diagnostic tests shall be based on lack of
831	demonstrated medical value and a level of general acceptance by
832	the relevant provider community and may shall not be dependent
833	for results entirely upon subjective patient response.
834	Notwithstanding its inclusion on a fee schedule in this
835	subsection, an insurer or insured is not required to pay any
836	charges or reimburse claims for any invalid diagnostic test as
837	determined by the Department of Health.
838	(c)1.  With respect to any treatment or service, other than
839	medical services billed by a hospital or other provider for
840	emergency services as defined in s. 395.002 or inpatient
841	services rendered at a hospital-owned facility, the statement of
842	charges must be furnished to the insurer by the provider and may
843	not include, and the insurer is not required to pay, charges for
844	treatment or services rendered more than 35 days before the
845	postmark date or electronic transmission date of the statement,
846	except for past due amounts previously billed on a timely basis
847	under this paragraph, and except that, if the provider submits
848	to the insurer a notice of initiation of treatment within 21
849	days after its first examination or treatment of the claimant,
850	the statement may include charges for treatment or services
851	rendered up to, but not more than, 75 days before the postmark
852	date of the statement. The injured party is not liable for, and
853	the provider may shall not bill the injured party for, charges
854	that are unpaid because of the provider's failure to comply with
855	this paragraph. Any agreement requiring the injured person or
856	insured to pay for such charges is unenforceable.
857	1.2.  If, however, the insured fails to furnish the
858	provider with the correct name and address of the insured's
859	personal injury protection insurer, the provider has 35 days
860	from the date the provider obtains the correct information to
861	furnish the insurer with a statement of the charges. The insurer
862	is not required to pay for such charges unless the provider
863	includes with the statement documentary evidence that was
864	provided by the insured during the 35-day period demonstrating
865	that the provider reasonably relied on erroneous information
866	from the insured and either:
867	a.  A denial letter from the incorrect insurer; or
868	b.  Proof of mailing, which may include an affidavit under
869	penalty of perjury, reflecting timely mailing to the incorrect
870	address or insurer.
871	2.3.  For emergency services and care as defined in s.
872	395.002 rendered in a hospital emergency department or for
873	transport and treatment rendered by an ambulance provider
874	licensed pursuant to part III of chapter 401, the provider is
875	not required to furnish the statement of charges within the time
876	periods established by this paragraph,; and the insurer is shall
877	not be considered to have been furnished with notice of the
878	amount of covered loss for purposes of paragraph (4)(b) until it
879	receives a statement complying with paragraph (d), or copy
880	thereof, which specifically identifies the place of service to
881	be a hospital emergency department or an ambulance in accordance
882	with billing standards recognized by the Centers for Medicare
883	and Medicaid Services (CMS) Health Care Finance Administration.
884	3.4.  Each notice of the insured's rights under s. 627.7401
885	must include the following statement in type no smaller than 12
886	points:
887
888	BILLING REQUIREMENTS.-Florida Statutes provide that
889	with respect to any treatment or services, other than
890	certain hospital and emergency services, the statement
891	of charges furnished to the insurer by the provider
892	may not include, and the insurer and the injured party
893	are not required to pay, charges for treatment or
894	services rendered more than 35 days before the
895	postmark date of the statement, except for past due
896	amounts previously billed on a timely basis, and
897	except that, if the provider submits to the insurer a
898	notice of initiation of treatment within 21 days after
899	its first examination or treatment of the claimant,
900	the first billing cycle statement may include charges
901	for treatment or services rendered up to, but not more
902	than, 75 days before the postmark date of the
903	statement.
