South Florida Workers Compensation Attorneys FAQ

South Florida Workers' Compensation Attorney
FAQ Frequently asked questions about workers' compensation.

What's Below:
What is workers' compensation?

Who pays workers' compensation benefits?

Are all on-the-job injuries covered by workers' compensation?

Does workers' compensation cover only injuries, or does it also cover long-term problems and illnesses?

Do I have to be injured at my workplace to be covered by workers' compensation?

What kind of benefits will I receive?

Can I be treated by my own doctor and, if not, can I trust a doctor provided by my employer?

If I am initially treated by an insurance company doctor, do I have a right to see my own doctor at some point?

Can I ever sue my employer in court over a work-related injury?

What if my employer tells me not to file a workers' compensation claim or threatens to fire me if I do?


What is workers' compensation?

Workers' compensation is a state-mandated insurance program that provides compensation to employees who suffer job-related injuries. An injured employee gets the benefits regardless of who was at fault -- the employee, the employer, a co-worker, a customer or some other third party. In exchange for these guaranteed benefits, the employees usually do not have the right to sue the employer in court for damages for the injuries.

Who pays workers' compensation benefits?

In most states, employers are required to purchase insurance for their employees from a workers' compensation insurance company -- also called an insurance carrier. However, in some states, smaller companies (with fewer than three or four employees) are not required to carry workers' compensation insurance. In some states, larger employers who are clearly solvent are allowed to self-insure, or act as their own insurance companies. When a worker is injured, his or her claim is filed with the insurance company -- or self-insuring employer -- who pays medical and disability benefits according to a state-approved formula.

Are all on-the-job injuries covered by workers' compensation?

Most are. The workers' compensation system is designed to provide benefits to injured workers, even if an injury is caused by the employer's or employee's carelessness. But there are some limits. Generally, injuries that happen because an employee is intoxicated or using illegal drugs are not covered by workers' compensation. Coverage may also be denied in situations involving: self-inflicted injuries (including those caused by a person who starts a fight) injuries suffered while a worker was committing a serious crime injuries suffered while an employee was not on the job, and injuries suffered when an employee's conduct violated company policy.

Does workers' compensation cover only injuries, or does it also cover long-term problems and illnesses?

Your injury need not be caused by an accident -- such as a fall from a ladder -- to be covered by workers' compensation. Many workers, for example, receive compensation for repetitive stress injuries, including carpal tunnel syndrome and back problems, that are caused by overuse or misuse over a long period of time. You may also be compensated for some illnesses and diseases that are the gradual result of work conditions -- for example, heart conditions, lung disease and stress-related digestive problems.

Are You Covered by Workers' Compensation?

Most workers are eligible for workers' compensation coverage, but every state excludes some workers. Exclusions often include: business owners, independent contractors, casual workers domestic employees in private homes, farm workers ,maritime workers ,railroad employees, and unpaid volunteers. Federal government employees are also excluded from state workers' compensation coverage, but they receive workers' compensation benefits under a separate federal law. In addition, about one-third of the states do not require workers' compensation coverage of employers having fewer than a designated number of employees -- three to five, depending on the state. So, if you work for one of these employers, you may be excluded from the state program.

Do I have to be injured at my workplace to be covered by workers' compensation?
No. As long as your injury is job-related, it's covered. For example, you'll be covered if you are injured while traveling on business, doing a work-related errand or even attending a required business-related social function.

What kind of benefits will I receive?
The workers' compensation system provides replacement income, medical expenses and sometimes vocational rehabilitation benefits -- that is, on the job training, schooling or job placement assistance. The benefits paid through workers' compensation, however, are almost always relatively modest. If you become temporarily unable to work, you'll usually receive two-thirds of your average wage up to a fixed ceiling. But because these payments are tax-free, if you received decent wages prior to your injury, you'll fare reasonably well in most states. You will be eligible for these wage-loss replacement benefits as soon as you've lost a few days of work because of an injury or illness that is covered by workers' compensation. If you become permanently unable to do the work you were doing prior to the injury, or unable to do any work at all, you may be eligible to receive long-term or lump-sum benefits. The amount of the payment will depend on the nature and extent of your injuries. If you anticipate a permanent work disability, contact your local Workers' Compensation office as soon as possible; these benefits are rather complex and may take a while to process. Social Security Benefits for the Permanently Disabled If you're permanently unable to return to work, you may qualify for Social Security Disability benefits.

Social Security will, over the long run, provide more benefits than workers' compensation -- but be forewarned that these benefits are hard to get. They are reserved for seriously injured workers. To qualify, your injury or illness: must prevent you from doing any "substantial gainful work," and must be expected to last at least twelve months, or to result in death. If you think you may meet the above requirements, contact your local Social Security office.

Can I be treated by my own doctor and, if not, can I trust a doctor provided by my employer?

In some states, you have a right to see your own doctor if you make this request in writing before the injury occurs. More typically, however, injured workers are referred to a doctor recruited and paid for by their employers. Your doctor's report will have a big impact upon the benefits you receive. While it's crucial that you tell the doctor the truth about both your injury and your medical history (your benefits may be denied based on fraud if you don't), be sure to clearly identify all possible job-related medical problems and sources of pain. This is no time to downplay or gloss over your injuries. Keep in mind that a doctor paid for by your employer's insurance company is not your friend. The desire to get future business from your employer or the insurance company may motivate a doctor to minimize the seriousness of your injury or to identify it as a pre-existing condition. For example, if you injure your back and the doctor asks you if you have ever had back problems before, it would be unwise to treat the doctor to a 20-year history of every time you suffered a minor pain or ache. Just say "no" unless you really have suffered a significant previous injury or chronic condition.

If I am initially treated by an insurance company doctor, do I have a right to see my own doctor at some point?

State workers' compensation systems establish technical and often tricky rules in this area. Often, you have the right to ask for another doctor at the insurance company's expense if you clearly state that you don't like the one the insurance company provides, although there is sometimes a waiting period before you can get a second doctor. Also, if your injury is serious, you usually have the right to a second opinion. And in some states, after you are treated by an insurance company's doctor for a certain period (90 days is typical), you may have the automatic right to transfer your treatment to your own doctor or health plan, while the worker's compensation insurance company continues to pay the bill. Because the insurance company is paying, don't hesitate to go to a doctor who specializes in your injury or illness -- even if the cost is great. To understand your rights, get a copy of your state's rules or, if necessary, research your state workers' compensation laws and regulations in the law library.

Can I ever sue my employer in court over a work-related injury?
Yes. If you are injured because of some reckless or intentional action on the part of your employer, you can bypass the workers' compensation system and sue your employer in court for a full range of damages, including punitive damages, pain and suffering and mental anguish.

What if my employer tells me not to file a workers' compensation claim or threatens to fire me if I do?

In most states, it is a violation of the workers' compensation laws to retaliate against an employee for filing a workers' compensation claim. If this happens, immediately report it to your local workers' compensation office. For further information regarding Florida Workers' Compensation injury cases, including those involving wrongful death and traumatic brain injury, or any other personal injury or accident, contact the attorneys at the Law Offices of Paul S. Rosenberg, David E. Rosenberg, and Abe Rosenberg at the law firm of Rosenberg & Rosenberg, P.A. today.

South Florida Workers' Compensation Attorney Paul S. Rosenberg, David E. Rosneberg, Abe Rosenberg or any associate attorneys at Rosenberg & Rosenberg, P.A. are always available to answer your questions about Florida workers compensation questions.

