SB 150 — Motor Vehicle Insurance

specifyingproviding requirementsinsurers anda procedurescivil relatingcause toof specifiedaction noticesagainst andcertain advisoriespersons who are convicted of or plead guilty or nolo contendre to insureds;certain acts of insurance fraud associated with claims for medical payments coverage benefits;

specifyingrequiring requirementsinsurers andreceiving proceduresnotice relatingof a claim to discoveryprovide ofa factsspecified aboutfraud anadvisory injurednotice personto andcertain disputes;persons;

definingproviding thethat termclaims “receipt”;generated as a result of certain patient brokering activities are nonreimbursable;

specifyingauthorizing requirements,notices, procedures,documentation, andtransmissions, prohibitionsor relatingcommunications to requiredbe mentaltransferred andelectronically physicalin examinationsa ofsecure injuredmanner; persons and physician reports;

defining the term “active practice”;

providing applicability of certain provisions regulating attorney fees;

specifying requirements and procedures for prelitigation demand letters to be provided to insurers;

requiring specified claims to be brought in a single civil action;

providing that an insurer engages in an unfair or deceptive practice if it fails, in a certain manner, to pay valid claims;

authorizing the Department of Legal Affairs to investigate and initiate certain actions;

providing construction relating to an insurer’s cause of action for insurance fraud;

specifying requirements for a fraud advisory notice provided by an insurer under certain circumstances;

providing construction relating to nonreimbursable claims;

authorizing certain notices, documentation, transmissions, or communications to be transferred electronically in a secure manner;

authorizing a medical payments insurer to include a certain right of subrogation provision in its policy;

requiring the Financial Services Commission to adopt rules;

providing applicability and construction;

revisingconforming theprovisions legalto liabilitychanges ofmade anby uninsuredthe motoristact; coverage insurer;

conforming a provision to changes made by the act;

conforming a provision to changes made by the act;

providing applicability and construction relating to thischanges made by the act;

194180 Be It Enacted by the Legislature of the State of Florida:

196182 Section 1. Sections 627.730, 627.731, 627.7311, 627.732, 627.733, 627.734, 627.736, 627.737, 627.739, 627.7401, 627.7403, and 627.7405, Florida Statutes, which comprise the Florida Motor Vehicle No-Fault Law, are repealed.

proof of security and display thereof.— (1) An(1) Any owner of a motor vehicle required to be registered in this state and an operator of a motor vehicle licensed in this state Any person required by s.

324.022 to maintain liability security for property damagedamage, liability security, required by s.

324.023 to maintain liability security for bodily injuryinjury, or death, or required by s.

300284 Under penalty of perjury, I ...(Name of insured)...

309293 Such affidavit must include the following warning:

311295 WARNING:

316300 If an application is made through a licensed motor vehicle dealer as required under s.

Section 7. Subsection7. Paragraph (3)(g) is added to subsection (1) of section 320.27, Florida Statutes, and subsection (3) of that section is amendedamended, to read:

320.27 Motor vehicle dealers.— (3) APPLICATION(1) DEFINITIONS.—The ANDfollowing FEE.—Thewords, applicationterms, forand thephrases licensewhen applicationused must shall be in suchthis formsection ashave may be prescribed by the departmentmeanings andrespectively isascribed shall be subject to suchthem rulesin withthis respectsubsection, theretoexcept aswhere maythe becontext soclearly prescribedindicates bya thedifferent departmentmeaning: it.

(g) “Garage liability insurance” means combined single limit liability coverage, including property damage and bodily injury liability coverage, in the amount of:

1. Beginning January 1, 2019, and continuing through December 31, 2020, at least $50,000.

2. Beginning January 1, 2021, and continuing through December 31, 2022, at least $60,000.

3. Beginning January 1, 2023 and thereafter, at least $70,000.

(3) APPLICATION AND FEE.—The application for the license application must shall be in such form as may be prescribed by the department and is shall be subject to such rules with respect thereto as may be so prescribed by the department it.

The applicant must furnish, including evidence, in a form approved by the department, that the applicant is insured under a garage liability insurance policy or a general liability insurance policy coupled with a business automobile policy having the garage liability insurance coverage required by this subsection, which shall include, at a minimum, $25,000 combined single-limit liability coverage including bodily injury and property damage protection and $10,000 personal injury protection.

Such policy must shall be for the license periodperiod, and mustevidence include,of at a minimum,new $70,000or combinedcontinued singlepolicy limitmust bodilyshall injurybe anddelivered propertyto damagethe liabilitydepartment coverageat that conforms to the requirementsbeginning of s.each license period.

324.151., and Evidence of a new or continued policy must shall be delivered to the department at the beginning of each license period.

An applicant for renewal shall pay to the department $75 for a 1-year renewal or $150 for a 2-year2 year renewal, in addition to any other fees required by law.

Each applicant, general partner in the case of a partnership, or corporate officer and director in the case of a corporate applicant,applicant shallshall, must file a set of fingerprints with the department for the purpose of determining any prior criminal record or any outstanding warrants.

(j) A statement that the applicant is insured under a garage liability insurance policy,policy whichin mustaccordance shallwith include,s. at a minimum, $70,000 $25,000 combined single-limit bodily injury and property damage liability coverage, including bodily injury and property damage protection, and $10,000 personal injury protection, if the applicant is to be licensed as a dealer in, or intends to sell, recreational vehicles.

464320.27(1)(g), Thewhich departmentshall shall,include, ifat ita deemsminimum, necessary,$25,000 causecombined ansingle-limit investigationliability tocoverage, beincluding madebodily toinjury ascertainand ifproperty thedamage factsprotection, set forth in the application are true and shall$10,000 notpersonal issueinjury aprotection, licenseif to the applicant untilis itto isbe satisfiedlicensed thatas thea factsdealer setin, forthor inintends theto applicationsell, arerecreational true.vehicles.

459 The department shall, if it deems necessary, cause an investigation to be made to ascertain if the facts set forth in the application are true and shall not issue a license to the applicant until it is satisfied that the facts set forth in the application are true.

Therefore, this chapter requires that ownersevery andowner operatorsor operator of a motor vehiclesvehicle required to be registered in this state establish, maintain, and it is required herein that the operator of a motor vehicle involved in a crash or convicted of certain traffic offenses meeting the operative provisions of s.

324.022 Financial responsibility requirements for property damage.— (1)(a) Every owner or operator of a motor vehicle required to be registered in this state and every operator of a motor vehicle who is licensed in this state shall establish and continuously maintain the ability to respond in damages for liability on account of accidents arising out of the ownership, maintenance, or use of the motor vehicle in the amount of:

1. At least $50,000 for every owner andor operator subject to the financial responsibility required in subparagraph (1)(a)1.

2. At least $60,000 for every owner andor operator subject to the financial responsibility required in subparagraph (1)(a)2.

3. At least $70,000 for every owner andor operator subject to the financial responsibility required in subparagraph (1)(a)3.

(a) “motor(a) “Motor vehicle” means any self-propelled vehicle that has four or more wheels and that is of a type designed and required to be licensed for use on the highways of this state, and any trailer or semitrailer designed for use with such vehicle.

(a)1. A1. A mobile home as defined in s.

(b)2. A2. A motor vehicle that is used in mass transit and designed to transport more than five passengers, exclusive of the operator of the motor vehicle, and that is owned by a municipality, transit authority, or political subdivision of the state.

