Florida Statute 627.613 - Full Text and Legal Analysis

The 2025 Florida Statutes

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.

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Amendments to 627.613

Annotations, Discussions, Cases:

Cases Citing Statute 627.613

Total Results: 8

William M. Shaw v. Connecticut General Life

353 F.3d 1276, 31 Employee Benefits Cas. (BNA) 2419, 2003 U.S. App. LEXIS 25860, 2003 WL 22976664

Court of Appeals for the Eleventh Circuit | Filed: Dec 19, 2003 | Docket: 177380

Cited 84 times | Published

premium benefits in violation of Florida Statute § 627.613, which governs the timely payment of insurance

Foundation Health v. WESTSIDE EKG ASSOC.

944 So. 2d 188

Supreme Court of Florida | Filed: Oct 19, 2006 | Docket: 1649903

Cited 23 times | Published

violations of section 641.3155 as well as section 627.613, Florida Statutes (2001), in the other two

Schuster v. Blue Cross and Blue Shield of Fla., Inc.

843 So. 2d 909, 2003 WL 354932

District Court of Appeal of Florida | Filed: Feb 19, 2003 | Docket: 1670551

Cited 10 times | Published

Clearly, both the insurance contract and section 627.613, Florida Statutes, require the insurer to pay

Madison v. Midland Nat. Life Ins. Co.

648 So. 2d 1226, 1995 WL 15522

District Court of Appeal of Florida | Filed: Jan 18, 1995 | Docket: 1342389

Cited 7 times | Published

1987). Third, assuming without deciding, that section 627.613(2), Florida Statutes (Supp. 1990), was applicable

State Farm Mut. Auto. Ins. Co. v. Jones

789 So. 2d 504, 2001 Fla. App. LEXIS 9717, 2001 WL 788357

District Court of Appeal of Florida | Filed: Jul 13, 2001 | Docket: 1696137

Cited 3 times | Published

2000). In Heidenfeldt, the court held that section 627.613, Florida Statutes (1997), which is substantially

Lane v. Provident Life & Accident Insurance

178 F. Supp. 2d 1281, 2001 U.S. Dist. LEXIS 21558, 2001 WL 1669380

District Court, S.D. Florida | Filed: May 3, 2001 | Docket: 2377225

Cited 3 times | Published

the claim, in contravention of Florida Statute § 627.613 (1997) and Florida case law. I. Timeliness of

Pioneer Life Ins. Co. v. Heidenfeldt

773 So. 2d 75, 2000 Fla. App. LEXIS 303, 2000 WL 35809

District Court of Appeal of Florida | Filed: Jan 19, 2000 | Docket: 1291709

Cited 2 times | Published

to comply with the notice requirements of section 627.613(2), Florida Statutes (1997). We agree and reverse

Blue Cross & Blue Shield of Florida, Inc. v. Ming

579 So. 2d 771, 1991 Fla. App. LEXIS 3957, 1991 WL 66666

District Court of Appeal of Florida | Filed: May 2, 1991 | Docket: 64658790

Published

non-participating/non-contracting health care provider. . Section 627.613, Florida Statutes, effective June 14, 1990