Florida Statute 627.419 | Lawyer Caselaw & Research

The 2024 Florida Statutes

Title XXXVII
INSURANCE

Chapter 627
INSURANCE RATES AND CONTRACTS

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F.S. 627.419

627.419 Construction of policies.—

(1) Every insurance contract shall be construed according to the entirety of its terms and conditions as set forth in the policy and as amplified, extended, or modified by any application therefor or any rider or endorsement thereto.

(2) The word “physician” or “medical doctor,” when used in any health insurance policy, health care services plan, or other contract providing for the payment of surgical procedures which are specified in the policy or contract or are performed in an accredited hospital in consultation with a licensed physician and are within the scope of a dentist’s professional license, shall be construed to include a dentist who performs such specified procedures.

(3) Notwithstanding any other provision of law, when any health insurance policy, health care services plan, or other contract provides for the payment for procedures specified in the policy or contract which are within the scope of an optometrist’s or podiatric physician’s professional license, such policy shall be construed to include payment to an optometrist or podiatric physician who performs such procedures. In the case of podiatric services, such payments shall be made in accordance with the coverage now provided for medical and surgical benefits.

(4) Notwithstanding any other provision of law, when any health insurance policy, health care services plan, or other contract provides for the payment for medical expense benefits or procedures, such policy, plan, or contract shall be construed to include payment to a chiropractic physician who provides the medical service benefits or procedures which are within the scope of a chiropractic physician’s license. Any limitation or condition placed upon payment to, or upon services, diagnosis, or treatment by, any licensed physician shall apply equally to all licensed physicians without unfair discrimination to the usual and customary treatment procedures of any class of physicians.

(5) For purposes of coverage under a policy of disability income or credit disability insurance, no determination of disability shall be rejected solely on the basis of the chapter under which the physician is licensed; however, such determination may be rejected on the basis that the determination is outside the scope of the physician’s authorized practice. However, the insurance carrier shall have the option after 30 days of disability to seek a second physician’s opinion prior to paying additional benefits.

(6) Notwithstanding any other provision of law, when any health insurance policy, health care services plan, or other contract provides for payment for surgical first assisting benefits or services, the policy, plan, or contract is to be construed as providing for payment to a registered nurse first assistant or employers of a physician assistant or nurse first assistant who performs such services that are within the scope of a physician assistant’s or a registered nurse first assistant’s professional license. The provisions of this subsection apply only if reimbursement for an assisting physician, licensed under chapter 458 or chapter 459, would be covered and a physician assistant or a registered nurse first assistant who performs such services is used as a substitute.

(7) No health insurance policy, health care services plan, or other contract which provides coverage for any diagnostic or surgical procedure involving bones or joints of the skeleton shall discriminate against coverage for any similar diagnostic or surgical procedure involving bones or joints of the jaw and facial region, if, under accepted medical standards, such procedure or surgery is medically necessary to treat conditions caused by congenital or developmental deformity, disease, or injury. This subsection shall not be construed to affect any other coverage under this part or to restrict the scope of coverage under any policy, plan, or contract. Nothing in this subsection shall be construed to discourage appropriate nonsurgical procedures or to prohibit the continued coverage of nonsurgical procedures in the treatment of a bone or joint of the jaw and facial region. Furthermore, nothing in this subsection requires coverage for care or treatment of the teeth or gums, for intraoral prosthetic devices, or for surgical procedures for cosmetic purposes. This section does not apply to accident only, disability income, specified disease, hospital indemnity, credit, Medicare supplement, or long-term care insurance policies.

(8) If an insurer or licensee advertises an insurance policy in a language other than English, the advertisements shall not be construed to modify or change the insurance policy written in English. The advertisement must disclose that the policy written in English controls in the event of a dispute and that statements contained in the advertisement do not necessarily, as a result of possible linguistic differences, reflect the contents of the policy written in English. Nothing in this subsection shall affect the provisions of s. 626.9541 relating to misrepresentations and false advertising of insurance policies.

