Florida Cabinet Adopts Personal Injury Protection Insurance Emergency Rule, Related Amended Rules Pursuant to HB 119

Dec 11, 2012

During its meeting today, December 11, 2012, the Florida Cabinet reviewed a slate of items from the Florida Office of Insurance Regulation (“OIR”) as part of its regular agenda.

Although it was the final item on the OIR agenda, the focus of the meeting was on Florida Insurance Commissioner Kevin McCarty’s request for approval of Emergency Rule 69OER12-01, entitled “Emergency Adoption of Revised Notification of Personal Injury Protection (“PIP”) Benefits Form.” 

During discussion on the request, Florida Attorney General Pam Bondi questioned the justification for its approval.  In response, Commissioner McCarty explained that it will allow the OIR to adopt Form OIR-ER1-1149, “Notification of Personal Injury Protection Benefits,” on January 1, 2013–the same day on which a number of changes to Florida’s PIP law take effect.  An Emergency Rule is being requested, since there is not sufficient time to promulgate a permanent Rule, he said.

A representative from the Personal Insurance Federation of Florida testified that, without the Emergency Rule, there will be confusion in the marketplace and some insurance consumers could be misinformed of their medical benefits under the new PIP law. 

The Emergency Rule was approved.

Along with the aforementioned Emergency Rule, the Cabinet considered other PIP-related items, approving Commissioner McCarty’s request for publication of proposed amendments to Rule 69O-170.0155, “Forms,” and Rule 69O-176.013, “Notification of Insured’s Rights and Standard Disclosure Form.”  Commissioner McCarty explained that the amendments would make these Rules consistent with changes to PIP benefits effectuated by the 2012 enactment of HB 119. 

Rule 69O-170.0155, also approved for publication, adopts Form OIR-B1-1809, known as the “Health Care Provider Certification of Eligibility.”  This Form requires health care professionals providing PIP benefits to certify that they are an eligible PIP provider by filing a copy of it with insurers upon making an initial claim for PIP medical benefits.  The proposed amendments to Form OIR-B1-1809 are technical in nature and designed to conform it with the language of the newly amended PIP statute.

Finally, proposed Rule 69O-176.013, which adopts Form OIR-B1-1149 “Notification of Personal Injury Protection Benefits,” was approved for publication.  Required to be given to PIP claimants upon filing a claim for PIP benefits, the Form is being revised to reflect that these benefits are now allocated for emergency medical treatment and a flat $5,000 death benefit.  The revised Form will incorporate technical edits relating to fraud reporting and billing disclosures.

Earlier in the meeting, Commissioner McCarty requested approval to repeal Rule 69O-164.030, entitled “Application of Rule 69O-164.020 to Various Product Designs.”  He explained that the OIR had conducted a comprehensive review of all of its Rules and determined that this one, which relates to reserving approaches for universal life insurance policies, is unnecessary and should be repealed.  Additionally, its repeal makes the Florida Insurance Code more consistent with the National Association of Insurance Commissioners’ (“NAIC”) model laws and rules.  The repeal was approved.

Next, Commissioner McCarty received approval for the final adoption of proposed amendments to Rule 69O-137.001, entitled “Annual and Quarterly Reporting Requirements,” as well as Rule 69O-138.001, “NAIC Financial Condition Examiners Handbook.”  Both Rules are being amended to adopt the current versions of the corresponding NAIC instructions, manuals and Financial Condition Handbook.

The repeal of Rule 69O-143.045, “Definitions,” was granted.  Initially adopted in the early 1970s, the Rule was said to contain outdated definitions that are now inconsistent with Florida Insurance Code. 

The following Rules also were approved for repeal, because laws that they were adopted to implement have either been repealed or they substantially restate statutory language and are deemed unecessary:

  • Rule 69O-157.018: Right to Return Policy-Free Look
  • Rule 69O-185.005: Advertisement of Mortgage Insurance
  • Rule 69O-196.008: Failure to Comply
  • Rule 69O-157.105: Refund of Premium
  • Rule 69O-198.003: License Required
  • Rule 69O-170.012: Sinkhole Insurance

However, Commissioner McCarty withdrew the OIR’s request for approval of final adoption of proposed Rule 69O-149.003, “Rate Filing Procedures,” which relates to health insurance rate filing procedures.  According to Florida law, health insurers seeking to issue or renew health insurance policy forms in the State of Florida must submit documentation (rating manuals, rating schedules, change in rating manual, change in rating schedule, etc) to the OIR demonstrating that the proposed policy or policy renewal’s premium rates are reasonable in relation to the benefits provided.  Proposed Rule 69O-149.003 would provide insurers with corresponding detailed rate filing procedures.

In regard to proposed Rule 69O-149.022, “Forms Adopted,” Commissioner McCarty stated that its purpose is to update and edit the contents of the Universal Standardized Data Letter Form and instructions used by life and health insurers to make electronic form filings through the OIR’s I-File system.  The proposed revisions simplify the reporting entries to reflect the OIR’s current technology.  He noted that most of the proposed changes are already in place and have been used in filings by insurers for some time.  The proposed Rule was approved for final adoption.

At this time, the aforementioned PIP-related items and Emergency Rule 69OER12-01 were taken up and subsequently adopted.

To view the complete OIR agenda for today’s Cabinet meeting, click here.  To view the OIR meeting packet, click here.


Should you have any questions or comments, please contact Colodny Fass& Webb.



Click here to follow Colodny Fass& Webb on Twitter (@CFTLAWcom)



To unsubscribe from this newsletter, please send an email to Brooke Ellis at bellis@cftlaw.com.