Florida PIP Claim Lawyer

Florida is a No-Fault insurance state. Every car registered in Florida must carry $10,000 of Personal Injury Protection (PIP) coverage and $10,000 of Property Damage Liability — and that PIP coverage is the first source of payment for medical bills and lost wages after most crashes, regardless of who was at fault. Florida's PIP system is also one of the most heavily litigated insurance schemes in the country, with technical requirements that consumers and even some medical providers do not fully understand. The Law Offices of Albert Goodwin helps injured Floridians enforce their PIP rights and litigates against carriers that wrongfully deny, delay, or underpay claims.

What PIP Covers

Under Florida Statute § 627.736, the standard $10,000 PIP policy pays:

• 80% of reasonable and necessary medical expenses
• 60% of lost wages
• 100% of replacement services (housework, childcare, etc.)
• $5,000 death benefit in addition to the standard limits

PIP applies to the policyholder, resident relatives, passengers, and certain pedestrians and cyclists struck by the insured vehicle. PIP follows the person — meaning your own PIP can apply when you are riding in someone else's car or are struck as a pedestrian.

The 14-Day Rule

The single biggest pitfall in Florida PIP is the 14-day rule. Under § 627.736(1)(a), PIP benefits are only available if the injured person receives initial medical care from a qualifying provider within 14 days of the crash. Qualifying providers include licensed physicians (MD or DO), hospitals, chiropractors, dentists, and certain emergency medical personnel. If you wait more than 14 days to seek treatment, you forfeit your right to PIP — period. This rule alone causes thousands of Floridians to lose their no-fault benefits every year.

EMC (Emergency Medical Condition) Determination

The amount of available PIP depends on whether a qualifying provider has determined that the injured person has an "Emergency Medical Condition" (EMC):

• EMC determined. Full $10,000 PIP available.
• No EMC determination. Only $2,500 of PIP is available.

An EMC determination must come from a physician (MD or DO), an osteopathic physician, a dentist, a physician assistant, or an advanced practice registered nurse. Chiropractors cannot make an EMC determination — a frequent issue in PIP litigation. Without a timely written EMC determination in the chart, the PIP carrier can lawfully cap payments at $2,500 even on a six-figure injury.

Examinations Under Oath (EUOs) and IMEs

PIP carriers routinely use two tools to deny or cut off benefits:

• Examination Under Oath (EUO). A sworn examination demanded under the policy. Failure to attend a properly scheduled and noticed EUO can void coverage. Many policies require the EUO to be a "condition precedent" to recovery.
• Independent Medical Examination (IME). Under § 627.736(7), the carrier can require the injured person to attend a medical examination by a doctor of the carrier's choosing. Unjustified refusal to attend can result in termination of benefits.

Both EUOs and IMEs have specific notice and procedure requirements. Carriers frequently use these tools to manufacture coverage defenses, and many denials based on no-show or "non-cooperation" can be challenged when the carrier did not follow the statute exactly.

Medical Provider PIP Suits

Most Florida PIP litigation is between medical providers (chiropractors, MRI facilities, pain clinics, physical therapy clinics) and PIP carriers, fighting over the application of the statutory fee schedule, reductions, and denied bills. These cases are pursued under an assignment of benefits (AOB) from the patient to the provider, and § 627.428 allows recovery of attorneys' fees from the carrier when a provider prevails.

Wage Loss Claims

PIP wage loss claims require documentation: a treating physician's disability slip taking the patient out of work or imposing restrictions, employer wage records (or self-employment income evidence), and a clear causal connection between the crash injuries and the inability to work. Carriers regularly deny wage loss claims when paperwork is incomplete or when the disability period does not match the medical records.

PIP and Your Liability Case

Florida's no-fault system limits the right to sue for non-economic damages (pain and suffering) unless the injured person meets the "serious injury threshold" under § 627.737. The threshold is met by: significant and permanent loss of an important bodily function; permanent injury within a reasonable degree of medical probability; significant and permanent scarring or disfigurement; or death. In practice, the permanency element is the most common path. Your treating physician's permanency opinion is therefore as important as the medical care itself.

Common PIP Disputes We Handle

• Denials based on alleged failure to seek treatment within 14 days
• Denials based on the absence (or alleged absence) of an EMC determination
• Termination of benefits after an IME "cut-off" report
• EUO non-cooperation denials
• Disputes over fee-schedule application and reimbursement rates
• Wage-loss denials
• Coverage disputes about residency, household members, and named-insured status

Eligible Providers and the 2012 Reform

The 2012 PIP overhaul (HB 119) narrowed the list of providers eligible to bill PIP. Licensed physicians (MDs and DOs), hospitals, dentists, chiropractors, ARNPs, and PAs acting under MD or DO supervision can bill. Massage therapists and acupuncturists were removed from the list and remain ineligible regardless of how the treatment is documented. The same reform created the $2,500 cap for non-EMC cases and confirmed the 14-day initial-treatment requirement. Provider eligibility comes up in nearly every PIP suit — a carrier will routinely deny bills from a clinic that has an unlicensed massage therapist on staff, or where the supervising physician's connection to the treating ARNP cannot be documented.