(c)3. A3. A school bus as defined in s.

(d) A4. A commercial motor vehicle as defined in s.

(e) A5. A nonpublic sector bus, which shall maintain security as required under ss.

(f)4. A6.4. A vehicle providing for-hire passenger transportation vehicle, which that is subject to the provisions of s.

(g)5. A7.5. A personal delivery device as defined in s.

reinstatement.— (1)(a) Each insurer that has issued a policy providing medical payments coverage or personal injury protection coverage or property damage liability coverage shall report the cancellation or nonrenewal thereof to the department within 10 days after the processing date or effective date of each cancellation or nonrenewal.

Upon the issuance of a policy providing medical payments coverage or personal injury protection coverage or property damage liability coverage to a named insured not previously insured by the insurer during that calendar year, the insurer shall report the issuance of the new policy to the department within 10 days.

(2) The department shall suspend, after due notice and an opportunity to be heard, the registration and driver license of any owner or operator registrant of a motor vehicle for with respect to which security is required under s.

(a) The department’s records showing that the owner or operator registrant of such motor vehicle did not have the in full force and effect when required security in full force and effect that complies with the requirements of ss.

(1) An owner,owner lessee, or operatorlessee of a for-hire passenger transportation vehicle that is required to be registered in this state shall establish and continuously maintain the ability to respond in damages for liability on account of accidents arising out of the ownership, maintenance, or use of the for-hire passenger transportation vehicle, in the amount of:

(2) Except as provided in subsection (3), the requirements of this section must be met by the owner,owner lessee, or operatorlessee providing satisfactory evidence of holding a motor vehicle liability policy conforming to the requirements of s.

945938 Upon request by the department, the applicant shall must provide the department at the applicant’s principal place of business in this state access to the applicant’s underlying financial information and financial statements that provide the basis of the certified public accountant’s certification.

985978 No such policy or bond shall be effective under this subsection unless it contains limits of not less than those specified in s.

324.031 and upon payment to the department of a nonrefundable reinstatement fee asof specified$15. in s.

324.0221 of $15.

324.031(1) must, shall be issued to owners and or operators of motor vehicles under the following provisions:

The policy must and shall insure the person or persons owner named therein and any resident relative of a named insured other person as operator using such motor vehicle or motor vehicles with the express or implied permission of such owner against loss from the liability imposed by law for damage arising out of the ownership, maintenance, or use of any such motor vehicle exceptor motor vehicles within the United States or the Dominion of Canada, subject to limits, exclusive of interest and costs with respect to each such motor vehicle as otherwiseis provided infor thisunder section.s.

The policy must also insure any person operating an insured motor vehicle with the express or implied permission of a named insured against loss from the liability imposed by law for damage arising out of the use of such vehicle.

However, the insurer may include provisions in its policy excluding liability coverage for a motor vehicle not designated as an insured vehicle on the policy, if such motor vehicle does not qualify as a newly acquired vehicle, does not qualify as a temporary substitute vehicle, and was owned by an insured or was furnished for an insured’s regular use for more than 30 consecutive days before the event giving rise to the claim or motor vehicles within the United States or the Dominion of Canada, subject to limits, exclusive of interest and costs with respect to each such motor vehicle as is provided for under s.

(b) A(b) An motor vehicle liability insurance policy issued to a person who does not own a motor vehicle registered in this state and who is not already insured under a policy described in paragraph (a) must An operator’s motor vehicle liability policy of insurance must shall insure the person or persons named therein against loss from the liability imposed upon him or her by law for damages arising out of the use by the person of any motor vehicle not owned by him or her, unless the vehicle was furnished for the named insured’s regular use and was used by the named insured for more than 30 consecutive days before the event giving rise to the claim with the same territorial limits and subject to the same limits of liability as referred to above with respect to an owner’s policy of liability insurance.

The policies must insure all persons covered under the liability coverage against loss from the liability imposed by law for any litigation costs or attorney fees in any civil action defended by the insurer which arises out of the ownership, maintenance, or use of a motor vehicle for which there is liability coverage under the policy.

However, the policies may contain provisions excluding liability coverage for a vehicle being used outside of the United States or Canada at the time of the accident.

(3) As used in this section, the term:

(a) “Newly acquired vehicle” means a vehicle owned by a named insured or resident relative of the named insured which was acquired within 30 days before an accident.

(b) “Resident relative” means a person related to a named insured by any degree by blood, marriage, or adoption, including a ward or foster child, who usually makes his or her home in the same family unit as the named insured, whether or not he or she temporarily lives elsewhere.

(c) “Temporary substitute vehicle” means any motor vehicle as defined in s.

320.01(1) not owned by the named insured which is temporarily used with the permission of the owner as a substitute for the owned motor vehicle designated on the policy, when the owned vehicle is withdrawn from normal use because of breakdown, repair, servicing, loss, or destruction.

13661319 Notwithstanding this subsection, an entity shall be deemed a clinic and must be licensed under this part in order to receive medical payments coverage reimbursement under s.

627.7265(6)(h) s.

13791332 INSURANCE FRAUD NOTICE.—A person commits a fraudulent insurance act, as defined in s.

627.7265(9)627.7265 s.

627.736, intentionally submitting a claim, statement, or bill that has been “upcoded”upcoded. as defined in that section s.

As used in this paragraph, the term “upcoded” means an action that submits a billing code that would result in payment greater in amount than would be paid using a billing code that accurately describes the services performed.

The term does not include an otherwise lawful bill by a magnetic resonance imaging facility, which globally combines both technical and professional components, if the amount of the global bill is not more than the components if billed separately;

however, payment of such a bill constitutes payment in full for all components of such service “upcoded” as defined in s.

or h. Failing to clearly explain the nature of the requested information and the reasons why such information is necessary;necessary.

or.i. Failing to pay personal injury protection insurance claims within the time periods required by s.

i. Failing to pay personal injury protection insurance claims for benefits under medical payments coverage within the time periods required by s.

627.7265(5)(b) s.

18401800 “The valid and collectible liability insurance and medical payments coverage personal injury protection insurance of an any authorized rental or leasing driver is primary for the limits of liability and personal injury protection coverage and medical payments coverage required under ss.

medical payments coverage.— (1) DEFINITIONS.—As(1) MEDICAL usedPAYMENTS inCOVERAGE thisREQUIRED.—A section,motor thevehicle term:liability insurance policy that is furnished as proof of financial responsibility pursuant to s.

(a) “Broker” means a person who does not possess a license under chapter 395, chapter 400, chapter 429, chapter 458, chapter 459, chapter 460, chapter 461, or chapter 641;

who charges or receives compensation for any use of medical equipment;

and who is not the 100 percent owner or the 100 percent lessee of such equipment.

For purposes of this section, such owner or lessee may be an individual, a corporation, a partnership, or any other entity and any of its 100-percent owned affiliates and subsidiaries.

As used in this subsection, the term “lessee” means a long-term lessee under a capital or operating lease, but does not include a part-time lessee.

The term “broker” does not include a hospital or physician management company whose medical equipment is ancillary to the practices managed;

a debt collection agency;

an entity that has contracted with the insurer to obtain a discounted rate for such services;

a management company that has contracted to provide general management services for a licensed physician or health care facility and whose compensation is not materially affected by the usage or frequency of usage of medical equipment;

or an entity that is 100-percent-owned by one or more hospitals or physicians.

