The 2023 Florida Statutes (including Special Session C)

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 from cite.case.law:

SCOTTSDALE INSURANCE COMPANY, v. OUTRIGGER BEACH CLUB CONDOMINIUM ASSOCIATION, INC., 304 F. Supp. 3d 1208 (M.D. Fla. 2018)

. . . Corp., 720 So.2d at 1075 ; see also § 627.419(1), Fla. Stat. (1997). . . .

A M GERBER CHIROPRACTIC LLC, a a o v. GEICO GENERAL INSURANCE COMPANY,, 291 F. Supp. 3d 1318 (S.D. Fla. 2017)

. . . . § 627.419(1). . . .

TUDOR INSURANCE COMPANY, v. AMERICAN CASUALTY COMPANY OF READING PENNSYLVANIA,, 274 F. Supp. 3d 1278 (N.D. Fla. 2017)

. . . . § 627.419(1); O.C.G.A § 13-2-2(4). III. . . .

STEADFAST INSURANCE COMPANY, v. CELEBRATION SOURCE, INC. J., 240 F. Supp. 3d 1295 (S.D. Fla. 2017)

. . . . § 627.419 (2010). . . .

PRINCETON EXPRESS v. DM VENTURES USA LLC, d b a LLC, d b a LLC, d b a a k a, 209 F. Supp. 3d 1252 (S.D. Fla. 2016)

. . . . § 627.419. . . .

LANDMARK AMERICAN INSURANCE COMPANY, v. PIN- PON CORPORATION, 155 So. 3d 432 (Fla. Dist. Ct. App. 2015)

. . . Indeed, section 627.419(1), Florida Statutes (2004), requires that “[e]very insurance contract shall . . .

SOUTHERN OWNERS INSURANCE COMPANY, v. COOPERATIVA DE SEGUROS MULTIPLES,, 143 So. 3d 439 (Fla. Dist. Ct. App. 2014)

. . . . § 627.419(1), Fla. . . .

LAMADRID, LLC, v. NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA,, 567 F. App'x 695 (11th Cir. 2014)

. . . . § 627.419(1) (West 1986); Haenal v. U.S. Fid. & Guar. . . .

CHESTNUT ASSOCIATES, INC. v. ASSURANCE COMPANY OF AMERICA, d b a, 17 F. Supp. 3d 1203 (M.D. Fla. 2014)

. . . Anderson, 756 So.2d 29, 34 (Fla.2000); see also Sec. 627.419(1), Fla. Stat. (2002). . . .

PENNSYLVANIA CHIROPRACTIC ASSOCIATION, v. BLUE CROSS BLUE SHIELD ASSOCIATION,, 286 F.R.D. 355 (N.D. Ill. 2012)

. . . In count three, certain plaintiffs allege violations of section 627.419 of the Florida Code, which prohibits . . . these limits discriminate against medical services provided by chiropractors in violation of section 627.419 . . . Plaintiffs allege that BCBSF’s changed practice violated section 627.419 of the Florida Code, which provides . . . Stat. § 627.419(4). . . . Section 627.419(4) states: Notwithstanding any other provision of law, when any health insurance policy . . .

R. ESTEVEZ, v. NORTHERN ASSURANCE COMPANY OF AMERICA,, 428 F. App'x 966 (11th Cir. 2011)

. . . . § 627.419(1); AAA Life Insurance, 603 So.2d at 623. . . .

AMERICAN EMPIRE SURPLUS LINES INSURANCE COMPANY, v. CHABAD HOUSE OF NORTH DADE, INC., 771 F. Supp. 2d 1336 (S.D. Fla. 2011)

. . . . § 627.419(1) (“Every insurance contract shall be construed according to the entirety of its terms and . . .

BARCELONA HOTEL, LLC, v. NOVA CASUALTY COMPANY,, 57 So. 3d 228 (Fla. Dist. Ct. App. 2011)

. . . with the entire policy, including the ... coverage provision and the policy declarations”); see also § 627.419 . . .

CONTENDER FISHING TEAM, LLC, v. CITY OF MIAMI, S. A. P., 405 F. App'x 422 (11th Cir. 2010)

. . . . § 627.419(1). . We DENY the Insurer's motion for attorney's fees. . . .

WESTPORT INSURANCE CORPORATION, v. VN HOTEL GROUP, LLC, V. J., 761 F. Supp. 2d 1337 (M.D. Fla. 2010)

. . . .; see also § 627.419(1), Fla. Stat. . . . (Policy at 15); see § 627.419(1), Fla. Stat. . . .