904
905	(d)  All statements and bills for medical services rendered
906	by any physician, hospital, clinic, or other person or
907	institution shall be submitted to the insurer on a properly
908	completed Centers for Medicare and Medicaid Services (CMS) 1500
909	form, UB 92 forms, or any other standard form approved by the
910	office or adopted by the commission for purposes of this
911	paragraph. All billings for such services rendered by providers
912	must shall, to the extent applicable, follow the Physicians'
913	Current Procedural Terminology (CPT) or Healthcare Correct
914	Procedural Coding System (HCPCS), or ICD-9 in effect for the
915	year in which services are rendered and comply with the Centers
916	for Medicare and Medicaid Services (CMS) 1500 form instructions
917	and the American Medical Association Current Procedural
918	Terminology (CPT) Editorial Panel and Healthcare Correct
919	Procedural Coding System (HCPCS). All providers other than
920	hospitals shall include on the applicable claim form the
921	professional license number of the provider in the line or space
922	provided for "Signature of Physician or Supplier, Including
923	Degrees or Credentials." In determining compliance with
924	applicable CPT and HCPCS coding, guidance shall be provided by
925	the Physicians' Current Procedural Terminology (CPT) or the
926	Healthcare Correct Procedural Coding System (HCPCS) in effect
927	for the year in which services were rendered, the Office of the
928	Inspector General (OIG), Physicians Compliance Guidelines, and
929	other authoritative treatises designated by rule by the Agency
930	for Health Care Administration. A No statement of medical
931	services may not include charges for medical services of a
932	person or entity that performed such services without possessing
933	the valid licenses required to perform such services. For
934	purposes of paragraph (4)(b), an insurer is shall not be
935	considered to have been furnished with notice of the amount of
936	covered loss or medical bills due unless the statements or bills
937	comply with this paragraph, and unless the statements or bills
938	are properly completed in their entirety as to all material
939	provisions, with all relevant information being provided
940	therein.
941	(e)1.  At the initial treatment or service provided, each
942	physician, other licensed professional, clinic, or other medical
943	institution providing medical services upon which a claim for
944	personal injury protection benefits is based shall require an
945	insured person, or his or her guardian, to execute a disclosure
946	and acknowledgment form, which reflects at a minimum that:
947	a.  The insured, or his or her guardian, must countersign
948	the form attesting to the fact that the services set forth
949	therein were actually rendered;
950	b.  The insured, or his or her guardian, has both the right
951	and affirmative duty to confirm that the services were actually
952	rendered;
953	c.  The insured, or his or her guardian, was not solicited
954	by any person to seek any services from the medical provider;
955	d.  The physician, other licensed professional, clinic, or
956	other medical institution rendering services for which payment
957	is being claimed explained the services to the insured or his or
958	her guardian; and
959	e.  If the insured notifies the insurer in writing of a
960	billing error, the insured may be entitled to a certain
961	percentage of a reduction in the amounts paid by the insured's
962	motor vehicle insurer.
963	2.  The physician, other licensed professional, clinic, or
964	other medical institution rendering services for which payment
965	is being claimed has the affirmative duty to explain the
966	services rendered to the insured, or his or her guardian, so
967	that the insured, or his or her guardian, countersigns the form
968	with informed consent.
969	3.  Countersignature by the insured, or his or her
970	guardian, is not required for the reading of diagnostic tests or
971	other services that are of such a nature that they are not
972	required to be performed in the presence of the insured.
973	4.  The licensed medical professional rendering treatment
974	for which payment is being claimed must sign, by his or her own
975	hand, the form complying with this paragraph.
976	5.  The original completed disclosure and acknowledgment
977	form is shall be furnished to the insurer pursuant to paragraph
978	(4)(b) and may not be electronically furnished.
979	6.  This disclosure and acknowledgment form is not required
980	for services billed by a provider for emergency services as
981	defined in s. 395.002, for emergency services and care as
982	defined in s. 395.002 rendered in a hospital emergency
983	department, or for transport and treatment rendered by an
984	ambulance provider licensed pursuant to part III of chapter 401.
985	7.  The Financial Services Commission shall adopt, by rule,
986	a standard disclosure and acknowledgment form to that shall be
987	used to fulfill the requirements of this paragraph, effective 90
988	days after such form is adopted and becomes final. The
989	commission shall adopt a proposed rule by October 1, 2003. Until
990	the rule is final, the provider may use a form of its own which
991	otherwise complies with the requirements of this paragraph.
992	8.  As used in this paragraph, the term "countersigned" or
993	"countersignature" means a second or verifying signature, as on
994	a previously signed document, and is not satisfied by the
995	statement "signature on file" or any similar statement.
996	9.  The requirements of this paragraph apply only with
997	respect to the initial treatment or service of the insured by a
998	provider. For subsequent treatments or service, the provider
999	must maintain a patient log signed by the patient, in
1000	chronological order by date of service, that is consistent with
1001	the services being rendered to the patient as claimed. The
1002	requirements of this subparagraph for maintaining a patient log
1003	signed by the patient may be met by a hospital that maintains
1004	medical records as required by s. 395.3025 and applicable rules
1005	and makes such records available to the insurer upon request.
