Florida PIP Denial Lawyer | Tampa Bay

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Florida PIP Denial Lawyer for Patients, Medical Providers, and Injury Attorneys

Your PIP denial letter is not the final word. Florida law tells insurers exactly what they must do before they deny, reduce, or cut off Personal Injury Protection benefits. When they skip a step, the denial can be challenged.

Can you fight a PIP denial in Florida? Yes. Under section 627.736, Florida Statutes, an insurer must pay PIP benefits within 30 days of proper notice. It can cut off treatment only with a valid report from a physician licensed under the same chapter as your treating provider. A denial that misses a statutory requirement can be challenged with a pre-suit demand letter and, if needed, a lawsuit in county court.

I’m Alexander Licznerski. PIP denials are a core part of my practice. I read the denial letter, the peer review or IME report, and the policy. Then I find where the insurer departed from the statute. I represent the injured person, not the clinic, and I keep my caseload small enough to work every file myself.

This page is written for three readers:

Patients whose PIP benefits were denied, stopped, or cut to $2,500.
Medical providers and billing staff watching PIP claims for their patients go unpaid.
Personal injury attorneys whose clients’ treatment is being cut off mid-case.

Call Alexander directly: 813-934-3519

Boutique Representation. Real Results. Your Attorney, Not a Case Number.

Start Here: Which One Are You?

I was hurt in a crash and my PIP was denied or stopped. You may be able to get those benefits paid and keep treating. Start with “What to Do Right Now” below, then read the section on the denial reason in your letter.

I run or bill for a medical practice, and my patients’ PIP claims are being denied. Since HB 837, provider-assignee lawsuits are harder and more expensive to bring. I represent your patient in the dispute, so the claim is pursued in the patient’s name. The insurer, not your practice, is the one that may end up paying the legal fees.

I’m a personal injury attorney, and my client’s PIP was cut off. A PIP cut-off stops treatment, and stopped treatment weakens the bodily injury case. I handle the PIP dispute only. Your client stays your client.

What Florida PIP Is Supposed to Pay

Florida is still a no-fault state. Lawmakers have filed repeal bills in recent sessions, but none has become law, so PIP remains mandatory. It pays your own medical bills and lost wages after a crash, no matter who caused it. The rules are in section 627.736, Florida Statutes.

Benefit	What the statute provides
Medical	80% of reasonable, medically necessary expenses, up to $10,000
Lost wages	60% of lost gross income, paid at least every two weeks
Death benefit	$5,000, in addition to medical and wage benefits
No emergency medical condition	Medical benefits capped at $2,500
Payment deadline	Overdue if not paid within 30 days of written notice of the claim and its amount
Late payment	Overdue benefits carry interest

Two threshold rules cause many denials. First, you must get initial care within 14 days of the crash from a qualifying provider: an MD, DO, chiropractor, dentist, qualifying APRN, a hospital, or emergency medical services. Second, the full $10,000 is available only if a qualifying provider determines you had an emergency medical condition. Otherwise medical benefits stop at $2,500.

PIP also covers people struck by a car while walking or riding a bike, and passengers. Who pays depends on vehicle ownership and household, and insurers sometimes get that wrong.

The PIP Denial Letters I Fight, and What the Law Requires

Insurers use a small set of stock phrases. Find the one in your letter below. Each section explains what the insurer is claiming, what Florida law requires, and where these denials tend to break down.

“Treatment is not reasonable, related, or necessary” (peer review or IME cut-off)

This is the most common way insurers stop paying for ongoing care. They hire a doctor to examine you (an IME) or simply review your records (a peer review). Then they withdraw payment for future treatment.

Under section 627.736(7)(a), an insurer cannot withdraw payment for a treating physician without your consent unless it first gets a valid report. A valid report must meet several requirements:

It comes from a Florida physician licensed under the same chapter as your treating physician. A medical doctor’s report generally cannot cut off a chiropractor’s treatment, and the reverse is also true.
It is prepared and signed by the physician who examined you or reviewed your records.
It is factually supported by the exam and the records.
No one other than that physician has modified it. Insurers and their vendors cannot materially change the doctor’s opinion, and a denial based on a changed opinion counts as a material misrepresentation under the insurance code.
The physician is in active clinical practice or teaching, as the statute defines it.

Reports often fail one or more of these tests. Common problems include the wrong license chapter, a reviewer who never saw key records, conclusions that contradict the reviewer’s own findings, and template language that does not match your chart.