Premises Liability and Your South Florida Private Investigator Cory T. Knight

Premises Liability

South Florida Premises Liability – Slip and Fall and Dog Bite Investigators – In Hollywood, Florida


We trust the places we go and the areas we walk to be safe and put our faith in the responsibility of those in charge of them. However, negligence can lead to dangerous slips, savage dog attacks, and many other catastrophes. Our South Florida slip and fall and dog bite private investigators in Ft. Lauderdale, Florida are experienced in premises liability. The private investigators at our private investigation agency of C.T.K. INVESTIGATIONS, LLC handle many different types of cases involving negligence on the part of a property owner.

What Is Premises Liability?

Slip and Fall
Dog Bite

Pursuing Compensation

What Is Premises Liability?

According to the law, property owners are responsible for keeping their premises safe for all visitors, employees, customers, and anyone who sets foot on the grounds. If someone suffers an injury on property that has not been properly maintained a premises liability claim against the owner or occupant of the property can be filed. Our premises liability private investigators in South Florida have hundreds of these types of personal injury cases, resulting from a variety of causes. Some examples of premises liability cases include:

• Slips and falls (detailed below)




• Dog Bites (detailed below)




• Falling products, objects, maintenance equipment, or debris at a store




• Accidents at construction sites




• Workers’ Compensation Claims

Every premises liability case is different, and we consider each one individually. The goal of a premises liability investigation prior to a lawsuit is to prove the negligence of the property owner in ensuring that the property was safe for visitors. This includes adequately displayed signs or warnings to guests or invitees to be careful where they walk if there are wet areas, not to touch certain objects, etc.

Unsafe property conditions can cause life-long injury, and even death. If you or a loved one has been a victim of negligence by a property owner or occupant, contact our licensed private investigators that have handled hundreds of premises liability cases in Fort Lauderdale Florida. We will review your case free of charge.

Slip and Fall

One of the most common forms of premises liability occurs when an individual has suffered injury or death resulting from a slip and fall on the property. These types of accidents can occur inside or outside the building. The South Florida slip and fall private investigators at C.T.K. INVESTIGATIONS, LLC have handled hundreds of these complex cases, which are frequently caused by:

• Cracks in sidewalks




• Poor lighting on stairs/steps




• Wet floors




• Uneven floors




• Objects or debris on the ground or flooring




• Loose floor mats
  
  

The property owner or occupant may be found liable if it can be proven that he or she caused or knew about the condition and did not correct it. The owner or occupant may also be found negligent if it is determined that he or she should have known about the dangerous condition as a responsible caretaker of the property.

In slip and fall accidents, lawyers for the defendant will frequently say they are not responsible for the dangerous condition that may have caused the injury, or that there was no dangerous condition on the property at all. Furthermore, they will likely try to place negligence on the part of the victim.

It is important for victims of slip and fall accidents to gather names and contact information for any witnesses to the event, and report what happened to the property owner or manager before leaving the scene. It is also important that victims seek medical treatment immediately, no matter how small the injury is. Remember to conserve clothing worn at the time of the accident, as well as photographs of the dangerous condition which caused the fall, as these are very important pieces of evidence.

Our South Florida slip and fall private investigators are strong advocates for all of our clients. We will work diligently to ensure that victims of negligent property owners or occupants receive reasonable and fair investigation and possible compensation for losses.

Dog Bite

Injuries from dog bites can cause long-term medical and psychological problems, disfigurement, and even death. An estimated 800,000 Americans are bitten by dogs every year, many of them children.

The South Florida dog bite private investigators at our Hollywood, Florida agency are well-versed in Florida law regarding dog bite injuries. In our state, the owner of the dog is liable should the animal harm a visitor, guest, employee, etc. The dog owner is responsible if he or she knows the dog is liable to attack someone, and can be found negligent and responsible for any unprovoked dog attack. Florida has a specific legal statute that makes dog owners virtual insurers of their dog's conduct. This is a valuable tool for our South Florida dog bite lawyers representing Broward County, Palm Beach County, Miami, Miami-Dade County, Monroe County, and all of South Florida residents who have been the victims of dog attacks.
Dog bites can have severe physical and emotional ramifications for victims, and pet owners need to be held responsible for the behavior of their animals. Our personal injury private investigators at C.T.K. INVESTIGATIONS, LLC have experience pursuing compensation in dog bite cases. We can help investigate and obtain information to assist in the recovery of damages in a range of areas, including mental anguish. Contact our South Florida Private Investigators at CTK INVESTIGATIONS, LLC today for a free consultation and we will review your case.

Pursuing Compensation

The premises liability private investigators at our South Florida Private Investigation Agency can work to secure your case after an injury. Financial damages from the parties responsible can be pursued for:

• Medical bills (past and future)




• Lost wages (past and future)




• Pain and suffering




• Mental anguish




• Lost capacity for the enjoyment of life
  

In addition to the physical and emotional toll personal injuries can take, the financial strain can be too much to bear. Let our private investigators help you gain financial stability for your needs, and hold the person or group responsible for your injury accountable.

Contact Our Premises Liability Private Investigators

Our South Florida slip and fall and premises liability private investigators in Hollywood, Florida are dedicated to sorting out the facts in your case and recovering damage for your injuries. At C.T.K. INVESTIGATIONS, LLC in South Florida. We work with south Florida attorneys with years of experience with premises liability and dog bite cases that cover Broward County, Dade County, Dade County, Miami Dade County, Monroe County and all of Florida. The personal injury lawyers serve all of Florida with their local offices based in South Florida, and surrounding areas with the support of a professional legal staff and decades of experience. We also investigate cases involving wrongful death, product liability, child injury, and more. Contact the offices of CTK INVESTIGATIONS, LLC today for a free consultation and we will review your case



http://www.ctkinvestigations.com/ provides the following types of investigations: Asset, Accident, Background, Bankruptcy, Business, Credibility, Civil, Computer Forensic, Corporate, Criminal, Custody, Data Bases, Death, Divorce, Driving, Debugging, Education, Electronic Tracking, Embezzlement, Employment, Estate, Financial, Fingerprint, Fraud, Infidelity, Insurance, Judgments, Liens, Locate Witness, Malpractice, Marriage, Media, Medical, Missing Persons, Notarized Witness Statements, Pen-Registers, Photography, Professional Licenses, Property, Public Records, Tenant, Theft, Security, Security Cameras, Surveillance, Vehicle, Video, Witness Statements, Workers' Compensation, and more!
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CTK INVESTIGATIONS, LLC also handles some of the following types of cases:
· Slip and Fall Injuries
· Personal Injury
· Nursing Home Abuse/Neglect
· Insurance Disputes
· Sink Hole
· Burn Accidents
· Car Crash Accidents
· Accident Reconstruction
· Train Accidents
· Bus Accident
· Roommate Check
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· Dog Bite Injuries
· Medical Malpractice
· Defective Products
· Wrongful Death
· Workers’ Compensation
· Accidents at school
· Skip Traces
· Municipality Claims
· Lost Family Members
· Asset Searches
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· Computer Forensics
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CTK INVESTIGATIONS, LLC will evaluate all of the circumstances surrounding your case.