L. DICKSON, v. ECONOMY PREMIER ASSURANCE COMPANY,, 36 So. 3d 789 (Fla. Dist. Ct. App. 2010)

. . . . § 627.419(1), Fla. Stat. (2009); First Prof'ls Ins. Co. v. . . .

STITZEL, Co- v. NEW YORK LIFE INSURANCE COMPANY,, 361 F. App'x 20 (11th Cir. 2009)

. . . . § 627.419(1) (2008) (“Every insurance contract shall be construed according to the entirety of its . . .

PHILADELPHIA AMERICAN LIFE INSURANCE COMPANY, v. BUCKLES, v., 350 F. App'x 376 (11th Cir. 2009)

. . . West’s FSA § 627.419(1). . . .

KEENAN HOPKINS SCHMIDT AND STOWELL CONTRACTORS, INC. a v. CONTINENTAL CASUALTY COMPANY,, 653 F. Supp. 2d 1255 (M.D. Fla. 2009)

. . . . § 627.419(1))). . . .

UNITED AUTOMOBILE INSURANCE COMPANY, v. SALGADO,, 22 So. 3d 594 (Fla. Dist. Ct. App. 2009)

. . . except ss. 627.409, 627.420, and 627.428. (4) Title insurance, except ss. 627.406, 627.415, 627.416, 627.419 . . . , 627.427, and 627.428. (5) Credit life or credit disability insurance, except ss. 627.419(5) and 627.428 . . .

STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, v. MASHBURN,, 15 So. 3d 701 (Fla. Dist. Ct. App. 2009)

. . . McKinney, 973 So.2d at 514 (quoting § 627.419(1), Fla. Stat.). . . .

ESSEX INSURANCE COMPANY, v. ZOTA,, 607 F. Supp. 2d 1340 (S.D. Fla. 2009)

. . . . § 627.419(1); see also Mathews v. Ranger Ins. Co., 281 So.2d 345, 348 (Fla.1973). . . .

THOSE CERTAIN UNDERWRITERS AT LLOYD S LONDON, v. GMC LAND SERVICES, INC. a a, 315 F. App'x 785 (11th Cir. 2009)

. . . . § 627.419(1). . . .

PENZER, v. TRANSPORTATION INSURANCE COMPANY, a CNA, a v., 545 F.3d 1303 (11th Cir. 2008)

. . . . § 627.419(1) (“Every insurance contract shall be construed according to the entirety of its terms and . . .

ITNOR CORPORATION, v. MARKEL INTERNATIONAL INSURANCE COMPANY, LTD., 981 So. 2d 661 (Fla. Dist. Ct. App. 2008)

. . . . § 627.419(1), Fla. Stat. (2007). . . .

ERNIE HAIRE FORD, INC. v. UNIVERSAL UNDERWRITERS INSURANCE COMPANY, v., 541 F. Supp. 2d 1295 (M.D. Fla. 2008)

. . . .; see also § 627.419(1), Fla. Stat. . . .

FIRST PROFESSIONALS INSURANCE COMPANY, INC. v. McKINNEY, M. D., 973 So. 2d 510 (Fla. Dist. Ct. App. 2007)

. . . Section 627.419(1), Florida Statutes (2000), states: Every insurance contract shall be construed according . . .

NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA, s a v. UNDERWRITERS AT LLOYD S, LONDON a s, a, 971 So. 2d 885 (Fla. Dist. Ct. App. 2007)

. . . Co., 584 So.2d 1068, 1070 (Fla. 1st DCA 1991); see also § 627.419(1), Fla. . . .

PENZER, v. TRANSPORTATION INSURANCE CO. v., 509 F. Supp. 2d 1278 (S.D. Fla. 2007)

. . . . § 627.419(1) (“Every insurance contract shall be construed according to the entirety of its terms and . . .

THE DOCTORS COMPANY, v. HEALTH MANAGEMENT ASSOCIATES, INC., 943 So. 2d 807 (Fla. Dist. Ct. App. 2006)

. . . Co., 845 So.2d 161, 166 (Fla.2003) (quoting § 627.419(1), Fla. Stat. (2002)). . . .

FIRST PROTECTIVE INSURANCE COMPANY, v. FEATHERSTON R., 906 So. 2d 1242 (Fla. Dist. Ct. App. 2005)

. . . Section 627.419(1), Florida Statutes (1999), provides that “[ejvery insurance contract shall be construed . . .

GENERAL STAR INDEMNITY COMPANY, v. WEST FLORIDA VILLAGE INN, INC. d b a, 874 So. 2d 26 (Fla. Dist. Ct. App. 2004)

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

ZENITH INSURANCE COMPANY, a f k a f k a v. COMMERCIAL FORMING CORPORATION, a, 850 So. 2d 568 (Fla. Dist. Ct. App. 2003)

. . . .” § 627.419(1), Fla. Stat. (1993). . . .

