OVIEDO CHIROPRACTIC LLC vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, 2022-SC-032421-O, No. 85176104 (Florida State, Orange County, Ninth Circuit Court Nov. 11, 2022) (2024)

`

`will be furnished to: Dalton Gray, Esquire, Law Office of Chad A. Barr, P.A., 238 North
`Westmonte Drive, Suite 200, Altamonte Springs, Florida 32714„ dalton@chadbarrlaw.com,
`dlgservice@chadbarrlaw.com, nately@chadbarrlaw.com, via electronic transmission by the
`FACC ePortal Filer.
`
`/s/ David M. Gagnon
`Attorney
`
`

`

`State Farm Mutual Automobile Insurance Company
`PO Box 89000
`Atlanta GA 30356-9900
`
`R 54496-2-P
`DECLARATIONS
`
`MUTL VOL
`PAGE
`
`AT2
`
`NAMED INSURED
`002726 0058
`& SANTANA
`LAGO LEYVA, RAMON
`OMERO
`
`59-6420-2 P
`
`A
`
`is RolmiSTATE
`
`iANIELA
`
`IIIINIIIII11440119W01101141111hildd
`
`'i
`s,
`r2°
`
`POLICY NUMBER
`POLICY PERIOD SEP 20 2021 to NOV 18 2021
`12:01 A.M. Standard Time
`
`FARM PAYMENT PLAN NUMBER
`1436981219
`AGENT
`CHRISTINE VELLA INS AGCY INC
`992 N SEMORAN BLVD
`ORLANDO, FL 32807-3529
`
`PHONE: (407)898-8836
`
`DO NOT PAY PREMIUMS SHOWN ON THIS PAGE.
`IF AN AMOUNT IS DUE. THEN A SEPARATE STATEMENT IS ENCLOSE D.
`YOUR CAR
`
`YEAR
`2018
`
`MAKE
`TOYOTA
`
`MODEL
`HIGHLANDER
`
`BODY STYLE
`SPORT WG
`
`VEHICLE ID. NUMBER
`
`SYMBOLS
`
`COVERAGE & LIMITS
`
`PREMIUMS
`
`A
`
`P14
`
`•
`
`R1
`
`U3
`
`Liability Coverage
`Bodily Injury Limits
`
`810.000
`
`820 000
`
`Each Accident
`$25,000
`No-Fault Coverage
`
`Collision Coverage - $500 Deductible
`Car Rental and Travel -Expenses Coverage
`- Car Rental Expense
`Limit
`
`80%
`$1,000
`Uninsured Motor Vehicle Coverage (Non-Stacking)
`Bodily Injury Limits
`
`$10,000
`
`$20,000
`
`_
`
`411111
`
`a=
`
`$13 57
`
`Total premium for SEP 20 2021 to NOV18 2021.
`
`MI.
`
`This is not a bill.
`
`l
`
`IMPORTANT MESSAGES
`IMPORTANT NOTICE- Under No-Fault Coverage, the only medical expenses we will pay are reasonable medical
`expenses that are payable under the Florida Motor Vehicle No-Fault Law. The most we will pay for such
`reasonable medical expenses is 80% of the "schedule of maximum charges" found in the Florida Motor
`Vehicle No-Fault Law and in the Limits section of the Florida Car Policys No-Fault Coverage.
`Replaced policy numbEl
`Your total renewal premium for MAY 18 2021 to NOV 18 2021 is $371.13.
`to obtain information about coverage call: (407)898-8836.
`For questions, problems or
`State Farrn works hard to offer you the best combination of price, service, and protection.
`insurance is determined by many factors such as the coverages you have, where you live,
`is used, who drives the car, and information from consumer
`reports.
`car
`You have the right to request, no more
`than once during your policy term, that your policy be re-rated using a current credit-based
`insurance score. Re-rating could result in a lower rate, no change in rate, or a higher rate.
`
`The amount you pay for automobile
`the kind of car you drive, how your
`
`EXCEPTIONS. POLICY BOOKLET & ENDORsem*nTS (See policy booklet & individual endorsem*nts
`YOUR POLICY CONSISTS OF THIS DECLARATIONS PAGE,
`THE POLICY BOOKLET -
`FORM 9810A
`INCLUDING THOSE ISSUED TO YOU
`AND ANY ENDORsem*nTS THAT APPLY,
`WITH ANY SOBSEQUENT RENEWAL NOTICE.
`CREDITOR- PUBLIX EMPLOYEE FEDERAL CREDIT UNION INSURANCE DEPT, PO BOX 1000,
`LAKELAND FL 33802-1000.
`6128S.1
`AMENDATORY ENDORsem*nT.
`6910A
`AMENDATORY ENDORsem*nT.
`
`for coverage details.)
`
`06307/02556
`155-3866 2 04-2005
`(o-12025hd)
`I4SXON
`(o1a0251e)
`
`See Reverse Side
`
`iola0254c)
`
`CHRISTINE VELLA INS AGCY INC
`Agent:
`Telephone: (407)898-8836
`SEP 24 2021
`Prepared
`
`6420-ACC
`
`