The term “broker” does not include a person or entity that certifies, upon request of an insurer, that:

1. It is a clinic licensed under ss.

400.990-400.995;

2. It is a 100-percent-owner of medical equipment;

and 3. The owner’s only part-time lease of medical equipment for medical payments coverage patients is on a temporary basis not to exceed 30 days in a 12-month period, and such lease is solely for the purposes of necessary repair or maintenance of the 100-percent-owned medical equipment or pending the arrival and installation of the newly purchased or a replacement for the 100-percent-owned medical equipment, or for patients for whom, because of physical size or claustrophobia, it is determined by the medical director or clinical director to be medically necessary that the test be performed in medical equipment that is open-style.

The leased medical equipment cannot be used by patients who are not patients of the registered clinic for medical treatment services.

Any person or entity making a false certification under this subsection commits insurance fraud as described in s.

817.234.

However, the 30-day period provided in this subparagraph may be extended for an additional 60 days as applicable to magnetic resonance imaging equipment, if the owner certifies that the extension otherwise complies with this subparagraph.

(b) “Entity wholly owned” means a proprietorship, group practice, partnership, or corporation that provides health care services rendered by licensed health care practitioners and in which licensed health care practitioners are the business owners of all aspects of the business entity, including, but not limited to, being reflected as the business owners on the title or lease of the physical facility, filing taxes as the business owners, being account holders on the entity’s bank account, being listed as the principals on all incorporation documents required by this state, and having ultimate authority over all personnel and compensation decisions relating to the entity.

However, this term does not include an entity that is wholly owned, directly or indirectly, by a hospital licensed under chapter 395.

(c) “Hospital” means a facility that, at the time medical care was rendered, was licensed under chapter 395.

(d) “Incident,” with respect to services considered as incident to a physician’s professional service for a physician licensed under chapter 458, chapter 459, chapter 460, or chapter 461, if not furnished in a hospital, means such services must be an integral, even if incidental, part of a covered physician’s service.

(e) “Knowingly” means a person has actual knowledge of information, acts in deliberate ignorance of the truth or falsity of the information, or acts in reckless disregard of the information.

Proof of specific intent to defraud is not required.

(f) “Lawful” or “lawfully” means in substantial compliance with all relevant applicable criminal, civil, and administrative requirements of state and federal law related to the provision of medical care.

(g) “Medical care” means any medical service, medical treatment, medical supply, medical transportation, prescription drug, or emergency services and care as defined in s.

395.002(9).

(h) “Medically necessary” means medical care that a prudent physician or other qualified health care professional would provide for the purpose of preventing, diagnosing, or treating an illness, injury, disease, or symptom in a manner that is:

1. In accordance with generally accepted standards of medical practice;

2. Clinically appropriate in terms of type, frequency, extent, site, and duration;

and 3. Not primarily for the convenience of the patient, physician, or other health care provider.

(i) “Motor vehicle” means a self-propelled vehicle with four or more wheels which is designed and required to be licensed for use on the highways of this state, and any trailer or semitrailer designed for use with such vehicle.

The term does not include:

1. A mobile home;

or 2. A motor vehicle that is used in mass transit, other than public school transportation;

that is designed to transport more than five passengers exclusive of the operator of the motor vehicle;

and that is owned by a municipality, a transit authority, or a political subdivision of the state.

(j) “Named insured” means a person identified in a policy by name as an insured under the policy.

(k) “Newly acquired vehicle” means a motor vehicle owned by a named insured or resident relative of the named insured which was acquired 30 or less days before an accident.

(l) “Properly completed” means providing truthful, substantially complete, and substantially accurate responses as to all material elements to each applicable request for information or for a statement, by a means that may lawfully be provided and that complies with this section or as agreed by the parties.

(m) “Resident relative” means a person related to a named insured by any degree by blood, marriage, or adoption, including a ward or foster child, who usually makes his or her home in the same family unit as the named insured, regardless of whether the resident relative temporarily lives elsewhere.

(n) “Temporary substitute vehicle” means a motor vehicle as defined in s.

320.01(1) which is not owned by the named insured and which is temporarily used with the permission of the owner as a substitute for the owned motor vehicle designated on the policy when the owned vehicle is withdrawn from normal use because of breakdown, repair, servicing, loss, or destruction.

(o) “Unbundled” means an action to submit a billing code that is properly billed under one billing code, but that has been separated into two or more billing codes, which would result in payment greater in amount than would be paid using one billing code.

(p) “Upcoded” means an action to submit a billing code that would result in payment greater in amount than would be paid using a billing code that accurately describes the services performed.

The term does not include an otherwise lawful bill by a magnetic resonance imaging facility, which globally combines both technical and professional components, if the amount of the global bill is not more than for the components if billed separately;

however, payment of such a bill constitutes payment in full for all components of such service.

(2) REQUIRED SECURITY.— (a) A motor vehicle liability insurance policy that is furnished as proof of financial responsibility pursuant to s.

The medical payments coverage must protect the named insured, resident relatives, persons operating the insured motor vehicle, passengers in the insured motor vehicle, and other persons who are struck by the insured motor vehicle and suffer bodily injury while not an occupant of a self-propelled motor vehicle, to a limit of at least $5,000 per person for medical expense incurred due to bodily injury, sickness, or disease arising out of the ownership, maintenance, or use of a motor vehicle.

(b) AnThe insurermedical maypayments notcoverage offermust medicalalso paymentsprovide coverageeach such person with a deductibledeath tobenefit anof applicantat orleast policyholder.$5,000.

(c) ThisThis section may not be construed to limit any other coverage made available by an insurer.

An insurer may not offer medical payments coverage with a deductible to an applicant or policyholder.

(2) REQUIRED BENEFITS.—Medical payments coverage must provide coverage for all of the following if medically necessary and the individual initially receives such treatment within 14 days after the motor vehicle accident:

(a) Emergency transport and treatment by a provider licensed under chapter 401.

(b) Emergency services and care provided by a hospital licensed under chapter 395.

(c) Emergency services and care as defined in s.

395.002, provided in a facility licensed under chapter 395 and rendered by a physician or dentist, and related hospital inpatient services rendered by a physician or dentist.

(d) Hospital inpatient services, other than emergency services and care.

(e) Hospital outpatient services, other than emergency services and care.

(f) Physician services and care provided by a physician licensed under chapter 458 or chapter 459 or a chiropractic physician licensed under chapter 460, or dental services and care provided by a dentist licensed under chapter 466.

(4) REQUIRED(4) PAYMENT OF BENEFITS.— (a) Medical(a) Benefits due from an insurer under medical payments coverage mustare provideprimary reimbursementto ofany medicallyhealth necessaryinsurance medical,benefit surgical,of X-ray,a dental,person andinjured rehabilitativein services,a includingmotor prostheticvehicle devicesaccident and ambulance,apply hospital,to andany nursingcoinsurance services,or ifdeductible theamount individualrequired receivesby initialthe servicesinjured andperson’s carehealth pursuantinsurance topolicy, subparagraphexcept 1.that:

within1. Benefits 14received daysunder afterany workers’ compensation law must be credited against medical payments coverage benefits, and are due and payable as losses accrue, upon reasonable proof of such losses and the motoramount vehicleof accident.expenses and losses incurred which are covered by the policy issued under this section.

