Protecting Healthcare Providers

At Licznerski Law, PLLC, we represent medical providers throughout Florida in all aspects of insurance, compliance, and litigation. Our firm understands the challenges healthcare professionals face when insurers delay, reduce, or deny payment — and we provide the legal experience and advocacy necessary to protect your rights and revenue.

We are not just claim lawyers — we are your long-term legal partners, focused on proactive consultation, compliance, and defense of your practice.

Who We Represent

Our firm represents a wide range of healthcare providers, including:

• Chiropractic and rehabilitation clinics
• Physical therapy and pain management centers
• Orthopedic, neurological, and diagnostic specialists
• Imaging facilities and multidisciplinary practices
• Other medical facilities.

Whether your practice is independent or part of a larger network, Licznerski Law, PLLC, offers personalized legal strategies designed to meet your specific operational and compliance needs.

Comprehensive Legal Services for Providers

1. Litigation Defense and Representation

When disputes escalate, our attorneys are prepared to defend your practice aggressively and effectively. We represent providers in litigation, subpoenas, discovery compliance, and related proceedings. Our litigation experience helps protect you from exposure.  We also assist with:

• Lawsuits involving insurance reimbursement
• Provider audit disputes
• Civil litigation defense related to treatment, billing, or claims handling,
• Other area of litigation support.

2. Strategic Legal Consultation

Our firm serves as a trusted advisor for medical providers seeking ongoing legal support.
We provide practical, results-oriented advice on:

• Compliance and operational risk
• Insurance carrier communications
• Business and regulatory issues
• Dispute prevention and resolution

We build long-term relationships with our clients — serving as your first call for legal guidance before issues become costly problems.

3. Compliance and Risk Management

We help ensure your practice remains compliant with Florida’s complex healthcare and insurance laws. Our team reviews your documentation, billing, and internal procedures to help prevent regulatory issues and support your responses to audits, subpoenas, and insurer demands.
We also advise on HIPAA compliance, patient records, and documentation policies.

4. Insurance Dispute and PIP Recovery

We represent medical providers in recovering unpaid or underpaid No-Fault (PIP) and MedPay benefits through both pre-suit and litigation processes.
Our goal is to streamline the recovery of benefits while minimizing the administrative and legal burden on your practice.

5. Contract Review and Business Counsel

We review and negotiate contracts affecting your practice’s financial and legal health, including:

• Provider and vendor agreements
• Employment and independent contractor contracts
• Referral and management arrangements
• Practice acquisitions and dissolutions

How Our Florida PIP Declaratory Judgment Strategy Works

We do not take an assignment of benefits and sue as the provider’s assignee. We represent the named insured — the patient — in a declaratory judgment action under Chapter 86, Florida Statutes.

The reasoning is straightforward. The right to attorney’s fees belongs to the insured and is not assignable. When a carrier issues a total coverage denial, the insured has a live controversy over whether coverage exists and whether the denial was contrary to Florida law. That is a question a Florida court can answer under Chapter 86. And § 86.121 provides for a fee award to the insured in a declaratory action involving a total coverage denial.

When the carrier pays after a suit is filed, the Wollard/Ivey confession of judgment doctrine treats that payment as the functional equivalent of a judgment in the insured’s favor — which triggers the fee entitlement against the carrier.

The practical effect for your practice: the bills get paid, and the insurance company pays the attorney’s fees. Not the provider.

What This Means for Your Practice

• You are not our client, and you owe us nothing. No retainer, no contingency, no fee out of your recovery. We are not sending your practice a bill, ever.
• You are not a party to the lawsuit. You are not the plaintiff. You are not being deposed as a litigant. Your clinic is not the one in the caption.
• You keep your AOB decision in your hands. In cases we take, the patient pursues the claim in their own name. We will talk through what that means for any assignment already in place before anything is signed, and we do not ask a practice to change its billing model.
• Your patient is represented. The person whose policy was wrongly shut off gets counsel on the coverage denial, and on the underlying personal injury claim where one exists.

Peer Review Denials — Florida Statute § 627.736(7)(a)

What the carrier is doing. Your patient is midway through a treatment plan. Payments have been going out. Then a letter arrives: the carrier has obtained a “peer review” or “records review” from a physician who has never seen the patient, concluding that treatment after a certain date was not reasonable, related, or necessary. Payment stops from that date forward.