(9) With respect to any group or individual insurer covering dental services, each claimant, or dentist acting for a claimant, who has had a claim denied as not medically or dentally necessary or who has had a claim payment based on an alternate dental service in accordance with accepted dental standards for adequate and appropriate care must be provided an opportunity for an appeal to the insurer’s licensed dentist who is responsible for the medical necessity reviews under the plan or is a member of the plan’s peer review group. The appeal may be by telephone, and the insurer’s dentist must respond within a reasonable time, not to exceed 15 business days.

History.—s. 468, ch. 59-205; s. 1, ch. 69-245; ss. 1, 2, ch. 72-11; s. 163A, ch. 73-333; s. 1, ch. 74-34; s. 1, ch. 74-87; s. 1, ch. 76-167; s. 3, ch. 76-168; s. 1, ch. 77-457; ss. 2, 3, ch. 81-318; ss. 371, 377, 809(2nd), ch. 82-243; s. 79, ch. 82-386; s. 1, ch. 86-40; s. 3, ch. 90-255; s. 114, ch. 92-318; s. 5, ch. 94-96; s. 2, ch. 96-361; s. 1, ch. 97-5; s. 3, ch. 97-178; s. 223, ch. 98-166; s. 3, ch. 2001-176; s. 107, ch. 2001-277.

Note.—Former s. 627.0118.

F.S. 627.419 on Google Scholar

F.S. 627.419 on Casetext

Amendments to 627.419

Arrestable Offenses / Crimes under Fla. Stat. 627.419

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

Current data shows no reason an arrest or criminal charge should have occurred directly under Florida Statute 627.419.

Annotations, Discussions, Cases:

Cases Citing Statute 627.419

Total Results: 20

Elizabeth Fojon v. Ascendant Commercial Insurance Company

Court: District Court of Appeal of Florida | Date Filed: 2024-08-28

Snippet: the plain meaning of the contract’s text.”); § 627.419(1), Fla. Stat.

Elizabeth Fojon v. Ascendant Commercial Insurance Company

Court: District Court of Appeal of Florida | Date Filed: 2024-08-28

Snippet: the plain meaning of the contract’s text.”); § 627.419(1), Fla. Stat.

PEOPLE'S TRUST INSURANCE COMPANY v. PAUL GUNNSSER

Court: District Court of Appeal of Florida | Date Filed: 2023-11-09

Snippet: Inc., 979 So. 2d 871, 877 (Fla. 2007); see § 627.419(1), Fla. Stat. (2019) (requiring every insurance

MARISOL ROSA vs SAFEPOINT INSURANCE COMPANY

Court: District Court of Appeal of Florida | Date Filed: 2022-11-14

Snippet: meaning as bargained for by the parties. See § 627.419(1), Fla. Stat. (2016) (requiring every insurance

GEICO INDEMNITY COMPANY v. MURANSKY CHIROPRACTIC P.A. a/a/o CARLOS DIESTE

Court: District Court of Appeal of Florida | Date Filed: 2021-06-24

Snippet: therefor or any rider or endorsement thereto.” § 627.419(1), Fla. Stat. (2017); see also Geico Gen. Ins

EXTREME EMERGENCY FIRE & WATER RESTORATION LLC v. CERTAIN UNDERWRITERS AT LLOYD'S OF LONDON

Court: District Court of Appeal of Florida | Date Filed: 2020-12-16

Snippet: together constitute the insurance contract. See § 627.419(1), Fla. Stat. (2018) (providing: “Every insurance

UPRIGHT OPEN MRI, LLC a/a/o VIRGINIA JURADO v. INFINITY AUTO INSURANCE COMPANY

Court: District Court of Appeal of Florida | Date Filed: 2020-09-23

Snippet: 3d 286, 288 (Fla. 4th DCA 2013). Section 627.419(1), Florida Statutes (2018), requires every insurance

Landmark American Insurance Company v. Pin-Pon Corporation and Lexington Insurance Company

Court: District Court of Appeal of Florida | Date Filed: 2015-01-07

Citation: 155 So. 3d 432, 2015 Fla. App. LEXIS 189, 2015 WL 71849

Snippet: 756 So. 2d 29, 34 (Fla. 2000). Indeed, section 627.419(1), Florida Statutes (2004), requires that “[e]very

Southern Owners Insurance Co. v. Cooperativa De Seguros Multiples

Court: District Court of Appeal of Florida | Date Filed: 2014-07-14

Citation: 143 So. 3d 439

Snippet: in isolation to the rest of the provisions. § 627.419(1), Fla. Stat. (2013) (“Every insurance contract

Barcelona Hotel, LLC v. Nova Casualty Co.

