Bill Text: FL H1411 | 2011 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Status: (Introduced - Dead) 2011-05-07 - Indefinitely postponed and withdrawn from consideration [H1411 Detail]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

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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; creating s. 626.9894, F.S.; providing definitions;
12	authorizing the Division of Insurance Fraud to establish a
13	direct-support organization for the purpose of
14	prosecuting, investigating, and preventing motor vehicle
15	insurance fraud; providing requirements for the
16	organization and the organization's contract with the
17	division; providing for a board of directors; authorizing
18	the organization to use the division's property and
19	facilities subject to certain requirements; authorizing
20	contributions from insurers; providing that any moneys
21	received by the organization may be held in a separate
22	depository account in the name of the organization;
23	requiring the division to deposit certain proceeds into
24	the Insurance Regulatory Trust Fund; amending s. 627.730,
25	F.S.; conforming a cross-reference; amending s. 627.731,
26	F.S.; providing legislative intent with respect to the
27	Florida Motor Vehicle No-Fault Law; amending s. 627.732,
28	F.S.; defining the terms "claimant" and "no-fault law";
29	amending s. 627.736, F.S.; conforming a cross-reference;
30	requiring certain entities providing medical services to
31	document that they meet required criteria; revising
32	requirements relating to the form that must be submitted
33	by providers; requiring an entity or clinic to file a new
34	form within a specified period after the date of a change
35	of ownership; revising provisions relating to when payment
36	for a benefit is due; providing that the time period for
37	paying or denying a claim is tolled during the
38	investigation of a fraudulent insurance act; specifying
39	when benefits are not payable; providing that a claimant
40	that violates certain provisions is not entitled to any
41	payment, regardless of whether a portion of the claim may
42	be legitimate; authorizing an insurer to recover payments
43	and bring a cause of action to recover payments;
44	forbidding a physician, hospital, clinic, or other medical
45	institution that fails to comply with certain provisions
46	from billing the injured person or the insured; providing
47	that an insurer has a right to conduct reasonable
48	investigations of claims; authorizing an insurer to
49	require a claimant to provide certain records; revising
50	the insurer's reimbursement limitation; deleting an
51	obsolete provision; revising requirements relating to
52	discovery; authorizing an insurer to conduct examinations
53	of claimants under oath or sworn statement; requiring the
54	provider to produce persons having the most knowledge in
55	specified circumstances; providing that an insurer that
56	requests an examination under oath without a reasonable
57	basis is engaging in an unfair and deceptive trade
58	practice; authorizing the insurer to conduct a physical
59	review of the treatment location; authorizing an insurer
60	to contract with a preferred provider network; authorizing
61	an insurer to provide a premium discount to an insured who
62	selects a preferred provider; authorizing an insurance
63	policy not to pay for nonemergency services performed by a
64	nonpreferred provider in specified circumstances;
65	authorizing an insurer to contract with a health insurer
66	in specified circumstances; amending s. 817.234, F.S.;
67	conforming a cross-reference; providing civil penalties
68	for criminal acts that result in the unlawful receipt of
69	insurance proceeds from a motor vehicle insurance
70	contract; amending ss. 324.021, 456.057, 627.7295,
71	627.733, 627.734, 627.737, 627.7401, 627.7405, 627.7407,
72	and 628.909, F.S.; conforming cross-references; providing
73	an effective date.
74
75	Be It Enacted by the Legislature of the State of Florida:
76
77	Section 1.  (1)  SHORT TITLE.-This act may be cited as the
78	"Comprehensive Insurance Fraud Investigation and Prevention
79	Act."
80	(2)  FINDINGS AND INTENT.-The Legislature intends to
81	balance the insured's interest in prompt payment of valid claims
82	for insurance benefits under the no-fault law with the public's
83	interest in reducing fraud, abuse, and overuse of the no-fault
84	system. To that end, the Legislature intends that the
85	investigation and prevention of fraudulent insurance acts in
86	this state be enhanced, that additional sanctions for such acts
87	be imposed, and that the no-fault law be revised to remove
88	incentives for fraudulent insurance acts. The Legislature
89	intends that the no-fault law be construed according to the
90	plain language of the statutory provisions, which are designed
91	to meet these goals.
92	(a)  The Legislature finds that:
93	1.  Motor vehicle insurance fraud remains a major problem
94	for state consumers and insurers. According to the National
95	Insurance Crime Bureau, in recent years this state has been
96	among those states that have the highest number of fraudulent
97	and questionable claims.
98	2.  The current regulatory process for health care clinics
99	under part X of chapter 400, Florida Statutes, which was
100	originally enacted to reduce motor vehicle insurance fraud, is
101	not adequately preventing fraudulent insurance acts with respect
102	to licensure exemptions and compliance with that part.
103	(b)  The Legislature intends that:
104	1.  Insurers properly investigate claims, and as such, this
105	act clarifies that insurers are allowed to obtain examinations
106	under oath and sworn statements from any claimant seeking no-
107	fault insurance benefits and to request mental and physical
108	examinations of persons seeking personal injury protection
109	coverage or benefits.
110	2.  Any false, misleading, or otherwise fraudulent activity
111	associated with a claim render the entire claim invalid. An
112	insurer must be able to raise fraud as a defense to a claim for
113	no-fault insurance benefits irrespective of any prior
114	adjudication of guilt or determination of fraud by the
115	Department of Financial Services.
116	3.  Insurers toll the payment or denial of a claim with
117	respect to any portion of a claim for which the insurer has a
118	reasonable belief that a fraudulent insurance act, as defined in
119	s. 626.989 or s. 817.234, Florida Statutes, has been committed.
120	4.  Insurers discover the names of all passengers involved
121	in a motor vehicle crash before paying claims or benefits
122	pursuant to an insurance policy governed by the no-fault law. A
123	rebuttable presumption must be established that a person was not
124	involved in the event giving rise to the claim if that person's
125	name does not appear on the police report.
126	Section 2.  Subsection (1) of section 316.066, Florida
127	Statutes, is amended to read:
128	316.066  Written reports of crashes.-
129	(1)(a)  A Florida Traffic Crash Report, Long Form, must is
130	required to be completed and submitted to the department within
131	10 days after completing an investigation is completed by the
132	every law enforcement officer who in the regular course of duty
133	investigates a motor vehicle crash:
134	1.  That resulted in death of, or personal injury to, or
135	any indication of complaints of pain or discomfort by any of the
136	parties or passengers involved in the crash;
137	2.  That involved one or more passengers, other than the
138	drivers of the vehicles, in any of the vehicles involved in the
139	crash;.
140	3.2.  That involved a violation of s. 316.061(1) or s.
141	316.193; or.
142	4.3.  In which a vehicle was rendered inoperative to a
143	degree that required a wrecker to remove it from traffic, if
144	such action is appropriate, in the officer's discretion.
145	(b)  The long form must include:
146	1.  The date, time, and location of the crash.
147	2.  A description of the vehicles involved.
148	3.  The names and addresses of the parties involved.
149	4.  The names and addresses of witnesses.
150	5.  The name, badge number, and law enforcement agency of
151	the officer investigating the crash.
152	6.  The names of the insurance companies for the respective
153	parties involved in the crash.
154	7.  The names and addresses of all passengers in all
155	vehicles involved in the crash, each clearly identified as being
156	a passenger, including the identification of the vehicle in
157	which each was a passenger.
158	(c)(b)  In every crash for which a Florida Traffic Crash
159	Report, Long Form, is not required by this section, the law
160	enforcement officer may complete a short-form crash report or
161	provide a short-form crash report to be completed by each party
162	involved in the crash. The short-form report must include all of
163	the items listed in subparagraphs (b)1.-6. Short-form crash
164	reports prepared by the law enforcement officer shall be
165	maintained by the officer's agency.:
166	1.  The date, time, and location of the crash.
167	2.  A description of the vehicles involved.
168	3.  The names and addresses of the parties involved.
169	4.  The names and addresses of witnesses.
170	5.  The name, badge number, and law enforcement agency of
171	the officer investigating the crash.
172	6.  The names of the insurance companies for the respective
173	parties involved in the crash.
174	(d)(c)  Each party to the crash must shall provide the law
175	enforcement officer with proof of insurance, which must to be
176	included in the crash report. If a law enforcement officer
177	submits a report on the accident, proof of insurance must be
178	provided to the officer by each party involved in the crash. Any
179	party who fails to provide the required information commits a
180	noncriminal traffic infraction, punishable as a nonmoving
181	violation as provided in chapter 318, unless the officer
182	determines that due to injuries or other special circumstances
183	such insurance information cannot be provided immediately. If
184	the person provides the law enforcement agency, within 24 hours
185	after the crash, proof of insurance that was valid at the time
186	of the crash, the law enforcement agency may void the citation.
187	(e)(d)  The driver of a vehicle that was in any manner
188	involved in a crash resulting in damage to any vehicle or other
189	property in an amount of $500 or more, which crash was not
190	investigated by a law enforcement agency, shall, within 10 days
191	after the crash, submit a written report of the crash to the
192	department or traffic records center. The entity receiving the
193	report may require witnesses of the crash crashes to render
194	reports and may require any driver of a vehicle involved in the
195	a crash of which a written report must be made as provided in
196	this section to file supplemental written reports if whenever
197	the original report is deemed insufficient by the receiving
198	entity.
199	(f)  The investigating law enforcement officer may testify
200	at trial or provide a signed affidavit to confirm or supplement
201	the information included on the long-form or short-form report.
202	(e)  Short-form crash reports prepared by law enforcement
203	shall be maintained by the law enforcement officer's agency.
204	Section 3.  Subsection (6) is added to section 400.991,
205	Florida Statutes, to read:
206	400.991  License requirements; background screenings;
207	prohibitions.-
208	(6)  All forms that constitute part of the application for
209	licensure or exemption from licensure under this part must
210	contain the following statement:
211
212	INSURANCE FRAUD NOTICE.-Submitting a false,
213	misleading, or fraudulent application or other
214	document when applying for licensure as a health care
215	clinic, when seeking an exemption from licensure as a
216	health care clinic, or when demonstrating compliance
217	with part X of chapter 400, Florida Statutes, is a
218	criminal act under s. 817.234, Florida Statutes, or a
219	fraudulent insurance act as defined in s. 626.989,
220	Florida Statutes, subject to investigation by the
221	Division of Insurance Fraud, and is grounds for
222	discipline by the appropriate licensing board of the
223	Florida Department of Health.
224	Section 4.  Section 626.9894, Florida Statutes, is created
225	to read:
226	626.9894  Motor vehicle insurance fraud direct-support
227	organization.-
228	(1)  DEFINITIONS.-As used in this section, the term:
229	(a)  "Division" means the Division of Insurance Fraud of
230	the Department of Financial Services.