`

`This policy is issued by State Farm Mutual Automobile Insurance Company.
`
`MUTUAL CONDITIONS
`1. Membership. While this policy is in force, the first insured shown on the Declarations Page is
`entitled to vote at all meetings of members and to receive dividends the Board of Directors in
`its discretion may declare in accordance with reasonable classifications and groupings of
`policyholders established by such Board.
`2. No Contingent Liability. This policy is non-assessable.
`3. Annual Meeting. The annual meeting of the members of
`the company shall be held at
`its
`home office at Bloomington,
`Illinois, on the second Monday of June at the hour of 10:00 A.M.,
`unless the Board of Directors shall elect to change the time and place of such meeting,
`in
`which case, but not otherwise, due notice shall be mailed each member at
`the address
`disclosed in this policy at least 10 days prior thereto.
`
`the State Farm Mutual Automobile Insurance Company has caused this
`In Witness Whereof,
`policy to be signed by its President and Secretary at Bloomington,
`Illinois.
`
`*0.4,2)11_110.44.0.,
`Secretary
`
`/11,./.•4,77-74, - D
`/
`President
`
`B10
`
`

`

`0
`
`(D
`
`U.1
`o
`
`tD
`
`(0 (NI 0
`
`to
`
`Can-
`
`May
`
`changed
`
`nonpayment
`
`of
`
`date
`
`im-
`
`days
`
`30
`
`check
`a
`if
`
`of
`
`type
`
`is
`
`Us
`
`dishonored
`
`invalid.
`
`subsequently
`
`or
`
`brought
`
`be
`
`immediate-
`
`accident
`
`we
`
`action
`
`of
`
`after
`
`Depart-
`
`accord-
`
`Florida
`
`in
`
`ap-
`
`ex-
`
`an
`
`agreed
`
`two
`
`their
`
`at
`
`owner
`
`the
`
`us.
`
`by
`
`fights
`
`1
`
`1o
`
`f
`
`6910A
`
`Page
`
`provisions
`
`other
`
`all
`
`any
`
`by
`
`both
`is
`
`that
`
`signed
`
`on
`
`any
`
`contains
`
`arrived
`
`and
`
`waive
`
`also
`
`they
`
`binding
`
`be
`
`vehicle
`
`We
`
`is
`
`When
`
`appraisal.
`
`first
`
`effective
`
`the
`
`the
`
`for
`
`policy
`
`is
`
`only
`
`other
`
`or
`
`so
`do
`
`will
`
`any
`
`was
`
`or
`
`premium
`
`rejected
`
`Against
`
`Action
`
`the
`of
`
`date
`
`limitation
`
`this
`
`days
`60
`of
`
`Florida
`
`the
`
`from
`
`years
`
`only
`
`five
`may
`
`624.155,
`
`Services,
`
`makes,
`
`that
`
`and
`
`how
`
`of
`
`will
`
`covered
`
`appraisal
`
`and
`
`by
`
`ritten
`
`an
`to
`
`not
`do
`
`you
`
`and
`
`be
`to
`
`payment
`
`and
`
`this
`
`during
`
`we
`
`following
`
`Cancellation,
`
`How
`
`cancel
`
`policy,
`
`the
`
`pay
`to
`
`reason
`
`any
`
`TERMS
`
`premium
`
`under
`
`the
`
`period
`a
`
`for
`
`notice
`
`However,
`
`within
`
`us
`
`action
`
`section
`
`Financial
`
`of
`
`with
`
`following
`
`tolled
`
`Statutes.
`
`read:
`
`to
`
`Legal
`
`of
`a.
`
`2020
`
`Company,
`
`Insurance
`
`Automobile
`
`upon
`
`praisers,
`
`planation
`
`appraisal,
`
`the
`of
`
`We
`
`submitting
`
`of
`(3)
`
`we
`lf
`
`of
`
`mediately
`
`this
`
`used
`
`for
`
`premium
`
`determined
`
`Legal
`
`against
`
`ly
`
`is
`
`loss.
`
`receive
`
`ment
`
`ance
`
`f.
`
`ltem
`
`mi.
`
`read:
`
`GENERAL
`
`2.
`
`a.
`
`a
`
`re-
`
`the
`
`ltem
`
`changed
`
`b.
`
`30
`
`to
`
`wit-
`
`owl
`
`will
`
`ap-
`
`the
`
`of
`
`Aw
`
`e.
`
`endorsem*nt
`
`this
`
`changes
`
`the
`
`for
`
`Except
`
`endorsem*nt
`
`this
`to
`
`Comprehen-
`
`—
`
`of
`
`cost
`
`glass,
`
`of
`
`step
`
`first
`
`the
`
`as
`
`select
`
`follow
`
`will
`
`below
`
`each
`
`third
`a
`
`unable
`
`are
`
`within
`
`may
`
`we
`
`or
`
`select
`
`jurisdiction
`
`its
`of
`
`cost
`
`expenses
`
`parties
`
`expert
`
`other
`
`Both
`
`and
`
`third
`
`the
`of
`
`have
`
`ques-
`
`recali-
`
`class-
`a
`
`shall
`
`and
`
`other
`
`on
`
`questions
`
`basis.
`
`determine
`
`any
`
`any
`
`Mutual
`
`Farm
`
`8-IS
`
`apply
`
`policy.
`
`and
`
`the
`of
`
`ENDORsem*nT
`
`Coverage
`
`the
`to
`as
`
`COVERAGES
`
`Collision
`
`Settlement
`
`listed
`
`as
`
`recalibration
`
`used
`
`or
`
`Appraisal
`
`be
`
`will
`
`we
`
`and
`
`they
`If
`
`will
`
`owner
`
`has
`
`appraiser
`
`the
`
`third
`a
`
`that
`
`appraiser.
`
`appraiser.
`
`appraiser.
`
`either
`
`the
`
`pay
`
`will
`
`any
`
`as
`
`party.
`
`cost
`
`the
`
`only
`
`shall
`
`replacement,
`
`attorneys,
`
`well
`
`Appraisers
`
`appraisal
`
`decide
`
`decide
`
`to
`
`SYste
`
`ZOPO-ZOZO
`
`Copyright,
`
`same
`
`the
`
`and
`
`added:
`
`is
`
`disagreement
`
`is
`
`Loss
`
`DAMAGE
`
`WU
`
`procedures
`
`owner
`
`resolution.
`
`and
`
`replacement,
`
`appraisers
`
`two
`
`court
`a
`
`third
`
`the
`
`then
`
`on
`
`agree
`
`that
`by
`
`as
`
`party
`
`equally
`
`competent
`
`competent
`
`petition
`
`select
`
`appraiser,
`
`nesses,
`
`incurred
`
`share
`
`praiser.
`
`glass.
`
`of
`
`repair,
`
`of
`
`appraisers
`
`authority
`
`cost
`
`bration
`
`fact,
`of
`
`conduct
`
`class-representative
`
`or
`
`or
`
`0,
`
`All
`(0;
`
`ap
`
`is
`
`art
`
`remain
`
`and
`
`appraisal
`
`Coverage
`
`following
`
`there
`If
`
`pair,
`
`an
`
`toward
`
`rules
`
`to
`
`days,
`
`The
`
`a.
`
`The
`
`b.
`
`Each
`
`c.
`
`no
`
`tions
`
`law,
`
`wide
`
`The
`
`d.
`
`AMENDATORY
`
`endorsem*nt
`
`6910A
`
`This
`
`policy
`
`the
`of
`
`PHYSICAL
`
`Limits
`
`sive
`
`The
`
`1.
`
`6910A
`
`c
`
`p)
`
`)
`
`75-c
`
`o...c.r1
`
`•0
`
`(4 0, ,r) oO
`
`4-j
`
`en o
`
`ff"1 VD
`
`e.,
`
`-1-
`
`c7
`
`i..:
`
`fu_ 4c
`
`z^
`
`4)
`.•:-,„,
`
`