SWIRE PACIFIC HOLDINGS, INC. v. ZURICH INSURANCE COMPANY,, 845 So. 2d 161 (Fla. 2003)

. . . Auto-Owners, 756 So.2d at 34; see also § 627.419(1), Fla. . . .

CHILTON, v. PRUDENTIAL INSURANCE COMPANY OF AMERICA,, 124 F. Supp. 2d 673 (M.D. Fla. 2000)

. . . Co., 979 F.2d 195 (11th Cir.1992), the court followed Anschultz, holding that sections 627.419 and 624.155 . . .

H. WALKER Jo v. STATE FARM FIRE CASUALTY COMPANY, a, 758 So. 2d 1161 (Fla. Dist. Ct. App. 2000)

. . . . § 627.419(1), Fla. Stat. (1997); Nationwide Mut. Fire Ins. Co. v. . . .

METROPOLITAN LIFE INSURANCE COMPANY, f k a v. K. DANIELS,, 745 So. 2d 1062 (Fla. Dist. Ct. App. 1999)

. . . concluded that the temporary policy had to be read together with the permanent policy, because of section 627.419 . . . other hand, was separate and apart from the application, and is not a document included in section 627.419 . . .

DURAN f k a v. OWNERS INSURANCE COMPANY, a, 779 So. 2d 307 (Fla. Dist. Ct. App. 1999)

. . . See § 627.419(1), Fla. . . .

STATE FARM FIRE AND CASUALTY COMPANY, v. CTC DEVELOPMENT CORPORATION,, 720 So. 2d 1072 (Fla. 1998)

. . . Olah, 662 So.2d 980, 982 (Fla. 2d DCA 1995); see also § 627.419(1), Fla. . . .

CTC DEVELOPMENT CORPORATION, INC. v. STATE FARM FIRE AND CASUALTY COMPANY,, 704 So. 2d 579 (Fla. Dist. Ct. App. 1997)

. . . As stated in section 627.419(1), Florida Statutes (1995), governing construction of policies: Every insurance . . .

MODDER v. AMERICAN NATIONAL LIFE INSURANCE COMPANY OF TEXAS,, 688 So. 2d 330 (Fla. 1997)

. . . by the law of a state other than Florida”; and (c) The policy provides the benefits specified in ss. 627.419 . . .

FEDERAL DEPOSIT INSURANCE CORPORATION, v. VEREX ASSURANCE, INC., 645 So. 2d 427 (Fla. 1994)

. . . insurance, except §§ 627.409, 627.420, and 627.428. (4) Title insurance, except §§ 627.406, 627.416, 627.419 . . . , 627.427, and 627.428. (5) Credit life or credit disability insurance, except §§ 627.419(5) and 627.428 . . .

K. TATUM, v. BOKOFSKY, 842 F. Supp. 521 (S.D. Fla. 1994)

. . . of the state other than Florida.’ ... and c) The policy provides the benefits specified in sections 627.419 . . .

FEDERAL DEPOSIT INSURANCE CORPORATION, a v. VEREX ASSURANCE, INC., 3 F.3d 391 (11th Cir. 1993)

. . . .-416, 627.419, 627.427, and 627.428. (5) Credit life or credit disability insurance, except §§ 627.419 . . .

PERKINS, v. A. PERKINS DRYWALL A. PERKINS DRYWALL, v. CIGNA PROPERTY AND CASUALTY COMPANIES,, 615 So. 2d 187 (Fla. Dist. Ct. App. 1993)

SWERHUN, v. GUARDIAN LIFE INS. CO. OF AMERICA,, 979 F.2d 195 (11th Cir. 1992)

. . . . § 627.419(4). . . . Swerhun argues, however, that section 627.419 is a law “which regulates insurance,” and thus “saved” . . . Section 627.419’s plain language does not establish a private right of action, and we will not infer . . . Section 627.419 simply never comes into play. . . . Fla.Stat.Ann. § 627.419(4) (West Supp.1992). . . . .

WELDON, v. ALL AMERICAN LIFE INSURANCE COMPANY,, 605 So. 2d 911 (Fla. Dist. Ct. App. 1992)

. . . exclusion provision, as so defined, discriminated against chiropractic physicians in violation of section 627.419 . . . physicians and discriminates against chiropractors as a class of physicians in violation of section 627.419 . . . Although section 627.419(4) was not in existence at the time All American’s policy form was approved . . . Under this court’s interpretation of the policy, section 627.419(4) is not involved and the question . . . Since we find that the policy, when properly interpreted, does not violate section 627.419(4) we will . . .