1006	(f)  Upon written notification by any person, an insurer
1007	shall investigate any claim of improper billing by a physician
1008	or other medical provider. The insurer shall determine if the
1009	insured was properly billed for only those services and
1010	treatments that the insured actually received. If the insurer
1011	determines that the insured has been improperly billed, the
1012	insurer shall notify the insured, the person making the written
1013	notification, and the provider of its findings and shall reduce
1014	the amount of payment to the provider by the amount determined
1015	to be improperly billed. If a reduction is made due to such
1016	written notification by any person, the insurer shall pay to the
1017	person 20 percent of the amount of the reduction, up to $500. If
1018	the provider is arrested due to the improper billing, then the
1019	insurer shall pay to the person 40 percent of the amount of the
1020	reduction, up to $500.
1021	(g)  An insurer may not systematically downcode with the
1022	intent to deny reimbursement otherwise due. Such action
1023	constitutes a material misrepresentation under s.
1024	626.9541(1)(i)2.
1025	(7)(6)  DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
1026	DISPUTES.-
1027	(a)  An insurer may require a claimant to submit to an
1028	examination under oath or sworn statement as often as reasonably
1029	requested by an insurer and at any reasonable location
1030	designated by the insurer. Submission to an examination under
1031	oath or sworn statement is a condition precedent to recovery or
1032	filing suit. The insurer is not liable for benefits under the
1033	no-fault law if the claimant fails to fully and truthfully
1034	answer all questions asked or violates any provision of
1035	paragraph (4)(j).
1036	1.  The insurer may conduct the examination outside the
1037	presence of any other person seeking coverage.
1038	2.  If an insurer requests an examination of a claimant
1039	that is in a hospital, clinic, or other medical institution,
1040	such claimant shall produce the persons with the most knowledge
1041	relating to the issues set forth by the insurer in the notice of
1042	examination.
1043	3.  The claimant must provide the insurer at the
1044	examination with all documents, papers, receipts, invoices,
1045	bills, records, or other tangible items requested by the
1046	insurer.
1047	4.  The examination may be recorded by audio, video, or
1048	court report or any combination thereof. The claimant may record
1049	the examination at the claimant's expense.
1050	5.  The claimant may have an attorney present at the
1051	examination at the claimant's expense.
1052	6.  An insurer that unreasonably requests an examination
1053	without a reasonable basis as a general business practice is
1054	engaging in an unfair insurance trade practice pursuant to s.
1055	626.9541.
1056	(a)  Every employer shall, if a request is made by an
1057	insurer providing personal injury protection benefits under ss.
1058	627.730-627.7405 against whom a claim has been made, furnish
1059	forthwith, in a form approved by the office, a sworn statement
1060	of the earnings, since the time of the bodily injury and for a
1061	reasonable period before the injury, of the person upon whose
1062	injury the claim is based.
1063	(b)  Every physician, hospital, clinic, or other medical
1064	institution providing, before or after bodily injury upon which
1065	a claim for personal injury protection insurance benefits is
1066	based, any products, services, or accommodations in relation to
1067	that or any other injury, or in relation to a condition claimed
1068	to be connected with that or any other injury, shall, if
1069	requested to do so by the insurer against whom the claim has
1070	been made, permit the insurer or the insurer's representative to
1071	conduct an onsite physical review and examination of the
1072	treatment location, treatment apparatuses, diagnostic devices,
1073	and any other medical equipment used for the services rendered
1074	within 10 days after the insurer's request and furnish forthwith
1075	a written report of the history, condition, treatment, dates,
1076	and costs of such treatment of the injured person and why the
1077	items identified by the insurer were reasonable in amount and
1078	medically necessary, together with a sworn statement that the
1079	treatment or services rendered were reasonable and necessary
1080	with respect to the bodily injury sustained and identifying
1081	which portion of the expenses for such treatment or services was
1082	incurred as a result of such bodily injury, and produce
1083	forthwith, and permit the inspection and copying of, his or her
1084	or its records regarding such history, condition, treatment,
1085	dates, and costs of treatment if; provided that this does shall
1086	not limit the introduction of evidence at trial. Such sworn
1087	statement must shall read as follows: "Under penalty of perjury,
1088	I declare that I have read the foregoing, and the facts alleged
1089	are true, to the best of my knowledge and belief." A No cause of
1090	action for violation of the physician-patient privilege or
1091	invasion of the right of privacy may not be brought shall be
1092	permitted against any physician, hospital, clinic, or other
1093	medical institution complying with the provisions of this
1094	section. The person requesting such records and such sworn
1095	statement shall pay all reasonable costs connected therewith. If
1096	an insurer makes a written request for documentation or
1097	information under this paragraph within 30 days after having
1098	received notice of the amount of a covered loss under paragraph
1099	(4)(a), the amount or the partial amount that which is the
1100	subject of the insurer's inquiry is shall become overdue if the
1101	insurer does not pay in accordance with paragraph (4)(b) or
1102	within 10 days after the insurer's receipt of the requested
1103	documentation or information, whichever occurs later. For
1104	purposes of this paragraph, the term "receipt" includes, but is
1105	not limited to, inspection and copying pursuant to this
1106	paragraph. An Any insurer that requests documentation or
1107	information pertaining to reasonableness of charges or medical
1108	necessity under this paragraph without a reasonable basis for
1109	such requests as a general business practice is engaging in an
1110	unfair trade practice under the insurance code.
