Letters of Protection in Florida Injury Cases: How They Work and How Juries Now See Them

An injured person in Miami often needs surgery, imaging, and therapy long before any insurance company writes a check. If that person has no health insurance, or has coverage that will not pay for accident-related care, a letter of protection is frequently the only way to get treated. A letter of protection, usually called an LOP, is a written promise from the patient and the patient's attorney that the medical provider will be paid out of any settlement or judgment in the injury case. The provider treats now and waits to be paid later.

For decades, LOPs operated quietly in the background of Florida injury litigation. That changed on March 24, 2023, when the Legislature enacted House Bill 837 and created section 768.0427, Florida Statutes. The statute forces detailed disclosure of every LOP, changes what a jury is allowed to hear about medical bills, and makes attorney referrals to LOP doctors fair game at trial. If you are treating under an LOP for a Miami injury case, or deciding whether to sign one, you need to know how these rules work.

What a Letter of Protection Is and Why Injured Miamians Use Them

An LOP is a three-party arrangement:

• The patient agrees that the provider's bill will be paid from the recovery in the injury case, and remains personally responsible for the bill if the case fails.
• The attorney agrees to honor the provider's lien and pay the bill from settlement funds before disbursing money to the client.
• The provider agrees to treat now and defer collection until the case resolves.

Miami-Dade County has one of the highest uninsured rates of any large county in the country. Many of our clients work in construction, hospitality, or the gig economy without employer health coverage. A work injury client whose employer disputes the workers' compensation claim may have no payer at all. In a car crash, Florida's no-fault law, section 627.736, Florida Statutes, provides only $10,000 in personal injury protection benefits, and PIP pays just 80 percent of covered medical charges. A single spinal fusion can exhaust that limit before the hospital bill arrives. The LOP fills the gap so the client can actually get the surgery a jury will later be asked to value.

Section 768.0427: The Statute That Now Governs LOPs

Section 768.0427, Florida Statutes, applies to causes of action filed after March 24, 2023. It does two things that matter for anyone treating under an LOP: it mandates disclosure, and it caps the billing evidence the jury hears.

Mandatory Disclosures Under Section 768.0427(4)

If any portion of your treatment was rendered under a letter of protection, you must disclose all of the following in the lawsuit:

1. A copy of the letter of protection itself.
2. An itemized bill for every service, coded under the CPT or HCPCS coding system in effect on the date of treatment. Lump-sum or block bills do not comply.
3. If the provider sold the account receivable to a medical factoring company, the identity of the buyer and the dollar amount the factoring company paid for the bill. If a Miami surgery center billed $80,000 and sold that bill to a funder for $28,000, the defense will learn both numbers.
4. Whether you had health care coverage at the time of treatment and, if so, the identity of that coverage.
5. Whether you were referred for treatment under the LOP and, if so, who made the referral.

Attorney Referrals Are No Longer Privileged

Item five is the sharpest change. Before HB 837, Florida case law generally shielded the question of whether your lawyer sent you to a particular doctor. Section 768.0427(4)(e) removes that shield for LOP treatment. If your attorney referred you to the orthopedic surgeon who operated under an LOP, the defense may ask about it in deposition and argue it to the jury. The attorney-client privilege does not apply to the fact of the referral. Any Miami firm that routinely funnels clients to the same handful of LOP clinics should expect that pattern to be put in front of the jury.

What the Jury Hears About the Bills: Section 768.0427(2)

The statute also rewrites the evidence of medical damages:

• Past bills already paid: the jury hears only the amount actually paid, regardless of the amount originally billed.
• Past unpaid bills, claimant has health coverage: the jury hears the amount the coverage is obligated to pay under its contract, plus the patient's own share, not the provider's sticker price.
• Past unpaid bills, claimant has coverage but treated under an LOP instead: the jury hears the amount the coverage would have been obligated to pay had the bills been submitted to it.
• Past unpaid bills, claimant is uninsured or covered by Medicare or Medicaid: the jury hears 120 percent of the Medicare reimbursement rate in effect at the time of trial. If no Medicare rate exists for the service, the figure is 170 percent of the applicable state Medicaid rate.
• Future treatment: the same framework applies to the projected cost of future care.

