Florida Statute 627.613 | Lawyer Caselaw & Research

The 2024 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

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 Citing Statute 627.613

Total Results: 9

Northwoods Sports Medicine & Physical Rehabilitation, Inc. v. State Farm Mutual Automobile Insurance Co.

Court: District Court of Appeal of Florida | Date Filed: 2014-03-05

Citation: 137 So. 3d 1049, 2014 WL 837091, 2014 Fla. App. LEXIS 2978

Snippet: PIP statute’s “prompt pay” provisions. See §§ 627.613, and 627.662(7), Fla. Stat. (provision established

Foundation Health v. WESTSIDE EKG ASSOC.

Court: Supreme Court of Florida | Date Filed: 2006-10-19

Citation: 944 So. 2d 188

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

Simon v. Progressive Exp. Ins. Co.

Court: District Court of Appeal of Florida | Date Filed: 2005-05-04

Citation: 904 So. 2d 449, 2005 WL 1026613

Snippet: PIP statute's "prompt pay" provisions. See §§ 627.613, and 627.662(7), Fla. Stat. (provision established

Westside EKG Associates v. Foundation Health

Court: District Court of Appeal of Florida | Date Filed: 2005-05-04

Citation: 932 So. 2d 214, 2005 WL 1026183

Snippet: DCA 1999). [3] See and compare: §§ 641.3155; 627.613; 627.614; 641.3104; 627.060; 641.31; 641.3101;

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

Court: District Court of Appeal of Florida | Date Filed: 2003-02-19

Citation: 843 So. 2d 909, 2003 WL 354932

Snippet: statutory interest or the contractual interest on the 627.613." BCBSF continued to insist that the Schusters

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

Court: District Court of Appeal of Florida | Date Filed: 2001-07-13

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

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

Pioneer Life Ins. Co. v. Heidenfeldt

Court: District Court of Appeal of Florida | Date Filed: 2000-01-19

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

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

Madison v. Midland Nat. Life Ins. Co.

Court: District Court of Appeal of Florida | Date Filed: 1995-01-18

Citation: 648 So. 2d 1226, 1995 WL 15522

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

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

Court: District Court of Appeal of Florida | Date Filed: 1991-05-02

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

Snippet: contracting health care provider. . Section 627.613, Florida Statutes, effective June 14, 1990, but