231	(b)  "Motor vehicle insurance fraud" means any act defined
232	as a "fraudulent insurance act" under s. 626.989 that relates to
233	the coverage of motor vehicle insurance as described in part XI
234	of chapter 627.
235	(c)  "Organization" means the direct-support organization
236	established under this section.
237	(2)  ORGANIZATION ESTABLISHED.-The division may establish a
238	direct-support organization, to be known as the "Fight Auto
239	Fraud Fund," whose sole purpose is to support the prosecution,
240	investigation, and prevention of motor vehicle insurance fraud.
241	The organization shall:
242	(a)  Be a not-for-profit corporation incorporated under
243	chapter 617 and approved by the Department of State.
244	(b)  Be organized and operated to conduct programs and
245	activities; to raise funds; to request and receive grants,
246	gifts, and bequests of money; to acquire, receive, hold, invest,
247	and administer, in its own name, securities, funds, objects of
248	value, or other real or personal property; and to make grants
249	and expenditures to or for the direct or indirect benefit of the
250	division, state attorneys' offices, the statewide prosecutor,
251	the Agency for Health Care Administration, and the Department of
252	Health, to the extent that such grants and expenditures are used
253	exclusively to advance the purpose of prosecuting,
254	investigating, or preventing motor vehicle insurance fraud.
255	Grants and expenditures may include the cost of salaries or
256	benefits of dedicated motor vehicle insurance fraud
257	investigators, prosecutors, or support personnel if such grants
258	and expenditures do not interfere with prosecutorial
259	independence or otherwise create conflicts of interest that
260	threaten the success of prosecutions.
261	(c)  Be determined by the division to operate in a manner
262	that promotes the goals of laws relating to motor vehicle
263	insurance fraud, that is in the best interest of the state, and
264	that is in accordance with the adopted goals and mission of the
265	division.
266	(d)  Use all of its grants and expenditures solely for the
267	purpose of preventing and decreasing motor vehicle insurance
268	fraud and not for the purpose of lobbying as defined in s.
269	11.045.
270	(e)  Be subject to an annual financial audit in accordance
271	with s. 215.981.
272	(3)  CONTRACT.-The organization shall operate under written
273	contract with the division. The contract must provide for:
274	(a)  Approval of the articles of incorporation and bylaws
275	of the organization by the division.
276	(b)  Submission of an annual budget for the approval of the
277	division.
278	(c)  Certification by the division that the direct-support
279	organization is complying with the terms of the contract and in
280	a manner consistent with the goals and purposes of the
281	department and in the best interest of the state. Such
282	certification must be made annually and reported in the official
283	minutes of a meeting of the organization.
284	(d)  Allocation of funds to address motor vehicle insurance
285	fraud.
286	(e)  Reversion of moneys and property held in trust by the
287	organization for motor vehicle insurance fraud prosecution,
288	investigation, and prevention to the division if the
289	organization is no longer approved to operate by the department
290	or if the organization ceases to exist, or to the state if the
291	division ceases to exist.
292	(f)  Specific criteria to be used by the organization's
293	board of directors to evaluate the effectiveness of funding used
294	to combat motor vehicle insurance fraud.
295	(g)  The fiscal year of the organization, which begins July
296	1 of each year and ends June 30 of the following year.
297	(h)  Disclosure of the material provisions of the contract,
298	and distinguishing between the department and the organization
299	to donors of gifts, contributions, or bequests, including
300	providing such disclosure on all promotional and fundraising
301	publications.
302	(4)  BOARD OF DIRECTORS.-The board of directors of the
303	organization shall consist of the following seven members:
304	(a)  The Chief Financial Officer, or his or her designee,
305	who shall serve as chair.
306	(b)  Two state attorneys, one of whom shall be appointed by
307	the Chief Financial Officer and one of whom shall be appointed
308	by the Attorney General.
309	(c)  Two representatives of motor vehicle insurers
310	appointed by the Chief Financial Officer.
311	(d)  Two representatives of local law enforcement agencies,
312	both of whom shall be appointed by the Chief Financial Officer.
313
314	The officer who appointed a member of the board may remove that
315	member for cause. The term of office of an appointed member may
316	not exceed 4 years and expires at the same time as the term of
317	the officer who appointed him or her or at such earlier time as
318	the member ceases to be qualified.
319	(5)  USE OF PROPERTY.-The department may authorize, without
320	charge, appropriate use of fixed property and facilities of the
321	division by the organization, subject to this subsection.
322	(a)  The department may prescribe by rule any condition
323	with which the organization must comply in order to use the
324	division's property or facilities.
325	(b)  The department may not authorize the use of the
326	division's property or facilities if the organization does not
327	provide equal membership and employment opportunities to all
328	persons regardless of race, religion, sex, age, or national
329	origin.
330	(c)  The department shall adopt rules prescribing the
331	procedures by which the organization is governed.
332	(6)  CONTRIBUTIONS.-Any contributions made by an insurer to
333	the organization shall be allowed as appropriate business
334	expenses for all regulatory purposes.
335	(7)  DEPOSITORY.-Any moneys received by the organization
336	may be held in a separate depository account in the name of the
337	organization and subject to the provisions of the contract with
338	the division.
339	(8)  DIVISION'S RECEIPT OF PROCEEDS.-If the division
340	receives proceeds from the organization, those proceeds shall be
341	deposited into the Insurance Regulatory Trust Fund.
342	Section 5.  Section 627.730, Florida Statutes, is amended
343	to read:
344	627.730  Florida Motor Vehicle No-Fault Law.-Sections
345	627.730-627.7407 627.730-627.7405 may be cited and known as the
346	"Florida Motor Vehicle No-Fault Law."
347	Section 6.  Section 627.731, Florida Statutes, is amended
348	to read:
349	627.731  Purpose; legislative intent.-
350	(1)  The purpose of the no-fault law ss. 627.730-627.7405
351	is to provide for medical, surgical, funeral, and disability
352	insurance benefits without regard to fault, and to require motor
353	vehicle insurance securing such benefits, for motor vehicles
354	required to be registered in this state and, with respect to
355	motor vehicle accidents, a limitation on the right to claim
356	damages for pain, suffering, mental anguish, and inconvenience.
357	(2)  The Legislature intends that the provisions,
358	schedules, and procedures authorized under the no-fault law be
359	implemented by the insurers offering policies pursuant to the
360	no-fault law. These provisions, schedules, and procedures have
361	full force and effect regardless of their express inclusion in
362	an insurance policy, and an insurer is not required to amend its
363	policy to implement and apply such provisions, schedules, or
364	procedures.
365	Section 7.  Section 627.732, Florida Statutes, is amended
366	to read:
367	627.732  Definitions.-As used in the no-fault law ss.
368	627.730-627.7405, the term:
369	(1)  "Broker" means any person not possessing a license
370	under chapter 395, chapter 400, chapter 429, chapter 458,
371	chapter 459, chapter 460, chapter 461, or chapter 641 who
372	charges or receives compensation for any use of medical
373	equipment and is not the 100-percent owner or the 100-percent
374	lessee of such equipment. For purposes of this section, such
375	owner or lessee may be an individual, a corporation, a
376	partnership, or any other entity and any of its 100-percent-
377	owned affiliates and subsidiaries. For purposes of this
378	subsection, the term "lessee" means a long-term lessee under a
379	capital or operating lease, but does not include a part-time
380	lessee. The term "broker" does not include a hospital or
381	physician management company whose medical equipment is
382	ancillary to the practices managed, a debt collection agency, or
383	an entity that has contracted with the insurer to obtain a
384	discounted rate for such services; or nor does the term include
385	a management company that has contracted to provide general
386	management services for a licensed physician or health care
387	facility and whose compensation is not materially affected by
388	the usage or frequency of usage of medical equipment or an
389	entity that is 100-percent owned by one or more hospitals or
390	physicians. The term "broker" does not include a person or
391	entity that certifies, upon request of an insurer, that:
392	(a)  It is a clinic licensed under ss. 400.990-400.995;
393	(b)  It is a 100-percent owner of medical equipment; and
394	(c)  The owner's only part-time lease of medical equipment
395	for personal injury protection patients is on a temporary basis,
396	not to exceed 30 days in a 12-month period, and such lease is
397	solely for the purposes of necessary repair or maintenance of
398	the 100-percent-owned medical equipment or pending the arrival
399	and installation of the newly purchased or a replacement for the
400	100-percent-owned medical equipment, or for patients for whom,
401	because of physical size or claustrophobia, it is determined by
402	the medical director or clinical director to be medically
403	necessary that the test be performed in medical equipment that
404	is open-style. The leased medical equipment may not cannot be
405	used by patients who are not patients of the registered clinic
406	for medical treatment of services. Any person or entity making a
407	false certification under this subsection commits insurance
408	fraud as defined in s. 817.234. However, the 30-day period
409	provided in this paragraph may be extended for an additional 60
410	days as applicable to magnetic resonance imaging equipment if
411	the owner certifies that the extension otherwise complies with
412	this paragraph.
413	(2)(7)  "Certify" means to swear or attest to being true or
414	represented in writing.
415	(3)  "Claimant" means the person, organization, or entity
416	seeking benefits, including all assignees.
417	(4)(12)  "Hospital" means a facility that, at the time
418	services or treatment were rendered, was licensed under chapter
419	395.
420	(5)(8)  "Immediate personal supervision," as it relates to
421	the performance of medical services by nonphysicians not in a
422	hospital, means that an individual licensed to perform the
423	medical service or provide the medical supplies must be present
424	within the confines of the physical structure where the medical
425	services are performed or where the medical supplies are
426	provided such that the licensed individual can respond
427	immediately to any emergencies if needed.