1111	(c)  If a request is made by an insurer, an employer must
1112	furnish, in a form approved by the office, a sworn statement of
1113	the earnings of the person upon whose injury a claim is based
1114	since the time of the bodily injury and for a reasonable period
1115	before the injury.
1116	(d)(c)  If there is a In the event of any dispute regarding
1117	an insurer's right to discovery of facts under this section, the
1118	insurer may petition the a court of competent jurisdiction to
1119	enter an order permitting such discovery. The order may be made
1120	only on motion for good cause shown and upon notice to all
1121	persons having an interest, and must it shall specify the time,
1122	place, manner, conditions, and scope of the discovery. The Such
1123	court may, in order to protect against annoyance, embarrassment,
1124	or oppression, as justice requires, enter an order refusing
1125	discovery or specifying conditions of discovery and may order
1126	payments of costs and expenses of the proceeding, including
1127	reasonable fees for the appearance of attorneys at the
1128	proceedings, as justice requires.
1129	(8)(7)  MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON;
1130	REPORTS.-
1131	(b)  If requested by the person examined, a party causing
1132	an examination to be made shall deliver to him or her a copy of
1133	every written report concerning the examination rendered by an
1134	examining physician, at least one of which reports must set out
1135	the examining physician's findings and conclusions in detail.
1136	After such request and delivery, the party causing the
1137	examination to be made is entitled, upon request, to receive
1138	from the person examined every written report available to him
1139	or her or his or her representative concerning any examination,
1140	previously or thereafter made, of the same mental or physical
1141	condition. By requesting and obtaining a report of the
1142	examination so ordered, or by taking the deposition of the
1143	examiner, the person examined waives any privilege he or she may
1144	have, in relation to the claim for benefits, regarding the
1145	testimony of every other person who has examined, or may
1146	thereafter examine, him or her in respect to the same mental or
1147	physical condition. If a person unreasonably refuses to submit
1148	to an examination, the personal injury protection carrier is no
1149	longer liable for subsequent personal injury protection benefits
1150	incurred after the date of the first request for examination.
1151	Failure to appear for an examination raises a rebuttable
1152	presumption that such failure was unreasonable. Submission to an
1153	examination is a condition precedent to the recovery of
1154	benefits.
1155	(9)(8)  APPLICABILITY OF PROVISION REGULATING ATTORNEY'S
1156	FEES.-With respect to any dispute under the provisions of ss.
1157	627.730-627.7405 between the insured and the insurer under the
1158	no-fault law, or between an assignee of an insured's rights and
1159	the insurer, the provisions of s. 627.428 applies shall apply,
1160	except as provided in subsections (11) and (16) (10) and (15).
1161	(10)(9)  PREFERRED PROVIDERS.-An insurer may negotiate and
1162	enter into contracts with preferred licensed health care
1163	providers for the benefits described in this section, referred
1164	to in this section as "preferred providers," which shall include
1165	health care providers licensed under chapter chapters 458,
1166	chapter 459, chapter 460, chapter 461, or chapter and 463.