`

`

`

`c)90StateFarm
`
`Certified Policy Record
`
`I, the undersigned, do hereby confirm that I am custodian of the records pertaining to the issuance of
`policies by State Farm Mutual Automobile Insurance Company.
`
`I certify that the attached documents represent a true and accurate record of the terms and conditions
`including any endorsem*nts, if applicable, for the policy term(s)
`of Policy Number
`09/20/2021 to 11/18/2021 and insuring LAGO LEYVA, RAMON & SANTANA ROMERO, ANIELA
`based on available records.
`
`is State Farm's business practice to print a new Declarations Page only when a policy issuance
`It
`transaction such as a change of coverage occurs.
`Therefore, the included Declarations Page which
`in effect at the time of loss will
`indicate the policy period of the last policy issuance transaction.
`was
`
`The policy was
`
`in effect on the loss date of 10/18/2021.
`
`4.4
`Msica Bass
`Underwriter
`Date: 09/01/2022
`
`1011493
`
`Page 1 of 1
`
`2000 157822 200 02-09-2022
`
`

`

`6128S.1 AMENDATORY ENDORsem*nT
`
`1.
`
`2.
`
`2.
`3.
`
`This endorsem*nt is a part of the policy. Except for the changes this endorsem*nt makes, all other
`provisions of the policy remain the same and apply to this endorsem*nt.
`related to any named insured in
`1. DEFINITIONS
`1.
`any degree by blood, by mar-
`a. Newly Acquired Car is changed to read:
`riage, or by adoption and who
`makes his or her home in the
`Newly Acquired Car means
`a car
`family unit with
`that
`a resident
`newly owned by you or
`same
`named insured, whether or not
`relative.
`temporarily living elsewhere, or
`A car
`to be a newly acquired
`ceases
`a ward or
`foster child of any
`on the earlier of:
`car
`named insured or of a person
`described in 1. above and who
`the effective date and time of a
`makes his or her home in the
`policy, including any binder, is-
`family unit with
`that
`sued by us or any other company
`same
`as an in-
`that describes the car
`named insured.
`sured vehicle; or
`COVERAGE (Bodily Injury
`LIABILITY
`the end of the 14th calendar day
`and Property Damage)
`immediately following the date
`Item 4. of Insured, under Additional
`a.
`is delivered to you or a
`the car
`Definition, is changed to read:
`resident relative.
`Insured means
`any other person or
`If a newly acquired car
`organization vicariously liable for
`is not other-
`the use of a vehicle by an insured as
`wise afforded comprehensive cover-
`defined in 1., 2., or 3. above, but
`age or collision coverage by this or
`only for such vicarious liability.
`any other policy,
`then this policy
`This provision applies only if the ve-
`will provide Comprehensive Cover-
`hicle is:
`age or Collision Coverage for that
`neither owned by, nor hired by,
`newly acquired car, subject to a de-
`that other person or organiza-
`ductible of $500.
`tion; and
`b. Pedestrian is changed to read:
`neither available for, nor being
`a person who is
`Pedestrian means
`used for, carrying persons for a
`not occupying:
`charge.
`a motor vehicle;
`1.
`The following is added to Supplemen-
`tary Payments:
`a self-propelled vehicle; or
`Attorney fees for attorneys repre-
`trailer
`or other vehicle at-
`a
`senting the person or entity assert-
`tached to a self-propelled vehi-
`ing a claim against an insured are
`cle.
`not a covered court cost, cost or ex-
`c. Relative is changed to read:
`pense under the Supplementary Pay-
`ments provision of this coverage in
`a person, other than
`Relative means
`this policy.
`you, who is:
`
`2.
`
`a.
`
`b.
`
`2.
`
`b.
`
`Page 1 of 11
`C, Copyright, State Fa= Mutual Automobile Insurance Company, 2017
`
`6128S.1
`
`