428	(6)(9)  "Incident," with respect to services considered as
429	incident to a physician's professional service, for a physician
430	licensed under chapter 458, chapter 459, chapter 460, or chapter
431	461, if not furnished in a hospital, means such services that
432	are must be an integral, even if incidental, part of a covered
433	physician's service.
434	(7)(10)  "Knowingly" means that a person, with respect to
435	information, has actual knowledge of the information,; acts in
436	deliberate ignorance of the truth or falsity of the
437	information,; or acts in reckless disregard of the information.,
438	and Proof of specific intent to defraud is not required.
439	(8)(11)  "Lawful" or "lawfully" means in substantial
440	compliance with all relevant applicable criminal, civil, and
441	administrative requirements of state and federal law related to
442	the provision of medical services or treatment.
443	(9)(2)  "Medically necessary" refers to a medical service
444	or supply that a prudent physician would provide for the purpose
445	of preventing, diagnosing, or treating an illness, injury,
446	disease, or symptom in a manner that is:
447	(a)  In accordance with generally accepted standards of
448	medical practice;
449	(b)  Clinically appropriate in terms of type, frequency,
450	extent, site, and duration; and
451	(c)  Not primarily for the convenience of the patient,
452	physician, or other health care provider.
453	(10)(3)  "Motor vehicle" means a any self-propelled vehicle
454	with four or more wheels that which is of a type both designed
455	and required to be licensed for use on the highways of this
456	state, and any trailer or semitrailer designed for use with such
457	vehicle, and includes:
458	(a)  A "private passenger motor vehicle," which is any
459	motor vehicle that which is a sedan, station wagon, or jeep-type
460	vehicle and, if not used primarily for occupational,
461	professional, or business purposes, a motor vehicle of the
462	pickup, panel, van, camper, or motor home type.
463	(b)  A "commercial motor vehicle," which is any motor
464	vehicle that which is not a private passenger motor vehicle.
465
466	The term "motor vehicle" does not include a mobile home or any
467	motor vehicle that which is used in mass transit, other than
468	public school transportation, and designed to transport more
469	than five passengers exclusive of the operator of the motor
470	vehicle and that which is owned by a municipality, a transit
471	authority, or a political subdivision of the state.
472	(11)(4)  "Named insured" means a person, usually the owner
473	of a vehicle, identified in a policy by name as the insured
474	under the policy.
475	(12)  "No-fault law" means the Florida Motor Vehicle No-
476	Fault Law, ss. 627.730-627.7407.
477	(13)(5)  "Owner" means a person who holds the legal title
478	to a motor vehicle; or, if in the event a motor vehicle is the
479	subject of a security agreement or lease with an option to
480	purchase with the debtor or lessee having the right to
481	possession, then the debtor or lessee is shall be deemed the
482	owner for the purposes of the no-fault law ss. 627.730-627.7405.
483	(14)(13)  "Properly completed" means providing truthful,
484	substantially complete, and substantially accurate responses as
485	to all material elements of to each applicable request for
486	information or statement by a means that may lawfully be
487	provided and that complies with this section, or as agreed by
488	the parties.
489	(15)(6)  "Relative residing in the same household" means a
490	relative of any degree by blood or by marriage who usually makes
491	her or his home in the same family unit, whether or not
492	temporarily living elsewhere.
493	(16)(15)  "Unbundling" means submitting an action that
494	submits a billing code that is properly billed under one billing
495	code, but that has been separated into two or more billing
496	codes, and would result in payment greater than the in amount
497	that than would be paid using one billing code.
498	(17)(14)  "Upcoding" means submitting an action that
499	submits a billing code that would result in payment greater than
500	the in amount that than would be paid using a billing code that
501	accurately describes the services performed. The term does not
502	include an otherwise lawful bill by a magnetic resonance imaging
503	facility, which globally combines both technical and
504	professional components, if the amount of the global bill is not
505	more than the components if billed separately; however, payment
506	of such a bill constitutes payment in full for all components of
507	such service.
508	Section 8.  Subsections (1), (3), and (4) of section
509	627.736, Florida Statutes, are amended, subsections (5) through
510	(16) of that section are renumbered as subsections (6) through
511	(17), respectively, a new subsection (5) is added to that
512	section, and present subsections (5), (6), (8), and (9),
513	paragraph (b) of present subsection (7), and present subsection
514	(16) of that section are amended, to read:
515	627.736  Required personal injury protection benefits;
516	exclusions; priority; claims.-
517	(1)  REQUIRED BENEFITS.-Every insurance policy complying
518	with the security requirements of s. 627.733 must shall provide
519	personal injury protection to the named insured, relatives
520	residing in the same household, persons operating the insured
521	motor vehicle, passengers in such motor vehicle, and other
522	persons struck by such motor vehicle and suffering bodily injury
523	while not an occupant of a self-propelled vehicle, subject to
524	the provisions of subsection (2) and paragraph (4)(g) (4)(e), to
525	a limit of $10,000 for loss sustained by any such person as a
526	result of bodily injury, sickness, disease, or death arising out
527	of the ownership, maintenance, or use of a motor vehicle as
528	follows:
529	(a)  Medical benefits.-Eighty percent of all reasonable
530	expenses for medically necessary medical, surgical, X-ray,
531	dental, and rehabilitative services, including prosthetic
532	devices, and for medically necessary ambulance, hospital, and
533	nursing services. However, the medical benefits shall provide
534	reimbursement only for such services and care that are lawfully
535	provided, supervised, ordered, or prescribed by a physician
536	licensed under chapter 458 or chapter 459, a dentist licensed
537	under chapter 466, or a chiropractic physician licensed under
538	chapter 460 or that are provided by any of the following persons
539	or entities:
540	1.  A hospital or ambulatory surgical center licensed under
541	chapter 395.
542	2.  A person or entity licensed under part III of chapter
543	401 that ss. 401.2101-401.45 that provides emergency
544	transportation and treatment.
545	3.  An entity wholly owned by one or more physicians
546	licensed under chapter 458 or chapter 459, chiropractic
547	physicians licensed under chapter 460, or dentists licensed
548	under chapter 466 or by such practitioner or practitioners and
549	the spouses, parents, children, or siblings spouse, parent,
550	child, or sibling of such that practitioner or those
551	practitioners.
552	4.  An entity wholly owned, directly or indirectly, by a
553	hospital or hospitals.
554	5.  A health care clinic licensed under part X of chapter
555	400 ss. 400.990-400.995 that is:
556	a.  Accredited by the Joint Commission on Accreditation of
557	Healthcare Organizations, the American Osteopathic Association,
558	the Commission on Accreditation of Rehabilitation Facilities, or
559	the Accreditation Association for Ambulatory Health Care, Inc.;
560	or
561	b.  A health care clinic that:
562	(I)  Has a medical director licensed under chapter 458,
563	chapter 459, or chapter 460;
564	(II)  Has been continuously licensed for more than 3 years
565	or is a publicly traded corporation that issues securities
566	traded on an exchange registered with the United States
567	Securities and Exchange Commission as a national securities
568	exchange; and
569	(III)  Provides at least four of the following medical
570	specialties:
571	(A)  General medicine.
572	(B)  Radiography.
573	(C)  Orthopedic medicine.
574	(D)  Physical medicine.
575	(E)  Physical therapy.
576	(F)  Physical rehabilitation.
577	(G)  Prescribing or dispensing outpatient prescription
578	medication.
579	(H)  Laboratory services.
580
581	If any services under this paragraph are provided by an entity
582	or clinic described in subparagraph 3., subparagraph 4., or
583	subparagraph 5., the entity or clinic must provide the insurer
584	at the initial submission of the claim with a form adopted by
585	the Department of Financial Services that documents that the
586	entity or clinic meets applicable criteria for such entity or
587	clinic and includes a sworn statement or affidavit to that
588	effect. Any change in ownership requires the filing of a new
589	form within 10 days after the date of the change in ownership.
590	The Financial Services Commission shall adopt by rule the form
591	that must be used by an insurer and a health care provider
592	specified in subparagraph 3., subparagraph 4., or subparagraph
593	5. to document that the health care provider meets the criteria
594	of this paragraph, which rule must include a requirement for a
595	sworn statement or affidavit.
596	(b)  Disability benefits.-Sixty percent of any loss of
597	gross income and loss of earning capacity per individual from
598	inability to work proximately caused by the injury sustained by
599	the injured person, plus all expenses reasonably incurred in
600	obtaining from others ordinary and necessary services in lieu of
601	those that, but for the injury, the injured person would have
602	performed without income for the benefit of his or her
603	household. All disability benefits payable under this paragraph
604	must provision shall be paid at least not less than every 2
605	weeks.
606	(c)  Death benefits.-Death benefits equal to the lesser of
607	$5,000 or the remainder of unused personal injury protection
608	benefits per individual. The insurer may pay such benefits to
609	the executor or administrator of the deceased, to any of the
610	deceased's relatives by blood, or legal adoption, or connection
611	by marriage, or to any person appearing to the insurer to be
612	equitably entitled thereto.
613
614	Only insurers writing motor vehicle liability insurance in this
615	state may provide the required benefits of this section, and no
616	such insurers may not insurer shall require the purchase of any
617	other motor vehicle coverage other than the purchase of property
618	damage liability coverage as required by s. 627.7275 as a
619	condition for providing such required benefits. Insurers may not
620	require that property damage liability insurance in an amount
621	greater than $10,000 be purchased in conjunction with personal
622	injury protection. Such insurers shall make benefits and
623	required property damage liability insurance coverage available
624	through normal marketing channels. An Any insurer writing motor
625	vehicle liability insurance in this state who fails to comply
626	with such availability requirement as a general business
627	practice violates shall be deemed to have violated part IX of
628	chapter 626, and such violation constitutes shall constitute an
629	unfair method of competition or an unfair or deceptive act or
630	practice involving the business of insurance. An; and any such
631	insurer committing such violation is shall be subject to the
632	penalties afforded in such part, as well as those that are which
633	may be afforded elsewhere in the insurance code.
