Florida Statutes

Fla. Stat. § 627.613 (2025)

Time of payment of claims.

✓ 2025 Florida Statutes — current through the 2025 Regular Session

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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.

Notes of Decisions

Cited in 9 cases, 1991–2014 · leading case: Found. Health v. WESTSIDE EKG ASSOC., 944 So. 2d 188 (Fla. 2006).

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Found. Health v. WESTSIDE EKG ASSOC., 944 So. 2d 188 (Fla. 2006). · cites it 3× “3155 as well as section 627.613, Florida Statutes (2001), in the other two counts of its amended complaint.”

Lane v. Provident Life & Accident Ins., 178 F. Supp. 2d 1281 (S.D. Fla. 2001). · cites it 7× “In his opposition to Provident’s summary ■ judgment motion, Lane argues that summary judgment for Provident is not warranted because (1) Provident was not prejudiced by his untimeliness, and (2) Provident is estopped from asserting untimeliness as a basis for denying the claim…”

Schuster v. Blue Cross & Blue Shield of Fla., Inc., 843 So. 2d 909 (Fla. 4th DCA 2003). · cites it 2× “Clearly, both the insurance contract and section 627.613, Florida Statutes, require the insurer to pay interest on overdue payments.”

Madison v. Midland Nat. Life Ins. Co., 648 So. 2d 1226 (Fla. 4th DCA 1995). · cites it 2× “Third, assuming without deciding, that section 627.613(2), Florida Statutes (Supp.”

State Farm Mut. Auto. Ins. Co. v. Jones, 789 So. 2d 504 (Fla. 1st DCA 2001). · cites it 2× “In Heidenfeldt , the court held that section 627.613, Florida Statutes (1997), which is substantially similar to section 627.”

Pioneer Life Ins. Co. v. Heidenfeldt, 773 So. 2d 75 (Fla. 2d DCA 2000). · cites it 20× “613, Florida Statutes (1997), provides, in part: (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…”

Simon v. Progressive Exp. Ins. Co., 904 So. 2d 449 (Fla. 4th DCA 2005). “Under such a theory, all potential payments to a service provider that were denied, or were subject to a reduction, would have to be held in reserve until the statute of limitations period expired or a suit was filed and concluded.”

Northwoods Sports Med. & Physical Rehab., Inc. v. State Farm Mut. Auto. Ins. Co., 137 So. 3d 1049 (Fla. 4th DCA 2014). “This would delay and reduce availability of funds for the payment of claims to other providers and would be inconsistent with the PIP statute’s “prompt pay” provisions.”

Blue Cross & Blue Shield of Florida, Inc. v. Ming, 579 So. 2d 771 (Fla. 2d DCA 1991). · cites it 2× “Section 627.613, Florida Statutes, effective June 14, 1990, but not applicable to this case, appears to legislate a time for payment of claims by health insurers.”

— 627.613(2) — 3 cases

Lane v. Provident Life & Accident Ins., 178 F. Supp. 2d 1281 (S.D. Fla. 2001). “In his opposition to Provident’s summary ■ judgment motion, Lane argues that summary judgment for Provident is not warranted because (1) Provident was not prejudiced by his untimeliness, and (2) Provident is estopped from asserting untimeliness as a basis for denying the claim…”

Madison v. Midland Nat. Life Ins. Co., 648 So. 2d 1226 (Fla. 4th DCA 1995). “Third, assuming without deciding, that section 627.613(2), Florida Statutes (Supp.”

Pioneer Life Ins. Co. v. Heidenfeldt, 773 So. 2d 75 (Fla. 2d DCA 2000). “613, Florida Statutes (1997), provides, in part: (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…”

— 627.613(6) — 1 case

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