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Your Denied PIP Claims From the Last Five Years May Still Be Recoverable

Peer review cut-offs, IME cut-offs and no-shows, EUO denials, and material misrepresentation rescissions. These four take the biggest bites out of PIP receivables, and most practices write them off because suing as the assignee stopped making sense after HB 837. The claims themselves didn’t disappear. Under Florida law, a PIP denial is a breach of the insurance contract, and many can still be pursued for up to five years.

Get a free PIP denial audit. Email me a de-identified list of your peer review, IME, EUO, and rescission denials. Start with the last 90 days, or send up to five years if you have it. Within a week, you’ll get back a short written assessment of which denials look challengeable, and why.

No patient names or PHI needed to start
No cost for the audit
Your practice doesn’t pay legal fees on any case that goes forward

Call 813-934-3519 or fill out our online contact form.

Why Old Denials Aren’t Necessarily Dead

A PIP benefit claim is a claim under the auto insurance policy, which is a written contract. Florida gives actions on a written contract five years under section 95.11(2)(b). HB 837 shortened the deadline for negligence claims to two years, but it didn’t change the five-year period for contract claims like PIP.

What that means for your accounts receivable:

A peer review cut-off from 2022 may still be within the limitations period.
Denials your billing company marked “closed” or “uncollectible” may not be.
Claims you didn’t sue on because the bill was too small to justify an assignee suit can be pursued the patient-side way.

The five-year clock generally runs from when the claim was breached, typically when payment became overdue or was denied, not from the date of service. Each claim has its own date. That’s exactly what the audit sorts out. A statutory demand letter also tolls the clock for 30 business days once it’s mailed. Older claims get looked at first, because they’re closest to expiring.

How It Works: Your Patient Is the Client, the Insurer Pays the Fees

The patient retains the firm. For each denial worth pursuing, your practice lets the patient know the claim may be recoverable and gives them my contact information. The patient decides whether to call. If they do and choose to go forward, they become my client. My duties run to them.
The assignment for the disputed claim is revoked. That puts the patient back in position to bring the claim in their own name. It matters because the fee rights that still exist after HB 837 belong to the insured and can’t be assigned to a provider.
The insurer pays. I send the statutory demand letter. If the insurer doesn’t pay, I file suit, usually a declaratory judgment action under Chapter 86 where the denial was total. When the insurer pays the claim, the outstanding bills are paid. Where the court awards fees under section 86.121, the insurer pays them. Your practice pays no legal fees either way.

I don’t pay for referrals, and I don’t accept payment from practices to pursue claims. That keeps the arrangement clean for you, for the patient, and under the Bar rules.

What to Send, and What You Get Back

One spreadsheet, one row per denied claim, emailed to [email protected]. No names, dates of birth, or claim numbers are needed for the first pass. Use an internal reference number your office can match later.

Column	Example
Your internal reference #	A-1043
Insurer	GEICO, Progressive, Direct General…
Denial type	Peer review cut-off, IME cut-off, IME no-show, EUO denial, material misrepresentation / rescission
Date of denial letter	03/14/2023
Dates of service affected	01/05/2023 – 03/10/2023
Amount billed and amount unpaid	$4,860 / $3,900
Any payment by the insurer before the denial?	Yes / No / Unsure
Treating provider’s license type	DC, MD, DO, PT, APRN
For peer review / IME: reviewing doctor’s specialty, if known	Orthopedist

What comes back within a week: a short written assessment that sorts your denials into three groups:

Worth pursuing: a legal problem with the denial, and within the limitations period
Worth a closer look: depends on documents you or the patient would need to provide
Not worth pursuing: and why, so your team stops chasing it

Oldest qualifying claims are flagged first, because they’re closest to the five-year line.

How to Reach Me

There’s no form. You reach me directly, the same way my clients do.

Email the spreadsheet to [email protected], with a few lines covering:

Practice name, your name and role, and the best number to reach you
Practice type and the counties you practice in
Roughly how many denials you’re sending, and how far back they go
For most of these claims, whether the insurer paid anything before denying

Or call 813-934-3519 and we’ll go through it by phone. If you’d rather not build the spreadsheet yourself, tell me and we’ll work out the simplest way to get the information over.

You’ll hear back from me, not an intake team.

What Qualifies, and What Doesn’t

Not every denial is worth pursuing, and I’ll tell you which ones aren’t.

The audit covers four denial types: peer review cut-offs, IME cut-offs and no-shows, EUO denials, and material misrepresentation rescissions. Fee schedule reductions, the $2,500 cap, and other denials aren’t part of it.

The patient has to want to go forward. Each claim depends on a patient choosing to bring it. Some won’t, and that’s their decision.
Some denials are correct. A properly supported, same-chapter peer review or a well-documented rescission may not be worth challenging.
Fee recovery isn’t guaranteed. Whether section 86.121 fees are available is unsettled in Florida’s courts, especially where the insurer paid part of the claim before denying. The audit flags those claims. I won’t promise an outcome the law doesn’t guarantee.
Time limits are claim by claim. The five-year period runs from each claim’s own breach date. Some older denials will already be past it.
I don’t represent practices in PIP disputes. If you need advice for the practice itself, such as on billing compliance or your contracts with billing companies, you’ll need separate counsel.

Provider FAQ

Is sending you this list a HIPAA problem?

The audit is built to avoid one. The first pass uses de-identified data: an internal reference number instead of a name, and no dates of birth or claim numbers. Patient information is exchanged only after a patient decides to retain the firm.

What happens to our assignment of benefits?

For claims a patient chooses to pursue, the assignment for that disputed claim is revoked so the patient can bring it in their own name. That’s what makes the fee-from-insurer route possible after HB 837. I’ll walk through the revocation form with you before any patient signs one.

Do our patients have to come in or go to court?

Rarely. Most PIP disputes resolve on documents. Patients sign the retainer, provide information when needed, and occasionally sit for a deposition.

How far back can we go?

PIP claims are breach of contract claims, and Florida allows five years for actions on written contracts. Each claim’s clock runs from its own breach date, usually when payment became overdue or was denied.

What does the audit cost? What do we pay if a case goes forward?

The audit is free. Your practice doesn’t pay legal fees on any case. When fees are recovered, they come from the insurer.

Will you contact our patients?

No. Your practice tells the patient the claim may be recoverable and gives them my information. The patient decides whether to call.

We use a billing company. Can they send the list?

Yes, with your authorization. Many billing companies already have the denial data in exportable form.

Do you pay referral fees?

No. I don’t pay for referrals and don’t accept payment from practices to pursue claims.

Find Out What’s Still Recoverable

Every month a denied claim sits, it moves closer to the five-year line. The audit takes one email and one week.