634	(3)  INSURED'S RIGHTS TO RECOVERY OF SPECIAL DAMAGES IN
635	TORT CLAIMS.-An No insurer shall not have a lien on any recovery
636	in tort by judgment, settlement, or otherwise for personal
637	injury protection benefits, whether suit has been filed or
638	settlement has been reached without suit. An injured party who
639	is entitled to bring suit under the no-fault law provisions of
640	ss. 627.730-627.7405, or his or her legal representative, shall
641	have no right to recover any damages for which personal injury
642	protection benefits are paid or payable. The plaintiff may prove
643	all of his or her special damages notwithstanding this
644	limitation, but if special damages are introduced in evidence,
645	the trier of facts, whether judge or jury, shall not award
646	damages for personal injury protection benefits paid or payable.
647	In all cases in which a jury is required to fix damages, the
648	court shall instruct the jury that the plaintiff shall not
649	recover such special damages for personal injury protection
650	benefits paid or payable.
651	(4)  BENEFITS; WHEN DUE.-Benefits due from an insurer under
652	the no-fault law are ss. 627.730-627.7405 shall be primary,
653	except that benefits received under any workers' compensation
654	law shall be credited against the benefits provided by
655	subsection (1) and are shall be due and payable as loss accrues,
656	upon the receipt of reasonable proof of such loss and the amount
657	of expenses and loss incurred that which are covered by the
658	policy issued under the no-fault law ss. 627.730-627.7405. If
659	When the Agency for Health Care Administration provides, pays,
660	or becomes liable for medical assistance under the Medicaid
661	program related to injury, sickness, disease, or death arising
662	out of the ownership, maintenance, or use of a motor vehicle,
663	the benefits are under ss. 627.730-627.7405 shall be subject to
664	the provisions of the Medicaid program.
665	(a)  An insurer may require written notice to be given as
666	soon as practicable after an accident involving a motor vehicle
667	with respect to which the policy affords the security required
668	by the no-fault law ss. 627.730-627.7405.
669	(b)  Personal injury protection insurance benefits paid
670	pursuant to this section are shall be overdue if not paid within
671	30 days after the insurer is furnished written notice of the
672	fact of a covered loss and of the amount of same. If such
673	written notice is not furnished to the insurer as to the entire
674	claim, any partial amount supported by written notice is overdue
675	if not paid within 30 days after such written notice is
676	furnished to the insurer. Any part or all of the remainder of
677	the claim that is subsequently supported by written notice is
678	overdue if not paid within 30 days after such written notice is
679	furnished to the insurer.
680	(c)  If When an insurer pays only a portion of a claim or
681	rejects a claim, the insurer shall provide at the time of the
682	partial payment or rejection an itemized specification of each
683	item that the insurer had reduced, omitted, or declined to pay
684	and any information that the insurer desires the claimant to
685	consider related to the medical necessity of the denied
686	treatment or to explain the reasonableness of the reduced
687	charge, provided that this does shall not limit the introduction
688	of evidence at trial.; and The insurer must shall include the
689	name and address of the person to whom the claimant should
690	respond and a claim number to be referenced in future
691	correspondence.
692	(d)  A However, notwithstanding the fact that written
693	notice has been furnished to the insurer, Any payment is shall
694	not be deemed overdue if when the insurer has reasonable proof
695	to establish that the insurer is not responsible for the
696	payment. For the purpose of calculating the extent to which any
697	benefits are overdue, payment shall be treated as being made on
698	the date a draft or other valid instrument which is equivalent
699	to payment was placed in the United States mail in a properly
700	addressed, postpaid envelope or, if not so posted, on the date
701	of delivery. This paragraph does not preclude or limit the
702	ability of the insurer to assert that the claim is was
703	unrelated, was not medically necessary, or was unreasonable, or
704	submitted that the amount of the charge was in excess of that
705	permitted under, or in violation of, subsection (6) (5). Such
706	assertion by the insurer may be made at any time, including
707	after payment of the claim or after the 30-day time period for
708	payment set forth in this paragraph (b). The 30-day period for
709	payment or denial is tolled with respect to any portion of a
710	claim for which the insurer has a reasonable belief that a
711	fraudulent insurance act as defined in s. 626.989 has been
712	committed while the insurer investigates such act. The insurer
713	must notify the claimant in writing that it is investigating a
714	fraudulent insurance act within 30 days after the date it has a
715	reasonable belief that such act has been committed. The insurer
716	must pay or deny the claim, in full or in part, within 120 days
717	after the date the written notice of the fact of a covered loss
718	and of the amount of the loss was provided to the insurer.
719	(e)(c)  Upon receiving notice of an accident that is
720	potentially covered by personal injury protection benefits, the
721	insurer must reserve $5,000 of personal injury protection
722	benefits for payment to physicians licensed under chapter 458 or
723	chapter 459 or dentists licensed under chapter 466 who provide
724	emergency services and care, as defined in s. 395.002(9), or who
725	provide hospital inpatient care. The amount required to be held
726	in reserve may be used only to pay claims from such physicians
727	or dentists until 30 days after the date the insurer receives
728	notice of the accident. After the 30-day period, any amount of
729	the reserve for which the insurer has not received notice of
730	such a claim from a physician or dentist who provided emergency
731	services and care or who provided hospital inpatient care may
732	then be used by the insurer to pay other claims. The time
733	periods specified in paragraph (b) for required payment of
734	personal injury protection benefits are shall be tolled for the
735	period of time that an insurer is required by this paragraph to
736	hold payment of a claim that is not from a physician or dentist
737	who provided emergency services and care or who provided
738	hospital inpatient care to the extent that the personal injury
739	protection benefits not held in reserve are insufficient to pay
740	the claim. This paragraph does not require an insurer to
741	establish a claim reserve for insurance accounting purposes.
742	(f)(d)  All overdue payments shall bear simple interest at
743	the rate established under s. 55.03 or the rate established in
744	the insurance contract, whichever is greater, for the year in
745	which the payment became overdue, calculated from the date the
746	insurer was furnished with written notice of the amount of
747	covered loss. Interest is shall be due at the time payment of
748	the overdue claim is made.
749	(g)(e)  The insurer of the owner of a motor vehicle shall
750	pay personal injury protection benefits for:
751	1.  Accidental bodily injury sustained in this state by the
752	owner while occupying a motor vehicle, or while not an occupant
753	of a self-propelled vehicle if the injury is caused by physical
754	contact with a motor vehicle.
755	2.  Accidental bodily injury sustained outside this state,
756	but within the United States of America or its territories or
757	possessions or Canada, by the owner while occupying the owner's
758	motor vehicle.
759	3.  Accidental bodily injury sustained by a relative of the
760	owner residing in the same household, under the circumstances
761	described in subparagraph 1. or subparagraph 2. if, provided the
762	relative at the time of the accident is domiciled in the owner's
763	household and is not himself or herself the owner of a motor
764	vehicle with respect to which security is required under the no-
765	fault law ss. 627.730-627.7405.
766	4.  Accidental bodily injury sustained in this state by any
767	other person while occupying the owner's motor vehicle or, if a
768	resident of this state, while not an occupant of a self-
769	propelled vehicle, if the injury is caused by physical contact
770	with such motor vehicle and if, provided the injured person is
771	not himself or herself:
772	a.  The owner of a motor vehicle with respect to which
773	security is required under the no-fault law ss. 627.730-
774	627.7405; or
775	b.  Entitled to personal injury benefits from the insurer
776	of the owner or owners of such a motor vehicle.
777	(h)(f)  If two or more insurers are liable to pay personal
778	injury protection benefits for the same injury to any one
779	person, the maximum payable is shall be as specified in
780	subsection (1), and any insurer paying the benefits is shall be
781	entitled to recover from each of the other insurers an equitable
782	pro rata share of the benefits paid and expenses incurred in
783	processing the claim.
784	(i)(g)  It is a violation of the insurance code for an
785	insurer to fail to timely provide benefits as required by this
786	section with such frequency as to constitute a general business
787	practice.
788	(j)(h)  Benefits are shall not be due or payable to or on
789	the behalf of a claimant who: an insured person if that person
790	has
791	1.  Submits a false or misleading statement, document,
792	record, or bill;
793	2.  Submits any other false or misleading information; or
794	3.  Has otherwise committed or attempted to commit a
795	fraudulent insurance act as defined in s. 626.989.
796
797	A claimant who violates this paragraph is not entitled to any
798	personal injury protection benefits or payment for any bills and
799	services, regardless of whether a portion of the claim may be
800	legitimate.
801	(k)  Notwithstanding any remedies afforded by law, the
802	insurer may recover from a claimant who has violated paragraph
803	(j) any sums previously paid to the claimant and may bring any
804	available common law and statutory causes of action committed,
805	by a material act or omission, any insurance fraud relating to
806	personal injury protection coverage under his or her policy, if
807	the fraud is admitted to in a sworn statement by the insured or
808	if it is established in a court of competent jurisdiction. If a
809	physician, hospital, clinic, or other medical institution
810	violates paragraph (j), the injured party is not liable for, and
811	the physician, hospital, clinic, or other medical institution
812	may not bill the insured for, charges that are unpaid because of
813	failure to comply with paragraph (j). Any agreement requiring
814	the injured person or insured to pay for such charges is
815	unenforceable. Any insurance fraud shall void all coverage
816	arising from the claim related to such fraud under the personal
817	injury protection coverage of the insured person who committed
818	the fraud, irrespective of whether a portion of the insured
819	person's claim may be legitimate, and any benefits paid prior to
820	the discovery of the insured person's insurance fraud shall be
821	recoverable by the insurer from the person who committed
822	insurance fraud in their entirety. The prevailing party is
823	entitled to its costs and attorney's fees in any action in which
824	it prevails in an insurer's action to enforce its right of
825	recovery under this paragraph.
826	(5)  INSURER INVESTIGATIONS.-An insurer has the right and
827	duty to conduct a reasonable investigation of a claim. In the
828	course of the investigation, the insurer may require the
829	insured, claimant, or medical provider to provide copies of the
830	treatment and examination records so that the insurer can
831	provide such records to a physician for a records review. A
832	records review need not be based on a physical examination and
833	may be obtained at any time, including after reduction or denial
834	of the claim. The 30-day period for payment under paragraph
835	(4)(b) is tolled from the date the insurer sends its request for
836	treatment records to the date that the insurer receives the
837	treatment records. The claim may be denied or reduced if the
838	medical provider fails to keep adequate records such that the
839	insurer is unable to obtain a records review.