Where these denials go wrong. Section 627.736(7)(a) does not let a carrier withdraw payment for treatment by a treating physician on nothing more than an adjuster’s judgment. The statute requires a valid report by a physician licensed under the same chapter as the treating physician whose treatment is at issue.

That single requirement is where a large share of these denials fail. Chiropractic physicians are licensed under Chapter 460. Medical doctors are Chapter 458. Osteopathic physicians are Chapter 459. Physical therapists are Chapter 486. Dentists are Chapter 466. Massage therapists are Chapter 480.

So when a carrier suspends a Chapter 460 chiropractor’s treatment on the strength of a report signed by an MD licensed under Chapter 458, the report does not do what the statute requires it to do. We see this constantly. Carriers use a small stable of reviewers, and the reviewers are not always matched to the treatment under review.

Other recurring defects worth checking on a peer review denial:

• The report is unsigned, undated, or signed by someone other than the reviewing physician. The statute requires the report be prepared and signed by the physician who examined the patient or reviewed the records.
• The reviewer never received the complete records. A report that reaches a conclusion on a partial chart is vulnerable, and the transmittal correspondence usually shows what was actually sent.
• The conclusions are boilerplate. Reports that reach the same cutoff date across unrelated patients, or that recite conclusions untethered to anything in the chart, tend not to survive scrutiny.
• The withdrawal is applied retroactively. Section 627.736(7)(a) speaks to withdrawal of payment going forward. Carriers sometimes attempt to claw back or deny bills predating the report.
• The denial was never accompanied by the report at all. A carrier that suspends benefits and only produces the report months later in litigation has a problem.

What to send us. The denial or suspension letter, the peer review report itself, the treating provider’s license type, the patient ledger, and the EOBs.

Email the peer review report and the denial letter to [email protected]. The first thing we will do is check the reviewer’s licensure chapter against your treating provider’s. That takes about five minutes and it decides a lot of files.

IME Suspension Denials — Florida Statute § 627.736(7)(b)

What the carrier is doing. The carrier schedules a compulsory medical examination. Either the patient does not appear, or the patient appears and the examining physician issues a report concluding no further treatment is needed. Benefits are suspended.

Where these denials go wrong. Section 627.736(7)(b) provides that an insured who unreasonably refuses to submit to or fails to appear at an examination forfeits benefits for subsequent treatment. Several things follow from that language, and carriers routinely stretch past all of them.

• The suspension is prospective, not retroactive. A carrier may not use an IME no-show in March to deny treatment rendered in January. This is one of the most common overreaches we see, and it is often visible on the face of the EOB.
• “Unreasonable” refusal is not the same as failure to appear. The Florida Supreme Court has treated unreasonable refusal as an affirmative defense the insurer must plead and prove. A patient who missed an appointment because the notice went to a stale address, because the location was two counties away, because of a work conflict, or because of the injury itself has not necessarily unreasonably refused anything.
• The notice has to actually be reasonable notice. Where it was mailed, when it was mailed, what address the carrier used, and whether the carrier offered to reschedule are all fair game — and the claim file usually tells the story.
• The examination location must be reasonably accessible. Sending a Spring Hill or Crystal River patient to a Tampa examiner, or a Sarasota patient to Orlando, raises a real question.
• The examining physician must be licensed under the same chapter as the treating physician. The same licensure requirement that governs peer review reports applies here.
• The IME report has to be a report. A conclusory two-paragraph form letter finding maximum medical improvement, with no examination findings supporting it, is a weak foundation for cutting off an entire treatment plan.

What to send us. The IME notice and any rescheduling correspondence, the IME report, the suspension letter, the date treatment was actually rendered relative to the IME date, and the patient’s address of record.

EUO No-Show Denials — Florida Statute § 627.736(6)(g)

What the carrier is doing. The carrier notices the patient for an examination under oath. The patient does not appear, or appears and the carrier deems the appearance non-compliant. The carrier then takes the position that a condition precedent to coverage has failed and denies the entire claim.

This one hurts the most, because it is usually a total denial of the whole claim rather than a cutoff from a date forward. Every bill your practice rendered goes unpaid.

