PIP IME in Florida: What to Expect, and How to Fight a Cut-Off
Your insurance company has scheduled you for an “independent medical examination.” Or you already went, and now a letter says it will stop paying for your treatment. Either way, Florida law sets rules for the exam and for the report, and insurers don’t always follow them.
Can a Florida PIP insurer cut off treatment after an IME? Yes, but only with a valid report. Under section 627.736(7)(a), Florida Statutes, the examining doctor must be licensed under the same chapter as your treating provider and must be in active practice. The report must be factually supported by the exam and records, and no one else may modify it. The exam itself must be held close to where you live or treat, at the insurer’s expense.
I’m Alexander Licznerski. I help patients across Tampa Bay before IMEs and challenge cut-offs after them.
Call Alexander directly: 813-934-3519 or fill out the online contact form.
Is the IME Doctor Really “Independent”?
No, not in the everyday sense of the word. Your insurance company chooses the doctor, usually through an IME vendor, and pays for the exam. The doctor has no treating relationship with you. Their job is to give the insurer an opinion about whether your treatment is reasonable, related to the crash, and medically necessary.
That doesn’t mean every IME doctor is unfair. It does mean the exam is part of the insurer’s claim process, not part of your medical care. Treat it that way: be polite, be accurate, and be careful.
Florida’s PIP statute gives insurers the right to request an exam whenever your physical or mental condition is material to a claim. You are generally required to attend. Florida law also puts limits on the insurer, explained below.
Before Your IME: What Florida Law Requires and What to Expect
Where the exam must be held. Section 627.736(7)(a) requires the IME to be held in one of these places:
- The municipality where you are receiving treatment, or
- A location reasonably accessible to you: anywhere in the municipality where you live, or within 10 miles by road of your home, in your home county.
Only if no qualified physician is available in an accessible location may the exam be held farther away, and then in the closest area to your home. An IME scheduled across the bay or two counties away deserves a written objection before the date, not a no-show.
Who pays. The insurer bears the entire cost of the exam.
How long it takes. Many PIP IMEs are short, often 20 to 30 minutes. The doctor typically asks about the accident, your symptoms, prior injuries, and your treatment, then performs a physical exam.
What to do before the exam:
- Check the notice. Confirm the date, time, address, and the doctor’s specialty. If the location breaks the 10-mile rule, or the doctor’s license differs from your treating provider’s, write it down.
- If you can’t make it, say so in writing, before the date. Ask to reschedule and give a reason. Keep a copy. This single step prevents most no-show denials.
- Bring a list of your symptoms and treatment. Accuracy matters. Don’t exaggerate, and don’t minimize either. “I’m doing better” on a good day can become “symptoms resolved” in the report.
- Write notes right after. Record the time you arrived, the time the doctor entered, how long the exam lasted, and what tests were actually done. These notes are often the most useful evidence if the report doesn’t match what happened.
- Call a lawyer before the exam if you can. It costs nothing, and it’s easier to protect a claim before the report exists than after.
After the IME: When the Report Says You Don’t Need More Treatment
The most common IME outcome letter says your treatment is “not reasonable, related, or necessary” after a certain date. Sometimes it says you have reached maximum medical improvement (MMI). Either way, the insurer stops paying for further care.
What the report must meet. An insurer cannot withdraw payment for your treating physician without your consent unless it first has a valid report. Under section 627.736(7)(a), the report must:
| Requirement | What to check |
|---|---|
| Same licensing chapter | Is the IME doctor licensed under the same chapter as the provider being cut off? An orthopedist (MD) generally can’t cut off chiropractic care, and the reverse is also true. |
| Prepared and signed by the examining doctor | Did the doctor who actually examined you write and sign it? |
| Factually supported by the exam and records | Do the findings support the conclusion? Did the doctor have your records? |
| Not modified by anyone else | Any sign that a vendor or the insurer changed the opinion? Changed-opinion denials are a material misrepresentation under the insurance code. |
| Active practice | Has the doctor been in active clinical practice, or qualifying teaching, in the past three years? |
| Obtained before the cut-off | Was the report in hand before payment was withdrawn? |
Get the report. If you ask, the insurer must give you a copy of every written report about the exam. At least one report must set out the doctor’s findings and conclusions in detail. One trade-off to know: once you request and receive the report, the insurer can ask for your reports about the same condition, and some privileges are waived. Decide this with a lawyer.