`

`a.
`
`b.
`
`b.
`
`c.
`
`is
`
`is
`
`b.
`
`b.
`
`c.
`
`a.
`
`c. Exclusions
`(1) The exception to exclusion 11.
`changed to read:
`This exclusion does not apply to
`damage to a:
`a. motor vehicle owned by the
`employer of you or
`the em-
`ployer of any resident rela-
`if
`tive
`such
`is
`damage
`caused by an insured while
`operating another motor
`ve-
`hicle;
`residence while rented to or
`leased to an insured; or
`private garage while rented
`leased to an insured;
`to or
`(2) The following exclusion is added:
`THERE IS NO COVERAGE
`FOR AN INSURED WHO IS:
`1. PROVIDING TRANSPOR-
`TATION NETWORK SER-
`VICES; OR
`OR
`2. OCCUPYING
`STRUCK BY YOUR CAR,
`A NEWLY ACQUIRED
`CAR, OR A TEMPORARY
`SUBSTITUTE
`CAR
`WHILE SUCH VEHICLE
`IS BEING USED TO PRO-
`VIDE TRANSPORTATION
`NETWORK SERVICES.
`3. PROPERTY DAMAGE LIABILITY
`COVERAGE
`Item 4. of Insured, under Additional
`Definition, is changed to read:
`Insured means any other person or
`organization vicariously liable for
`the use of a vehicle by an insured as
`defmed in 1., 2., or 3. above, but
`only for
`such vicarious liability.
`Page 2 of 11
`C, Copyright, State Farm Mutual Automobile Insurance Company, 2017
`
`This provision applies only if the ve-
`hicle is:
`neither owned by, nor hired by,
`that other person or organiza-
`tion; and
`neither available for, nor being
`used for, carrying persons for a
`charge.
`The following is added to Supplemen-
`tary Payments:
`Attorney fees for attorneys repre-
`senting the person or entity assert-
`ing a claim against an insured are
`not a covered court cost, cost or ex-
`pense under the Supplementary Pay-
`ments provision of this coverage in
`this policy.
`c. Exclusions
`(1) The exception to exclusion 9.
`changed to read:
`This exclusion does not apply to
`damage to a:
`a. motor vehicle owned by the
`employer of you or
`the em-
`ployer of any resident rela-
`if
`tive
`such
`is
`damage
`caused by an insured while
`operating another motor
`ve-
`hicle;
`residence while rented to or
`leased to an insured; or
`private garage while rented
`leased to an insured;
`to or
`(2) The following exclusion is added:
`THERE IS NO COVERAGE
`FOR AN INSURED WHO IS:
`1. PROVIDING
`TRANS-
`PORTATION NETWORK
`SERVICES; OR
`2. OCCUPYING OR STRUCK
`BY YOUR CAR, A NEWLY
`6128S.1
`
`

`

`c.
`d.
`
`ACQUIRED CAR, OR A
`TEMPORARY
`SUBSTI-
`TUTE CAR WHILE SUCH
`VEHICLE
`BEING
`IS
`USED
`PROVIDE
`TO
`TRANSPORTATION NET-
`WORK SERVICES.
`4. NO-FAULT COVERAGE
`a. Additional Definition
`the definition of Insured is
`Item 2. of
`changed to read:
`Insured means
`any other person
`while occupying or struck as a pe-
`destrian by:
`your car;
`a.
`b.
`a newly acquired car;
`a temporary substitute car; or
`a trailer while attached to a car
`described in a., b., or c. above.
`Insuring Agreement
`Item 1.C. is changed to read:
`follow-up services and care
`con-
`sistent with the underlying medical
`to A.
`diagnosis rendered pursuant
`above which may also be provided
`by the followingpersons or entities:
`(1) a hospital or ambulatory surgi-
`licensed under chap-
`cal center
`ter 395 of the Florida Statutes;
`(2) an entity wholly owned by one
`or more physicians licensed un-
`der chapter 458 or 459 of
`the
`Florida Statutes,
`chiropractic
`physicians licensed under chap-
`ter 460 of the Florida Statutes or
`dentists licensed under chapter
`466 of
`the Florida Statutes, or
`by such practitioners and the
`spouse, parent, child, or sibling
`of such practitioners;
`
`b.
`
`(3) an entity that owns
`is wholly
`or
`owned, directly or
`indirectly, by
`a hospital or hospitals;
`(4) a physical therapist licensed un-
`der chapter 486 of the Florida
`Statutes, based upon referral by
`a provider described in B.
`above; and
`(5) a health care clinic licensed un-
`der part X of chapter 400 of the
`Florida Statutes which is ac-
`credited by an accrediting or-
`whose
`standards
`ganization
`incorporate comparable regula-
`tions required by the state of
`Florida; or
`li-
`(a) has a medical director
`censed under chapter 458,
`chapter 459, or chapter 460
`of the Florida Statutes;
`(b) has been continuously li-
`censed for more
`than three
`is a publicly traded
`years or
`corporation that
`issues se-
`curities traded on
`an
`ex-
`change registered with the
`United States Securities and
`Exchange Commission as a
`national
`securities
`ex-
`change; and
`(c) provides at least four of the
`following medical special-
`ties:
`i.
`general medicine;
`ii.
`radiography;
`iii. orthopedic medicine;
`iv. physical medicine;
`physical therapy;
`v.
`vi. physical rehabilitation;
`6128S.1
`
`Page 3 of 11
`C, Copyright, State Fa= Mutual Automobile Insurance Company, 2017
`
`