“Failure to attend independent medical examination”

If you unreasonably refuse or fail to appear for an IME, the insurer is no longer liable for later benefits. Missing two IMEs creates a presumption that the refusal was unreasonable. The insurer has to play by the rules too. The exam must be held where you are treating, or within 10 miles by road of your home in your home county, unless no qualified physician is available nearby. The insurer pays the cost. Notices sent to an old address, scheduled with no real notice, or set in the wrong place are worth examining closely.

“Failure to appear for examination under oath”

An examination under oath (EUO) is a recorded question-and-answer session with the insurer’s lawyer. Section 627.736(6)(g) makes compliance a condition of receiving benefits. Questions must be limited to relevant information. Your policy’s EUO terms, the notice you received, and whether you asked to reschedule all matter. An insurer that demands EUOs without a reasonable basis as a general business practice violates the insurance code. If you have an EUO notice and have not appeared yet, talk to a lawyer before the date.

“No emergency medical condition — benefits limited to $2,500”

The $10,000 limit applies when a qualifying physician, dentist, physician assistant, or APRN determines you had an emergency medical condition. If a provider determines you did not, medical benefits are capped at $2,500. These disputes often turn on paperwork. Was a determination made, by whom, and what does the chart actually say?

“Reduced per fee schedule” or “CPT code recoded”

Insurers can limit payment to set percentages of Medicare and other schedules, but only if the policy gave notice that it would use them. Before an insurer changes a provider’s billing codes for upcoding or unbundling, it must contact the provider and discuss the change, or make a documented good-faith effort to do so. Systematic downcoding to avoid payment is prohibited. For patients there is a protection too. When an insurer properly limits payment under the schedule, the provider generally cannot bill you for the difference.

“Request for documentation under section 627.736(6)(b)”

This is not a denial, but it often delays payment for months. If the insurer requests records within 30 days of receiving the bill, payment is due within the normal 30-day window or within 10 days of receiving the records, whichever is later. The insurer pays the reasonable cost of the records. A request without a reasonable basis, made as a general business practice, is an unfair trade practice.

“Claim under investigation for suspected fraud”

An insurer that reasonably suspects fraud must notify the claimant in writing within 30 days of the claim. It then has 60 more days to investigate. No later than 90 days after the claim was submitted, it must deny it or pay it with interest. Claims left in limbo past that point deserve attention.

“Material misrepresentation” or “Policy rescinded”

Sometimes the insurer does not deny a bill. It declares that the whole policy never existed because of something on the application, such as an unlisted household driver or a garaging address. Rescission is a serious step with its own legal requirements. The insurer must generally show that the misstatement was material and would have changed its decision to issue the policy. Treat these letters as urgent.

“Benefits exhausted”

The $10,000 runs out. The question is whether the insurer paid the right bills in the right amounts and order. On request in a dispute, the insurer must tell you within 15 days after the limits are reached. It must also keep a log of PIP payments made for you and produce it within 30 days of a request once litigation starts. Exhaustion claims should be checked against that log.

Recognize the language in your letter? Send it to me. I’ll tell you whether the insurer followed the statute, at no charge. Call today at 813-934-3519.

For Patients: What to Do Right Now

If your PIP was denied or cut off, these steps protect your claim.

Keep every letter and envelope. Dates matter. When an insurer denies or reduces a claim, it must give an itemized explanation of each item it refused to pay, plus a name, address, and claim number for your response. A letter missing those pieces is itself useful.
Do not skip a scheduled IME or EUO without talking to a lawyer. A missed appointment can end your benefits. If the date or location doesn’t work, ask in writing to reschedule and keep a copy.
Ask for the report. If an IME or peer review was used against you, you are entitled to a copy on request. That report is where most cut-offs are won or lost.
Keep treating if your doctor says you need it. A denial is a payment dispute, not a medical decision. Talk with your provider about how they will handle bills while the dispute is pending.
Don’t sign anything new from the insurer. That includes recorded statements, releases, and new authorizations. Have a lawyer look first.
Don’t wait. Before suing, Florida requires a formal pre-suit demand letter and a 30-day window for the insurer to pay. That clock only starts when the letter goes out. Other deadlines also apply.

Will this cost me money? I review PIP denials at no charge. If I take your case, I explain the fee arrangement in writing before you sign anything. In many PIP cases my goal is to have the insurer pay the legal fees. Whether that is possible depends on how the dispute is brought, which is explained under “How Attorney’s Fees Work” below.

Patients: get your free PIP denial review. Take a photo of your denial letter and send it with your name and phone number. I’ll call you back personally, usually the same business day. Call or text me today at 813-934-3519.

For Medical Providers and Billing Teams

If you manage a chiropractic office, physical medicine clinic, pain practice, or imaging center, you already know the pattern. Peer review lands, payment stops, and the denied claims pile up. You may also have noticed that suing as the assignee no longer makes economic sense on most files.