Where IME reports go wrong
- “The doctor saw me for five minutes.” A detailed report that describes tests you don’t remember being performed. Your post-exam notes matter here.
- Wrong license chapter for the provider being cut off.
- Findings that contradict the conclusion. Restricted range of motion or positive orthopedic tests, followed by “no further treatment necessary.”
- Missing records. The doctor didn’t review imaging, specialist notes, or recent treatment.
- MMI used as a cut-off for all care. Maximum medical improvement doesn’t automatically mean every form of treatment is unnecessary. Palliative care to keep you at that level may still be reasonable.
- Template language with the wrong body part, accident date, or provider.
- Vendor edits or addenda that change the opinion after the fact.
None of these automatically wins a case. Each is a reason the report may not be valid, or may carry less weight against your treating doctor.
Missed Your IME? What a No-Show Means for Your PIP
If you unreasonably refuse or fail to appear for an IME, the insurer is no longer liable for later PIP benefits. Missing two IMEs creates a rebuttable presumption that your refusal was unreasonable. That’s section 627.736(7)(b).
Three points work in your favor:
- The insurer has to prove it was unreasonable. The Florida Supreme Court held in Custer Medical Center v. United Automobile Insurance Co. (Fla. 2010) that unreasonable failure to attend is the insurer’s defense to prove. It isn’t automatic. After two missed exams, the statute’s presumption makes that easier for the insurer, but you can still rebut it with evidence.
- Only later benefits are affected. The statute cuts off subsequent benefits. Treatment before the missed exam should still be considered and paid if it was reasonable, related, and necessary.
- Notice and location matter. A notice mailed to an old address, one that arrived after the exam date, an exam scheduled outside the 10-mile rule, or a reschedule request the insurer ignored all go directly to whether a no-show was unreasonable.
If you missed one IME and a second is scheduled, attend it, or put your reason in writing before the date. Two misses shifts the burden toward you.
If benefits were already denied for a no-show, gather the notices, the envelopes, any reschedule requests, and anything showing why you couldn’t attend. Then get the denial reviewed.
How to Fight an IME Cut-Off in Florida
Florida’s PIP statute has no formal “appeal” of an IME cut-off. You can write to the adjuster, but the legal remedy is a statutory pre-suit demand letter under section 627.736(10). When the demand concerns withdrawal of payment for future treatment, it must attach the insurer’s cut-off notice and an itemized statement of the type, frequency, and duration of treatment claimed. The insurer then has 30 days to agree to pay. If it doesn’t, the dispute can go to county court.
If you’re the patient
Whether your IME is next week or the cut-off letter came yesterday, the most useful thing you can do is get it reviewed early. Before the exam, I can check the notice, the location, and the doctor’s license. After it, I read the report against your chart and your notes from the exam.
Get help with your IME. Send a photo of the IME notice or the cut-off letter. I’ll review it myself and call you back, usually the same business day. Call or text 813-934-3519.
If you’re a medical provider or billing team
IME cut-offs and no-show denials hit your schedule and your receivables at the same time. Patients stop coming in once they hear PIP won’t pay. I represent the patient, not the practice. The assignment for the disputed claim is revoked, the patient brings the claim, and where the law allows, the insurer pays the legal fees. Your practice does not.
One low-cost way to protect your patients: when one tells you an IME is scheduled, have the front desk check the location against the 10-mile rule. Remind the patient to request any reschedule in writing.
Request a free 90-day denial audit. Send a de-identified list of IME cut-offs and no-show denials from the last 90 days with insurer, IME doctor specialty, date, and amount. Within a week, you’ll get a short written assessment of which look challengeable. Call 813-934-3519 or fill out the online contact form.