Medical2. When the Agency for Health Care Administration provides, pays for, or becomes liable for medical assistance under the Medicaid program which is related to injury, sickness, disease, or death arising out of the ownership, maintenance, or use of a motor vehicle, medical payments coveragebenefits providesare reimbursementsubject onlyto for:the provisions of the Medicaid program, and, within 30 days after receiving notice that the Medicaid program paid such benefits, the insurer must repay the full amount of the benefits to the Medicaid program.

1. Initial(b) A servicesmedical andpayments careinsurance thatpolicy aremay lawfullyinclude provided,a supervised,provision ordered,allowing orsubrogation prescribedfor bymedical apayments physicianbenefits licensedpaid, underif chapterthe 458expenses orgiving chapterrise 459,to athe dentistpayments licensedwere undercaused chapterby 466,wrongful act or aomission chiropracticof physiciananother. licensed under chapter 460;

or(c) Upon receiving notice of an accident that areis providedpotentially incovered aby hospitalmedical orpayments incoverage abenefits, facilitythe thatinsurer owns,must reserve $2,500 of medical payments coverage benefits for payment to physicians licensed under chapter 458 or ischapter wholly459 ownedor by,dentists alicensed hospital.under chapter 466 who provide emergency services and care, as defined in s.

Initial services and care may also be provided by a person or entity licensed under part III of chapter 401 which provides emergency transportation and treatment.

2. Upon referral by a provider described in subparagraph 1., followup services and care consistent with the underlying medical diagnosis rendered pursuant to subparagraph 1.

which may be provided, supervised, ordered, or prescribed only by a physician licensed under chapter 458 or chapter 459;

a chiropractic physician licensed under chapter 460;

a dentist licensed under chapter 466;

or, to the extent permitted by applicable law and under the supervision of such physician, osteopathic physician, chiropractic physician, or dentist, by a physician assistant licensed under chapter 458 or chapter 459 or an advanced registered nurse practitioner licensed under chapter 464.

Followup services and care may also be provided by the following persons or entities:

a. A hospital or ambulatory surgical center licensed under chapter 395.

b. An entity wholly owned by one or more physicians licensed under chapter 458 or chapter 459, chiropractic physicians licensed under chapter 460, or dentists licensed under chapter 466, or by such practitioners and the spouse, parent, child, or sibling of such practitioners.

c. An entity that owns or is wholly owned, directly or indirectly, by a hospital or hospitals.

d. A physical therapist licensed under chapter 486, based upon a referral by a provider described in this subparagraph.

e. A health care clinic licensed under part X of chapter 400 which is accredited by an accrediting organization whose standards incorporate comparable regulations required by this state, or which:

(I) Has a medical director licensed under chapter 458, chapter 459, or chapter 460;

(II) Has been continuously licensed for more than 3 years or is a publicly traded corporation that issues securities traded on an exchange registered with the United States Securities and Exchange Commission as a national securities exchange;

and (III) Provides at least four of the following medical specialties:

(A) General medicine.

(B) Radiography.

(C) Orthopedic medicine.

(D) Physical medicine.

(E) Physical therapy.

(F) Physical rehabilitation.

(G) Prescribing or dispensing outpatient prescription medication.

(H) Laboratory services.

(b) Medical benefits do not include massage as defined in s.

480.033 or acupuncture as defined in s.

457.102, regardless of the person, entity, or licensee providing massage or acupuncture, and a licensed massage therapist or licensed acupuncturist may not be reimbursed for medical benefits under this section.

(c) The commission shall adopt by rule the form that must be used by an insurer and a health care provider specified in sub-subparagraph (a)2.b., sub-subparagraph (a)2.c., or sub subparagraph (a)2.e.

to document that the health care provider meets the criteria of this subsection.

Such rule must include a requirement for a sworn statement or affidavit.

(5) PAYMENT OF BENEFITS.— (a) Benefits due from an insurer under medical payments coverage are primary to any health insurance benefit of a person injured in a motor vehicle accident and apply to any coinsurance or deductible amount required by the injured person’s health insurance policy, except that:

1. Benefits received under any workers’ compensation law must be credited against medical payments coverage benefits and must be due and payable as loss accrues.

2. When the Agency for Health Care Administration provides, pays, or becomes liable for medical assistance under the Medicaid program related to injury, sickness, disease, or death arising out of the ownership, maintenance, or use of a motor vehicle, medical payments benefits are subject to the provisions of the Medicaid program, and, within 30 days after receiving notice that the Medicaid program paid such benefits, the insurer must repay the full amount of the benefits to the Medicaid program.

(b) Medical payments coverage benefits payable under this section are overdue if they are not paid within 30 days after the insurer is furnished with written notice of the fact and the amount of a covered loss.

However:

1. If written notice of the entire claim is not furnished to the insurer, any partial amount supported by written notice is overdue if it is not paid within 30 days after the notice is furnished to the insurer.

The remainder of the claim, or any part thereof, which is subsequently supported by written notice is overdue if not paid within 30 days after the notice is furnished to the insurer.

2. If an insurer pays only a portion of a claim or rejects a claim, the insurer must provide at the time of the partial payment or rejection an itemized specification of each item that the insurer had reduced, omitted, or declined to pay and any information that the insurer desires the claimant to consider related to the medical necessity of the denied treatment or any information that explains the reasonableness of the reduced charge if this does not limit the introduction of evidence at trial.

The insurer shall also include the name and address of the person to whom the claimant should respond and a claim number to be referenced in future correspondence.

3. If an insurer pays only a portion of a claim or rejects a claim due to an alleged error in the claim, the insurer, at the time of the partial payment or rejection, must provide an itemized specification or explanation of benefits not paid or rejected due to the specified error.

Upon receiving the specification or explanation, the claimant, at his or her option and without waiving any other legal remedy for payment, has 15 days to submit a revised claim.

The submission of a revised claim is considered a timely submission of written notice of a claim.

4. Notwithstanding the fact that written notice has been furnished to the insurer, payment is not overdue if the insurer has reasonable proof that the insurer is not responsible for the payment.

5. For the purpose of calculating the extent to which benefits are overdue, payment is treated as being made on the date that a draft, or other valid instrument that is equivalent to payment, was placed in the United States mail in a properly addressed, postpaid envelope or, if not so posted, on the date of delivery.

6. This paragraph does not preclude or limit the ability of the insurer to assert that the claim was unrelated, was not medically necessary, or was unreasonable or that the amount of the charge was in excess of that permitted under, or is in violation of, subsection (6).

Such assertion may be made at any time, including after payment of the claim or after the 30-day period for payment specified in this paragraph.

(c) All overdue payments bear simple interest at the rate established under s.

55.03 or the rate established in the insurance contract, whichever is greater, for the quarter in which the payment became overdue, calculated from the date the insurer was furnished with written notice of the amount of covered loss.

Interest is due at the time payment of the overdue claim is made.

(d) It is a violation of the Florida Insurance Code for an insurer to fail to timely provide benefits as required by this section with such frequency as to constitute a general business practice.

(e) If two or more insurers are liable for paying medical payments coverage benefits for the same injury to any one person, the maximum payable benefits are as specified in subsection (2), and the insurer paying the benefits is entitled to recover from each of the other insurers an equitable pro rata share of the benefits paid and expenses incurred in processing the claim.