Why the old model stopped working. HB 837, effective March 24, 2023, eliminated the one-way attorney’s fee statute that provider-assignee PIP suits relied on. Without it, a lawsuit over a $1,200 bill can cost more than it recovers.

How my practice works instead. I represent the patient, not the practice. When a patient retains me, the assignment of benefits for the disputed claim is revoked so the patient can bring the claim in their own name. Where the insurer has totally denied coverage, I pursue a declaratory judgment action under Chapter 86, Florida Statutes. Section 86.121 allows the court to award the insured’s attorney’s fees against the insurer in certain coverage actions. When that works, the claim gets paid and the insurer pays the fees. Your practice does not pay my fees.

Be clear about the limits. The patient is my client, and my duties run to the patient. I do not pay for referrals, and I do not accept payment from providers to pursue claims. Not every denial fits this model. Whether section 86.121 applies to a particular denial is unsettled in Florida’s courts, and I explain that below.

What a denial review looks like. Send me a list of PIP claims denied in the last 90 days: insurer, denial reason, date, and amount. To start, de-identified data is fine; no patient names are needed. I will tell you which denials appear to have a legal problem worth pursuing and which do not. There is no charge for this review. If a patient wants to go forward, I speak with that patient directly.

Denials I see most often from the provider side:

Peer review cut-offs signed by a physician licensed under a different chapter than the treating provider
IME no-show denials based on notices the patient never received
Fee schedule reductions under policies that may not have given the required notice
Codes changed without the required pre-recoding contact
Records requests that stall payment far beyond the 10-day window

Providers: request your free 90-day denial audit. Send a de-identified list of PIP denials from the last 90 days with insurer, denial reason, date of service, and amount. Within a week you’ll get back a short written assessment of which denials look challengeable and why. No patient information is needed to start, and there is no charge. Call 813-934-3519 or fill out the online contact form.

For Personal Injury Attorneys

When a carrier cuts off your client’s PIP after a peer review, the damage goes beyond the PIP claim. Treatment gaps appear, the medical record thins out, and the defense gets a causation argument it didn’t have before. Getting PIP restored keeps your client treating and keeps the record intact.

Most injury firms don’t litigate PIP disputes, and the economics changed after HB 837. That’s the gap I fill.

How I work with referring counsel:

PIP only. I handle the PIP dispute and nothing else. I will not handle, solicit, or advise on the bodily injury claim, and I put that commitment in writing at the start of every referral.
Your client stays your client. You remain lead counsel on the injury case. I coordinate with your office on records, treatment status, and timing so nothing I do complicates your case.
No lien on your recovery. Florida law gives PIP insurers no lien on tort recoveries. Restored PIP benefits pay medical bills that would otherwise have to be resolved out of your settlement.
Referral arrangements follow the Bar rules. Any fee division is in writing, disclosed to and approved by the client, consistent with Rule 4-1.5. Many PIP matters are pursued through the fee-from-insurer route described below, so the economics are explained up front.

Attorneys: refer a PIP cut-off. Send the denial letter and the peer review or IME report. I’ll give you a straight answer on whether there’s a challenge worth bringing, usually within two business days, and a written non-solicitation letter with every referral. Call 813-934-3519 or fill out the online contact form.

How Attorney’s Fees Work After HB 837

Who pays the lawyer is the question that decides most PIP disputes, so here is the full picture.

What changed. Before 2023, Florida’s one-way fee statute meant an insurer that lost a PIP suit paid the claimant’s attorney’s fees. HB 837 repealed that. Today, fees in ordinary PIP suits are governed mainly by Florida’s proposal-for-settlement statute. Even when fees are awarded, the law bars a contingency risk multiplier.

The route I use. When an insurer has totally denied coverage for a claim, the insured can file a declaratory judgment action under Chapter 86, Florida Statutes, asking the court to decide whether the claim is covered. Section 86.121 allows a court to award the insured’s attorney’s fees against the insurer in that kind of action. This fee right belongs to the insured and can’t be assigned to a provider. That is why the patient, not the clinic, is the plaintiff.

Where the law is unsettled. Courts disagree about what a “total coverage denial” means. Some judges read it bill by bill. Others look at the entire PIP claim from the accident. Several county judges in Hillsborough and Orange Counties have awarded fees under section 86.121 in my cases. Other judges, also in my cases, have refused. One recurring problem is a claim where the insurer made any earlier partial payment, which some courts treat as defeating a total denial. In 2026, Florida’s Second District Court of Appeal dismissed an insurer’s challenge to one of these fee awards. A dismissal is not a ruling on the merits, though, and no Florida appellate court has decided the core question yet.

