HB 1447 by Rep. Bryan Nelson
Section-by-Section Summary

(This did not pass during the 2010 session, but was proposed by the Florida insurance Council Fraud Committee. similar legislation is being introduced for the 2011 session. Contact Sam Miller at (850) 386-6668, ext. 223)  

Section 1. Findings and intent
Provides that the act may be cited as the Comprehensive Insurance Fraud Investigation and Prevention Act of 2010. Provides that the intent is to enhance investigation and prevention of fraudulent insurance acts, to provide additional sanctions, and to revise laws that create incentives for fraudulent insurance acts. Includes findings with respect to the increase in auto insurance fraud, regulation of health care clinics, and property insurance issues including sinkholes, mitigation, and replacement cost. (Lines 74-104)

Section 2. Amending s. 316.066, relating to crash reports
Requires law enforcement to use the full form of a crash report (rather than a short form) when a crash involves a vehicle that was transporting passengers other than the driver, and requires the report to include the names and addresses of all passengers. (Lines 108-139)

Section 3. Amending s. 400.991, relating to health care clinic licensure
Requires clinic application and exemption forms to include a notice that knowingly providing a false, misleading, or fraudulent application or document relating to licensure or exemption or compliance with the clinic licensing law is a fraudulent insurance act and may be grounds for discipline by Department of Health licensing boards. (Lines 144-155)

Section 4. Creating s. 400.9933, relating to insurer reports of suspected violations of the clinic licensing law
Provides immunity for insurer reports of suspected violations of the clinic licensing law and exchange of information between insurers (based on the immunity provided by existing law for reports to the Division of Insurance Fraud). (Lines 159-181)

Section 5. Amending s. 443.1715, relating to disclosure of wage information to workers’ comp employer/carrier
Eliminates the requirement that the employer/carrier’s request to the Agency for Workforce Innovation for an injured employee’s wage information be signed by the employee. (Lines 184-207)

Section 6. Amending s. 456.072, relating to grounds for discipline of health care professionals
Provides that it is grounds for disciplinary action for a licensee to knowingly provide false, misleading, or fraudulent applications or documents relating to health care clinic licensure or exemptions or compliance with the clinic licensing law. (Lines 214-219)

Section 7. Amending s. 626.989, relating to the Division of Insurance Fraud
Defines “fraudulent insurance act” to include knowingly providing or submitting false, misleading, or fraudulent applications or other documents relating to licensure as a health care clinic, exemption from licensure, or compliance with the clinic licensing law. (Lines 239-245)

Section 8. Amending s. 627.7011, relating to replacement cost coverage
Provides that in order to reduce the incentives for claims fraud, a residential property policy that includes replacement cost coverage may allow the insurer to hold back the difference between actual cash value and replacement cost until the policyholder repairs or replaces the property. (Lines 254-262)

Section 9. Amending s. 627.70131, relating to a property insurer’s deadline for paying or denying a claim
Provides that a property insurer’s 90-day deadline to pay or deny a property insurance claim applies to the initial claim and also to a supplemental claim. (Line 268)

Section 10. Amending s. 627.706, relating to optional sinkhole coverage
Requires an insurer to make optional sinkhole coverage available at the time the policyholder applies for coverage or, with respect to coverage in effect on 10/1/2010, at the first renewal after 10/1/2010. Provides that the insurer making optional sinkhole coverage available may limit coverage to no more than 25 percent of the Coverage A limit, and that this amount covers both indemnification and expenses. (Lines 298-314)

Section 11. Amending s. 627.7073, relating to sinkhole reports
Provides that the current statutory provision that the findings, opinions, and recommendations of the engineer or geologist are “presumed correct” means that the party disputing the findings, opinions, or recommendations has the burden of proving by a preponderance of the evidence that they are not valid. (Lines 327-331)

Section 12. Amending s. 627.7074, relating to alternative dispute resolution for sinkhole claims
Provides that the neutral evaluation process does not supersede the appraisal clause, if any, of the insurance policy. (Lines 341-342)

Section 13. Amending s. 627.711, relating to notice of mitigation discounts
Provides that an insurer must accept a mitigation verification form only if signed by specified inspectors. (Lines 379-395)

Requires the inspector to certify or attest that he or she personally inspected the structure. (Lines 396-398)

Specifies what constitutes misconduct on the part of an inspector and provides for disciplinary action by licensing boards and the Office of Insurance Regulation. (Lines 399-428)

Revises penalties for fraudulent mitigation forms. A first violation becomes a second degree misdemeanor (currently a first degree misdemeanor), but subsequent violations are felonies. (Lines 429-437)

Requires the mitigation inspection form to include a strong notice relating to insurance fraud, including a statement that mitigation inspection fraud may be a felony under 817.234 and is a misdemeanor under 627.711 for a first violation and a felony for a subsequent violation. (Lines 438-455)

Requires policyholders who benefit from fraudulently-obtained mitigation discounts to repay the value of the wind deductible and any discounts, going back to the first application of the discount. (Lines 457-467)

Section 16. Amending s. 627.736, relating to PIP claims payments
Requires a certification form before payment to a licensed clinic, an exempt clinic owned by practitioners, or an exempt clinic owned by a hospital. (Lines 537-550)

Provides that the deadline for payment is tolled with respect to any portion or portions of a claim for which the insurer has a reasonable suspicion of a fraudulent insurance act (as defined in 626.989), provided the insurer notifies the policyholder that it is investigating the claim. (Lines 598-605)

Provides that benefits are not due or payable to or on behalf of any person (rather than “an insured person”) who has committed a fraudulent insurance act. (Lines 620-628)

Provides that benefits are not due or payable to or on behalf of any person (rather than “an insured person”) who has committed a fraudulent insurance act. (Lines 629-645)

Provides that the insurer is not required to pay any charges from a person who knowingly submits or attempts to submit false or misleading information in connection with a particular insured (but does not affect charges from other providers with respect to that insured or charges from that provider with respect to other insureds). (Lines 656-687)

Provides that an insurer is not required to pay a claim from a provider that is not in full compliance with the clinic licensing law and other applicable licensing or regulatory requirements. Provides for examination under oath in the course of investigating compliance. (Lines 688-700)

Requires the provider to submit to the insurer, within 14 days after initial contact with the injured person, an initial medical report outlining medical history, examination findings, and preliminary diagnosis. (Lines 736-744)

Section 15. Amending s. 932.701, relating to contraband forfeiture
Provides that the contraband forfeiture law covers tangible and intangible property used in the commission of a fraudulent insurance act and any real or personal, tangible or intangible property derived from the proceeds of a fraudulent insurance act. (Lines 812-831)

Section 16. Effective date
Provides that the bill takes effect October 1, 2010. (Line 832)