We have successfully helped client’s like you throughout Ft. Lauderdale, Plantation, Davie, Miami, Miami Dade County, Monroe County to assist with your private investigation needs in places like: Coral Gables University Park Kendall Miami Beach Hialeah Golden Glades North Miami Aventura Carol City Country Club Hallandale Beach Cooper City Plantation Ft. Lauderdale Sunrise Miramar Hollywood Oakland Park Pompano Beach Coconut Creek Margate Coral Springs Boca Raton Delray Beach Florida Keys Fort Lauderdale FSU Roommate searches NSU UM FAU FIU Florida Florida Keys

Background

Who We Are:
CTK INVESTIGATIONS, LLC is a private investigation agency that provides a broad spectrum of services. We are called upon daily for pre-employment screening, skip traces, surveillance of suspected spouses or business associates as well as computer forensics and services for attorney’s offices. We provide a complete range of services for attorney’s offices such as client sign-ups, accident investigations, satellite imagery, workers’ compensation claims investigation and surveillance just to name a few. Cory T. Knight is the President and CEO of CTK INVESTIGATIONS, and he brings over twenty years of investigative experience to you. CTK INVESTIGATIONS, is a licensed and insured Florida Private Investigation company perfectly located in Hollywood, Florida. CTK INVESTIGATIONS, has clients located from the Florida Keys to Jacksonville. We have the ability to conduct a multitude of investigations such as skip traces, finding lost family members, fraud investigation, identity theft, crime scene investigation, accident investigation, personal injury claims, workers’ compensation claims, surveillance, body guard services just to name a few. Cory T. Knight is a licensed Florida Private Investigator available 24/7 to answer you questions. Please feel free to contact us at
954-652-0733.









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Traumatic Brain Injury and CTK INVESTIGATIONS, LLC CORY T. KNIGHT

Brain Injury

Traumatic brain injury (TBI) refers to a blow or a jolt to the head. A traumatic brain injury can disrupt functioning of the brain and can cause anything from a mild concussion to permanent injury, coma, and even fatalities. Each year in the U. S., roughly 1.4 million people sustain a TBI, often from firearms, slip and fall accidents, automobile accidents, and other injuries. Today, more than 5.3 million Americans live with permanent disabilities resulting from brain injuries. In many cases, these injuries require them to hire caregivers, undergo extensive medical treatments, and miss significant amounts of work. The qualified Florida investigators at CTK INVESTIGATIONS, LLC have investigated many clients who have suffered brain injuries. Our experienced in investigating and dealing with South Florida brain injury attorneys have helped people get the medical treatment and the assistance they needed to rebuild their lives after serious brain injury.

Because of our extensive experience, CTK INVESTIGATIONS, LLC understands how traumatic TBI can be, both to the victim and to the family. We also understand how important it is to get help quickly from a qualified Florida lawyer. Is important to get immediate assistance so that medical bills can be paid and lost income can be replaced. If you have suffered from a brain injury or have a loved one who has sustained a TBI, contact our office so that we can discuss your situation. We work with attorneys that may be able to help ensure that insurance companies will continue to pay for any future medical treatments necessary in order to help the injury heal as much as possible. We will investigate the case, help you understand all your legal options, and work hard to ensure that you get the maximum amount of assistance as quickly as possible.
In many cases, brain injuries change lives forever. However, with the right Florida Investigator, you may be able to get the help you need to rebuild your life. CTK INVESTIGATION, LLC has the brain injury experience you need to get you the help you deserve.
Our Florida Private Investigators can meet in your home, hospital room, or office to discuss your particular case. Our complimentary consultation comes with no obligation whatsoever, this is simply a chance for you to ask questions and get the information you need to make an informed decision. Keep in mind, too, that the attorneys we work with we work on a contingency basis. They are willing to defer fees until you reach an out-of-court settlement or win your case.
Our Florida Licensed Private Investigators’ are available to answer your questions. Please feel free to contact us anytime at CTK INVESTIGATIONS 954-652-0733.

Cory T. Knight

Florida Automobile Insurance Coverage

Florida Automobile Insurance Coverage

Automobile insurance laws in Florida require the owner of a vehicle to have a certain amount of personal injury protection. Fla. Sta § 627.736. http://www.leg.state.fl.us/Statutes/index.cfm?mode=View%20Statutes&SubMenu=1&App_mode=Display_Statute&Search_String=&URL=CH0627/SEC736.HTM.

Personal injury protection provides compensation to you in the event you are in an accident. The minimum amount of personal injury coverage required by law is $10,000.00 according to Fla Sta. §627.736, but you can purchase higher amounts of insurance that covers medical, surgical, funeral, and disability benefits regardless of fault. This is known as no-fault insurance. Please feel free to contact Cory T. Knight at 954-652-0733 at CTK INVESTIGATIONS, LLC to ask any questions. Mr. Knight has over 20 years experience dealing with accident investigations and has a comprehensive understanding of PIP cases and investigation.

Here is some more direct information on Florida's PIP or NO-Fault Law:

1627.736 Required personal injury protection benefits; exclusions; priority; claims.--
(1) REQUIRED BENEFITS.--Every insurance policy complying with the security requirements of s. 627.733 shall provide personal injury protection to the named insured, relatives residing in the same household, persons operating the insured motor vehicle, passengers in such motor vehicle, and other persons struck by such motor vehicle and suffering bodily injury while not an occupant of a self-propelled vehicle, subject to the provisions of subsection (2) and paragraph (4)(d), to a limit of $10,000 for loss sustained by any such person as a result of bodily injury, sickness, disease, or death arising out of the ownership, maintenance, or use of a motor vehicle as follows:
(a) Medical benefits.--Eighty percent of all reasonable expenses for medically necessary medical, surgical, X-ray, dental, and rehabilitative services, including prosthetic devices, and medically necessary ambulance, hospital, and nursing services. Such benefits shall also include necessary remedial treatment and services recognized and permitted under the laws of the state for an injured person who relies upon spiritual means through prayer alone for healing, in accordance with his or her religious beliefs; however, this sentence does not affect the determination of what other services or procedures are medically necessary.
(b) Disability benefits.--Sixty percent of any loss of gross income and loss of earning capacity per individual from inability to work proximately caused by the injury sustained by the injured person, plus all expenses reasonably incurred in obtaining from others ordinary and necessary services in lieu of those that, but for the injury, the injured person would have performed without income for the benefit of his or her household. All disability benefits payable under this provision shall be paid not less than every 2 weeks.
(c) Death benefits.--Death benefits of $5,000 per individual. The insurer may pay such benefits to the executor or administrator of the deceased, to any of the deceased's relatives by blood or legal adoption or connection by marriage, or to any person appearing to the insurer to be equitably entitled thereto. Only insurers writing motor vehicle liability insurance in this state may provide the required benefits of this section, and no such insurer shall require the purchase of any other motor vehicle coverage other than the purchase of property damage liability coverage as required by s. 627.7275 as a condition for providing such required benefits. Insurers may not require that property damage liability insurance in an amount greater than $10,000 be purchased in conjunction with personal injury protection. Such insurers shall make benefits and required property damage liability insurance coverage available through normal marketing channels. Any insurer writing motor vehicle liability insurance in this state who fails to comply with such availability requirement as a general business practice shall be deemed to have violated part IX of chapter 626, and such violation shall constitute an unfair method of competition or an unfair or deceptive act or practice involving the business of insurance; and any such insurer committing such violation shall be subject to the penalties afforded in such part, as well as those which may be afforded elsewhere in the insurance code.
(2) AUTHORIZED EXCLUSIONS.--Any insurer may exclude benefits:
(a) For injury sustained by the named insured and relatives residing in the same household while occupying another motor vehicle owned by the named insured and not insured under the policy or for injury sustained by any person operating the insured motor vehicle without the express or implied consent of the insured.
(b) To any injured person, if such person's conduct contributed to his or her injury under any of the following circumstances:
1. Causing injury to himself or herself intentionally; or
2. Being injured while committing a felony. Whenever an insured is charged with conduct as set forth in subparagraph 2., the 30-day payment provision of paragraph (4)(b) shall be held in abeyance, and the insurer shall withhold payment of any personal injury protection benefits pending the outcome of the case at the trial level. If the charge is nolle prossed or dismissed or the insured is acquitted, the 30-day payment provision shall run from the date the insurer is notified of such action.
(3) INSURED'S RIGHTS TO RECOVERY OF SPECIAL DAMAGES IN TORT CLAIMS.--No insurer shall have a lien on any recovery in tort by judgment, settlement, or otherwise for personal injury protection benefits, whether suit has been filed or settlement has been reached without suit. An injured party who is entitled to bring suit under the provisions of ss. 627.730-627.7405, or his or her legal representative, shall have no right to recover any damages for which personal injury protection benefits are paid or payable. The plaintiff may prove all of his or her special damages notwithstanding this limitation, but if special damages are introduced in evidence, the trier of facts, whether judge or jury, shall not award damages for personal injury protection benefits paid or payable. In all cases in which a jury is required to fix damages, the court shall instruct the jury that the plaintiff shall not recover such special damages for personal injury protection benefits paid or payable.
(4) BENEFITS; WHEN DUE.--Benefits due from an insurer under ss. 627.730-627.7405 shall be primary, except that benefits received under any workers' compensation law shall be credited against the benefits provided by subsection (1) and shall be due and payable as loss accrues, upon receipt of reasonable proof of such loss and the amount of expenses and loss incurred which are covered by the policy issued under ss. 627.730-627.7405. 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, benefits under ss. 627.730-627.7405 shall be subject to the provisions of the Medicaid program.
(a) An insurer may require written notice to be given as soon as practicable after an accident involving a motor vehicle with respect to which the policy affords the security required by ss. 627.730-627.7405.
(b) Personal injury protection insurance benefits paid pursuant to this section shall be overdue if not paid within 30 days after the insurer is furnished written notice of the fact of a covered loss and of the amount of same. If such written notice is not furnished to the insurer as to the entire claim, any partial amount supported by written notice is overdue if not paid within 30 days after such written notice is furnished to the insurer. Any part or all of the remainder of the claim that is subsequently supported by written notice is overdue if not paid within 30 days after such written notice is furnished to the insurer. When an insurer pays only a portion of a claim or rejects a claim, the insurer shall 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 to explain the reasonableness of the reduced charge, provided that this shall not limit the introduction of evidence at trial; and the insurer shall include the name and address of the person to whom the claimant should respond and a claim number to be referenced in future correspondence. However, notwithstanding the fact that written notice has been furnished to the insurer, any payment shall not be deemed overdue when the insurer has reasonable proof to establish that the insurer is not responsible for the payment. For the purpose of calculating the extent to which any benefits are overdue, payment shall be treated as being made on the date a draft or other valid instrument which 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. 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 in violation of, subsection (5). Such assertion by the insurer may be made at any time, including after payment of the claim or after the 30-day time period for payment set forth in this paragraph.
(c) All overdue payments shall bear simple interest at the rate established under s. 55.03 or the rate established in the insurance contract, whichever is greater, for the year in which the payment became overdue, calculated from the date the insurer was furnished with written notice of the amount of covered loss. Interest shall be due at the time payment of the overdue claim is made.
(d) The insurer of the owner of a motor vehicle shall pay personal injury protection benefits for:
1. Accidental bodily injury sustained in this state by the owner while occupying a motor vehicle, or while not an occupant of a self-propelled vehicle if the injury is caused by physical contact with a motor vehicle.
2. Accidental bodily injury sustained outside this state, but within the United States of America or its territories or possessions or Canada, by the owner while occupying the owner's motor vehicle.
3. Accidental bodily injury sustained by a relative of the owner residing in the same household, under the circumstances described in subparagraph 1. or subparagraph 2., provided the relative at the time of the accident is domiciled in the owner's household and is not himself or herself the owner of a motor vehicle with respect to which security is required under ss. 627.730-627.7405.
4. Accidental bodily injury sustained in this state by any other person while occupying the owner's motor vehicle or, if a resident of this state, while not an occupant of a self-propelled vehicle, if the injury is caused by physical contact with such motor vehicle, provided the injured person is not himself or herself:
a. The owner of a motor vehicle with respect to which security is required under ss. 627.730-627.7405; or
b. Entitled to personal injury benefits from the insurer of the owner or owners of such a motor vehicle.
(e) If two or more insurers are liable to pay personal injury protection benefits for the same injury to any one person, the maximum payable shall be as specified in subsection (1), and any insurer paying the benefits shall be 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) It is a violation of the 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.
(g) Benefits shall not be due or payable to or on the behalf of an insured person if that person has committed, by a material act or omission, any insurance fraud relating to personal injury protection coverage under his or her policy, if the fraud is admitted to in a sworn statement by the insured or if it is established in a court of competent jurisdiction. Any insurance fraud shall void all coverage arising from the claim related to such fraud under the personal injury protection coverage of the insured person who committed the fraud, irrespective of whether a portion of the insured person's claim may be legitimate, and any benefits paid prior to the discovery of the insured person's insurance fraud shall be recoverable by the insurer from the person who committed insurance fraud in their entirety. The prevailing party is entitled to its costs and attorney's fees in any action in which it prevails in an insurer's action to enforce its right of recovery under this paragraph.
(5) CHARGES FOR TREATMENT OF INJURED PERSONS.--
(a) Any physician, hospital, clinic, or other person or institution lawfully rendering treatment to an injured person for a bodily injury covered by personal injury protection insurance may charge the insurer and injured party only a reasonable amount pursuant to this section for the services and supplies rendered, and the insurer providing such coverage may pay for such charges directly to such person or institution lawfully rendering such treatment, if the insured receiving such treatment or his or her guardian has countersigned the properly completed invoice, bill, or claim form approved by the office upon which such charges are to be paid for as having actually been rendered, to the best knowledge of the insured or his or her guardian. In no event, however, may such a charge be in excess of the amount the person or institution customarily charges for like services or supplies. With respect to a determination of whether a charge for a particular service, treatment, or otherwise is reasonable, consideration may be given to evidence of usual and customary charges and payments accepted by the provider involved in the dispute, and reimbursement levels in the community and various federal and state medical fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement for the service, treatment, or supply.
(b)1. An insurer or insured is not required to pay a claim or charges:
a. Made by a broker or by a person making a claim on behalf of a broker;
b. For any service or treatment that was not lawful at the time rendered;
c. To any person who knowingly submits a false or misleading statement relating to the claim or charges;
d. With respect to a bill or statement that does not substantially meet the applicable requirements of paragraph (d);
e. For any treatment or service that is upcoded, or that is unbundled when such treatment or services should be bundled, in accordance with paragraph (d). To facilitate prompt payment of lawful services, an insurer may change codes that it determines to have been improperly or incorrectly upcoded or unbundled, and may make payment based on the changed codes, without affecting the right of the provider to dispute the change by the insurer, provided that before doing so, the insurer must contact the health care provider and discuss the reasons for the insurer's change and the health care provider's reason for the coding, or make a reasonable good faith effort to do so, as documented in the insurer's file; and
f. For medical services or treatment billed by a physician and not provided in a hospital unless such services are rendered by the physician or are incident to his or her professional services and are included on the physician's bill, including documentation verifying that the physician is responsible for the medical services that were rendered and billed.
2. Charges for medically necessary cephalic thermograms, peripheral thermograms, spinal ultrasounds, extremity ultrasounds, video fluoroscopy, and surface electromyography shall not exceed the maximum reimbursement allowance for such procedures as set forth in the applicable fee schedule or other payment methodology established pursuant to s. 440.13.
3. Allowable amounts that may be charged to a personal injury protection insurance insurer and insured for medically necessary nerve conduction testing when done in conjunction with a needle electromyography procedure and both are performed and billed solely by a physician licensed under chapter 458, chapter 459, chapter 460, or chapter 461 who is also certified by the American Board of Electrodiagnostic Medicine or by a board recognized by the American Board of Medical Specialties or the American Osteopathic Association or who holds diplomate status with the American Chiropractic Neurology Board or its predecessors shall not exceed 200 percent of the allowable amount under the participating physician fee schedule of Medicare Part B for year 2001, for the area in which the treatment was rendered, adjusted annually on August 1 to reflect the prior calendar year's changes in the annual Medical Care Item of the Consumer Price Index for All Urban Consumers in the South Region as determined by the Bureau of Labor Statistics of the United States Department of Labor.
4. Allowable amounts that may be charged to a personal injury protection insurance insurer and insured for medically necessary nerve conduction testing that does not meet the requirements of subparagraph 3. shall not exceed the applicable fee schedule or other payment methodology established pursuant to s. 440.13.
5. Allowable amounts that may be charged to a personal injury protection insurance insurer and insured for magnetic resonance imaging services shall not exceed 175 percent of the allowable amount under the participating physician fee schedule of Medicare Part B for year 2001, for the area in which the treatment was rendered, adjusted annually on August 1 to reflect the prior calendar year's changes in the annual Medical Care Item of the Consumer Price Index for All Urban Consumers in the South Region as determined by the Bureau of Labor Statistics of the United States Department of Labor for the 12-month period ending June 30 of that year, except that allowable amounts that may be charged to a personal injury protection insurance insurer and insured for magnetic resonance imaging services provided in facilities accredited by the Accreditation Association for Ambulatory Health Care, the American College of Radiology, or the Joint Commission on Accreditation of Healthcare Organizations shall not exceed 200 percent of the allowable amount under the participating physician fee schedule of Medicare Part B for year 2001, for the area in which the treatment was rendered, adjusted annually on August 1 to reflect the prior calendar year's changes in the annual Medical Care Item of the Consumer Price Index for All Urban Consumers in the South Region as determined by the Bureau of Labor Statistics of the United States Department of Labor for the 12-month period ending June 30 of that year. This paragraph does not apply to charges for magnetic resonance imaging services and nerve conduction testing for inpatients and emergency services and care as defined in chapter 395 rendered by facilities licensed under chapter 395.
6. The Department of Health, in consultation with the appropriate professional licensing boards, shall adopt, by rule, a list of diagnostic tests deemed not to be medically necessary for use in the treatment of persons sustaining bodily injury covered by personal injury protection benefits under this section. The initial list shall be adopted by January 1, 2004, and shall be revised from time to time as determined by the Department of Health, in consultation with the respective professional licensing boards. Inclusion of a test on the list of invalid diagnostic tests shall be based on lack of demonstrated medical value and a level of general acceptance by the relevant provider community and shall not be dependent for results entirely upon subjective patient response. Notwithstanding its inclusion on a fee schedule in this subsection, an insurer or insured is not required to pay any charges or reimburse claims for any invalid diagnostic test as determined by the Department of Health.
(c)1. With respect to any treatment or service, other than medical services billed by a hospital or other provider for emergency services as defined in s. 395.002 or inpatient services rendered at a hospital-owned facility, the statement of charges must be furnished to the insurer by the provider and 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 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 shall 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 person or insured to pay for such charges is unenforceable.
2. If, however, the insured fails to furnish the provider with the correct name and address of the insured's personal injury protection 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 for 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.
3. For emergency services and care as defined in s. 395.002 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 time periods established by this paragraph; and the insurer shall not be considered to have been furnished with notice of the amount of covered loss for purposes of paragraph (4)(b) until it receives a statement complying with paragraph (d), or copy thereof, which specifically identifies the place of service to be a hospital emergency department or an ambulance in accordance with billing standards recognized by the Health Care Finance Administration.
4. Each notice of insured's rights under s. 627.7401 must include the following statement in type no smaller than 12 points:
BILLING REQUIREMENTS.--Florida Statutes provide 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.