Section 768.0427(3) then caps the recovery itself. Damages for medical treatment cannot exceed the sum of amounts actually paid, amounts necessary to satisfy unpaid charges under the statute's evidence rules, and amounts necessary for reasonably certain future care.

A Worked Example

Assume a client falls from scaffolding at a Brickell construction site in June 2024 and has no health insurance. She undergoes a lumbar fusion under an LOP. The surgeon and hospital bill a combined $190,000. Suppose the Medicare reimbursement rate for the same procedures at the time of trial totals $52,000.

• Under the old law, the jury could see the full $190,000 in billed charges.
• Under section 768.0427(2)(b)3, the jury now hears $62,400, which is 120 percent of the $52,000 Medicare rate.
• If the hospital sold its $150,000 receivable to a factoring company for $45,000, the defense may introduce that $45,000 purchase price and argue it reflects the bill's true value.

The takeaway is not that LOP cases are worthless. It is that the paper value of the bills no longer drives the verdict. The medical necessity of the treatment, the credibility of the surgeon, and the human impact of the injury now carry the weight the billed charges used to carry. Falls from height, like those we handle as a ladder fall injury firm in Miami, frequently involve exactly this kind of high-dollar LOP surgery, so the framing of the medical evidence matters from the first visit.

How Juries Now See LOP Treatment

Defense lawyers in Miami-Dade courtrooms have adopted a consistent playbook since HB 837:

• Bias attacks on treating physicians: a doctor waiting on the case outcome for payment gets cross-examined as an interested witness. The defense argues the doctor has a financial stake in a bigger verdict.
• The referral argument: if the lawyer selected the doctor, the defense suggests the treatment was built for litigation rather than recovery.
• The factoring discount: where a bill was sold at a steep discount, the defense argues the discount is the honest measure of what the care was worth.
• The coverage question: if you had insurance available and chose an LOP instead, expect the jury to hear about it and expect the defense to ask why.

None of these arguments is unanswerable. Jurors understand that an uninsured dishwasher cannot get a fusion without some financing mechanism. A treating surgeon with strong credentials, contemporaneous records, and objective imaging holds up well under bias cross-examination. But the case must be built with these attacks in mind from the outset, not patched together on the eve of trial.

Choosing Between an LOP and Your Health Insurance

Because section 768.0427(2)(b)2 limits the billing evidence to what your insurance would have paid whenever you had coverage available, the decision to bypass health insurance in favor of an LOP now carries serious litigation consequences. Sometimes the LOP is still the right call: the needed specialist may not accept your plan, or the plan may deny accident-related care and force a subrogation fight. Sometimes running the bills through insurance produces a cleaner damages presentation and a smaller lien at the end. We walk through this analysis with every client, and we cover the tradeoffs in detail in our guide to using private health insurance for a work injury. The wrong choice made in the first month of treatment can cost far more than any lien savings at settlement.

Deadlines: Do Not Let the LOP Outlive Your Claim

HB 837 also cut the statute of limitations for negligence claims from four years to two. Under section 95.11(4)(a), Florida Statutes, a negligence cause of action accruing after March 24, 2023 must be filed within two years. A client injured in a Miami crash on May 1, 2024 must file suit by May 1, 2026. Treatment under an LOP often stretches over many months, and clients sometimes assume the claim can wait until treatment ends. It cannot. If care is ongoing as the deadline approaches, suit gets filed and treatment continues. We explain the accrual rules and the exceptions in our page on the Florida personal injury statute of limitations after HB 837.

What We Do Differently in LOP Cases

• Provider selection on the merits: we work with board-certified Miami specialists whose opinions withstand cross-examination, and we document why each referral was made.
• Coding compliance from day one: every LOP bill in our files is itemized with CPT and HCPCS codes so the section 768.0427(4) disclosures are ready before the defense asks.
• Medicare-rate modeling: we calculate the 120 percent Medicare figure for every procedure early, so settlement demands and trial presentations rest on numbers the statute actually permits.
• Lien negotiation at resolution: the LOP amount is a starting point, not a fixed cost. We negotiate provider balances at settlement so more of the recovery reaches the client.

You can contact the Law Offices of Albert Goodwin by phone at 786-522-1411 or by email at [email protected].