The 2023 Florida Statutes (including Special Session C)

Title XXXVII
INSURANCE

Chapter 627
INSURANCE RATES AND CONTRACTS

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F.S. 627.613

627.613 Time of payment of claims.—

(1) The contract shall include the following provision:

“Time of Payment of Claims: After receiving written proof of loss, the insurer will pay monthly all benefits then due for (type of benefit) . Benefits for any other loss covered by this policy will be paid as soon as the insurer receives proper written proof.”

(2) Health insurers shall reimburse all claims or any portion of any claim from an insured or an insured’s assignees, for payment under a health insurance policy, within 45 days after receipt of the claim by the health insurer. If a claim or a portion of a claim is contested by the health insurer, the insured or the insured’s assignees shall be notified, in writing, that the claim is contested or denied, within 45 days after receipt of the claim by the health insurer. The notice that a claim is contested shall identify the contested portion of the claim and the reasons for contesting the claim.

(3) A health insurer, upon receipt of the additional information requested from the insured or the insured’s assignees shall pay or deny the contested claim or portion of the contested claim, within 60 days.

(4) An insurer shall pay or deny any claim no later than 120 days after receiving the claim.

(5) 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.

(6) All overdue payments shall bear simple interest at the rate of 10 percent per year.

(7) Upon written notification by an insured, an insurer shall investigate any claim of improper billing by a physician, hospital, or other health care provider. The insurer shall determine if the insured was properly billed for only those procedures and services that the insured actually received. If the insurer determines that the insured has been improperly billed, the insurer shall notify the insured 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 notification by the insured, the insurer shall pay to the insured 20 percent of the amount of the reduction up to $500.

History.—s. 556, ch. 59-205; s. 3, ch. 76-168; s. 1, ch. 77-457; ss. 2, 3, ch. 81-318; ss. 462, 497, 809(2nd), ch. 82-243; s. 79, ch. 82-386; s. 2, ch. 90-85; s. 5, ch. 91-296; s. 114, ch. 92-318.

F.S. 627.613 on Google Scholar

F.S. 627.613 on Casetext

Amendments to 627.613

Arrestable Offenses / Crimes under Fla. Stat. 627.613

Level: Degree
Misdemeanor/Felony: First/Second/Third

Current data shows no reason an arrest or criminal charge should have occurred directly under Florida Statute 627.613.

Annotations, Discussions, Cases:

Cases from cite.case.law:

NORTHWOODS SPORTS MEDICINE AND PHYSICAL REHABILITATION, INC. a a o a a o v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY USAA, 137 So. 3d 1049 (Fla. Dist. Ct. App. 2014)

. . . See §§ 627.613, and 627.662(7), Fla. Stat. . . .

FOUNDATION HEALTH, v. WESTSIDE EKG ASSOCIATES, v. EKG v. EKG, 944 So. 2d 188 (Fla. 2006)

. . . Westside specifically alleged violations of section 641.3155 as well as section 627.613, Florida Statutes . . . Section 627.613 provides time periods in which health insurers must pay claims for medical services. . . .

WESTSIDE EKG ASSOCIATES, v. FOUNDATION HEALTH a f k a PCA f k a f k a PCA, 932 So. 2d 214 (Fla. Dist. Ct. App. 2005)

. . . See and compare: §§ 641.3155; 627.613; 627.614; 641.3104; 627.060; 641.31; 641.3101; 641.3106; 641.3917 . . .

Dr. D. SIMON, M. D. P. A. a a o v. PROGRESSIVE EXPRESS INSURANCE COMPANY,, 904 So. 2d 449 (Fla. Dist. Ct. App. 2005)

. . . See §§ 627.613, and 627.662(7), Fla. Stat. . . .

M. SHAW, v. CONNECTICUT GENERAL LIFE INSURANCE COMPANY, a, 353 F.3d 1276 (11th Cir. 2003)

. . . disability benefits and waiver of life insurance premium benefits in violation of Florida Statute § 627.613 . . .

SCHUSTER v. BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. a, 843 So. 2d 909 (Fla. Dist. Ct. App. 2003)

. . . the purposes of this case are going to be the statutory interest or the contractual interest on the 627.613 . . . Clearly, both the insurance contract and section 627.613, Florida Statutes, require the insurer to pay . . .

STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, v. JONES,, 789 So. 2d 504 (Fla. Dist. Ct. App. 2001)

. . . In Heidenfeldt, the court held that section 627.613, Florida Statutes (1997), which is substantially . . .

WHOLE HEALTH CHIROPRACTIC WELLNESS, INC. a v. HUMANA MEDICAL PLAN, INC., 254 F.3d 1317 (11th Cir. 2001)

. . . contract and statutory violations, and specifically alleged that Humana violated Florida Statutes chapter 627.613 . . . that because it is an HMO governed by Florida Statutes chapter 641, insurance laws such as chapter 627.613 . . .

A. LANE, v. PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY,, 178 F. Supp. 2d 1281 (S.D. Fla. 2001)

. . . The first legal justification offered by Lane for his estoppel theory is Florida Statute § 627.613 (1997 . . . Florida Statute § 627.613(2) (1997) provides: Health insurers shall reimburse all claims or any portion . . . Therefore, as a matter of law, Florida Statute § 627.613(2) (1997) simply will not support Lane’s theory . . . Lane cited section (a) of Florida Statute § 627.613 (1997). However, there is no section (a). . . . Therefore, the Court has assumed that Lane is relying on § 627.613(2) (1997), which contains language . . .

PIONEER LIFE INSURANCE COMPANY, v. HEIDENFELDT,, 773 So. 2d 75 (Fla. Dist. Ct. App. 2000)

. . . from denying insurance benefits due to its failure to comply with the notice requirements of section 627.613 . . . Pioneer Life failed to respond to the claims within the 45-day time period required under section 627.613 . . . Section 627.613(6) provides that all overdue payments will bear interest at the rate of ten percent. . . . This appears to be the only penalty an insurer would be subject to under section 627.613. . . . Section 627.613 was subsequently amended in 1991 to increase the number of days insurers had to pay a . . .

MADISON, v. MIDLAND NATIONAL LIFE INSURANCE COMPANY, f k a, 648 So. 2d 1226 (Fla. Dist. Ct. App. 1995)

. . . Third, assuming without deciding, that section 627.613(2), Florida Statutes (Supp.1990), was applicable . . .

BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. v. L. MING,, 579 So. 2d 771 (Fla. Dist. Ct. App. 1991)

. . . Section 627.613, Florida Statutes, effective June 14, 1990, but not applicable to this case, appears . . .