(d) All statements and bills for medical services rendered by any physician, hospital, clinic, or other person or institution shall be submitted to the insurer on a properly completed Centers for Medicare and Medicaid Services (CMS) 1500 form, UB 92 forms, or any other standard form approved by the office or adopted by the commission for purposes of this paragraph. All billings for such services rendered by providers shall, to the extent applicable, follow the Physicians' Current Procedural Terminology (CPT) or Healthcare Correct Procedural Coding System (HCPCS), or ICD-9 in effect for the year in which services are rendered and comply with the Centers for Medicare and Medicaid Services (CMS) 1500 form instructions and the American Medical Association Current Procedural Terminology (CPT) Editorial Panel and Healthcare Correct Procedural Coding System (HCPCS). All providers other than hospitals shall 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." In determining compliance with applicable CPT and HCPCS coding, guidance shall be provided by the Physicians' Current Procedural Terminology (CPT) or the Healthcare Correct Procedural Coding System (HCPCS) in effect for the year in which services were rendered, the Office of the Inspector General (OIG), Physicians Compliance Guidelines, and other authoritative treatises designated by rule by the Agency for Health Care Administration. No statement of medical services may include charges for medical services of a person or entity that performed such services without possessing the valid licenses required to perform such services. For purposes of paragraph (4)(b), an insurer shall not be considered to have been furnished with notice of the amount of covered loss or medical bills due unless the statements or bills comply with this paragraph, and unless the statements or bills are properly completed in their entirety as to all material 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 personal injury protection benefits is based shall require an insured person, or his or her guardian, to execute a disclosure and acknowledgment form, which 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. That 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 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 the services rendered to the insured, or his or her guardian, so that the insured, or his or her guardian, countersigns the form with informed consent.
3. 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 must sign, by his or her own hand, the form complying with this paragraph.
5. The original completed disclosure and acknowledgment form shall be furnished to the insurer pursuant to paragraph (4)(b) and may not be electronically furnished.
6. This disclosure and acknowledgment form is not required for services billed by a provider for emergency services as defined in s. 395.002, for emergency services and care as defined in s. 395.002 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 Financial Services Commission shall adopt, by rule, a standard disclosure and acknowledgment form that shall be used to fulfill the requirements of this paragraph, effective 90 days after such form is adopted and becomes final. The commission shall adopt a proposed rule by October 1, 2003. Until the rule is final, the provider may use a form of its own which otherwise complies with the requirements of this paragraph.
8. As used in this paragraph, "countersigned" means a second or verifying signature, as on a previously signed document, and is not satisfied by the statement "signature on file" or any similar statement.
9. The requirements of this paragraph apply only with respect to the initial treatment or service of 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, that is consistent with the services being rendered to the patient as claimed. The requirements of this subparagraph for maintaining 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 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 those services and treatments that the insured actually received. If the insurer determines that the insured has been improperly billed, the insurer shall notify the insured, the person making the written notification and the provider of its findings and shall reduce the amount of payment to the provider by the amount determined to be improperly billed. If a reduction is made due to such written notification by any person, the insurer shall 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, then the insurer shall 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.
(6) DISCOVERY OF FACTS ABOUT AN INJURED PERSON; DISPUTES.--
(a) Every employer shall, if a request is made by an insurer providing personal injury protection benefits under ss. 627.730-627.7405 against whom a claim has been made, furnish forthwith, in a form approved by the office, a sworn statement of the earnings, since the time of the bodily injury and for a reasonable period before the injury, of the person upon whose injury the claim is based.
(b) Every physician, hospital, clinic, or other medical institution providing, before or after bodily injury upon which a claim for personal injury protection insurance benefits is based, any products, services, or accommodations in relation to that or any other injury, or in relation to a condition claimed to be connected with that or any other injury, shall, if requested to do so by the insurer against whom the claim has been made, furnish forthwith a written report of the history, condition, treatment, dates, and costs of such 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 treatment or services rendered were reasonable and necessary with respect to the bodily injury sustained and identifying which portion of the expenses for such treatment or services was incurred as a result of such bodily injury, and produce forthwith, and permit the inspection and copying of, his or her or its records regarding such history, condition, treatment, dates, and costs of treatment; provided that this shall not limit the introduction of evidence at trial. Such sworn statement shall 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." No cause of action for violation of the physician-patient privilege or invasion of the right of privacy shall be permitted against any physician, hospital, clinic, or other medical institution complying with the provisions of this section. The person requesting such records and such 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 (4)(a), the amount or the partial amount which is the subject of the insurer's inquiry shall become overdue if the insurer does not pay in accordance with paragraph (4)(b) or within 10 days after the insurer's receipt of the requested documentation or information, whichever occurs later. For purposes of this paragraph, the term "receipt" includes, but is not limited to, inspection and copying pursuant to this paragraph. Any 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 insurance code.
(c) In the event of any 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 it shall specify the time, place, manner, conditions, and scope of the discovery. Such court may, in order to protect against annoyance, embarrassment, or oppression, as justice requires, enter an order refusing discovery or specifying conditions of discovery and may order payments of costs and expenses of the proceeding, including reasonable fees for the appearance of attorneys at the proceedings, as justice requires.
(d) The injured person shall be furnished, upon request, a copy of all information obtained by the insurer under the provisions of this section, and shall pay a reasonable charge, if required by the insurer.
(e) Notice to an insurer of the existence of a claim shall not be unreasonably withheld by an insured.
(7) MENTAL AND PHYSICAL EXAMINATION OF INJURED PERSON; REPORTS.--
(a) Whenever the mental or physical condition of an injured person covered by personal injury protection is material to any claim that has been or may be made for past or future personal injury protection insurance benefits, such person shall, upon the request of an insurer, submit to mental or physical examination by a physician or physicians. The costs of any examinations requested by an insurer shall be borne entirely by the insurer. Such examination shall be conducted within the municipality where the insured is receiving treatment, or 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, provided 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, then such examination shall be conducted in an area of the closest proximity to the insured's residence. Personal protection insurers are authorized to include reasonable provisions in personal injury protection insurance policies for mental and physical examination of those claiming personal injury protection insurance benefits. An insurer may not withdraw payment of a treating physician without the consent of the injured person covered by the personal injury protection, 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. 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 and 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. 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 or teaching hospital or accredited residency program. The physician preparing a report at the request of an insurer and physicians rendering expert opinions on behalf of persons claiming medical benefits for personal injury protection, 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. Neither an insurer nor any person acting at the direction of or on behalf of an insurer may 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 an examination, the personal injury protection carrier is no longer liable for subsequent personal injury protection benefits.
(8) APPLICABILITY OF PROVISION REGULATING ATTORNEY'S FEES.--With respect to any dispute under the provisions of ss. 627.730-627.7405 between the insured and the insurer, or between an assignee of an insured's rights and the insurer, the provisions of s. 627.428 shall apply, except as provided in subsection (11).