Where these denials go wrong. Compliance with a properly noticed EUO is a condition precedent under § 627.736(6)(g). But the carrier does not get there automatically, and these denials are frequently defective:

• Defective or unserved notice. Where the notice went, when it went, whether it went to the address of record, and whether the patient ever received it. Carriers rely on mailing, and mailing records are discoverable.
• The location was not reasonably accessible. A patient in Brooksville or Inverness noticed to appear in downtown Tampa or Miami has an argument.
• No opportunity to reschedule. A carrier that noticed one EUO, got no response, and denied the entire claim without a second attempt is in a different posture than one that made repeated good-faith efforts.
• Timing. EUO demands that arrive long after the claim was submitted, or that appear designed to run out the clock, invite scrutiny about the purpose.
• Scope. An EUO is an investigative tool tied to the claim. Demands that veer into unrelated territory, or that condition benefits on production of material the statute does not require, are contestable.
• The patient actually appeared. We have seen “no-show” denials issued for patients who attended, and denials issued after a patient’s counsel offered alternative dates that the carrier never answered.

What to send us. The EUO notice or notices, any correspondence between the patient or their counsel and the carrier, the denial letter, and the complete ledger — because on an EUO denial, the entire balance is usually in play.

“Not Reasonable, Related, or Necessary” Reductions and Denials

What the carrier is doing. No peer review, no IME, no formal investigation — just an EOB line reading that services were not reasonable, related, or necessary. Sometimes the reduction hits a handful of codes. Sometimes it wipes out an entire course of treatment.

Where these denials go wrong. A carrier’s obligation is to pay reasonable expenses for medically necessary services related to the accident. When a carrier withdraws payment for a treating physician’s services, § 627.736(7)(a) sets out what it takes to do so. An adjuster’s unsupported determination, or a software edit, is not a substitute for the statutory process.

Related issues that show up in the same EOBs:

• Relatedness denials based on gaps in treatment or prior conditions — often assertion rather than evidence, and the chart frequently contradicts the assertion.
• Denials keyed to the 14-day rule under § 627.736(1)(a) where initial services actually were rendered within the window, or where the carrier miscounts from the wrong date.
• Emergency medical condition determinations limiting benefits to $2,500 rather than $10,000, where a qualified provider did make an EMC determination or where the carrier ignored one in the records.
• Denials that never explain themselves. An EOB code with no substantive explanation leaves the provider guessing, which is often the point.

What to send us. The EOBs showing the reduction codes, the corresponding CMS-1500s, the chart notes for the denied dates of service, and any correspondence explaining the basis.

Email your EOBs to [email protected] and we will tell you whether the carrier followed the statute or simply asserted a conclusion.

Fraud Allegations, Billing Recharacterization, and “Not Lawfully Rendered” Denials

What the carrier is doing. This is the most aggressive tool in the box, and its use has climbed sharply. Rather than dispute medical necessity, the carrier attacks the legitimacy of the practice or the billing itself:

• The CMS-1500 is characterized as false or misleading, invoking § 627.736(5)(b), which relieves a carrier of the obligation to pay a claim where the provider knowingly submits a false or misleading statement.
• Services are alleged not to have been lawfully rendered, typically on a licensure theory — clinic licensure under the Health Care Clinic Act, exemption status, ownership structure, or supervision arrangements.
• Coding is recharacterized as upcoding or unbundling, with the carrier treating a coding disagreement as evidence of intent.
• The file is referred to a special investigative unit, records demands and subpoenas follow, and payment stops during the “investigation” with no end date.

Where these denials go wrong. The statutory bar is knowing submission of a false or misleading statement. That is a serious allegation with a real standard behind it — and it is not established by a carrier’s disagreement about a modifier, a unit count, or a documentation preference. A coding dispute is a coding dispute. Recharacterizing it as fraud is a strategy, and it works because most practices cannot afford to test it.

Common defects:

• The allegation is never stated. The denial gestures at fraud without identifying which statement is false, in what respect, or how the carrier concluded it was knowing.
• Licensure theories that do not hold. Exemption status, ownership, and supervision arrangements are frequently misread by carriers working from incomplete information.
• Indefinite investigation. A carrier cannot simply stop paying and stop communicating. The statutory framework contemplates timelines.
• Denials issued before the practice was ever asked to explain. Where the carrier never sought clarification on the billing it now calls fraudulent, that gap is meaningful.