1167	(a)  The insurer may provide an option to an insured to use
1168	a preferred provider at the time of purchase of the policy for
1169	personal injury protection benefits, if the requirements of this
1170	subsection are met. However, if the insurer offers a preferred
1171	provider option, it must also offer a nonpreferred provider
1172	policy. If the insured elects to use a provider who is not a
1173	preferred provider, whether the insured purchased a preferred
1174	provider policy or a nonpreferred provider policy, the medical
1175	benefits provided by the insurer shall be as required by this
1176	section.
1177	(b)  If the insured elects the to use a provider who is a
1178	preferred provider option, the insurer may pay medical benefits
1179	in excess of the benefits required by this section and may waive
1180	or lower the amount of any deductible that applies to such
1181	medical benefits. As an alternative, or in addition to such
1182	benefits, waiver, or reduction, the insurer may provide an
1183	actuarially appropriate premium discount as specified in an
1184	approved rate filing to an insured who selects the preferred
1185	provider option. If the preferred provider option provides a
1186	premium discount, the policy may provide that charges for
1187	nonemergency services provided within this state are payable
1188	only if performed by members of the preferred provider network
1189	unless there is no member of the preferred provider network
1190	located within 15 miles of the insured's place of residence
1191	whose scope of practice includes the required services. If the
1192	insurer offers a preferred provider policy to a policyholder or
1193	applicant, it must also offer a nonpreferred provider policy.
1194	(c)  The insurer shall provide each insured policyholder
1195	with a current roster of preferred providers in the county in
1196	which the insured resides at the time of purchasing purchase of
1197	such policy, and shall make such list available for public
1198	inspection during regular business hours at the insurer's
1199	principal office of the insurer within the state. The insurer
1200	may contract with another health insurer for the right to use an
1201	existing preferred provider network to implement the preferred
1202	provider option. Any other arrangement is subject to the
1203	approval of the Office of Insurance Regulation.
1204	(17)(16)  SECURE ELECTRONIC DATA TRANSFER.-If all parties
1205	mutually and expressly agree, a notice, documentation,
1206	transmission, or communication of any kind required or
1207	authorized under the no-fault law ss. 627.730-627.7405 may be
1208	transmitted electronically if it is transmitted by secure
1209	electronic data transfer that is consistent with state and
1210	federal privacy and security laws.
1211	Section 8.  Paragraph (c) of subsection (7) of section
1212	817.234, Florida Statutes, is amended, present subsection (12)
1213	of that section is renumbered as subsection (13), and a new
1214	subsection (12) is added to that section, to read:
1215	817.234  False and fraudulent insurance claims.-
1216	(7)
1217	(c)  An insurer, or any person acting at the direction of
1218	or on behalf of an insurer, may not change an opinion in a
1219	mental or physical report prepared under s. 627.736(8)
1220	627.736(7) or direct the physician preparing the report to
1221	change such opinion; however, this provision does not preclude
1222	the insurer from calling to the attention of the physician
1223	errors of fact in the report based upon information in the claim
1224	file. Any person who violates this paragraph commits a felony of
1225	the third degree, punishable as provided in s. 775.082, s.
1226	775.083, or s. 775.084.
1227	(12)  In addition to any criminal liability, a person
1228	convicted of violating any provision of this section for the
1229	purpose of receiving insurance proceeds from a motor vehicle
1230	insurance contract is subject to a civil penalty.
1231	(a)  Except for a violation of subsection (9), the civil
1232	penalty shall be:
1233	1.  A fine up to $5,000 for a first offense.
1234	2.  A fine greater than $5,000, but not to exceed $10,000,
1235	for a second offense.
1236	3.  A fine greater than $10,000, but not to exceed $15,000,
1237	for a third or subsequent offense.
1238	(b)  The civil penalty for a violation of subsection
1239	(9)_must be at least $15,000 but may not exceed $50,000.
1240	(c)  The civil penalty shall be paid to the Insurance
1241	Regulatory Trust Fund within the Department of Financial
1242	Services and used by the department for the investigation and
1243	prosecution of insurance fraud.
1244	(d)  This subsection does not prohibit a state attorney
1245	from entering into a written agreement in which the person
1246	charged with the violation does not admit to or deny the charges
1247	but consents to payment of the civil penalty.