What that means for you. Before taking a PIP case, I review the payment history for exactly these issues. If a claim doesn’t fit, I will say so and explain any other options. I won’t promise a fee outcome the law doesn’t guarantee.

How a PIP Denial Case Works With Me

Free denial review. Send the denial letter, the explanation of benefits, and any IME or peer review report. I tell you whether there is a legal problem with the denial and what the realistic options are.
Records and payment history. I gather the policy, the claim file, the PIP payment log, and the medical records the insurer relied on. This step answers the fee question before you commit.
Statutory demand letter. Florida requires a written pre-suit demand sent by certified mail. The insurer then has 30 days to pay the overdue amount with interest and a penalty of 10%, capped at $250.
Suit, if needed. If the insurer doesn’t pay, I file in county court. Depending on the denial, that may be a declaratory judgment action, a claim for overdue benefits, or both.
Resolution. Most disputes end when the insurer pays the claim. When fees are recoverable, I pursue them from the insurer.

You deal with me at every step, not a case manager.

Serving Tampa Bay and West Central Florida

I handle PIP denials for injured people throughout Hillsborough, Pinellas, Pasco, Hernando, Citrus, Sumter, Polk, Manatee, and Sarasota counties. That includes Tampa, St. Petersburg, Clearwater, Largo, Oldsmar, Brandon, Riverview, Wesley Chapel, New Port Richey, Spring Hill, Brooksville, Inverness, The Villages, Lakeland, Bradenton, and Sarasota. I also review denials from elsewhere in Florida.

Mówię po polsku.

PIP Denial FAQ

Can my insurance company just stop paying my PIP?

Not without following the statute. To stop paying for a treating physician’s care without your consent, the insurer needs a valid report from a Florida physician licensed under the same chapter as your treating provider. Payment can also stop if you unreasonably miss an IME or fail an EUO requirement.

My PIP was cut off after a peer review. I never even saw the doctor. Is that allowed?

Yes, a records-only peer review can be the basis for withdrawing payment, but it must meet the same valid-report requirements as an exam. It must come from a same-chapter physician, be supported by the records, and not have been modified by anyone else. Many peer reviews fall short.

Why was my PIP limited to $2,500?

The full $10,000 in medical benefits requires a determination by a qualifying provider that you had an emergency medical condition. Without one, medical benefits are capped at $2,500. Whether a determination was made, and by whom, is worth checking.

I missed my IME. Have I lost my benefits?

Possibly for future treatment, but not automatically. The question is whether your absence was unreasonable. Notice, location, and scheduling all matter. One missed exam is different from two.

Does PIP still exist in Florida in 2026?

Yes. Repeal bills have been filed in recent legislative sessions, but none has become law. PIP remains mandatory.

How long does an insurer have to pay my PIP claim?

Generally 30 days after receiving written notice of the claim and its amount. Overdue benefits carry interest. A records request or fraud investigation can extend that time, but only within limits the statute sets.

Can my doctor bill me for what PIP didn’t pay?

It depends on why it wasn’t paid. If the insurer properly limited payment under the statutory fee schedule, the provider generally can’t bill you the difference. Other unpaid balances are treated differently. Ask before you pay.

I’m a provider. Can you sue the insurer for my practice?

No. I represent patients, not practices, in PIP disputes. When your patient retains me, the claim is pursued in the patient’s name. The insurer may be ordered to pay the fees if the case qualifies.

I’m a PI lawyer. Will you contact my client about the injury case?

No. I handle only the PIP dispute and confirm that in writing at the start of every referral.

What does a PIP denial review cost?

Nothing. Send the denial letter and any report, and I’ll tell you whether there is a problem worth pursuing.

Get Your PIP Denial Reviewed

A denial letter is the insurer’s opening position, not the law’s final word. Choose the option that fits you:

If you are…	Send me	You get	Start here
A patient whose PIP was denied or cut off	Your denial letter and any IME or peer review report	A free review and a personal call back from Alexander	[Button: Get a Free PIP Denial Review]
A medical practice or billing team	A de-identified list of PIP denials from the last 90 days	A free written denial audit	[Button: Request a Free 90-Day Denial Audit]
A personal injury attorney	The denial letter and the report behind it	A fast yes or no, plus a written non-solicitation letter	[Button: Refer a PIP Cut-Off]

Call or text 813-934-3519, email [email protected], or use the contact form. You’ll hear back from me, not a call center.

Licznerski Law, PLLC · Oldsmar, Florida