(9)(a) Each insurer which has issued a policy providing personal injury protection benefits shall report the renewal, cancellation, or nonrenewal thereof to the Department of Highway Safety and Motor Vehicles within 45 days from the effective date of the renewal, cancellation, or nonrenewal. Upon the issuance of a policy providing personal injury protection benefits to a named insured not previously insured by the insurer thereof during that calendar year, the insurer shall report the issuance of the new policy to the Department of Highway Safety and Motor Vehicles within 30 days. The report shall be in such form and format and contain such information as may be required by the Department of Highway Safety and Motor Vehicles which shall include a format compatible with the data processing capabilities of said department, and the Department of Highway Safety and Motor Vehicles is authorized to adopt rules necessary with respect thereto. Failure by an insurer to file proper reports with the Department of Highway Safety and Motor Vehicles as required by this subsection or rules adopted with respect to the requirements of this subsection constitutes a violation of the Florida Insurance Code. Reports of cancellations and policy renewals and reports of the issuance of new policies received by the Department of Highway Safety and Motor Vehicles are confidential and exempt from the provisions of s. 119.07(1). These records are to be used for enforcement and regulatory purposes only, including the generation by the department of data regarding compliance by owners of motor vehicles with financial responsibility coverage requirements. In addition, the Department of Highway Safety and Motor Vehicles shall release, upon a written request by a person involved in a motor vehicle accident, by the person's attorney, or by a representative of the person's motor vehicle insurer, the name of the insurance company and the policy number for the policy covering the vehicle named by the requesting party. The written request must include a copy of the appropriate accident form as provided in s. 316.065, s. 316.066, or s. 316.068.
(b) Every insurer with respect to each insurance policy providing personal injury protection benefits shall notify the named insured or in the case of a commercial fleet policy, the first named insured in writing that any cancellation or nonrenewal of the policy will be reported by the insurer to the Department of Highway Safety and Motor Vehicles. The notice shall also inform the named insured that failure to maintain personal injury protection and property damage liability insurance on a motor vehicle when required by law may result in the loss of registration and driving privileges in this state, and the notice shall inform the named insured of the amount of the reinstatement fees required by s. 627.733(7). This notice is for informational purposes only, and no civil liability shall attach to an insurer due to failure to provide this notice.
(10) An insurer may negotiate and enter into contracts with licensed health care providers for the benefits described in this section, referred to in this section as "preferred providers," which shall include health care providers licensed under chapters 458, 459, 460, 461, and 463. The insurer may provide an option to an insured to use a preferred provider at the time of purchase of the policy for personal injury protection benefits, if the requirements of this subsection are met. If the insured elects to use a provider who is not a preferred provider, whether the insured purchased a preferred provider policy or a nonpreferred provider policy, the medical benefits provided by the insurer shall be as required by this section. If the insured elects to use a provider who is a preferred provider, the insurer may pay medical benefits in excess of the benefits required by this section and may waive or lower the amount of any deductible that applies to such medical benefits. If the insurer offers a preferred provider policy to a policyholder or applicant, it must also offer a nonpreferred provider policy. The insurer shall provide each policyholder with a current roster of preferred providers in the county in which the insured resides at the time of purchase of such policy, and shall make such list available for public inspection during regular business hours at the principal office of the insurer within the state.
(11) DEMAND LETTER.--
(a) As a condition precedent to filing any action for benefits under this section, the insurer must be provided with written notice of an intent to initiate litigation. 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 (4)(b).
(b) The notice required shall state that it is a "demand letter under s. 627.736(11)" and shall state with specificity:
1. The name of the insured upon which such benefits are being sought, including a copy of the assignment giving rights to the claimant if the claimant is not the insured.
2. The claim number or policy number upon which such claim was originally submitted to the insurer.
3. 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. A completed form satisfying the requirements of paragraph (5)(d) or the lost-wage statement previously submitted may be used as the itemized statement. To the extent that the demand involves an insurer's withdrawal of payment under paragraph (7)(a) 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 United States certified or registered mail, return receipt requested. Such postal costs shall be reimbursed by the insurer if so 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 designation of the name and address of the person to whom notices pursuant to this subsection shall be sent which the office shall make available on its Internet website. The name and address on file with the office pursuant to s. 624.422 shall be deemed the authorized representative to accept notice pursuant to this subsection in the event no other designation has been made.
(d) If, within 15 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, no action may be brought against the insurer. If the demand involves an insurer's withdrawal of payment under paragraph (7)(a) for future treatment not yet rendered, no action may be brought against the insurer if, within 15 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 shall not be payable in any subsequent action. For purposes of this subsection, payment or the insurer's agreement shall 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 shall not be obligated to pay any attorney's 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 shall be tolled for a period of 15 business days by the mailing of the notice required by this subsection.
(f) Any insurer making a general business practice of not paying valid claims until receipt of the notice required by this subsection is engaging in an unfair trade practice under the insurance code.
(12) CIVIL ACTION FOR INSURANCE FRAUD.--An insurer shall have 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. 817.234, patient brokering under s. 817.505, or kickbacks under s. 456.054, associated with a claim for personal injury protection benefits in accordance with this section. An insurer prevailing in an action brought under this subsection may recover compensatory, consequential, and punitive damages subject to the requirements and limitations of part II of chapter 768, and attorney's fees and costs incurred in litigating 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. 817.234, patient brokering under s. 817.505, or kickbacks under s. 456.054, associated with a claim for personal injury protection benefits in accordance with this section.
(13) MINIMUM BENEFIT COVERAGE.--If the Financial Services Commission determines that the cost savings under personal injury protection insurance benefits paid by insurers have been realized due to the provisions of this act, prior legislative reforms, or other factors, the commission may increase the minimum $10,000 benefit coverage requirement. In establishing the amount of such increase, the commission must determine that the additional premium for such coverage is approximately equal to the premium cost savings that have been realized for the personal injury protection coverage with limits of $10,000.
(14) 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:
(a) Pursuant to s. 626.9892, the Department of Financial Services 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 Insurance Fraud arising from violations of s. 440.105, s. 624.15, s. 626.9541, s. 626.989, or s. 817.234.
(b) Solicitation of a person injured in a motor vehicle crash for purposes of filing personal injury protection 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 Insurance Fraud if such conduct has taken place.
History.--s. 7, ch. 71-252; s. 3, ch. 76-168; s. 4, ch. 76-266; s. 1, ch. 77-457; s. 33, ch. 77-468; s. 3, ch. 78-374; s. 114, ch. 79-40; s. 165, ch. 79-164; s. 239, ch. 79-400; s. 3, ch. 80-206; s. 430, ch. 81-259; ss. 2, 3, ch. 81-318; ss. 554, 563, ch. 82-243; s. 31, ch. 87-226; s. 1, ch. 87-282; ss. 19, 20, 21, 22, ch. 88-370; s. 2, ch. 89-243; s. 1, ch. 89-313; s. 40, ch. 90-119; s. 7, ch. 90-232; s. 11, ch. 90-248; s. 36, ch. 90-295; s. 7, ch. 91-106; s. 66, ch. 91-282; s. 84, ch. 92-318; s. 7, ch. 93-289; s. 1, ch. 94-123; s. 8, ch. 95-202; s. 83, ch. 95-211; s. 381, ch. 96-406; s. 1738, ch. 97-102; s. 2, ch. 98-270; s. 262, ch. 99-8; s. 62, ch. 2001-63; s. 6, ch. 2001-271; s. 1195, ch. 2003-261; ss. 8, 19, ch. 2003-411; s. 124, ch. 2004-5; s. 121, ch. 2005-2; s. 13, ch. 2006-305.
1Note.--Section 19, ch. 2003-411, provides that:
"(1) Effective October 1, 2007, sections 627.730, 627.731, 627.732, 627.733, 627.734, 627.736, 627.737, 627.739, 627.7401, 627.7403, and 627.7405, Florida Statutes, constituting the Florida Motor Vehicle No-Fault Law, are repealed, unless reenacted by the Legislature during the 2006 Regular Session and such reenactment becomes law to take effect for policies issued or renewed on or after October 1, 2006.
"(2) Insurers are authorized to provide, in all policies issued or renewed after October 1, 2006, that such policies may terminate on or after October 1, 2007, as provided in subsection (1)."