840	(6)(5)  CHARGES FOR TREATMENT OF INJURED PERSONS.-
841	(a)1.  Any physician, hospital, clinic, or other person or
842	institution lawfully rendering treatment to an injured person
843	for a bodily injury covered by personal injury protection
844	insurance may charge the insurer and injured party only an a
845	reasonable amount pursuant to this section for the services and
846	supplies rendered, and the insurer providing such coverage may
847	pay for such charges directly to such person or institution
848	lawfully rendering such treatment, if the insured receiving such
849	treatment or his or her guardian has countersigned the properly
850	completed invoice, bill, or claim form approved by the office
851	upon which such charges are to be paid for as having actually
852	been rendered, to the best knowledge of the insured or his or
853	her guardian. In no event, However, may such a charge may not
854	exceed be in excess of the amount the person or institution
855	customarily charges for like services or supplies. When
856	determining With respect to a determination of whether a charge
857	for a particular service, treatment, or otherwise is reasonable,
858	consideration may be given to evidence of usual and customary
859	charges and payments accepted by the provider involved in the
860	dispute, and reimbursement levels in the community and various
861	federal and state medical fee schedules applicable to automobile
862	and other insurance coverages, and other information relevant to
863	the reasonableness of the reimbursement for the service,
864	treatment, or supply.
865	1.2.  The insurer may limit reimbursement to 80 percent of
866	the following schedule of maximum charges:
867	a.  For emergency transport and treatment by providers
868	licensed under chapter 401, 200 percent of Medicare.
869	b.  For emergency services and care provided by a hospital
870	licensed under chapter 395, 75 percent of the hospital's usual
871	and customary charges.
872	c.  For emergency services and care as defined by s.
873	395.002(9) provided in a facility licensed under chapter 395
874	rendered by a physician or dentist, and related hospital
875	inpatient services rendered by a physician or dentist, the usual
876	and customary charges in the community.
877	d.  For hospital inpatient services, other than emergency
878	services and care, 200 percent of the Medicare Part A
879	prospective payment applicable to the specific hospital
880	providing the inpatient services.
881	e.  For hospital outpatient services, other than emergency
882	services and care, 200 percent of the Medicare Part A Ambulatory
883	Payment Classification for the specific hospital providing the
884	outpatient services.
885	f.  For all other medical services, supplies, and care, 200
886	percent of the allowable amount under the participating
887	physicians schedule of Medicare Part B. However, if such
888	services, supplies, or care is not reimbursable under Medicare
889	Part B, the insurer may limit reimbursement to 80 percent of the
890	maximum reimbursable allowance under workers' compensation, as
891	determined under s. 440.13 and rules adopted thereunder which
892	are in effect at the time such services, supplies, or care is
893	provided. Services, supplies, or care that is not reimbursable
894	under Medicare or workers' compensation is not required to be
895	reimbursed by the insurer.
896	2.3.  For purposes of subparagraph 1. 2., the applicable
897	fee schedule or payment limitation under Medicare is the fee
898	schedule or payment limitation in effect on January 1 of the
899	year in which at the time the services, supplies, or care was
900	rendered and for the area in which such services were rendered,
901	notwithstanding any subsequent changes made to such fee schedule
902	or payment limitation, except that it may not be less than the
903	allowable amount under the participating physicians schedule of
904	Medicare Part B for 2007 for medical services, supplies, and
905	care subject to Medicare Part B.
906	3.4.  Subparagraph 1. 2. does not allow the insurer to
907	apply any limitation on the number of treatments or other
908	utilization limits that apply under Medicare or workers'
909	compensation. An insurer that applies the allowable payment
910	limitations of subparagraph 1. 2. must reimburse a provider who
911	lawfully provided care or treatment under the scope of his or
912	her license, regardless of whether such provider is would be
913	entitled to reimbursement under Medicare due to restrictions or
914	limitations on the types or discipline of health care providers
915	who may be reimbursed for particular procedures or procedure
916	codes.
917	4.5.  If an insurer limits payment as authorized by
918	subparagraph 1. 2., the person providing such services,
919	supplies, or care may not bill or attempt to collect from the
920	insured any amount in excess of such limits, except for amounts
921	that are not covered by the insured's personal injury protection
922	coverage due to the coinsurance amount or maximum policy limits.
923	(b)1.  An insurer or insured is not required to pay a claim
924	or charges:
925	a.  Made by a broker or by a person making a claim on
926	behalf of a broker;
927	b.  For any service or treatment that was not lawful at the
928	time rendered;
929	c.  To any person who knowingly submits a false or
930	misleading statement relating to the claim or charges;
931	d.  With respect to a bill or statement that does not
932	substantially meet the applicable requirements of paragraphs (c)
933	and paragraph (d);
934	e.  For any treatment or service that is upcoded, or that
935	is unbundled if when such treatment or services should be
936	bundled, in accordance with paragraph (d). To facilitate prompt
937	payment of lawful services, an insurer may change codes that it
938	determines to have been improperly or incorrectly upcoded or
939	unbundled, and may make payment based on the changed codes,
940	without affecting the right of the provider to dispute the
941	change by the insurer if, provided that before doing so, the
942	insurer contacts must contact the health care provider and
943	discusses discuss the reasons for the insurer's change and the
944	health care provider's reason for the coding, or makes make a
945	reasonable good faith effort to do so, as documented in the
946	insurer's file; and
947	f.  For medical services or treatment billed by a physician
948	and not provided in a hospital unless such services are rendered
949	by the physician or are incident to his or her professional
950	services and are included on the physician's bill, including
951	documentation verifying that the physician is responsible for
952	the medical services that were rendered and billed.
953	2.  The Department of Health, in consultation with the
954	appropriate professional licensing boards, shall adopt, by rule,
955	a list of diagnostic tests deemed not to be medically necessary
956	for use in the treatment of persons sustaining bodily injury
957	covered by personal injury protection benefits under this
958	section. The initial list shall be adopted by January 1, 2004,
959	and shall be revised from time to time as determined by the
960	Department of Health, in consultation with the respective
961	professional licensing boards. Inclusion of a test on the list
962	must of invalid diagnostic tests shall be based on lack of
963	demonstrated medical value and a level of general acceptance by
964	the relevant provider community and may shall not be dependent
965	for results entirely upon subjective patient response.
966	Notwithstanding its inclusion on a fee schedule in this
967	subsection, an insurer or insured is not required to pay any
968	charges or reimburse claims for any invalid diagnostic test as
969	determined by the Department of Health.
970	(c)1.  With respect to any treatment or service, other than
971	medical services billed by a hospital or other provider for
972	emergency services as defined in s. 395.002 or inpatient
973	services rendered at a hospital-owned facility, the statement of
974	charges must be furnished to the insurer by the provider and may
975	not include, and the insurer is not required to pay, charges for
976	treatment or services rendered more than 35 days before the
977	postmark date or electronic transmission date of the statement,
978	except for past due amounts previously billed on a timely basis
979	under this paragraph, and except that, if the provider submits
980	to the insurer a notice of initiation of treatment within 21
981	days after its first examination or treatment of the claimant,
982	the statement may include charges for treatment or services
983	rendered up to, but not more than, 75 days before the postmark
984	date of the statement. The injured party is not liable for, and
985	the provider may shall not bill the injured party for, charges
986	that are unpaid because of the provider's failure to comply with
987	this paragraph. Any agreement requiring the injured person or
988	insured to pay for such charges is unenforceable.
989	1.2.  If, however, the insured fails to furnish the
990	provider with the correct name and address of the insured's
991	personal injury protection insurer, the provider has 35 days
992	from the date the provider obtains the correct information to
993	furnish the insurer with a statement of the charges. The insurer
994	is not required to pay for such charges unless the provider
995	includes with the statement documentary evidence that was
996	provided by the insured during the 35-day period demonstrating
997	that the provider reasonably relied on erroneous information
998	from the insured and either:
999	a.  A denial letter from the incorrect insurer; or
1000	b.  Proof of mailing, which may include an affidavit under
1001	penalty of perjury, reflecting timely mailing to the incorrect
1002	address or insurer.
1003	2.3.  For emergency services and care as defined in s.
1004	395.002 rendered in a hospital emergency department or for
1005	transport and treatment rendered by an ambulance provider
1006	licensed pursuant to part III of chapter 401, the provider is
1007	not required to furnish the statement of charges within the time
1008	periods established by this paragraph,; and the insurer is shall
1009	not be considered to have been furnished with notice of the
1010	amount of covered loss for purposes of paragraph (4)(b) until it
1011	receives a statement complying with paragraph (d), or copy
1012	thereof, which specifically identifies the place of service to
1013	be a hospital emergency department or an ambulance in accordance
1014	with billing standards recognized by the Centers for Medicare
1015	and Medicaid Services (CMS) Health Care Finance Administration.
1016	3.4.  Each notice of the insured's rights under s. 627.7401
1017	must include the following statement in type no smaller than 12
1018	points:
1019
1020	BILLING REQUIREMENTS.-Florida Statutes provide that
1021	with respect to any treatment or services, other than
1022	certain hospital and emergency services, the statement
1023	of charges furnished to the insurer by the provider
1024	may not include, and the insurer and the injured party
1025	are not required to pay, charges for treatment or
1026	services rendered more than 35 days before the
1027	postmark date of the statement, except for past due
1028	amounts previously billed on a timely basis, and
1029	except that, if the provider submits to the insurer a
1030	notice of initiation of treatment within 21 days after
1031	its first examination or treatment of the claimant,
1032	the first billing cycle statement may include charges
1033	for treatment or services rendered up to, but not more
1034	than, 75 days before the postmark date of the
1035	statement.