(f) Benefits are not due or payable to or on behalf of an insured person if that person has committed, by a material act or omission, insurance fraud relating to medical payments coverage under his or her policy and if the fraud is admitted to in a sworn statement by the insured or established in a court of competent jurisdiction.

Any insurance fraud voids all coverage arising from the claim related to such fraud under the medical payments coverage of the insured person who committed the fraud, regardless of whether a portion of the insured person’s claim may be legitimate, and any benefits paid before the discovery of the fraud are recoverable by the insurer in their entirety from the person who committed the insurance fraud.

The prevailing party is entitled to its costs and attorney fees in any action to enforce the insurer’s right of recovery under this paragraph.

(g) If an insurer has a reasonable belief that a fraudulent insurance act, for the purposes of s.

626.989 or s.

817.234, has been committed, the insurer must notify the claimant in writing within 30 days after submission of the claim that the claim is being investigated for suspected fraud.

Beginning at the end of the initial 30-day period, the insurer has an additional 60 days to conduct its fraud investigation.

No later than 90 days after the submission of the claim, the insurer must deny the claim or pay the claim with simple interest as provided in paragraph (c).

Interest is assessed from the day the claim is submitted until the day the claim is paid.

All claims denied for suspected fraudulent insurance acts must be reported to the Division of Investigative and Forensic Services.

(h) An insurer shall create and maintain for each insured a log of medical payments benefits paid by the insurer on behalf of the insured.

The insurer shall provide to the insured a copy of the log within 30 days after receiving a request for the log from the insured.

(i) Upon receiving notice of an accident that is potentially covered by medical payments benefits, the insurer must reserve $2,500 of medical payments benefits for payment to physicians licensed under chapter 458 or chapter 459 or dentists licensed under chapter 466 who provide emergency services and care, as defined in s.

The timeframes specified in paragraph (b) for payment of medical payments benefits are tolled for the period of time an insurer must hold payment of a claim that is not from such physician or dentist to the extent that the medical payments benefits not held in reserve are insufficient to pay the claim.

(6) CHARGES(5) CHARGES FOR CARE OF INJURED PERSONS.— (a) A physician, hospital, clinic, or other person or institution lawfully providing medical care to an injured person for a bodily injury covered by medical payments coverage may charge the insurer and injured party only a reasonable amount pursuant to this sectionsection. for the medical care provided, and the insurer providing such coverage may pay such charges directly to the person or institution lawfully providing such medical care if the insured receiving the care, or his or her guardian, has countersigned the properly completed invoice, bill, or claim form approved by the office upon which the charges are to be paid for as having actually been provided, to the best knowledge of the insured or his or her guardian.

f. For1938 allHowever, otherif medicalsuch services, supplies, andor care,care 200is not reimbursable under Medicare Part B as provided in this sub-subparagraph, the insurer may limit reimbursement to 80 percent of the allowablemaximum amountreimbursable under:allowance under workers’ compensation.

(I) The participating physician’s fee schedule of Medicare Part B, except as provided in sub-sub-subparagraphs (II) and (III).

(II) Medicare Part B, in the case of services, supplies, and care provided by ambulatory surgical centers and clinical laboratories.

(III) The Durable Medical Equipment Prosthetics/Orthotics and Supplies fee schedule of Medicare Part B, in the case of durable medical equipment.

2285 However, if such services, supplies, or care is not reimbursable under Medicare Part B as provided in this sub-subparagraph, the insurer may limit reimbursement to 80 percent of the maximum reimbursable allowance under workers’ compensation.

a. Madea. For byany aservice broker or bytreatment athat personwas makingnot alawful claimat onthe behalftime ofrendered; a broker;

b. Forb. To any serviceperson orwho treatmentknowingly thatsubmits wasa notfalse lawfulor atmisleading statement relating to the timeclaim rendered;or charges;

c. Toor c. For any persontreatment whoor knowinglyservice submitsthat ais falseupcoded or misleadingthat statementis relatingunbundled towhen the claimtreatment or charges;services should be bundled.

d. With respect to a bill or statement that does not substantially meet the applicable requirements of paragraph (d);

e. For medical care billed by a physician and not provided in a hospital unless the care is rendered by the physician or is incident to his or her professional services and is included on the physician’s bill, including documentation verifying that the physician is responsible for the medical care that was rendered and billed;

or f. For any treatment or service that is upcoded or that is unbundled when the treatment or services should be bundled.

The statement may not include, and the insurer is not required to pay, charges for treatment or services rendered more than 35 days before the postmark date or electronic transmission date of the statement, except for past due amounts previously billed on a timely basis under this paragraph and except that, if the provider submits to the insurer a notice of initiation of treatment within 21 days after its first examination or treatment of the claimant, the statement may include charges for treatment or services rendered up to, but not more than, 75 days before the postmark date of the statement.

The injured party is not liable for, and the provider may not bill the injured party for, charges that are unpaid because of the provider’s failure to comply with this paragraph.

Any agreement requiring the injured party or insured to pay such charges is unenforceable.

1. If the insured fails to furnish the provider with the correct name and address of the insured’s medical payments coverage insurer, the provider has 35 days from the date the provider obtains the correct information to furnish the insurer with a statement of the charges.

The insurer is not required to pay such charges unless the provider includes with the statement documentary evidence that was provided by the insured during the 35-day period demonstrating that the provider reasonably relied on erroneous information from the insured, and either:

a. A denial letter from the incorrect insurer;

or b. Proof of mailing, which may include an affidavit under penalty of perjury, reflecting timely mailing to the incorrect address or insurer.

2. For emergency services and care rendered in a hospital emergency department or for transport and treatment rendered by an ambulance provider licensed pursuant to part III of chapter 401, the provider is not required to furnish the statement of charges within the timeframes established by this paragraph, and the insurer is not deemed to have been furnished with notice of the amount of covered loss for purposes of paragraph (5)(b) until it receives a statement, or a copy thereof, complying with paragraph (d) which specifically identifies the place of service to be a hospital emergency department or an ambulance in accordance with billing standards recognized by the federal Centers for Medicare and Medicaid Services.

All providers, other than hospitals, must include on the applicable claim form the professional license number of the provider in the line or space provided for “Signature of Physician or Supplier, Including Degrees or Credentials.” The guidance for determining compliance with applicable CPT and HCPCS coding must be provided by the CPT or the HCPCS in effect for the year in which services were rendered, the Office of the Inspector General, Physicians Compliance Guidelines, and other authoritative treatises designated by rule by the Agency for Health Care Administration.

For(6) CIVIL purposesACTION ofFOR paragraphINSURANCE (5)(b),FRAUD.—An an insurer ishas nota consideredcause to have been furnished with notice of theaction amountagainst ofany coveredperson lossconvicted orof, medical bills due unless the statements or billswho, complyregardless withof thisadjudication paragraphof andguilt, arepleads properlyguilty completedor innolo theircontendere entiretyto, asinsurance tofraud allunder materials. provisions, with all relevant information being provided therein.

(e)1. At the initial treatment or service provided, each physician, other licensed professional, clinic, or other medical institution providing medical services upon which a claim for medical payments coverage benefits is based shall require the insured or his or her guardian to execute a disclosure and acknowledgment form that reflects at a minimum that:

a. The insured, or his or her guardian, must countersign the form, attesting to the fact that the services set forth therein were actually rendered;

b. The insured, or his or her guardian, has both the right and affirmative duty to confirm that the services were actually rendered;

c. The insured, or his or her guardian, was not solicited by any person to seek any services from the medical provider;

d. The physician, other licensed professional, clinic, or other medical institution rendering services for which payment is being claimed explained the services to the insured or to his or her guardian;

and e. If the insured notifies the insurer in writing of a billing error, the insured may be entitled to a certain percentage of a reduction in the amounts paid by the insured’s motor vehicle insurer.