1248	Section 9.  Subsection (1) of section 324.021, Florida
1249	Statutes, is amended to read:
1250	324.021  Definitions; minimum insurance required.-The
1251	following words and phrases when used in this chapter shall, for
1252	the purpose of this chapter, have the meanings respectively
1253	ascribed to them in this section, except in those instances
1254	where the context clearly indicates a different meaning:
1255	(1)  MOTOR VEHICLE.-Every self-propelled vehicle that which
1256	is designed and required to be licensed for use upon a highway,
1257	including trailers and semitrailers designed for use with such
1258	vehicles, except traction engines, road rollers, farm tractors,
1259	power shovels, and well drillers, and every vehicle that which
1260	is propelled by electric power obtained from overhead wires but
1261	not operated upon rails, but not including any bicycle or moped.
1262	However, the term does "motor vehicle" shall not include a any
1263	motor vehicle as defined in s. 627.732(3) if when the owner of
1264	such vehicle has complied with the no-fault law requirements of
1265	ss. 627.730-627.7405, inclusive, unless the provisions of s.
1266	324.051 apply; and, in such case, the applicable proof of
1267	insurance provisions of s. 320.02 apply.
1268	Section 10.  Paragraph (k) of subsection (2) of section
1269	456.057, Florida Statutes, is amended to read:
1270	456.057  Ownership and control of patient records; report
1271	or copies of records to be furnished.-
1272	(2)  As used in this section, the terms "records owner,"
1273	"health care practitioner," and "health care practitioner's
1274	employer" do not include any of the following persons or
1275	entities; furthermore, the following persons or entities are not
1276	authorized to acquire or own medical records, but are authorized
1277	under the confidentiality and disclosure requirements of this
1278	section to maintain those documents required by the part or
1279	chapter under which they are licensed or regulated:
1280	(k)  Persons or entities practicing under s. 627.736(8)
1281	627.736(7).
1282	Section 11.  Subsection (7) of section 627.7295, Florida
1283	Statutes, is amended to read:
1284	627.7295  Motor vehicle insurance contracts.-
1285	(7)  A policy of private passenger motor vehicle insurance
1286	or a binder for such a policy may be initially issued in this
1287	state only if the insurer or agent has collected from the
1288	insured an amount equal to 2 months' premium. An insurer, agent,
1289	or premium finance company may not, directly or indirectly, take
1290	any action resulting in the insured having paid from the
1291	insured's own funds an amount less than the 2 months' premium
1292	required by this subsection. This subsection applies without
1293	regard to whether the premium is financed by a premium finance
1294	company or is paid pursuant to a periodic payment plan of an
1295	insurer or an insurance agent. This subsection does not apply if
1296	an insured or member of the insured's family is renewing or
1297	replacing a policy or a binder for such policy written by the
1298	same insurer or a member of the same insurer group. This
1299	subsection does not apply to an insurer that issues private
1300	passenger motor vehicle coverage primarily to active duty or
1301	former military personnel or their dependents. This subsection
1302	does not apply if all policy payments are paid pursuant to a
1303	payroll deduction plan or an automatic electronic funds transfer
1304	payment plan from the policyholder, provided that the first
1305	policy payment is made by cash, cashier's check, check, or a
1306	money order. This subsection and subsection (4) do not apply if
1307	all policy payments to an insurer are paid pursuant to an
1308	automatic electronic funds transfer payment plan from an agent,
1309	a managing general agent, or a premium finance company and if
1310	the policy includes, at a minimum, personal injury protection
1311	pursuant to ss. 627.730-627.7407 627.730-627.7405; motor vehicle
1312	property damage liability pursuant to s. 627.7275; and bodily
1313	injury liability in at least the amount of $10,000 because of
1314	bodily injury to, or death of, one person in any one accident
1315	and in the amount of $20,000 because of bodily injury to, or
1316	death of, two or more persons in any one accident. This
1317	subsection and subsection (4) do not apply if an insured has had
1318	a policy in effect for at least 6 months, the insured's agent is
1319	terminated by the insurer that issued the policy, and the
1320	insured obtains coverage on the policy's renewal date with a new
1321	company through the terminated agent.
1322	Section 12.  Subsections (3) and (4) of section 627.733,
1323	Florida Statutes, are amended to read:
1324	627.733  Required security.-
1325	(3)  Such security shall be provided:
1326	(a)  By an insurance policy delivered or issued for
1327	delivery in this state by an authorized or eligible motor
1328	vehicle liability insurer which provides the benefits and
1329	exemptions contained in the no-fault law ss. 627.730-627.7405.