1036
1037	(d)  All statements and bills for medical services rendered
1038	by any physician, hospital, clinic, or other person or
1039	institution shall be submitted to the insurer on a properly
1040	completed Centers for Medicare and Medicaid Services (CMS) 1500
1041	form, UB 92 forms, or any other standard form approved by the
1042	office or adopted by the commission for purposes of this
1043	paragraph. All billings for such services rendered by providers
1044	must shall, to the extent applicable, follow the Physicians'
1045	Current Procedural Terminology (CPT) or Healthcare Correct
1046	Procedural Coding System (HCPCS), or ICD-9 in effect for the
1047	year in which services are rendered and comply with the Centers
1048	for Medicare and Medicaid Services (CMS) 1500 form instructions
1049	and the American Medical Association Current Procedural
1050	Terminology (CPT) Editorial Panel and Healthcare Correct
1051	Procedural Coding System (HCPCS). All providers other than
1052	hospitals shall include on the applicable claim form the
1053	professional license number of the provider in the line or space
1054	provided for "Signature of Physician or Supplier, Including
1055	Degrees or Credentials." In determining compliance with
1056	applicable CPT and HCPCS coding, guidance shall be provided by
1057	the Physicians' Current Procedural Terminology (CPT) or the
1058	Healthcare Correct Procedural Coding System (HCPCS) in effect
1059	for the year in which services were rendered, the Office of the
1060	Inspector General (OIG), Physicians Compliance Guidelines, and
1061	other authoritative treatises designated by rule by the Agency
1062	for Health Care Administration. A No statement of medical
1063	services may not include charges for medical services of a
1064	person or entity that performed such services without possessing
1065	the valid licenses required to perform such services. For
1066	purposes of paragraph (4)(b), an insurer is shall not be
1067	considered to have been furnished with notice of the amount of
1068	covered loss or medical bills due unless the statements or bills
1069	comply with this paragraph, and unless the statements or bills
1070	are properly completed in their entirety as to all material
1071	provisions, with all relevant information being provided
1072	therein.
1073	(e)1.  At the initial treatment or service provided, each
1074	physician, other licensed professional, clinic, or other medical
1075	institution providing medical services upon which a claim for
1076	personal injury protection benefits is based shall require an
1077	insured person, or his or her guardian, to execute a disclosure
1078	and acknowledgment form, which reflects at a minimum that:
1079	a.  The insured, or his or her guardian, must countersign
1080	the form attesting to the fact that the services set forth
1081	therein were actually rendered;
1082	b.  The insured, or his or her guardian, has both the right
1083	and affirmative duty to confirm that the services were actually
1084	rendered;
1085	c.  The insured, or his or her guardian, was not solicited
1086	by any person to seek any services from the medical provider;
1087	d.  The physician, other licensed professional, clinic, or
1088	other medical institution rendering services for which payment
1089	is being claimed explained the services to the insured or his or
1090	her guardian; and
1091	e.  If the insured notifies the insurer in writing of a
1092	billing error, the insured may be entitled to a certain
1093	percentage of a reduction in the amounts paid by the insured's
1094	motor vehicle insurer.
1095	2.  The physician, other licensed professional, clinic, or
1096	other medical institution rendering services for which payment
1097	is being claimed has the affirmative duty to explain the
1098	services rendered to the insured, or his or her guardian, so
1099	that the insured, or his or her guardian, countersigns the form
1100	with informed consent.
1101	3.  Countersignature by the insured, or his or her
1102	guardian, is not required for the reading of diagnostic tests or
1103	other services that are of such a nature that they are not
1104	required to be performed in the presence of the insured.
1105	4.  The licensed medical professional rendering treatment
1106	for which payment is being claimed must sign, by his or her own
1107	hand, the form complying with this paragraph.
1108	5.  The original completed disclosure and acknowledgment
1109	form is shall be furnished to the insurer pursuant to paragraph
1110	(4)(b) and may not be electronically furnished.
1111	6.  This disclosure and acknowledgment form is not required
1112	for services billed by a provider for emergency services as
1113	defined in s. 395.002, for emergency services and care as
1114	defined in s. 395.002 rendered in a hospital emergency
1115	department, or for transport and treatment rendered by an
1116	ambulance provider licensed pursuant to part III of chapter 401.
1117	7.  The Financial Services Commission shall adopt, by rule,
1118	a standard disclosure and acknowledgment form to that shall be
1119	used to fulfill the requirements of this paragraph, effective 90
1120	days after such form is adopted and becomes final. The
1121	commission shall adopt a proposed rule by October 1, 2003. Until
1122	the rule is final, the provider may use a form of its own which
1123	otherwise complies with the requirements of this paragraph.
1124	8.  As used in this paragraph, the term "countersigned" or
1125	"countersignature" means a second or verifying signature, as on
1126	a previously signed document, and is not satisfied by the
1127	statement "signature on file" or any similar statement.
1128	9.  The requirements of this paragraph apply only with
1129	respect to the initial treatment or service of the insured by a
1130	provider. For subsequent treatments or service, the provider
1131	must maintain a patient log signed by the patient, in
1132	chronological order by date of service, that is consistent with
1133	the services being rendered to the patient as claimed. The
1134	requirements of this subparagraph for maintaining a patient log
1135	signed by the patient may be met by a hospital that maintains
1136	medical records as required by s. 395.3025 and applicable rules
1137	and makes such records available to the insurer upon request.
1138	(f)  Upon written notification by any person, an insurer
1139	shall investigate any claim of improper billing by a physician
1140	or other medical provider. The insurer shall determine if the
1141	insured was properly billed for only those services and
1142	treatments that the insured actually received. If the insurer
1143	determines that the insured has been improperly billed, the
1144	insurer shall notify the insured, the person making the written
1145	notification, and the provider of its findings and shall reduce
1146	the amount of payment to the provider by the amount determined
1147	to be improperly billed. If a reduction is made due to such
1148	written notification by any person, the insurer shall pay to the
1149	person 20 percent of the amount of the reduction, up to $500. If
1150	the provider is arrested due to the improper billing, then the
1151	insurer shall pay to the person 40 percent of the amount of the
1152	reduction, up to $500.
1153	(g)  An insurer may not systematically downcode with the
1154	intent to deny reimbursement otherwise due. Such action
1155	constitutes a material misrepresentation under s.
1156	626.9541(1)(i)2.
1157	(7)(6)  DISCOVERY OF FACTS ABOUT AN INJURED PERSON;
1158	DISPUTES.-
1159	(a)  An insurer may require a claimant to submit to an
1160	examination under oath or sworn statement as often as reasonably
1161	requested by an insurer and at any reasonable location
1162	designated by the insurer. Submission to an examination under
1163	oath or sworn statement is a condition precedent to recovery or
1164	filing suit. The insurer is not liable for benefits under the
1165	no-fault law if the claimant fails to fully and truthfully
1166	answer all questions asked or violates any provision of
1167	paragraph (4)(j).
1168	1.  The insurer may conduct the examination outside the
1169	presence of any other person seeking coverage.
1170	2.  If an insurer requests an examination of a claimant
1171	that is in a hospital, clinic, or other medical institution,
1172	such claimant shall produce the persons with the most knowledge
1173	relating to the issues set forth by the insurer in the notice of
1174	examination.
1175	3.  The claimant must provide the insurer at the
1176	examination with all documents, papers, receipts, invoices,
1177	bills, records, or other tangible items requested by the
1178	insurer.
1179	4.  The examination may be recorded by audio, video, or
1180	court report or any combination thereof. The claimant may record
1181	the examination at the claimant's expense.
1182	5.  The claimant may have an attorney present at the
1183	examination at the claimant's expense.
1184	6.  An insurer that unreasonably requests an examination
1185	without a reasonable basis as a general business practice is
1186	engaging in an unfair insurance trade practice pursuant to s.
1187	626.9541.
1188	(a)  Every employer shall, if a request is made by an
1189	insurer providing personal injury protection benefits under ss.
1190	627.730-627.7405 against whom a claim has been made, furnish
1191	forthwith, in a form approved by the office, a sworn statement
1192	of the earnings, since the time of the bodily injury and for a
1193	reasonable period before the injury, of the person upon whose
1194	injury the claim is based.
1195	(b)  Every physician, hospital, clinic, or other medical
1196	institution providing, before or after bodily injury upon which
1197	a claim for personal injury protection insurance benefits is
1198	based, any products, services, or accommodations in relation to
1199	that or any other injury, or in relation to a condition claimed
1200	to be connected with that or any other injury, shall, if
1201	requested to do so by the insurer against whom the claim has
1202	been made, permit the insurer or the insurer's representative to
1203	conduct an onsite physical review and examination of the
1204	treatment location, treatment apparatuses, diagnostic devices,
1205	and any other medical equipment used for the services rendered
1206	within 10 days after the insurer's request and furnish forthwith
1207	a written report of the history, condition, treatment, dates,
1208	and costs of such treatment of the injured person and why the
1209	items identified by the insurer were reasonable in amount and
1210	medically necessary, together with a sworn statement that the
1211	treatment or services rendered were reasonable and necessary
1212	with respect to the bodily injury sustained and identifying
1213	which portion of the expenses for such treatment or services was
1214	incurred as a result of such bodily injury, and produce
1215	forthwith, and permit the inspection and copying of, his or her
1216	or its records regarding such history, condition, treatment,
1217	dates, and costs of treatment if; provided that this does shall
1218	not limit the introduction of evidence at trial. Such sworn
1219	statement must shall read as follows: "Under penalty of perjury,
1220	I declare that I have read the foregoing, and the facts alleged
1221	are true, to the best of my knowledge and belief." A No cause of
1222	action for violation of the physician-patient privilege or
1223	invasion of the right of privacy may not be brought shall be
1224	permitted against any physician, hospital, clinic, or other
1225	medical institution complying with the provisions of this
1226	section. The person requesting such records and such sworn
1227	statement shall pay all reasonable costs connected therewith. If
1228	an insurer makes a written request for documentation or
1229	information under this paragraph within 30 days after having
1230	received notice of the amount of a covered loss under paragraph
1231	(4)(a), the amount or the partial amount that which is the
1232	subject of the insurer's inquiry is shall become overdue if the
1233	insurer does not pay in accordance with paragraph (4)(b) or
1234	within 10 days after the insurer's receipt of the requested
1235	documentation or information, whichever occurs later. For
1236	purposes of this paragraph, the term "receipt" includes, but is
1237	not limited to, inspection and copying pursuant to this
1238	paragraph. An Any insurer that requests documentation or
1239	information pertaining to reasonableness of charges or medical
1240	necessity under this paragraph without a reasonable basis for
1241	such requests as a general business practice is engaging in an
1242	unfair trade practice under the insurance code.