2. The physician, other licensed professional, clinic, or other medical institution rendering services for which payment is being claimed has the affirmative duty to explain to the insured or to his or her guardian the services rendered, so that the insured or his or her guardian countersigns the form with informed consent.

3. A countersignature by the insured or his or her guardian is not required for the reading of diagnostic tests or other services that are of such a nature that they are not required to be performed in the presence of the insured.

4. The licensed medical professional rendering treatment for which payment is being claimed shall sign, by his or her own hand, the form complying with this paragraph.

5. The original completed disclosure and acknowledgment form must be furnished to the insurer pursuant to paragraph (5)(b) and may not be electronically furnished.

6. The disclosure and acknowledgment form is not required for emergency services and care, as defined in s.

395.002, which are billed by a provider and which are rendered in a hospital emergency department, or for transport and treatment rendered by an ambulance provider licensed pursuant to part III of chapter 401.

7. The commission shall adopt by rule a standard disclosure and acknowledgment form to be used to fulfill the requirements of this paragraph.

8. As used in this paragraph, the terms “countersign” and “countersignature” mean a second or verifying signature, as on a previously signed document.

The statement “signature on file” or any similar statement does not constitute a countersignature.

9. The requirements of this paragraph apply only with respect to the initial treatment of or service rendered to the insured by a provider.

For subsequent treatments or service, the provider must maintain a patient log signed by the patient, in chronological order by date of service, which is consistent with the services being rendered to the patient as claimed.

The requirement to maintain a patient log signed by the patient may be met by a hospital that maintains medical records as required by s.

395.3025 and applicable rules and that makes such records available to the insurer upon request.

(f) Upon written notification by any person, an insurer shall investigate any claim of improper billing by a physician or other medical provider.

The insurer shall determine if the insured was properly billed for only the medical care the insured actually received.

If the insurer determines that the insured has been improperly billed, the insurer must notify the insured, the person making the written notification, and the provider of its findings and reduce the amount of payment to the provider by the amount determined to be improperly billed.

If a reduction is made due to a written notification by any person, the insurer must pay to the person 20 percent of the amount of the reduction, up to $500.

If the provider is arrested due to the improper billing, the insurer must pay to the person 40 percent of the amount of the reduction, up to $500.

(g) An insurer may not systematically downcode with the intent to deny reimbursement otherwise due.

Such action constitutes a material misrepresentation under s.

626.9541(1)(i) 2.

(h) An entity excluded from the definition of the term “clinic” in s.

400.9905 must be deemed a clinic and must be licensed under part X of chapter 400 in order to receive reimbursement under medical payments coverage.

However, this licensing requirement does not apply to:

1. An entity wholly owned by a physician licensed under chapter 458 or chapter 459, or by the physician and the spouse, parent, child, or sibling of the physician;

2. An entity wholly owned by a dentist licensed under chapter 466, or by the dentist and the spouse, parent, child, or sibling of the dentist;

3. An entity wholly owned by a chiropractic physician licensed under chapter 460, or by the chiropractic physician and the spouse, parent, child, or sibling of the chiropractic physician;

4. A hospital or ambulatory surgical center licensed under chapter 395;

5. An entity that wholly owns or that is wholly owned, directly or indirectly, by a hospital or hospitals licensed under chapter 395;

6. An entity that is a clinical facility affiliated with an accredited medical school at which training is provided for medical students, residents, or fellows;

7. An entity that is certified under 42 C.F.R.

part 485, subpart H;

or 8. An entity that is owned by a publicly traded corporation, either directly or indirectly through its subsidiaries, which has $250 million or more in total annual sales of health care services provided by licensed health care practitioners, if one or more of the persons responsible for the operations of the entity are health care practitioners who are licensed in this state and who are responsible for supervising the business activities of the entity and the entity’s compliance with state law for purposes of this section.

(7) NOTIFICATION TO INSUREDS OF RIGHTS.— (a) The commission shall adopt by rule a form for notification to an insured of his or her right to receive medical payments coverage.

Such notice must include:

1. A description of the benefits provided by medical payments coverage, when payments are due, how benefits are coordinated with other insurance benefits that the insured may have, penalties and interest that may be imposed on insurers for failure to make timely payments of benefits, and rights of parties regarding disputes as to benefits.

2. The following statement in at least 12-point type:

2587 BILLING REQUIREMENTS.—Florida law provides that with respect to any treatment or services, other than certain hospital and emergency services, the statement of charges furnished to the insurer by the provider may not include, and the insurer and the injured party are not required to pay, charges for treatment or services rendered more than 35 days before the postmark date of the statement, except for past due amounts previously billed on a timely basis and except that, if the provider submits to the insurer a notice of initiation of treatment within 21 days after its first examination or treatment of the claimant, the statement may include charges for treatment or services rendered up to, but not more than, 75 days before the postmark date of the statement.

2603 3. An advisory informing the insured that, pursuant to s.

626.9892, the department may pay rewards of up to $25,000 to persons providing information leading to the arrest and conviction of persons committing crimes investigated by the Division of Investigative and Forensic Services arising from violations of s.

440.105, s.

624.15, s.

626.9541, s.

626.989, or s.

817.234.

4. An advisory informing the insured that, pursuant to sub subparagraph (6)(e)1.e., if the insured notifies the insurer of a billing error, the insured may be entitled to a certain percentage of a reduction in the amount paid by the insured’s motor vehicle insurer.

5. A notice that solicitation of a person injured in a motor vehicle crash for purposes of filing medical payments coverage or tort claims could be a violation of s.

817.234, s.

817.505, or the rules regulating The Florida Bar and should be immediately reported to the Division of Investigative and Forensic Services if such conduct has taken place.

(b) An insurer issuing a policy in this state providing medical payments coverage benefits must mail or deliver the notice as specified in paragraph (a) to the named insured within 21 days after receiving from the insured notice of an automobile accident or claim involving personal injury to an insured who is covered under the policy.

The office may allow an insurer additional time to provide the notice specified in paragraph (a), not to exceed 30 days, upon a showing by the insurer that an emergency justifies an extension of time.

(c) The notice required by this subsection does not alter or modify the terms of the insurance contract or other requirements of this section.

(8) DISCOVERY OF FACTS ABOUT AN INJURED PERSON;

DISPUTES.— (a) A person making a claim under medical payments coverage must, if requested by the insurer against whom the claim has been made, furnish a written report of the history, condition, treatment, dates, and costs of treatment of the injured person and why the items identified by the insurer were reasonable in amount and medically necessary, together with a sworn statement that the medical care rendered was reasonable and necessary with respect to the bodily injury sustained and identifying which portion of the expenses for the medical care was incurred as a result of the bodily injury.

If requested by the insurer, the person making the claim under medical payments coverage must also produce, and allow the inspection and copying of, his, her, or its records regarding the history, condition, treatment, dates, and costs of treatment of the injured person.

The sworn statement must read as follows:

“Under penalty of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief.” A cause of action for violation of the physician-patient privilege or invasion of the right of privacy may not be brought against any physician, hospital, clinic, or other medical institution complying with this section.