`

`vii. prescribing or dispens-
`ing outpatient prescrip-
`tion medication; or
`viii. laboratory services.
`
`c.
`
`is
`
`Limits
`(1) Item 2.f.(I) is changed to read:
`For all other medical services,
`supplies, and care, 200 percent
`of the allowable amount under:
`(I) The participating physician
`fee schedule of Medicare
`Part B, except as provided
`in sub-sub-subparagraphs (II)
`and (III).
`(2) The last paragraph of item 2.
`changed to read:
`For purposes of the above, the
`applicable fee schedule or pay-
`limitation under
`ment
`is the fee schedule or payment
`limitation in effect on March 1
`of the service year in which the
`is
`services, supplies,
`or
`care
`rendered and for
`in
`the area
`which such services, supplies,
`or care is rendered, and the ap-
`plicable fee schedule or pay-
`limitation
`ment
`to
`applies
`services, supplies, or care
`ren-
`dered during that service year,
`subse-
`notwithstanding
`any
`quent change made to the fee
`schedule or payment limitation,
`it will not be less
`except that
`than the allowable amount
`un-
`der the applicable schedule of
`Medicare Part B for 2007 for
`medical services, supplies, and
`care subject to Medicare Part B.
`For purposes of this paragraph,
`the term "service year" means
`from March
`the period
`through the end of February of
`the following year.
`
`1
`
`d. Exclusions
`The following exclusion is added:
`THERE IS NO COVERAGE FOR
`AN INSURED WHO IS:
`1. PROVIDING TRANSPORTA-
`TION NETWORK SERVICES;
`OR
`2. OCCUPYING OR STRUCK
`BY YOUR CAR, A NEWLY
`ACQUIRED CAR, OR A TEM-
`PORARY SUBSTITUTE CAR
`WHILE SUCH VEHICLE IS
`BEING USED TO PROVIDE
`TRANSPORTATION
`NET-
`WORK SERVICES.
`5. MEDICAL PAYMENTS COVERAGE
`Insuring Agreement
`a.
`Item 2.C. is changed to read:
`follow-up services and care
`con-
`sistent with the underlying medical
`diagnosis rendered pursuant
`to A.
`above which may also be provided
`by the followingpersons or entities:
`(1) a hospital or ambulatory surgi-
`licensed under chap-
`cal center
`ter 395 of the Florida Statutes;
`(2) an entity wholly owned by one
`or more physicians licensed un-
`der chapter 458 or 459 of the
`Florida Statutes,
`chiropractic
`physicians licensed under chap-
`ter 460 of the Florida Statutes or
`dentists licensed under chapter
`466 of the Florida Statutes, or
`by such practitioners and the
`spouse, parent, child, or sibling
`of such practitioners;
`(3) an entity that owns
`is wholly
`or
`owned, directly or
`indirectly, by
`a hospital or hospitals;
`(4) a physical therapist licensed un-
`der chapter 486 of the Florida
`6128 S. 1
`
`Page 4 of 11
`C, Copyright, State Fa= Mutual Automobile Insurance Company, 2017
`
`

`

`Statutes, based upon referral by
`a provider described in B.
`above; and
`(5) a health care clinic licensed un-
`der part X of chapter 400 of the
`Florida Statutes which is
`ac-
`credited by an accrediting or-
`ganization whose
`standards
`incorporate comparable regula-
`tions required by the state of
`Florida; or
`li-or
`(a) has a medical director
`censed under chapter 458,
`chapter 459, or chapter 460
`of the Florida Statutes;
`(b) has been continuously li-
`censed for more
`than three
`is a publicly traded
`years or
`corporation that
`issues se-
`curities traded on
`an
`ex-
`change registered with the
`United States Securities and
`Exchange Commission as a
`national
`securities
`ex-
`change; and
`(c) provides at least four of the
`following medical special-
`ties:
`general medicine;
`i.
`ii.
`radiography;
`iii. orthopedic medicine;
`iv. physical medicine;
`physical therapy;
`v.
`vi. physical rehabilitation;
`vii. prescribing or dispens-
`ing outpatient prescrip-
`tion medication; or
`viii.laboratory services.
`
`Limits
`(1) Item 3.f.(I) is changed to read:
`
`b.
`
`a.
`
`item 3.
`
`is
`
`For all other medical services,
`supplies, and care, 200 percent
`of the allowable amount under:
`(I) The participating physician
`fee schedule of Medicare
`Part B, except as provided
`in sub-sub-subparagraphs (II)
`and (III).
`(2) The last paragraph of
`changed to read:
`purposes of
`the
`the above,
`F
`applicable fee schedule or pay-
`limitation under
`ment
`is the fee schedule or payment
`limitation in effect on March 1 of
`the service year in which the ser-
`is ren-
`vices, supplies, or
`care
`in which
`dered and for the area
`such services, supplies, or care is
`rendered, and the applicable fee
`limitation
`schedule or payment
`applies to services, supplies, or
`care rendered during that service
`year, notwithstanding any subse-
`quent change made to the fee
`schedule or payment limitation,
`except that it will not be less than
`the allowable amount under the
`applicable schedule of Medicare
`Part B for 2007 for medical ser-
`vices, supplies, and care subject
`to Medicare Part B. For pur-
`poses of this paragraph, the term
`"service year" means
`the period
`from March 1 through the end of
`February of the following year.
`c. Exclusions
`(1) Exclusion 7. is changed to read:
`THERE IS NO COVERAGE FOR
`AN INSURED WHO:
`OR
`OCCUPYING
`IS
`THROUGH BEING STRUCK
`
`Page 5 of 11
`C, Copyright, State Farm Mutual Automobile Insurance Company, 2017
`
`6128S.1
`
`