1330	Any policy of insurance represented or sold as providing the
1331	security required hereunder shall be deemed to provide insurance
1332	for the payment of the required benefits; or
1333	(b)  By any other method authorized by s. 324.031(2), (3),
1334	or (4) and approved by the Department of Highway Safety and
1335	Motor Vehicles as affording security equivalent to that afforded
1336	by a policy of insurance or by self-insuring as authorized by s.
1337	768.28(16). The person filing such security shall have all of
1338	the obligations and rights of an insurer under the no-fault law
1339	ss. 627.730-627.7405.
1340	(4)  An owner of a motor vehicle with respect to which
1341	security is required by this section who fails to have such
1342	security in effect at the time of an accident shall have no
1343	immunity from tort liability, but shall be personally liable for
1344	the payment of benefits under s. 627.736. With respect to such
1345	benefits, such an owner shall have all of the rights and
1346	obligations of an insurer under the no-fault law ss. 627.730-
1347	627.7405.
1348	Section 13.  Section 627.734, Florida Statutes, is amended
1349	to read:
1350	627.734  Proof of security; security requirements;
1351	penalties.-
1352	(1)  The provisions of chapter 324 that which pertain to
1353	the method of giving and maintaining proof of financial
1354	responsibility and that which govern and define a motor vehicle
1355	liability policy shall apply to filing and maintaining proof of
1356	security required by the no-fault law ss. 627.730-627.7405.
1357	(2)  Any person who:
1358	(a)  Gives information required in a report or otherwise as
1359	provided for in the no-fault law ss. 627.730-627.7405, knowing
1360	or having reason to believe that such information is false;
1361	(b)  Forges or, without authority, signs any evidence of
1362	proof of security; or
1363	(c)  Files, or offers for filing, any such evidence of
1364	proof, knowing or having reason to believe that it is forged or
1365	signed without authority,
1366
1367	commits is guilty of a misdemeanor of the first degree,
1368	punishable as provided in s. 775.082 or s. 775.083.
1369	Section 14.  Subsections (1), (2), and (3) of section
1370	627.737, Florida Statutes, are amended to read:
1371	627.737  Tort exemption; limitation on right to damages;
1372	punitive damages.-
1373	(1)  Every owner, registrant, operator, or occupant of a
1374	motor vehicle with respect to which security has been provided
1375	as required by the no-fault law ss. 627.730-627.7405, and every
1376	person or organization legally responsible for her or his acts
1377	or omissions, is hereby exempted from tort liability for damages
1378	because of bodily injury, sickness, or disease arising out of
1379	the ownership, operation, maintenance, or use of such motor
1380	vehicle in this state to the extent that the benefits described
1381	in s. 627.736(1) are payable for such injury, or would be
1382	payable but for any exclusion authorized by the no-fault law ss.
1383	627.730-627.7405, under any insurance policy or other method of
1384	security complying with the requirements of s. 627.733, or by an
1385	owner personally liable under s. 627.733 for the payment of such
1386	benefits, unless a person is entitled to maintain an action for
1387	pain, suffering, mental anguish, and inconvenience for such
1388	injury under the provisions of subsection (2).
1389	(2)  In any action of tort brought against the owner,
1390	registrant, operator, or occupant of a motor vehicle with
1391	respect to which security has been provided as required by the
1392	no-fault law ss. 627.730-627.7405, or against any person or
1393	organization legally responsible for her or his acts or
1394	omissions, a plaintiff may recover damages in tort for pain,
1395	suffering, mental anguish, and inconvenience because of bodily
1396	injury, sickness, or disease arising out of the ownership,
1397	maintenance, operation, or use of such motor vehicle only in the
1398	event that the injury or disease consists in whole or in part
1399	of:
1400	(a)  Significant and permanent loss of an important bodily
1401	function.
1402	(b)  Permanent injury within a reasonable degree of medical
1403	probability, other than scarring or disfigurement.
1404	(c)  Significant and permanent scarring or disfigurement.
1405	(d)  Death.
1406	(3)  When a defendant, in a proceeding brought pursuant to
1407	the no-fault law ss. 627.730-627.7405, questions whether the
1408	plaintiff has met the requirements of subsection (2), then the
1409	defendant may file an appropriate motion with the court, and the
1410	court shall, on a one-time basis only, 30 days before the date
1411	set for the trial or the pretrial hearing, whichever is first,
1412	by examining the pleadings and the evidence before it, ascertain
1413	whether the plaintiff will be able to submit some evidence that
1414	the plaintiff will meet the requirements of subsection (2). If
1415	the court finds that the plaintiff will not be able to submit
1416	such evidence, then the court shall dismiss the plaintiff's
1417	claim without prejudice.
