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

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.