`

`in-
`is
`
`2.
`
`AS A PEDESTR/ANBY A VE-
`HICLE OWNED BY ANY
`NAMED INSURED OR ANY
`RELATIVE WHICH IS NOT
`INSURED UNDER THIS POL-
`ICY; OR
`b. AT THE TIME OF THE ACCI-
`DENT OWNS A MOTOR VE-
`HICLE
`SUBJECT TO THE
`NO-FAULT ACT AND IS NOT
`INSURED FOR THE COVER-
`AGE REQUIRED BY THE
`NO-FAULT ACT.
`This exclusion (7.b.) does not
`apply to:
`(1) any named insured;
`(2) the spouse of any named in-
`sured; and
`(3) any relative while occupy-
`ing your
`a newly ac-
`car,
`quired car,
`temporary
`a
`substitute car,
`or
`a non-
`if
`owned car
`the accident
`outside Florida, but
`occurs
`within
`the area described
`under Where Coverage
`Applies for Medical Pay-
`ments Coverage;
`(2) The following exclusion is added:
`THERE IS NO COVERAGE
`FOR AN INSURED WHO IS:
`1. PROVIDING
`TRANS-
`PORTATION NETWORK
`SERVICES; OR
`OR
`2. OCCUPYING
`STRUCK BY YOUR CAR,
`A NEWLY ACQUIRED
`CAR, OR A TEMPORARY
`SUBSTITUTE
`CAR
`Page 6 of 11
`C, Copyright, State Fa= Mutual Automobile Insurance Company, 2017
`
`WHILE SUCH VEHICLE
`IS BEING USED TO PRO-
`VIDE
`TRANSPORTA-
`TION
`NETWORK
`SERVICES.
`6. UNINSURED MOTOR VEHICLE COV-
`ERAGE (Stacking)
`a. Additional Definitions
`"Uninsured Motor Vehicle does not
`trailer"
`clude a land motor vehicle or
`changed to read:
`Uninsured Motor Vehicle does not
`include a
`vehicle or
`land motor
`trailer:
`1. whose ownership, maintenance,
`or use is provided Liability Cov-
`erage by this policy. However,
`any such vehicle will be deemed
`to be an uninsured motor vehi-
`de for bodily injuly sustained
`relative
`a resident
`by you or
`while the vehicle is being oper-
`ated by a person other than you
`or a resident relative;
`designed for use primarily off
`public roads except while on
`public roads;
`3. while located for use as a dwell-
`ing or other premises; or
`or operator could
`4. whose owner
`have been reasonably identified.
`b. Exclusions
`The following exclusion is added:
`THERE IS NO COVERAGE FOR
`AN INSURED WHO IS:
`1. PROVIDING TRANSPORTA-
`TION NETWORK SERVICES;
`OR
`2. OCCUPYING OR STRUCK
`BY YOUR CAR, A NEWLY
`6128S.1
`
`