A note on what a fraud allegation actually is. It is a threat to your practice’s reputation and to every other carrier relationship you have, not just to one balance. Do not respond to a fraud-based denial or an SIU records demand without counsel reviewing it first. If your practice needs direct representation on that — as opposed to the patient-side work described above — that is a separate engagement and we handle it.

Email the denial letter and any SIU correspondence to [email protected]. If the file needs a fast answer, say so in the subject line.

Fee Schedule Reductions and Down-Coding

What the carrier is doing. The bill is paid, but at a fraction of what was charged, with the EOB citing the schedule of maximum charges — typically 200% of the applicable Medicare Part B fee schedule under § 627.736(5)(a).

Where these denials go wrong. A carrier may only apply the permissive fee schedule if the policy clearly and unambiguously elected it. Florida law is settled that a carrier cannot take the benefit of the schedule without having said so in the policy. Providers rarely see the policy language, which is exactly why these reductions go unchallenged.

Also worth checking: whether the carrier applied the correct year’s schedule, the correct geographic locality, the correct code set, and whether it applied the schedule to services the schedule does not reach.

What to send us. The EOBs, the CMS-1500s, and the declarations page or policy if the patient has it.

Email [email protected] if reductions look systematic across your patients from a particular carrier. Patterns are more actionable than single files.

Which PIP Denial Files Are Worth Sending Us

Not every denial fits the declaratory approach, and we would rather tell a practice that up front than waste your staff’s time.

The strongest files share these features:

• The carrier issued a total denial or suspension of PIP benefits — not a reduction, not a partial payment on the same claim. This is the single most important screen. Where a carrier has already made partial payments on the claim, at least one Hillsborough County court has struck the § 86.121 claim on the ground that there was no total coverage denial.
• The denial rests on a legal defect — a peer review from a reviewer licensed under the wrong chapter, a defective EUO notice, an IME suspension applied retroactively, or a fraud recharacterization unsupported by the file.
• The treatment is documented and the billing is clean.
• The patient is reachable and willing to participate.

EUO no-show denials and outright coverage denials tend to fit best, because they are total by nature. Peer review suspensions often fit. Line-item reductions on a claim the carrier is otherwise paying usually do not.

Send us the denial letter, the EOBs, and the patient ledger. We will tell you within a few days whether it fits. If it does not, we will say so and explain why.

Why Providers Choose Licznerski Law, PLLC

• Experienced Representation: We have in-depth knowledge of healthcare, insurance, and litigation strategy.
• Proactive Counsel: We focus on avoiding disputes through informed, strategic legal advice.
• Responsive and Transparent: You’ll always have direct access to your attorney and clear communication every step of the way.
• Ethical and Professional: All engagements are governed by written agreements and the Florida Statement of Client’s Rights.

An Honest Word About Where Florida Law Stands

We think practices are entitled to a straight answer rather than a sales pitch, so: this is a developing area of Florida insurance law.

Florida trial courts are currently split on what “total coverage denial of a claim” means under § 86.121 — whether it refers to each denied bill or to the entire PIP claim arising from one accident. We have obtained favorable orders from multiple judges in Hillsborough County and Orange County. We have also seen adverse orders, including cases where the § 86.121 claim was struck.

In June 2026, Florida’s Second District Court of Appeal dismissed a carrier’s certiorari petition challenging one of these rulings. That is a favorable development, but a dismissal of a certiorari petition is not a merits affirmance and it does not settle the question.

No binding appellate decision has resolved the issue. Any practice evaluating this approach should understand that, and any lawyer telling you otherwise is not being candid with you.

Areas We Serve Across Tampa Bay and West Central Florida

Licznerski Law, PLLC works with medical providers throughout the Tampa Bay region and the surrounding West Central Florida counties:

Hillsborough County (Thirteenth Judicial Circuit) — Tampa, Brandon, Riverview, Plant City, Temple Terrace, Valrico, Lutz, Apollo Beach, Ruskin, Sun City Center

Pinellas County (Sixth Judicial Circuit) — St. Petersburg, Clearwater, Largo, Pinellas Park, Palm Harbor, Dunedin, Safety Harbor, Tarpon Springs, Seminole, St. Pete Beach

