No qualifying initial care within 14 days of the crash. The hardest denial to undo — but check whether any visit inside the window (ER, urgent care, EMT evaluation) exists in your records.
DENIED OR SHORT-PAID
PIP Claim Denied in Florida: What Now?
PIP is coverage you already paid for, and denials are challengeable. Here are the most common denial reasons and the practical next steps. General information, not legal advice.
Quick answer: If your Florida PIP claim is denied, find the specific reason (missed 14-day window, no EMC determination, IME cutoff, or 'not medically necessary'), gather your records, and challenge it — many denials are reversible with a demand letter or legal help.
Benefits capped at $2,500 because no emergency medical condition was documented. Often fixable — see the EMC rule explained.
Insurers use record reviews and independent medical exams (IMEs) to cut off treatment. A cutoff after an IME is an insurer's opinion, not a court ruling.
Late crash reporting, missed examination-under-oath requests, or incomplete wage documentation. Cooperation requirements are real, but denials on technicalities are frequently disputed.
WHAT TO DO
Four steps after a denial
First, get the denial in writing with the specific reason — Florida claims practice requires insurers to state a basis. Second, collect your records: the explanation of benefits, medical charts, the crash report, and your policy's declarations page. Third, ask your provider to respond — many denials collapse when a physician documents medical necessity or an EMC. Fourth, get a professional review: Florida law requires a pre-suit demand letter before a PIP lawsuit, and attorneys commonly review PIP denials on contingency, at no upfront cost. Know exactly what you were owed by reviewing what PIP covers.
FAQ
Denial questions, answered
How long does the insurer have to pay a PIP claim?
Florida law generally makes PIP benefits overdue if not paid within 30 days after the insurer receives written notice of a covered loss, with interest owed on late payments — subject to the insurer's investigation rights.
Can I be denied for missing an independent medical exam?
Under Florida law, an unreasonable refusal to attend an IME can suspend benefits. Many people choose to attend and, if the exam or a cutoff that follows seems unfair, raise their concerns afterward with help from their provider or a licensed attorney.
Is there a deadline to fight a PIP denial?
Yes — PIP disputes are contract claims with their own limitations period, generally five years from the breach in Florida, but earlier is far better while records and witnesses are fresh. Confirm your exact deadline with a licensed Florida attorney.
Will fighting a denial raise my rates?
Florida law prohibits insurers from raising rates solely because a not-at-fault insured made a claim. Pursuing benefits you paid for is the point of the coverage.
NEXT STEP
Start with the basics
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