`

`ACQUIRED CAR, OR A TEM-
`PORARY SUBSTITUTE CAR
`WHILE SUCH VEHICLE IS
`BEING USED TO PROVIDE
`TRANSPORTATION
`NET-
`WORK SERVICES.
`7. UNINSURED MOTOR VEHICLE COV-
`ERAGE (Non-Stacking)
`a. Additional Definitions
`in-
`"Uninsured Motor Vehicle does not
`trailee is
`clude a land motor vehicle or
`changed to read:
`Uninsured Motor Vehicle does not
`include a
`vehicle or
`land motor
`trailer:
`1. whose ownership, maintenance,
`or use is provided Liability Cov-
`erage by this policy. However,
`any such vehicle will be deemed
`to be an uninsured motor vehi-
`cle for bodily injury sustained
`relative
`a resident
`by you or
`while the vehicle is being oper-
`ated by a person other than you
`or a resident relative;
`designed for use primarily off
`public roads except while on
`public roads;
`3. while located for use as a dwell-
`ing or other premises; or
`or operator could
`4. whose owner
`have been reasonably identified.
`b. Exclusions
`(1) Exclusion 2. is changed to read:
`THERE IS NO COVERAGE
`FOR AN INSURED WHO
`SUSTAINS BODILY INJURY:
`a. WHILE OCCUPYING A
`VEHICLE
`OWNED BY
`YOU IF IT IS NOT YOUR
`Page 7 of 11
`C, Copyright, State Fa= Mutual Automobile Insurance Company, 2017
`
`CAR OR A NEWLY AC-
`QUIRED CAR;
`b. WHILE OCCUPYING A
`VEHICLE
`OWNED BY
`ANY RESIDENT RELA-
`TIVE IF IT IS NOT YOUR
`CAR OR A NEWLY AC-
`QUIRED CAR. This exclu-
`sion (2.b.) does not apply to
`the first person shown as a
`named insured on the Dec-
`larations Page
`that
`and
`insured's
`named
`spouse
`who resides primarily with
`that named insured, pro-
`vided that
`the vehicle is
`neither
`that
`owned
`by
`insured nor
`that
`named
`spouse; OR
`C. WHILE A PEDESTRIAN
`AND IS STRUCK BY A
`VEHICLE
`OWNED BY
`ANY RESIDENT RELA-
`TIVE;
`(2) The following exclusions are added:
`(a) THERE IS NO COVER-
`AGE FOR AN INSURED
`WHO SUSTAINS BODILY
`INJURY WHILE OCCU-
`PYING
`A
`VEHICLE
`OWNED BY THAT IN-
`SURED IF THAT VEHI-
`CLE IS NOT INSURED
`FOR UNINSURED MO-
`TOR VEHICLE COVER-
`AGE
`THIS
`UNDER
`POLICY OR ANY OTHER
`POLICY.
`(b) THERE IS NO COVER-
`AGE FOR AN INSURED
`WHO IS:
`1. PROVIDING TRANS-
`PORTATION
`NET-
`WORK
`SERVICES;
`OR
`
`2.
`
`6128S.1
`
`

`

`9'
`
`from per-
`business
`
`OR
`2. OCCUPYING
`STRUCK BY YOUR
`CAR, A NEWLY AC-
`QUIRED CAR, OR A
`TEMPORARY
`SUB-
`STITUTE CAR WHILE
`SUCH VEHICLE
`IS
`BEING
`USED
`TO
`PROVIDE
`TRANS-
`PORTATION
`NET-
`WORK SERVICES.
`8. PHYSICAL DAMAGE COVERAGES
`The paragraph that reads:
`If a deductible applies to Compre-
`hensive Coverage, then it is shown
`on the Declarations Page. The de-
`ductible that applies to Collision
`Coverage is shown on the Declara-
`tions Page.
`is changed to read:
`Deductible
`is shown under "SYM-
`If "D"
`1.
`the Declarations
`BOLS"
`on
`then the deductible that
`Page,
`applies to Comprehensive Cov-
`if
`the dollar
`is
`any,
`erage,
`amount shown on the Declara-
`to the title of this
`tions Page next
`coverage. However, we will not
`than $500 for any
`deduct more
`loss to a newly acquired car.
`If "G"
`is shown under "SYM-
`BOLS"
`the Declarations
`on
`then the deductible that
`Page,
`applies to Collision Coverage is
`the dollar amount shown on the
`to the ti-
`Declarations Page next
`tle of
`this coverage. However,
`we will
`not deduct more
`than
`$500 for any loss caused by col-
`lision to a newly acquired car.
`Page 8 of 11
`C, Copyright, State Farm Mutual Automobile Insurance Company, 2017
`
`b. Exclusions
`The following exclusion is added:
`THERE IS NO COVERAGE FOR
`ANY
`COVERED
`VEHICLE
`WHILE IT IS USED TO PROVIDE
`TRANSPORTATION
`NETWORK
`SERVICES.
`INSURED'S DUTIES
`Item 7.a.(3) is changed to read:
`a.
`An insured making claim under:
`a. No-Fault Coverage, Medical
`Payments Coverage, Uninsured
`Motor Vehicle Coverage,
`or
`Death, Dismemberment
`and
`Loss of Sight Coverage must:
`(3) provide written authoriza-
`tion for us to obtain medical
`bills, medical records, wage
`information, salary infor-
`in-
`mation, employment
`formation, and any other
`relevant
`information
`we
`deem reasonably neces-
`substantiate
`the
`to
`sary
`claim.
`Such authorizations must
`not:
`(a) restrict
`us
`forming our
`functions in:
`relevant
`(i) obtaining
`and reasonably nec-
`essary records, bills,
`information,
`and
`data; nor
`(ii) using or
`retaining
`relevant
`and
`rea-
`sonably necessary
`records, bills, infor-
`and data
`mation,
`collected
`or
`re-
`ceived by us;
`6128S.1
`
`a
`
`2.
`
`