Pasco County (Sixth Judicial Circuit) — New Port Richey, Port Richey, Wesley Chapel, Land O’ Lakes, Zephyrhills, Dade City, Hudson, Trinity, Odessa, Holiday

Hernando County (Fifth Judicial Circuit) — Brooksville, Spring Hill, Weeki Wachee, Ridge Manor, Hernando Beach

Citrus County (Fifth Judicial Circuit) — Inverness, Crystal River, Homosassa, Lecanto, Beverly Hills, Floral City, Hernando

Polk County (Tenth Judicial Circuit) — Lakeland, Winter Haven, Bartow, Haines City, Auburndale, Davenport

Manatee County (Twelfth Judicial Circuit) — Bradenton, Lakewood Ranch, Palmetto, Parrish, Ellenton

Sarasota County (Twelfth Judicial Circuit) — Sarasota, Venice, North Port, Osprey, Nokomis

Florida PIP law is statewide. If your practice sits outside these counties, email us anyway and we will tell you honestly whether we are the right firm for the file.

Frequently Asked Questions About Florida PIP Denials

My patient’s benefits were suspended after a peer review. Can anything be done?

Often, yes. Start by comparing the reviewer’s license to the treating provider’s. Section 627.736(7)(a) requires the reviewing physician to be licensed under the same chapter as the treating physician whose treatment is at issue. A Chapter 458 medical doctor reviewing a Chapter 460 chiropractor’s treatment is a recurring defect.

Can a carrier deny bills from before the IME the patient missed?

Section 627.736(7)(b) addresses subsequent treatment. Retroactive application of an IME suspension to earlier dates of service is a frequent overreach and is often visible on the EOB itself.

Is an EUO no-show automatically fatal to the claim?

No. Compliance with a properly noticed EUO is a condition precedent, but the notice has to have been proper, the location reasonably accessible, and the carrier’s conduct consistent with the statute. Defective notice and single-attempt denials are common.

The carrier is calling our billing fraudulent. What do we do?

Do not respond alone. A fraud allegation under § 627.736(5)(b) requires a knowing false or misleading statement, which is not the same as a coding disagreement — but how you respond to the first records demand matters. Have counsel review before anything goes back.

Does my practice pay anything to work with Licznerski Law, PLLC?

No. In the patient-side declaratory judgment cases described on this page, the provider is not our client and pays no fee. Our fee comes from the insurance carrier under § 86.121, or it does not come at all.

Do I have to give up my assignment of benefits?

The declaratory action is brought by the named insured in their own name, because the statutory right to attorney’s fees is not assignable. We will walk through what that means for any assignment already in place before anything is signed. We do not ask practices to change how they bill.

Can I send a file if the carrier paid part of the claim?

Send it, but understand the screen. A partial payment on the same claim may defeat the “total coverage denial” requirement under § 86.121. We will tell you quickly whether the file works.

What should I email with a referral?

The denial or suspension letter, any peer review or IME report, the EOBs, the patient ledger, and the patient’s contact information. That is usually enough for an initial read.

Do you handle the patient’s injury case too?

Yes, where there is one. Many PIP denials sit on top of an underlying personal injury claim, and we handle both.

Did Florida repeal PIP in 2026?

No. SB 522 and HB 769 both died in committee, and the legislative session ended March 13, 2026. Florida’s no-fault system and the § 627.736 PIP framework remain in effect.

Email Us the File

If a carrier has denied or suspended your patient’s PIP benefits — peer review, IME, EUO no-show, “not reasonable, related, or necessary,” fee schedule, or fraud allegation — send it to us at:

Email: [email protected]
Phone: 813-934-3519

Attach the denial letter, the EOBs, and the patient ledger. Put the denial type in the subject line if you know it. We read every one, and we will tell you straight whether there is something here or not.

Partner With Us

If your practice is facing insurance payment disputes, litigation, or compliance challenges, Licznerski Law, PLLC can help. We provide the experience, advocacy, and guidance you need to protect your business and your patients.

Contact us today to schedule a consultation and learn how we can serve your medical practice.

When Insurers Bet That You Won’t Fight, We Make Them Pay.

813-934-3519

[email protected]

 Serving medical providers in Hillsborough, Pinellas, Pasco, Hernando, Citrus, Polk, Manatee, and Sarasota Counties.