1418	Section 15.  Subsection (1) of section 627.7401, Florida
1419	Statutes, is amended to read:
1420	627.7401  Notification of insured's rights.-
1421	(1)  The commission, by rule, shall adopt a form for the
1422	notification of insureds of their right to receive personal
1423	injury protection benefits under the Florida Motor Vehicle no-
1424	fault law. Such notice shall include:
1425	(a)  A description of the benefits provided by personal
1426	injury protection, including, but not limited to, the specific
1427	types of services for which medical benefits are paid,
1428	disability benefits, death benefits, significant exclusions from
1429	and limitations on personal injury protection benefits, when
1430	payments are due, how benefits are coordinated with other
1431	insurance benefits that the insured may have, penalties and
1432	interest that may be imposed on insurers for failure to make
1433	timely payments of benefits, and rights of parties regarding
1434	disputes as to benefits.
1435	(b)  An advisory informing insureds that:
1436	1.  Pursuant to s. 626.9892, the Department of Financial
1437	Services may pay rewards of up to $25,000 to persons providing
1438	information leading to the arrest and conviction of persons
1439	committing crimes investigated by the Division of Insurance
1440	Fraud arising from violations of s. 440.105, s. 624.15, s.
1441	626.9541, s. 626.989, or s. 817.234.
1442	2.  Pursuant to s. 627.736(6)(e)1. 627.736(5)(e)1., if the
1443	insured notifies the insurer of a billing error, the insured may
1444	be entitled to a certain percentage of a reduction in the amount
1445	paid by the insured's motor vehicle insurer.
1446	(c)  A notice that solicitation of a person injured in a
1447	motor vehicle crash for purposes of filing personal injury
1448	protection or tort claims could be a violation of s. 817.234, s
1449	817.505, or the rules regulating The Florida Bar and should be
1450	immediately reported to the Division of Insurance Fraud if such
1451	conduct has taken place.
1452	Section 16.  Section 627.7405, Florida Statutes, is amended
1453	to read:
1454	627.7405  Insurers' right of reimbursement.-Notwithstanding
1455	any other provisions of the no-fault law ss. 627.730-627.7405,
1456	any insurer providing personal injury protection benefits on a
1457	private passenger motor vehicle has shall have, to the extent of
1458	any personal injury protection benefits paid to any person as a
1459	benefit arising out of such private passenger motor vehicle
1460	insurance, a right of reimbursement against the owner or the
1461	insurer of the owner of a commercial motor vehicle, if the
1462	benefits paid result from such person having been an occupant of
1463	the commercial motor vehicle or having been struck by the
1464	commercial motor vehicle while not an occupant of any self-
1465	propelled vehicle.
1466	Section 17.  Subsection (1) of section 627.7407, Florida
1467	Statutes, is amended to read:
1468	627.7407  Application of the Florida Motor Vehicle No-Fault
1469	Law.-
1470	(1)  Any person subject to the requirements of ss. 627.730-
1471	627.7405, the Florida Motor Vehicle No-Fault Law, as revived and
1472	amended by this act, must maintain security for personal injury
1473	protection as required by the Florida Motor Vehicle No-Fault
1474	Law, as revived and amended by this act, beginning on January 1,
1475	2008.
1476	Section 18.  Paragraph (d) of subsection (2) and paragraph
1477	(d) of subsection (3) of section 628.909, Florida Statutes, are
1478	amended to read:
1479	628.909  Applicability of other laws.-
1480	(2)  The following provisions of the Florida Insurance Code
1481	shall apply to captive insurers who are not industrial insured
1482	captive insurers to the extent that such provisions are not
1483	inconsistent with this part:
1484	(d)  Sections 627.730-627.7407 627.730-627.7405, when no-
1485	fault coverage is provided.
1486	(3)  The following provisions of the Florida Insurance Code
1487	shall apply to industrial insured captive insurers to the extent
1488	that such provisions are not inconsistent with this part:
1489	(d)  Sections 627.730-627.7407 627.730-627.7405 when no-
1490	fault coverage is provided.
1491	Section 19.  This act shall take effect July 1, 2011.

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