`

`a.
`
`or Death, Dismember-
`violate
`to
`(b) require us
`Coverage,
`ment and Loss of Sight Coverage
`federal or state laws or
`must submit to us all information we
`regulations;
`need to comply with federal and
`from
`(c) prevent
`us
`state laws and regulations.
`filling our data report-ful-
`10. GENERAL TERMS
`ing and data retention
`obligations to insurance
`The following is added to Limited Cov-
`regulators; or
`erage in Mexico:
`from dis-
`(d) prevent
`us
`Uninsured Motor Vehicle Cover-
`claim infor-
`closing
`age (Stacking and Non-Stacking)
`mation and data:
`b. Under Limited Coverage in Mexico,
`enable peifor-
`to
`(i)
`Legal Action Against Us is changed to
`of our busi-
`mance
`read:
`functions;
`ness
`Any legal action against us arising
`(ii) to meet our
`report-
`out of an accident or
`loss occurring
`ing obligations to
`in the country of Mexico must be
`insurance
`regula-
`in the
`brought in a Florida state court
`tors;
`United States of America,
`or
`a
`(iii) to meet our
`report-
`United States of America District
`ing obligations to
`insurance data con-Court
`that has jurisdiction.
`The provision entitled Persons Acting
`solidators; and
`(iv) as otherwise per-On
`Our Behalf
`is deleted in its en-
`tirety.
`mitted by law.
`following is added to Newly
`d. The
`If an
`injured insured is a
`Owned or Newly Leased Car:
`minor, unable to act,
`or
`then his or her legal
`dead,
`If a resident relative wants to insure
`representative must provide
`a car newly owned by the resident
`us with the written authori-
`relative with the State Farm Com-
`zation.
`panies after that car
`to be a
`ceases
`the holder of the infor-
`If
`then the resi-
`newly acquired car,
`mation refuses to provide it
`dent relative must apply to the State
`to us despite the authoriza-
`Farm Companies for a separate pol-
`request the
`tion, then at our
`icy to insure the car newly owned by
`person making claim or his
`the resident
`relative. Such policy
`or her
`legal
`representative
`will be issued only if both the appli-
`must obtain the information
`cant and the vehicle are eligible for
`and promptly provide it to
`coverage at the time of the applica-
`us; and
`tion.
`b. The following is added to item 7.:
`The following is added to Premium:
`An insured making claim under No-
`Fault Coverage, Medical Payments
`If due to insufficient
`funds, payment
`Coverage, Uninsured Motor Vehicle
`of premium for this policy by debit
`Page 9 of 11
`6128S.1
`C, Copyright, State Farm Mutual Automobile Insurance Company, 2017
`
`c.
`
`e.
`
`

`

`g.
`
`Premium is
`
`funds
`card, credit card, electronic
`transfer, or electronic check is re-
`turned, is declined, or cannot be pro-
`impose
`cessed,
`may
`we
`an
`insufficient
`funds fee of $15 per oc-
`currence.
`f. Return
`of Unearned
`changed to read:
`(1) Ifyou cancel this policy:
`premium will
`then
`be
`(a)
`earned on a pro rata basis.
`We may retain up to 10% of
`unearned
`premium.
`any
`Any remaining unearned
`premium will be mailed or
`electronically transferred to
`you within 30 days after the
`effective date of the policy
`cancellation, or 30 days af-
`ter we receive your
`request
`to cancel this policy, which-
`is later. Delay in the
`ever
`return of unearned premium
`does not affect the cancella-
`tion;
`(b) you may elect to apply the
`unearned portion of any
`premium paid to unpaid bal-
`ances of other policies with
`the State Farm Companies.
`(2) If we cancel this policy:
`premium will
`then
`be
`(a)
`earned on a pro rata basis.
`Any unearned premium will
`be mailed or electronically
`the time we
`transferred at
`cancel the policy or within
`15 days after the effective
`date of the policy cancella-
`tion. Delay in the return of
`unearned premium does not
`affect the cancellation;
`(b) you may elect to apply the
`unearned portion of any
`Page 10 of 11
`C, Copyright, State Fa= Mutual Automobile Insurance Company, 2017
`
`premium paid to unpaid bal-
`ances of other policies with
`the State Farm Companies.
`The following are added to GENERAL
`TERMS:
`Electronic Delivery
`if al-
`With your consent, we may,
`lowed by law, electronically deliver
`any document or notice, including a
`notice to renew, instead of mailing it
`or delivering it by other means.
`Proof of transmission will be suffi-
`cient proof of notice. This provision
`does not apply to any notice to non-
`or cancel.
`renew
`Our Rights Regarding Claim In-
`formation
`a. We will collect, receive, obtain,
`use, and retain all the items de-
`scribed in item b.(1) below and
`use and retain the information
`described in item b.(3)(b) be-
`low, in accordance with applica-
`ble federal and state laws and
`regulations and consistent with
`the performance of our business
`functions.
`b. Subject to a. above, we will not
`be restricted in or prohibited
`from:
`(1) collecting, receiving, or ob-
`taining records, receipts, in-
`medical
`bills,
`voices,
`medical
`records, wage in-
`infor-
`formation,
`salary
`motion,
`employment
`relevant data,
`information,
`and any other reasonable in-
`formation to process
`the
`claim;
`(2) using any of
`the items de-
`scribed in item b.(1) above;
`Or
`
`6128S.1
`
`

`

`(3) retaining:
`(a) any of the items in item
`b.(1) above; or
`information
`(b) any other
`we have in our posses-
`sion as a result of our
`processing, handling, or
`otherwise
`resolving
`claims submitted under
`this policy.
`c. We may disclose any of
`the
`items in item b.(1) above and
`the information
`any of
`de-
`scribed in item b.(3)(b) above:
`(1) to enable performance of
`our business functions;
`reporting obli-
`(2) to meet our
`gations to insurance regula-
`tors;
`
`reporting obli-
`(3) to meet our
`insurance data
`gations to
`cons