The Demand Letter Under § 627.736(10)

Before any PIP lawsuit, the claimant — usually the medical provider as assignee — must serve a statutory demand letter under § 627.736(10) identifying the unpaid bills with specificity. The carrier has 30 days to pay the overdue amount plus statutory interest and penalty, after which suit may be filed. A defective demand letter — one that does not itemize the bills, name the correct insured, or attach the assignment — can be dismissed without prejudice and force the claim to restart. Carriers will sometimes pay the demanded amount within the 30 days, which moots the suit but typically still triggers attorney's fees under § 627.736(8) when fees are tied to a recovery on a billing dispute.

Tort Threshold and the Bodily Injury Case

PIP is no-fault medical coverage; it does not pay pain and suffering. To recover non-economic damages from the at-fault driver, the injured person must cross the serious-injury threshold of § 627.737(2): significant and permanent loss of an important bodily function, permanent injury within a reasonable degree of medical probability (other than scarring or disfigurement), significant and permanent scarring or disfigurement, or death. In practice, the permanency element drives most cases. The treating physician's written permanency opinion — using the statutory "reasonable degree of medical probability" language — is therefore as critical to the bodily-injury case as it is to the PIP file. Many otherwise meritorious cases are derailed because the chart contains the medicine but not the magic words.

Stacking PIP With Other Benefits

PIP is primary for medical bills up to $10,000 (or $2,500 without an EMC). Beyond the PIP limit, health insurance, MedPay, and the at-fault driver's bodily-injury liability coverage become the sources of recovery. Hospital and Medicare/Medicaid liens can attach to any third-party recovery. Workers' compensation can also intersect when the crash occurred in the course and scope of employment. Coordination of these sources — and resolving the lien exposure before settlement — is part of every PIP-plus-bodily-injury case. We do not let a client settle a liability claim without first reducing the lien exposure to a known number.

Evidence to Preserve in a PIP Case

• The Florida Traffic Crash Report and any supplemental reports
• Initial treatment records dated within 14 days of the crash
• Written EMC determination by a qualifying provider
• All medical bills, payment ledgers, and explanation-of-benefits forms from the PIP carrier
• Disability slips and work absence documentation for wage-loss claims
• Employer wage records, tax returns, or 1099 records for self-employed claimants
• Every communication with the PIP adjuster in writing
• Notice of any EUO or IME and proof of attendance or rescheduling

What to Do After a Crash

1. Get checked by a qualifying provider within 14 days, even for soft-tissue complaints.
2. Ask the treating physician for a written EMC determination if symptoms warrant.
3. Keep copies of every bill, prescription, and clinical note.
4. If the carrier schedules an IME or EUO, attend with counsel — never simply ignore the notice.
5. Do not give a recorded statement to the PIP adjuster without legal advice.
6. If you missed work, get a written disability slip and employer wage-loss documentation immediately.
7. Calendar the four-year contract limitation period for PIP suits and the two-year tort limitation for the bodily-injury claim.

Common Defense Tactics

• "No EMC." The carrier caps benefits at $2,500 by arguing the chart does not contain a qualifying EMC determination.
• "IME cut-off." A carrier-selected doctor opines that further treatment is unrelated or unnecessary, and the carrier stops paying as of the IME date.
• "EUO no-show." The carrier voids benefits for an alleged failure to attend an EUO, even when notice was defective.
• "Unlicensed provider." The carrier denies bills from a clinic with an ineligible provider under § 627.736(1)(a).
• "Reasonable, related, and necessary." The carrier challenges individual line items as not medically necessary or above the schedule of maximum reimbursement.

Frequently Asked Questions

What if I don't own a car but was hit as a pedestrian?

PIP follows the person. If you live with a resident relative who has Florida PIP, that policy covers you. If not, the PIP on the vehicle that struck you generally responds.

Can I see my own doctor for PIP treatment?

Yes, as long as the provider is eligible under § 627.736 and is willing to bill PIP at the statutory rates.

Will using PIP make my premium go up?

Florida law restricts surcharges for not-at-fault PIP use, but practical premium impact varies by carrier. The right to use the coverage you paid for is not waived by the rate concern.

What if my employer is self-insured for the company vehicle?

Commercial fleets and self-insured employers have their own PIP obligations under § 627.733. The analysis is the same — the named insured, occupancy, and 14-day rules all still apply.

If your PIP carrier has denied, reduced, or delayed your benefits — or if you have questions about how PIP applies to your case — contact the Law Offices of Albert Goodwin. Call 786-522-1411 or email [email protected] for a free consultation.