The person requesting such records and sworn statement shall pay all reasonable costs connected therewith.

If an insurer makes a written request for documentation or information under this paragraph within 30 days after having received notice of the amount of a covered loss under paragraph (5)(b), the amount or the partial amount that is the subject of the insurer’s inquiry is overdue if the insurer does not pay in accordance with paragraph (5)(b) or within 10 days after the insurer’s receipt of the requested documentation or information, whichever occurs later.

As used in this paragraph, the term “receipt” includes, but is not limited to, inspection and copying pursuant to this paragraph.

An insurer that requests documentation or information pertaining to reasonableness of charges or medical necessity under this paragraph without a reasonable basis for such requests as a general business practice is engaging in an unfair trade practice under the Florida Insurance Code.

(b) In the event of a dispute regarding an insurer’s right to discovery of facts under this section, the insurer may petition a court of competent jurisdiction to enter an order permitting such discovery.

The order may be made only on motion for good cause shown and upon notice to all persons having an interest and must specify the time, place, manner, conditions, and scope of the discovery.

In order to protect against annoyance, embarrassment, or oppression, as justice requires, the court may enter an order refusing discovery or specifying conditions of discovery and may order payment of costs and expenses of the proceeding, including reasonable fees for the appearance of attorneys at the proceedings, as justice requires.

(c) Upon request, the injured person must be furnished a copy of all information obtained by the insurer under this section, and pay a reasonable charge, if required by the insurer.

(d) An insured may not unreasonably withhold notice to an insurer of the existence of a claim.

(e) In a dispute between the insured and the insurer, or between an assignee of the insured’s rights and the insurer, upon request, the insurer must notify the insured or the assignee that the policy limits under this section have been reached within 15 days after the limits have been reached.

(f) In any civil action to recover medical payments benefits brought against an insurer by a claimant pursuant to this section, all claims related to the same health care provider for the same injured person must be brought in one action, unless good cause is shown why the claims should be brought separately.

(g) An insured seeking medical payments coverage benefits, including an omnibus insured, must comply with the terms of the policy, which include, but are not limited to, submitting to an examination under oath.

The scope of questioning during the examination under oath is limited to relevant information or information that could reasonably be expected to lead to relevant information.

Compliance with this paragraph is a condition precedent to receiving benefits.

An insurer that, as a general business practice as determined by the office, requests an examination under oath of an insured or an omnibus insured without a reasonable basis is subject to s.

626.9541.

(9) MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON;

REPORTS.— (a) Whenever the mental or physical condition of an injured person covered by medical payments benefits is material to any claim that has been or may be made for past or future medical payments coverage benefits, such person must, upon the request of an insurer, submit to a mental or physical examination by a physician or physicians.

The costs of any examination requested by an insurer must be borne entirely by the insurer.

Such examination must be conducted within the municipality where the insured is receiving treatment;

in a location reasonably accessible to the insured, which, for purposes of this paragraph, means any location within the municipality in which the insured resides;

or any location within 10 miles by road of the insured’s residence, if such location is within the county in which the insured resides.

If the examination is to be conducted in a location reasonably accessible to the insured and if there is no qualified physician to conduct the examination in a location reasonably accessible to the insured, such examination must be conducted in an area of the closest proximity to the insured’s residence.

Insurers may include reasonable provisions in medical payments coverage insurance policies for mental and physical examination of those claiming medical payments coverage benefits.

An insurer may not withdraw payment of a treating physician without the consent of the injured person covered by medical payments benefits unless the insurer first obtains a valid report by a Florida physician licensed under the same chapter as the treating physician whose treatment authorization is sought to be withdrawn, stating that treatment was not reasonable, related, or necessary.

For purposes of this paragraph, a valid report is one that is prepared and signed by the physician examining the injured person or reviewing the treatment records of the injured person;

that is factually supported by the examination and treatment records, if reviewed;

and that has not been modified by anyone other than the physician.

The physician preparing the report must be in active practice unless the physician is physically disabled.

As used in this paragraph, the term “active practice” means that during the 3 years immediately preceding the date of the physical examination or review of the treatment records, the physician must have devoted professional time to the active clinical practice of evaluation, diagnosis, or treatment of medical conditions, or to the instruction of students in an accredited health professional school or accredited residency program, or a clinical research program that is affiliated with an accredited health professional school, a teaching hospital, or an accredited residency program.

The physician preparing a report at the request of an insurer and the physicians rendering expert opinions on behalf of persons claiming medical payments coverage benefits, or on behalf of an insured through an attorney or another entity, shall maintain, for at least 3 years, copies of all examination reports as medical records and shall maintain, for at least 3 years, records of all payments for the examinations and reports.

An insurer or any person acting at the direction of or on behalf of an insurer may not materially change an opinion in a report prepared under this paragraph or direct the physician preparing the report to change such opinion.

The denial of a payment as the result of such a changed opinion constitutes a material misrepresentation under s.

626.9541(1)(i)2.;

however, this provision does not preclude the insurer from calling to the attention of the physician errors of fact in the report based upon information in the claim file.

(b) If requested by the person examined, a party causing an examination to be made shall deliver to him or her a copy of every written report concerning the examination rendered by an examining physician, at least one of which reports must set out the examining physician’s findings and conclusions in detail.

After such request and delivery, the party causing the examination to be made is entitled, upon request, to receive from the person examined every written report available to him or her or his or her representative concerning any examination, previously or thereafter made, of the same mental or physical condition.

By requesting and obtaining a report of the examination so ordered, or by taking the deposition of the examiner, the person examined waives any privilege he or she may have, in relation to the claim for benefits, regarding the testimony of every other person who has examined, or may thereafter examine, him or her in respect to the same mental or physical condition.

If a person unreasonably refuses to submit to, or fails to appear at, an examination, the medical payments benefits carrier is no longer liable for subsequent medical payments benefits.

An insured’s refusal to submit to or failure to appear at two examinations raises a rebuttable presumption that the insured’s refusal or failure was unreasonable.

(10) APPLICABILITY OF PROVISION REGULATING ATTORNEY FEES.

With respect to any dispute under this section between the insured and the insurer or between an assignee of an insured’s rights and the insurer, ss.

627.428 and 768.79 apply except as provided in subsections (11) and (12) and except that any attorney fees recovered must:

(a) Comply with prevailing professional standards;

(b) Not overstate or inflate the number of hours reasonably necessary for a case of comparable skill or complexity;

and (c) Represent legal services that are reasonable and necessary to achieve the result obtained.

2808 Upon request by either party, a judge must make written findings, substantiated by evidence presented at trial or any hearings associated therewith, that any award of attorney fees complies with this subsection.

Notwithstanding s.

627.428, attorney fees recovered under this section must be calculated without regard to a contingency risk multiplier.

(11) DEMAND LETTER.— (a) As a condition precedent to filing any action for benefits under this section, written notice of an intent to initiate litigation must be provided to the insurer.

Such notice may not be sent until the claim is overdue, including any additional time the insurer has to pay the claim pursuant to paragraph (5)(b).

(b) The notice must state with specificity:

1. “This is a demand letter under s.

627.7265, Florida Statutes.” 2. The name of the insured for whom such benefits are being sought, including a copy of the assignment giving rights to the claimant if the claimant is not the insured.