1243	(c)  If a request is made by an insurer, an employer must
1244	furnish, in a form approved by the office, a sworn statement of
1245	the earnings of the person upon whose injury a claim is based
1246	since the time of the bodily injury and for a reasonable period
1247	before the injury.
1248	(d)(c)  If there is a In the event of any dispute regarding
1249	an insurer's right to discovery of facts under this section, the
1250	insurer may petition the a court of competent jurisdiction to
1251	enter an order permitting such discovery. The order may be made
1252	only on motion for good cause shown and upon notice to all
1253	persons having an interest, and must it shall specify the time,
1254	place, manner, conditions, and scope of the discovery. The Such
1255	court may, in order to protect against annoyance, embarrassment,
1256	or oppression, as justice requires, enter an order refusing
1257	discovery or specifying conditions of discovery and may order
1258	payments of costs and expenses of the proceeding, including
1259	reasonable fees for the appearance of attorneys at the
1260	proceedings, as justice requires.
1261	(8)(7)  MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON;
1262	REPORTS.-
1263	(b)  If requested by the person examined, a party causing
1264	an examination to be made shall deliver to him or her a copy of
1265	every written report concerning the examination rendered by an
1266	examining physician, at least one of which reports must set out
1267	the examining physician's findings and conclusions in detail.
1268	After such request and delivery, the party causing the
1269	examination to be made is entitled, upon request, to receive
1270	from the person examined every written report available to him
1271	or her or his or her representative concerning any examination,
1272	previously or thereafter made, of the same mental or physical
1273	condition. By requesting and obtaining a report of the
1274	examination so ordered, or by taking the deposition of the
1275	examiner, the person examined waives any privilege he or she may
1276	have, in relation to the claim for benefits, regarding the
1277	testimony of every other person who has examined, or may
1278	thereafter examine, him or her in respect to the same mental or
1279	physical condition. If a person unreasonably refuses to submit
1280	to an examination, the personal injury protection carrier is no
1281	longer liable for subsequent personal injury protection benefits
1282	incurred after the date of the first request for examination.
1283	Failure to appear for an examination raises a rebuttable
1284	presumption that such failure was unreasonable. Submission to an
1285	examination is a condition precedent to the recovery of
1286	benefits.
1287	(9)(8)  APPLICABILITY OF PROVISION REGULATING ATTORNEY'S
1288	FEES.-With respect to any dispute under the provisions of ss.
1289	627.730-627.7405 between the insured and the insurer under the
1290	no-fault law, or between an assignee of an insured's rights and
1291	the insurer, the provisions of s. 627.428 applies shall apply,
1292	except as provided in subsections (11) and (16) (10) and (15).
1293	(10)(9)  PREFERRED PROVIDERS.-An insurer may negotiate and
1294	enter into contracts with preferred licensed health care
1295	providers for the benefits described in this section, referred
1296	to in this section as "preferred providers," which shall include
1297	health care providers licensed under chapter chapters 458,
1298	chapter 459, chapter 460, chapter 461, or chapter and 463.
1299	(a)  The insurer may provide an option to an insured to use
1300	a preferred provider at the time of purchase of the policy for
1301	personal injury protection benefits, if the requirements of this
1302	subsection are met. However, if the insurer offers a preferred
1303	provider option, it must also offer a nonpreferred provider
1304	policy. If the insured elects to use a provider who is not a
1305	preferred provider, whether the insured purchased a preferred
1306	provider policy or a nonpreferred provider policy, the medical
1307	benefits provided by the insurer shall be as required by this
1308	section.
1309	(b)  If the insured elects the to use a provider who is a
1310	preferred provider option, the insurer may pay medical benefits
1311	in excess of the benefits required by this section and may waive
1312	or lower the amount of any deductible that applies to such
1313	medical benefits. As an alternative, or in addition to such
1314	benefits, waiver, or reduction, the insurer may provide an
1315	actuarially appropriate premium discount as specified in an
1316	approved rate filing to an insured who selects the preferred
1317	provider option. If the preferred provider option provides a
1318	premium discount, the policy may provide that charges for
1319	nonemergency services provided within this state are payable
1320	only if performed by members of the preferred provider network
1321	unless there is no member of the preferred provider network
1322	located within 15 miles of the insured's place of residence
1323	whose scope of practice includes the required services. If the
1324	insurer offers a preferred provider policy to a policyholder or
1325	applicant, it must also offer a nonpreferred provider policy.
1326	(c)  The insurer shall provide each insured policyholder
1327	with a current roster of preferred providers in the county in
1328	which the insured resides at the time of purchasing purchase of
1329	such policy, and shall make such list available for public
1330	inspection during regular business hours at the insurer's
1331	principal office of the insurer within the state. The insurer
1332	may contract with another health insurer for the right to use an
1333	existing preferred provider network to implement the preferred
1334	provider option. Any other arrangement is subject to the
1335	approval of the Office of Insurance Regulation.
1336	(17)(16)  SECURE ELECTRONIC DATA TRANSFER.-If all parties
1337	mutually and expressly agree, a notice, documentation,
1338	transmission, or communication of any kind required or
1339	authorized under the no-fault law ss. 627.730-627.7405 may be
1340	transmitted electronically if it is transmitted by secure
1341	electronic data transfer that is consistent with state and
1342	federal privacy and security laws.
1343	Section 9.  Paragraph (c) of subsection (7) of section
1344	817.234, Florida Statutes, is amended, present subsection (12)
1345	of that section is renumbered as subsection (13), and a new
1346	subsection (12) is added to that section, to read:
1347	817.234  False and fraudulent insurance claims.-
1348	(7)
1349	(c)  An insurer, or any person acting at the direction of
1350	or on behalf of an insurer, may not change an opinion in a
1351	mental or physical report prepared under s. 627.736(8)
1352	627.736(7) or direct the physician preparing the report to
1353	change such opinion; however, this provision does not preclude
1354	the insurer from calling to the attention of the physician
1355	errors of fact in the report based upon information in the claim
1356	file. Any person who violates this paragraph commits a felony of
1357	the third degree, punishable as provided in s. 775.082, s.
1358	775.083, or s. 775.084.
1359	(12)  In addition to any criminal liability, a person
1360	convicted of violating any provision of this section for the
1361	purpose of receiving insurance proceeds from a motor vehicle
1362	insurance contract is subject to a civil penalty.
1363	(a)  Except for a violation of subsection (9), the civil
1364	penalty shall be:
1365	1.  A fine up to $5,000 for a first offense.
1366	2.  A fine greater than $5,000, but not to exceed $10,000,
1367	for a second offense.
1368	3.  A fine greater than $10,000, but not to exceed $15,000,
1369	for a third or subsequent offense.
1370	(b)  The civil penalty for a violation of subsection
1371	(9)_must be at least $15,000 but may not exceed $50,000.
1372	(c)  The civil penalty shall be paid to the Insurance
1373	Regulatory Trust Fund within the Department of Financial
1374	Services and used by the department for the investigation and
1375	prosecution of insurance fraud.
1376	(d)  This subsection does not prohibit a state attorney
1377	from entering into a written agreement in which the person
1378	charged with the violation does not admit to or deny the charges
1379	but consents to payment of the civil penalty.
1380	Section 10.  Subsection (1) of section 324.021, Florida
1381	Statutes, is amended to read:
1382	324.021  Definitions; minimum insurance required.-The
1383	following words and phrases when used in this chapter shall, for
1384	the purpose of this chapter, have the meanings respectively
1385	ascribed to them in this section, except in those instances
1386	where the context clearly indicates a different meaning:
1387	(1)  MOTOR VEHICLE.-Every self-propelled vehicle that which
1388	is designed and required to be licensed for use upon a highway,
1389	including trailers and semitrailers designed for use with such
1390	vehicles, except traction engines, road rollers, farm tractors,
1391	power shovels, and well drillers, and every vehicle that which
1392	is propelled by electric power obtained from overhead wires but
1393	not operated upon rails, but not including any bicycle or moped.
1394	However, the term does "motor vehicle" shall not include a any
1395	motor vehicle as defined in s. 627.732(3) if when the owner of
1396	such vehicle has complied with the no-fault law requirements of
1397	ss. 627.730-627.7405, inclusive, unless the provisions of s.
1398	324.051 apply; and, in such case, the applicable proof of
1399	insurance provisions of s. 320.02 apply.
1400	Section 11.  Paragraph (k) of subsection (2) of section
1401	456.057, Florida Statutes, is amended to read:
1402	456.057  Ownership and control of patient records; report
1403	or copies of records to be furnished.-
1404	(2)  As used in this section, the terms "records owner,"
1405	"health care practitioner," and "health care practitioner's
1406	employer" do not include any of the following persons or
1407	entities; furthermore, the following persons or entities are not
1408	authorized to acquire or own medical records, but are authorized
1409	under the confidentiality and disclosure requirements of this
1410	section to maintain those documents required by the part or
1411	chapter under which they are licensed or regulated:
1412	(k)  Persons or entities practicing under s. 627.736(8)
1413	627.736(7).