AAA LIFE INSURANCE CO. v. NICOLAS,, 603 So. 2d 622 (Fla. Dist. Ct. App. 1992)

. . . Paul Guardian, 548 So.2d at 1160 (quoting § 627.419(1), Fla.Stat. (1987). . . .

PRUDENTIAL PROPERTY AND CASUALTY INSURANCE COMPANY, v. A. BONNEMA, 601 So. 2d 269 (Fla. Dist. Ct. App. 1992)

. . . Section 627.419(1), Florida Statutes (Supp.1990), provides, “Every insurance contract shall be construed . . .

NUGGET OIL, INC. a v. UNIVERSAL SECURITY INSURANCE COMPANY, a, 584 So. 2d 1068 (Fla. Dist. Ct. App. 1991)

. . . Section 627.419(1), Florida Statutes, provides, “Every insurance contract shall be construed according . . . Co., 231 So.2d 22, 25 (Fla. 4th DCA 1970) (construing § 627.0118, renumbered as § 627.419(1)); State . . .

NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, P. A. v. CHASE,, 575 So. 2d 720 (Fla. Dist. Ct. App. 1991)

. . . . § 627.419(1), Fla.Stat. (Supp.1984). . . .

STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, v. MALLARD,, 548 So. 2d 733 (Fla. Dist. Ct. App. 1989)

. . . Section 627.419(1), Florida Statutes (1987) provides: Every insurance contract shall be construed according . . .

ST. PAUL GUARDIAN INSURANCE COMPANY, v. CANTERBURY SCHOOL OF FLORIDA, INC., 548 So. 2d 1159 (Fla. Dist. Ct. App. 1989)

. . . .” § 627.419(1), Fla.Stat. (1987). See Ellenwood v. Southern United Life Ins. . . . See Treasure Salvors; § 627.419(1). See also Hoffman v. . . .

INTERNATIONAL INSURANCE CO. a v. M. JOHNS, W. V. W. G., 874 F.2d 1447 (11th Cir. 1989)

. . . . § 627.419(1) (West 1986). . . .

CONTINENTAL INSURANCE COMPANY, v. Dr. DE QUESADA,, 518 So. 2d 931 (Fla. Dist. Ct. App. 1987)

. . . . §§ 627.419(1), 682.02, Fla. Stat. (1985). See Lee v. National Union Fire Ins. . . .

HEPLER, v. ATLAS MUTUAL INSURANCE CO., 501 So. 2d 681 (Fla. Dist. Ct. App. 1987)

. . . In analyzing the policy provisions, we must comply with the requirement in section 627.419(1) that “every . . .

TRAVELERS INDEMNITY COMPANY, v. M. GORMAN E. s FIREMAN S FUND INSURANCE COMPANY, v. M. GORMAN E., 404 So. 2d 1147 (Fla. Dist. Ct. App. 1981)

. . . Section 627.419, Florida Statutes (1979), provides that every insurance contract shall be construed according . . .

ILLINOIS MUTUAL LIFE AND CASUALTY COMPANY, v. STEIN,, 379 So. 2d 449 (Fla. Dist. Ct. App. 1980)

. . . Myles, 347 So.2d 1060 (Fla. 1st DCA 1977); Section 627.419(2), Florida Statutes (1977). . . .

M. ELLENWOOD, K. v. SOUTHERN UNITED LIFE INSURANCE COMPANY, a, 373 So. 2d 392 (Fla. Dist. Ct. App. 1979)

. . . First, we are enjoined both by statute, Section 627.419(1), Florida Statutes (1977), and by case law, . . .

UNITED SERVICES AUTOMOBILE ASSOCIATION, v. McCRAY, UNITED SERVICES AUTOMOBILE ASSOCIATION, v. STOCKTON,, 348 So. 2d 6 (Fla. Dist. Ct. App. 1977)

. . . Central National Insurance Co. of Omaha, 279 So.2d 897 (Fla.3d DCA 1973) and Section 627.419(1), Florida . . .

INSURANCE COMPANY OF NORTH AMERICA, v. J. COATES, L., 318 So. 2d 474 (Fla. Dist. Ct. App. 1975)

. . . . § 627.419(1). . . .

MATHEWS, a v. RANGER INSURANCE COMPANY,, 281 So. 2d 345 (Fla. 1973)

. . . Section 627.419(1), Florida Statutes, F.S.A. . . . Section 627.419(1), F.S. A. Ambiguity such as we see in this agreement need not exist. . . .