Court: District Court of Appeal of Florida | Date Filed: 2011-03-02

Citation: 57 So. 3d 228, 2011 Fla. App. LEXIS 2653

Snippet: provision and the policy declarations”); see also § 627.419(1), Fla. Stat. (2010); State Farm Fire & Cas. Co

Dickson v. Economy Premier Assurance Co.

Court: District Court of Appeal of Florida | Date Filed: 2010-05-14

Citation: 36 So. 3d 789, 2010 Fla. App. LEXIS 6959, 2010 WL 1923960

Snippet: provision its full meaning and operative effect. § 627.419(1), Fla. Stat. (2009); First Prof'ls Ins. Co. v

United Automobile Insurance Co. v. Salgado

Court: District Court of Appeal of Florida | Date Filed: 2009-08-05

Citation: 22 So. 3d 594, 2009 Fla. App. LEXIS 10733, 2009 WL 2382408

Snippet: insurance, except ss. 627.406, 627.415, 627.416, 627.419, 627.427, and 627.428. (5) Credit life or credit

State Farm Mutual Automobile Insurance v. Mashburn

Court: District Court of Appeal of Florida | Date Filed: 2009-06-30

Citation: 15 So. 3d 701, 2009 Fla. App. LEXIS 8486, 2009 WL 1856046

Snippet: thereto." McKinney, 973 So.2d at 514 (quoting § 627.419(1), Fla. Stat.). Endorsement 6910 expressly changes

Itnor Corp. v. MARKEL INTERN. INS. CO.

Court: District Court of Appeal of Florida | Date Filed: 2008-05-21

Citation: 981 So. 2d 661, 2008 Fla. App. LEXIS 7212, 2008 WL 2120826

Snippet: insurance contract must be read as a whole. § 627.419(1), Fla. Stat. (2007). Where policy language is

FIRST PROFESSIONAL INS. CO. v. McKinney

Court: District Court of Appeal of Florida | Date Filed: 2007-12-17

Citation: 973 So. 2d 510, 2007 WL 4372744

Snippet: 890 So.2d 357, 359 (Fla. 1st DCA 2004). Section 627.419(1), Florida Statutes (2000), states: Every insurance

National Union Fire Insurance Co. of Pittsburgh, P.A. v. Underwriters at Lloyd's, London

Court: District Court of Appeal of Florida | Date Filed: 2007-11-28

Citation: 971 So. 2d 885, 2007 Fla. App. LEXIS 18750, 2007 WL 4179675

Snippet: 2d 1068, 1070 (Fla. 1st DCA 1991); see also § 627.419(1), Fla. Stat. (2001) (“Every insurance contract

The Doctors Co. v. Health Management Associates, Inc.

Court: District Court of Appeal of Florida | Date Filed: 2006-09-13

Citation: 943 So. 2d 807, 2006 Fla. App. LEXIS 15191

Snippet: Co., 845 So.2d 161, 166 (Fla.2003) (quoting § 627.419(1), Fla. Stat. (2002)). Ambiguity does not exist

Tdc v. Hma

Court: District Court of Appeal of Florida | Date Filed: 2006-09-13

Citation: 943 So. 2d 807

Snippet: Co., 845 So.2d 161, 166 (Fla.2003) (quoting § 627.419(1), Fla. Stat. (2002)). Ambiguity does not exist

First Protective Ins. Co. v. Featherston

Court: District Court of Appeal of Florida | Date Filed: 2005-07-27

Citation: 906 So. 2d 1242, 2005 WL 1761937

Snippet: Co., 463 So.2d 1153, 1157 (Fla.1985). Section 627.419(1), Florida Statutes (1999), provides that "[e]very

General Star Indem. Co. v. W. Fla. Village Inn, Inc.

Court: District Court of Appeal of Florida | Date Filed: 2004-04-30

Citation: 874 So. 2d 26, 2004 WL 912604

Snippet: Co., 845 So.2d 161, 166 (Fla.2003) (citing § 627.419(1), Fla. Stat. (2002)); The Praetorians v. Fisher