1414	Section 12.  Subsection (7) of section 627.7295, Florida
1415	Statutes, is amended to read:
1416	627.7295  Motor vehicle insurance contracts.-
1417	(7)  A policy of private passenger motor vehicle insurance
1418	or a binder for such a policy may be initially issued in this
1419	state only if the insurer or agent has collected from the
1420	insured an amount equal to 2 months' premium. An insurer, agent,
1421	or premium finance company may not, directly or indirectly, take
1422	any action resulting in the insured having paid from the
1423	insured's own funds an amount less than the 2 months' premium
1424	required by this subsection. This subsection applies without
1425	regard to whether the premium is financed by a premium finance
1426	company or is paid pursuant to a periodic payment plan of an
1427	insurer or an insurance agent. This subsection does not apply if
1428	an insured or member of the insured's family is renewing or
1429	replacing a policy or a binder for such policy written by the
1430	same insurer or a member of the same insurer group. This
1431	subsection does not apply to an insurer that issues private
1432	passenger motor vehicle coverage primarily to active duty or
1433	former military personnel or their dependents. This subsection
1434	does not apply if all policy payments are paid pursuant to a
1435	payroll deduction plan or an automatic electronic funds transfer
1436	payment plan from the policyholder, provided that the first
1437	policy payment is made by cash, cashier's check, check, or a
1438	money order. This subsection and subsection (4) do not apply if
1439	all policy payments to an insurer are paid pursuant to an
1440	automatic electronic funds transfer payment plan from an agent,
1441	a managing general agent, or a premium finance company and if
1442	the policy includes, at a minimum, personal injury protection
1443	pursuant to ss. 627.730-627.7407 627.730-627.7405; motor vehicle
1444	property damage liability pursuant to s. 627.7275; and bodily
1445	injury liability in at least the amount of $10,000 because of
1446	bodily injury to, or death of, one person in any one accident
1447	and in the amount of $20,000 because of bodily injury to, or
1448	death of, two or more persons in any one accident. This
1449	subsection and subsection (4) do not apply if an insured has had
1450	a policy in effect for at least 6 months, the insured's agent is
1451	terminated by the insurer that issued the policy, and the
1452	insured obtains coverage on the policy's renewal date with a new
1453	company through the terminated agent.
1454	Section 13.  Subsections (3) and (4) of section 627.733,
1455	Florida Statutes, are amended to read:
1456	627.733  Required security.-
1457	(3)  Such security shall be provided:
1458	(a)  By an insurance policy delivered or issued for
1459	delivery in this state by an authorized or eligible motor
1460	vehicle liability insurer which provides the benefits and
1461	exemptions contained in the no-fault law ss. 627.730-627.7405.
1462	Any policy of insurance represented or sold as providing the
1463	security required hereunder shall be deemed to provide insurance
1464	for the payment of the required benefits; or
1465	(b)  By any other method authorized by s. 324.031(2), (3),
1466	or (4) and approved by the Department of Highway Safety and
1467	Motor Vehicles as affording security equivalent to that afforded
1468	by a policy of insurance or by self-insuring as authorized by s.
1469	768.28(16). The person filing such security shall have all of
1470	the obligations and rights of an insurer under the no-fault law
1471	ss. 627.730-627.7405.
1472	(4)  An owner of a motor vehicle with respect to which
1473	security is required by this section who fails to have such
1474	security in effect at the time of an accident shall have no
1475	immunity from tort liability, but shall be personally liable for
1476	the payment of benefits under s. 627.736. With respect to such
1477	benefits, such an owner shall have all of the rights and
1478	obligations of an insurer under the no-fault law ss. 627.730-
1479	627.7405.
1480	Section 14.  Section 627.734, Florida Statutes, is amended
1481	to read:
1482	627.734  Proof of security; security requirements;
1483	penalties.-
1484	(1)  The provisions of chapter 324 that which pertain to
1485	the method of giving and maintaining proof of financial
1486	responsibility and that which govern and define a motor vehicle
1487	liability policy shall apply to filing and maintaining proof of
1488	security required by the no-fault law ss. 627.730-627.7405.
1489	(2)  Any person who:
1490	(a)  Gives information required in a report or otherwise as
1491	provided for in the no-fault law ss. 627.730-627.7405, knowing
1492	or having reason to believe that such information is false;
1493	(b)  Forges or, without authority, signs any evidence of
1494	proof of security; or
1495	(c)  Files, or offers for filing, any such evidence of
1496	proof, knowing or having reason to believe that it is forged or
1497	signed without authority,
1498
1499	commits is guilty of a misdemeanor of the first degree,
1500	punishable as provided in s. 775.082 or s. 775.083.
1501	Section 15.  Subsections (1), (2), and (3) of section
1502	627.737, Florida Statutes, are amended to read:
1503	627.737  Tort exemption; limitation on right to damages;
1504	punitive damages.-
1505	(1)  Every owner, registrant, operator, or occupant of a
1506	motor vehicle with respect to which security has been provided
1507	as required by the no-fault law ss. 627.730-627.7405, and every
1508	person or organization legally responsible for her or his acts
1509	or omissions, is hereby exempted from tort liability for damages
1510	because of bodily injury, sickness, or disease arising out of
1511	the ownership, operation, maintenance, or use of such motor
1512	vehicle in this state to the extent that the benefits described
1513	in s. 627.736(1) are payable for such injury, or would be
1514	payable but for any exclusion authorized by the no-fault law ss.
1515	627.730-627.7405, under any insurance policy or other method of
1516	security complying with the requirements of s. 627.733, or by an
1517	owner personally liable under s. 627.733 for the payment of such
1518	benefits, unless a person is entitled to maintain an action for
1519	pain, suffering, mental anguish, and inconvenience for such
1520	injury under the provisions of subsection (2).
1521	(2)  In any action of tort brought against the owner,
1522	registrant, operator, or occupant of a motor vehicle with
1523	respect to which security has been provided as required by the
1524	no-fault law ss. 627.730-627.7405, or against any person or
1525	organization legally responsible for her or his acts or
1526	omissions, a plaintiff may recover damages in tort for pain,
1527	suffering, mental anguish, and inconvenience because of bodily
1528	injury, sickness, or disease arising out of the ownership,
1529	maintenance, operation, or use of such motor vehicle only in the
1530	event that the injury or disease consists in whole or in part
1531	of:
1532	(a)  Significant and permanent loss of an important bodily
1533	function.
1534	(b)  Permanent injury within a reasonable degree of medical
1535	probability, other than scarring or disfigurement.
1536	(c)  Significant and permanent scarring or disfigurement.
1537	(d)  Death.
1538	(3)  When a defendant, in a proceeding brought pursuant to
1539	the no-fault law ss. 627.730-627.7405, questions whether the
1540	plaintiff has met the requirements of subsection (2), then the
1541	defendant may file an appropriate motion with the court, and the
1542	court shall, on a one-time basis only, 30 days before the date
1543	set for the trial or the pretrial hearing, whichever is first,
1544	by examining the pleadings and the evidence before it, ascertain
1545	whether the plaintiff will be able to submit some evidence that
1546	the plaintiff will meet the requirements of subsection (2). If
1547	the court finds that the plaintiff will not be able to submit
1548	such evidence, then the court shall dismiss the plaintiff's
1549	claim without prejudice.
1550	Section 16.  Subsection (1) of section 627.7401, Florida
1551	Statutes, is amended to read:
1552	627.7401  Notification of insured's rights.-
1553	(1)  The commission, by rule, shall adopt a form for the
1554	notification of insureds of their right to receive personal
1555	injury protection benefits under the Florida Motor Vehicle no-
1556	fault law. Such notice shall include:
1557	(a)  A description of the benefits provided by personal
1558	injury protection, including, but not limited to, the specific
1559	types of services for which medical benefits are paid,
1560	disability benefits, death benefits, significant exclusions from
1561	and limitations on personal injury protection benefits, when
1562	payments are due, how benefits are coordinated with other
1563	insurance benefits that the insured may have, penalties and
1564	interest that may be imposed on insurers for failure to make
1565	timely payments of benefits, and rights of parties regarding
1566	disputes as to benefits.
1567	(b)  An advisory informing insureds that:
1568	1.  Pursuant to s. 626.9892, the Department of Financial
1569	Services may pay rewards of up to $25,000 to persons providing
1570	information leading to the arrest and conviction of persons
1571	committing crimes investigated by the Division of Insurance
1572	Fraud arising from violations of s. 440.105, s. 624.15, s.
1573	626.9541, s. 626.989, or s. 817.234.
1574	2.  Pursuant to s. 627.736(6)(e)1. 627.736(5)(e)1., if the
1575	insured notifies the insurer of a billing error, the insured may
1576	be entitled to a certain percentage of a reduction in the amount
1577	paid by the insured's motor vehicle insurer.
1578	(c)  A notice that solicitation of a person injured in a
1579	motor vehicle crash for purposes of filing personal injury
1580	protection or tort claims could be a violation of s. 817.234, s
1581	817.505, or the rules regulating The Florida Bar and should be
1582	immediately reported to the Division of Insurance Fraud if such
1583	conduct has taken place.
1584	Section 17.  Section 627.7405, Florida Statutes, is amended
1585	to read:
1586	627.7405  Insurers' right of reimbursement.-Notwithstanding
1587	any other provisions of the no-fault law ss. 627.730-627.7405,
1588	any insurer providing personal injury protection benefits on a
1589	private passenger motor vehicle has shall have, to the extent of
1590	any personal injury protection benefits paid to any person as a
1591	benefit arising out of such private passenger motor vehicle
1592	insurance, a right of reimbursement against the owner or the
1593	insurer of the owner of a commercial motor vehicle, if the
1594	benefits paid result from such person having been an occupant of
1595	the commercial motor vehicle or having been struck by the
1596	commercial motor vehicle while not an occupant of any self-
1597	propelled vehicle.
1598	Section 18.  Subsection (1) of section 627.7407, Florida
1599	Statutes, is amended to read:
1600	627.7407  Application of the Florida Motor Vehicle No-Fault
1601	Law.-
1602	(1)  Any person subject to the requirements of ss. 627.730-
1603	627.7405, the Florida Motor Vehicle No-Fault Law, as revived and
1604	amended by this act, must maintain security for personal injury
1605	protection as required by the Florida Motor Vehicle No-Fault
1606	Law, as revived and amended by this act, beginning on January 1,
1607	2008.
1608	Section 19.  Paragraph (d) of subsection (2) and paragraph
1609	(d) of subsection (3) of section 628.909, Florida Statutes, are
1610	amended to read:
1611	628.909  Applicability of other laws.-
1612	(2)  The following provisions of the Florida Insurance Code
1613	shall apply to captive insurers who are not industrial insured
1614	captive insurers to the extent that such provisions are not
1615	inconsistent with this part:
1616	(d)  Sections 627.730-627.7407 627.730-627.7405, when no-
1617	fault coverage is provided.
1618	(3)  The following provisions of the Florida Insurance Code
1619	shall apply to industrial insured captive insurers to the extent
1620	that such provisions are not inconsistent with this part:
1621	(d)  Sections 627.730-627.7407 627.730-627.7405 when no-
1622	fault coverage is provided.
1623	Section 20.  This act shall take effect July 1, 2011.

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