Cory Knight Florida Private Investigator Hiring, Law

Information on Florida Private Investigators
Nature of the Work

Private detectives and investigators use many methods to determine the facts in a variety of matters. To carry out investigations, they may use various types of surveillance or searches. To verify facts, such as an individual’s place of employment or income, they may make phone calls or visit a subject’s workplace. In other cases, especially those involving missing persons and background checks, investigators often interview people to gather as much information as possible about an individual. In all cases, private detectives and investigators assist attorneys, businesses, and the public with legal, financial, and personal problems.
Private detectives and investigators offer many services, including executive, corporate, and celebrity protection; pre-employment verification; and individual background profiles. They investigate computer crimes, such as identity theft, harassing e-mails, and illegal downloading of copyrighted material. They also provide assistance in civil liability and personal injury cases, insurance claims and fraud, child custody and protection cases, missing persons cases, and premarital screening. They are sometimes hired to investigate individuals to prove or disprove infidelity.
Most detectives and investigators are trained to perform physical surveillance. They may observe a site, such as the home of a subject, from an inconspicuous location or a vehicle. They continue the surveillance, which is often carried out using still and video cameras, binoculars, and a cell phone, until the desired evidence is obtained. This watching and waiting often continues for a long time.
Detectives also may perform computer database searches or work with someone who does. Computers allow investigators to quickly obtain massive amounts of information on individuals’ prior arrests, convictions, and civil legal judgments; telephone numbers; motor vehicle registrations; association and club memberships; and other matters.
The duties of private detectives and investigators depend on the needs of their clients. In cases for employers that involve fraudulent workers’ compensation claims, for example, investigators may carry out long-term covert observation of subjects. If an investigator observes a subject performing an activity that contradicts injuries stated in a worker’s compensation claim, the investigator would take video or still photographs to document the activity and report it to the client.
Private detectives and investigators often specialize. Those who focus on intellectual property theft, for example, investigate and document acts of piracy, help clients stop illegal activity, and provide intelligence for prosecution and civil action. Other investigators specialize in developing financial profiles and asset searches. Their reports reflect information gathered through interviews, investigation and surveillance, and research, including review of public documents.
Legal investigators specialize in cases involving the courts and are normally employed by law firms or lawyers. They frequently assist in preparing criminal defenses, locating witnesses, serving legal documents, interviewing police and prospective witnesses, and gathering and reviewing evidence. Legal investigators also may collect information on the parties to the litigation, take photographs, testify in court, and assemble evidence and reports for trials.
Corporate investigators conduct internal and external investigations for corporations. In internal investigations, they may investigate drug use in the workplace, ensure that expense accounts are not abused, or determine whether employees are stealing merchandise or information. External investigations are typically done to uncover criminal schemes originating outside the corporation, such as theft of company assets through fraudulent billing of products by suppliers.
Financial investigators may be hired to develop confidential financial profiles of individuals or companies that are prospective parties to large financial transactions. These investigators often are certified public accountants (CPAs) who work closely with investment bankers and other accountants. They search for assets in order to recover damages awarded by a court in fraud or theft cases.
Detectives who work for retail stores or hotels are responsible for controlling losses and protecting assets. Store detectives, also known as loss prevention agents, safeguard the assets of retail stores by apprehending anyone attempting to steal merchandise or destroy store property. They prevent theft by shoplifters, vendor representatives, delivery personnel and even store employees. Store detectives also conduct periodic inspections of stock areas, dressing rooms, and restrooms, and sometimes assist in opening and closing the store. They may prepare loss prevention and security reports for management and testify in court against persons they apprehend. Hotel detectives protect guests of the establishment from theft of their belongings and preserve order in hotel restaurants and bars. They also may keep undesirable individuals, such as known thieves, off the premises.
Working Conditions