3. The claim number or policy number upon which the claim was originally submitted to the insurer.

4. To the extent applicable, the name of any medical provider who rendered to an insured the treatment, services, accommodations, or supplies that form the basis of such claim;

and an itemized statement specifying each exact amount, the date of treatment, service, or accommodation, and the type of benefit claimed to be due.

To the extent that the demand involves an insurer’s withdrawal of payment for future treatment not yet rendered, the claimant shall attach a copy of the insurer’s notice withdrawing such payment and an itemized statement of the type, frequency, and duration of future treatment claimed to be reasonable and medically necessary.

(c) Each notice required by this subsection must be delivered to the insurer by certified or registered mail, return receipt requested.

Such postal costs must be reimbursed by the insurer, if requested by the claimant in the notice, when the insurer pays the claim.

Such notice must be sent to the person and address specified by the insurer for the purposes of receiving notices under this subsection.

Each licensed insurer, whether domestic, foreign, or alien, shall file with the office the name and address of the designated person to whom notices must be sent, which the office shall make available on its website.

The person whose name and address is on file with the office pursuant to s.

624.422 is deemed the authorized representative to accept notice pursuant to this subsection if no other designation has been made.

(d) If, within 30 days after receipt of notice by the insurer, the overdue claim specified in the notice is paid by the insurer together with applicable interest and a penalty of 10 percent of the overdue amount paid by the insurer, subject to a maximum penalty of $250, an action may not be brought against the insurer.

If the demand involves an insurer’s withdrawal of payment for future treatment not yet rendered, an action may not be brought against the insurer if, within 30 days after its receipt of the notice, the insurer mails to the person filing the notice a written statement of the insurer’s agreement to pay for such treatment in accordance with the notice and to pay a penalty of 10 percent, subject to a maximum penalty of $250, when it pays for such future treatment in accordance with the requirements of this section.

To the extent the insurer determines not to pay any amount demanded, the penalty is not payable in any subsequent action.

For purposes of this subsection, payment or the insurer’s agreement must be treated as being made on the date a draft or other valid instrument that is equivalent to payment, or the insurer’s written statement of agreement, is placed in the United States mail in a properly addressed, postpaid envelope or, if not so posted, on the date of delivery.

The insurer is not obligated to pay any attorney fees if the insurer pays the claim or mails its agreement to pay for future treatment within the time prescribed by this subsection.

(e) The applicable statute of limitation for an action under this section is tolled for 30 business days by the mailing of the notice required by this subsection.

(12) ALL CLAIMS BROUGHT IN A SINGLE ACTION.—In any civil action to recover medical payments coverage benefits brought by a claimant pursuant to this section against an insurer, all claims related to the same health care provider for the same injured person must be brought in one action unless good cause is shown why such claims should be brought separately.

If the court determines that a civil action is filed for a claim that should have been brought in a prior civil action, the court may not award attorney fees to the claimant.

(13) FAILURE TO PAY VALID CLAIMS;

UNFAIR OR DECEPTIVE PRACTICE.— (a) An insurer is engaging in a prohibited unfair or deceptive practice that is subject to the penalties provided in s.

626.9521, and the office has the powers and duties specified in ss.

626.9561-626.9601, if the insurer, with such frequency so as to indicate a general business practice, fails to pay valid claims for medical payments benefits or fails to pay valid claims until receipt of the notice required under subsection (11).

(b) Notwithstanding s.

501.212, the Department of Legal Affairs may investigate and initiate actions for a violation of this subsection, including, but not limited to, the powers and duties specified in part II of chapter 501.

(14) CIVIL ACTION FOR INSURANCE FRAUD.—An insurer has a cause of action against any person convicted of, or who, regardless of adjudication of guilt, pleads guilty or nolo contendere to, insurance fraud under s.

(15) FRAUD(7) FRAUD ADVISORY NOTICE.—Upon receiving notice of a claim under this section, an insurer shall provide a notice to the insured or to a person for whom a claim for reimbursement for diagnosis or treatment of injuries has been filed, advising that:

(16) NONREIMBURSABLE(8) NONREIMBURSABLE CLAIMS.—Claims generated as a result of activities that are unlawful pursuant to s.

(17) SECURE(9) SECURE ELECTRONIC DATA TRANSFER.—ExceptTRANSFER.—A as otherwise provided in subparagraph (6)(e)5., a notice, documentation, transmission, or communication of any kind required or authorized under this section may be transmitted electronically if it is transmitted by secure electronic data transfer that is consistent with state and federal privacy and security laws.

(18) INSURER’SSection RIGHT40. Subsections OF(1) SUBROGATION.—and (a) A(7) medicalof paymentssection insurer627.727, mayFlorida includeStatutes, aare provisionamended, inand itspresent policysubsections which(8), permits(9), subrogationand for(10) medicalof paymentsthat benefitssection itare paidredesignated ifas thesubsections expenses(7), giving(8), riseand to(9), therespectively, paymentsto wereread: caused by the wrongful act or omission of another.

However, this subrogation right is inferior to the rights of the injured insured, and is available only after all the insured’s damages have been recovered and the insured has been made whole.

An insured who obtains a recovery from a third party of the full amount of the damages sustained and delivers a release or satisfaction that impairs a medical payments insurer’s subrogation right is liable to the insurer for repayment of medical payments benefits, less any expenses of acquiring the recovery, including a prorated share of attorney fees and costs, and shall hold that net recovery in trust to be delivered to the medical payments insurer.

(b) The insurer does not have a right of subrogation for medical payments coverage benefits paid for the insured if the tortfeasor who caused the motor vehicle accident is also an insured under the policy that paid the medical payments benefits.

Section 40. Subsections (1) and (7) of section 627.727, Florida Statutes, are amended to read:

(7) The legal liability of an uninsured motorist coverage insurer includes does not include damages in tort for pain, suffering, disability or physical impairment, disfigurement, mental anguish, and inconvenience,inconvenience and the loss of capacity for the enjoyment of life experienced in the past and to be experienced in the future unless the injury or disease is described in one or more of paragraphs (a)-(d) of s.

31322263 The term “policy” does not include a binder as defined in s.

32332364 A violation of this section is a noncriminal traffic infraction, punishable as a nonmoving violation as provided in chapter 318.

32632394 This section also applies to premium financing by any insurance agent or insurance company under part XVI.

33982529 CLAIM OF LIEN State of ........

34202551 However, the negligent inclusion or omission of any information in this claim of lien which does not prejudice the owner does not constitute a default that operates to defeat an otherwise valid lien.

627.7265(9) s.

324.022, Florida Statutes, must maintain minimum security requirements that enable the person to respond in damages for liability on account of accidents arising out of the ownership, maintenance, or use of a motor vehicle in the following amounts:

Medical payments coverage also provides a death benefit of at least $5,000.

Medical payments coverage reimburses fewer medical services and care than were reimbursable under personal injury protection.

Medical payments coverage provides reimbursement for the following if medically necessary and if an individual initially receives such treatment within 14 days after the motor vehicle accident:

1. Emergency transportation and treatment.

2. Emergency services and care provided by a hospital.

3. Emergency services and care provided by a licensed physician or licensed dentist in a hospital, ambulatory surgical center, or mobile surgical facility licensed under chapter 395, Florida Statutes, and related hospital inpatient care.

4. Hospital inpatient services, other than emergency services and care.

5. Hospital outpatient services, other than emergency services and care.