If you’re a personal injury attorney
The PIP IME report often becomes a defense exhibit in the bodily injury case, and the cut-off creates a treatment gap. Challenging the IME on the PIP side keeps your client treating and tests the report before the defense relies on it. I handle the PIP dispute only. I put a written non-solicitation commitment on every referral, and your client stays your client.
Refer an IME cut-off. Send the cut-off letter and the IME report. You’ll get a straight answer on whether there’s a challenge worth bringing, usually within two business days. Call 813-934-3519 or fill out the online contact form today.
Treatment, Bills, and Who Pays the Lawyer
You can keep treating. An IME cut-off is a payment decision, not a medical one. Whether to continue care is between you and your doctor. Ask your provider how they will handle bills while the dispute is pending. If someone else caused the crash, medical payments coverage, health insurance, or their bodily injury coverage may help.
Who pays the lawyer. HB 837 (2023) ended the one-way fee statute that once made insurers pay the claimant’s lawyer in most PIP suits. When an insurer has totally denied coverage, I may bring a declaratory judgment action under Chapter 86. Section 86.121 lets the court award the insured’s attorney’s fees against the insurer. Courts disagree about what counts as a “total” denial, especially when the insurer paid some bills before the IME. No Florida appellate court has settled it. I check the payment history first and tell you plainly where your claim stands.
PIP IME FAQ
Do I have to go to an IME for PIP in Florida?
Generally yes. If your condition is material to the claim, you must submit to an exam on the insurer’s request. Unreasonably refusing or failing to appear can end your benefits for later treatment.
How far do I have to travel for a PIP IME?
The exam must be in the municipality where you’re treating, the municipality where you live, or within 10 miles by road of your home in your home county. Farther locations are allowed only if no qualified physician is available closer.
Who pays for the IME?
The insurer pays the entire cost.
Can I reschedule my IME?
You can ask. Do it in writing, before the date, with a reason, and keep a copy. A documented reschedule request is strong evidence that a missed exam wasn’t unreasonable.
What happens if I miss my IME?
The insurer can stop paying for later treatment only if your absence was unreasonable, and it must prove that. Missing two exams creates a presumption against you, though you can rebut it. Treatment before the missed exam should still be payable.
The IME doctor said I reached maximum medical improvement. Is my PIP over?
Not necessarily. MMI means you’re not expected to improve much further. It doesn’t automatically mean all treatment is unnecessary, and the report still has to meet Florida’s valid-report requirements.
The IME doctor only saw me for a few minutes. Does that matter?
It can. The report must be factually supported by the exam. A short exam paired with a detailed report of tests you don’t recall is a reason to examine the report closely. Write down what happened right after the exam.
Can I get a copy of my IME report?
Yes. On your request, the insurer must give you every written report about the exam. Requesting it has some trade-offs, so talk to a lawyer first.
Does the IME doctor have to be a chiropractor?
To cut off a chiropractor’s care, the report must come from a physician licensed under the same chapter, so a chiropractor. The same rule applies to MDs and DOs.
Does it cost anything to have my IME notice or cut-off reviewed?
No. Send it to me and I’ll review it at no charge.
Get Your IME Reviewed: Before or After the Exam
An IME report is one insurer-selected doctor’s opinion. Whether it’s a valid basis for cutting off your PIP is a legal question, and the earlier you ask it, the more options you have.
| If you are… | Send me | You get | |
|---|---|---|---|
| A patient with an IME coming up, or a cut-off letter | The IME notice or the cut-off letter and report | A free review and a personal call back from Alexander | |
| A medical practice or billing team | A de-identified list of IME cut-offs and no-show denials from the last 90 days | A free written denial audit | |
| A personal injury attorney | The cut-off letter and the IME report | A fast yes or no, plus a written non-solicitation letter |
Call or text 813-934-3519, or email [email protected]. Serving Hillsborough, Pinellas, Pasco, Hernando, Citrus, Sumter, Polk, Manatee, and Sarasota counties from Oldsmar.
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This page provides general information about Florida law and is not legal advice. Every case depends on its facts. Contacting the firm does not create an attorney-client relationship.