Private detectives and investigators often work irregular hours because of the need to conduct surveillance and contact people who are not available during normal working hours. Early morning, evening, weekend, and holiday work is common.
Many detectives and investigators spend time away from their offices conducting interviews or doing surveillance, but some work in their office most of the day conducting computer searches and making phone calls. Those who have their own agencies and employ other investigators may work primarily in an office and have normal business hours.
When the investigator is working on a case away from the office, the environment might range from plush boardrooms to seedy bars. Store and hotel detectives work in the businesses that they protect. Investigators generally work alone, but they sometimes work with others during surveillance or when following a subject in order to avoid detection by the subject.
Some of the work involves confrontation, so the job can be stressful and dangerous. Some situations call for the investigator to be armed, such as certain bodyguard assignments for corporate or celebrity clients. Detectives and investigators who carry handguns must be licensed by the appropriate authority. In most cases, however, a weapon is not necessary, because the purpose of the work is gathering information and not law enforcement or criminal apprehension. Owners of investigative agencies have the added stress of having to deal with demanding and sometimes distraught clients.
Training, Other Qualifications, and Advancement

There are no formal education requirements for most private detective and investigator jobs, although many private detectives have college degrees. Private detectives and investigators typically have previous experience in other occupations. Some work initially for insurance or collections companies, in the private security industry, or as paralegals. Many investigators enter the field after serving in law enforcement, the military, government auditing and investigative positions, or Federal intelligence jobs.
Former law enforcement officers, military investigators, and government agents, who are frequently able to retire after 25 years of service, often become private detectives or investigators in a second career. Others enter from such diverse fields as finance, accounting, commercial credit, investigative reporting, insurance, and law. These individuals often can apply their prior work experience in a related investigative specialty. A few enter the occupation directly after graduation from college, generally with associate’s or bachelor’s degrees in criminal justice or police science.
The majority of States and the District of Colombia require private detectives and investigators to be licensed. Licensing requirements vary, however. Seven States—Alabama, Alaska, Colorado, Idaho, Mississippi, Missouri, and South Dakota—have no statewide licensing requirements, some States have few requirements, and many other States have stringent regulations. A growing number of States are enacting mandatory training programs for private detectives and investigators. For example, the Bureau of Security and Investigative Services of the California Department of Consumer Affairs requires private investigators to be 18 years of age or older; have a combination of education in police science, criminal law, or justice and experience equaling 3 years (6,000 hours) of investigative experience; pass a criminal history background check by the California Department of Justice and the FBI (in most States, convicted felons cannot be issued a license); and receive a qualifying score on a 2-hour written examination covering laws and regulations. There are additional requirements for a firearms permit.
For private detective and investigator jobs, most employers look for individuals with ingenuity, persistence, and assertiveness. A candidate must not be afraid of confrontation, should communicate well, and should be able to think on his or her feet. Good interviewing and interrogation skills also are important and usually are acquired in earlier careers in law enforcement or other fields. Because the courts often are the ultimate judge of a properly conducted investigation, the investigator must be able to present the facts in a manner that a jury will believe.
Training in subjects such as criminal justice and police science is helpful to aspiring private detectives and investigators. Most corporate investigators must have a bachelor’s degree, preferably in a business-related field. Some corporate investigators have a master’s degree in business administration or a law degree, while others are CPAs. Corporate investigators hired by large companies may receive formal training from their employers on business practices, management structure, and various finance-related topics. The screening process for potential employees typically includes a background check for a criminal history.
Some investigators receive certification from a professional organization to demonstrate competency in a field. For example, the National Association of Legal Investigators (NALI) confers the Certified Legal Investigator designation to licensed investigators who devote a majority of their practice to negligence or criminal defense investigations. To receive the designation, applicants must satisfy experience, educational, and continuing-training requirements and must pass written and oral exams administered by the NALI.
Most private-detective agencies are small, with little room for advancement. Usually, there are no defined ranks or steps, so advancement takes the form of increases in salary and assignment status. Many detectives and investigators work for detective agencies at the beginning of their careers and, after a few years, start their own firms. Corporate and legal investigators may rise to supervisor or manager of the security or investigations department.
Employment

Private detectives and investigators held about 43,000 jobs in 2004. About 26 percent were self-employed, including many who held a secondary job as a self-employed private detective. Around 27 percent of jobs were in investigation and security services, including private detective agencies, while another 15 percent were in department or other general merchandise stores. The rest worked mostly in State and local government, legal services firms, employment services companies, insurance agencies, and credit mediation establishments, including banks and other depository institutions.
Job Outlook

Keen competition is expected because private detective and investigator careers attract many qualified people, including relatively young retirees from law enforcement and military careers. The best opportunities will be in entry-level jobs with detective agencies or in stores that hire detectives on a part-time basis. The best prospects for those seeking store detective jobs will be with large chains and discount stores.
Employment of private detectives and investigators is expected to grow faster than the average for all occupations through 2014. In addition to growth, replacement of those who retire or leave the occupation for other reasons should create many job openings. Increased demand for private detectives and investigators will result from fear of crime, increased litigation, and the need to protect confidential information and property of all kinds. The proliferation of criminal activity on the Internet, such as identity theft, spamming, e-mail harassment, and illegal downloading of copyrighted materials, will increase the demand for private investigators. Employee background checks, conducted by private investigators, will become standard for an increasing number of jobs. Growing financial activity worldwide will increase the demand for investigators to control internal and external financial losses and to monitor competitors and prevent industrial spying.
Earnings

Median annual earnings of salaried private detectives and investigators were $32,110 in May 2004. The middle 50 percent earned between $24,080 and $43,260. The lowest 10 percent earned less than $19,260, and the highest 10 percent earned more than $58,470. Earnings of private detectives and investigators vary greatly by employer, specialty, and geographic area.
Related Occupations

Private detectives and investigators often collect information and protect the property and other assets of companies and individuals. Others with related duties include bill and account collectors; claims adjusters, appraisers, examiners, and investigators; police and detectives; and security guards and gaming surveillance officers. Investigators who specialize in conducting financial profiles and asset searches perform work closely related to that of accountants, auditors, financial analysts, and personal financial advisors.