If you were injured in a Florida car accident and filed a Personal Injury Protection (PIP) claim, you might wonder whether your insurer can refuse to pay. The short answer is: yes — a Florida PIP claim can be denied under certain circumstances. Understanding why that happens and what to do next is crucial to protecting your recovery.
Florida’s PIP system is part of the state’s no-fault insurance law, and it has strict rules and deadlines. Missing one of those rules can cost you thousands of dollars in medical and wage benefits.
What Is PIP Insurance in Florida?
All Florida drivers are required to carry Personal Injury Protection (PIP) coverage as part of their auto insurance. PIP:
- Pays 80% of reasonable and necessary medical expenses related to a car accident
- Pays 60% of lost wages (up to policy limits)
- Applies regardless of who caused the crash
- Covers drivers, passengers in your vehicle, and pedestrians hit by a car
These benefits are limited to up to $10,000 per person, and insurers will only pay if you meet statutory requirements. FL Highway Safety
Common Reasons a Florida PIP Claim Can Be Denied
Here are the most frequent reasons insurers deny PIP claims:
1. You Didn’t Seek Medical Treatment Within 14 Days
Florida’s “14-day rule” is the most common reason for denial. Under Florida Statute § 627.736, you must receive medical treatment within 14 days of the accident for your PIP coverage to activate. If you wait longer, your insurer can lawfully deny benefits.
2. Your Injury Isn’t Linked to the Crash
Insurers may claim that your injuries are unrelated to the accident. They often scrutinize medical records to see if your diagnosis and treatment can reasonably be connected to the collision.
3. Treatment Isn’t Medically Necessary or Reasonable
Florida law requires that care be “medically necessary and reasonable.” If the insurer believes treatment was not needed or excessive, it may deny part or all of the claim. This often happens when bills exceed typical reimbursement amounts in the community.
4. Treatment Wasn’t Provided by a Qualified Provider
Certain types of providers (e.g., massage therapists, acupuncturists) may not count toward satisfying the 14-day rule or the insurer’s requirements. Failure to see a covered medical provider within the required timeframe can result in denial.
5. Documentation Errors or Missing Info
Insurance companies can deny claims for paperwork issues, such as incorrect dates, missing mileage logs for lost wages, or a lack of supporting medical documentation.
6. You Exhausted Your PIP Benefits
If the $10,000 PIP limit is reached, insurers may stop paying further benefits even if additional treatment is ongoing. Remaining medical bills and lost time may then need to be pursued through other coverage or legal action.
What Happens After a PIP Claim Is Denied?
A denial can be stressful — especially when you have medical bills piling up. But a denial isn’t the end of the road. Here’s what often comes next:
Ask for a Written Explanation
Florida insurers must explain why a PIP claim was denied. Requesting this written explanation helps you understand the exact reason and what evidence is needed to fix it.
Review Your Insurance Policy & Records
Compare your insurer’s reasoning to your policy and submitted documentation. Sometimes a denial results from missing records or misfiled bills.
Provide Additional Evidence or Correct Errors
If the denial was due to missing information — such as medical records, timelines, or provider info — you may be able to supplement your claim with the missing items.
Appeal or File a Lawsuit
Under Florida law, you have legal options if your PIP claim is wrongly denied. You can file a demand for an internal review, appeal the decision, and in many cases, sue the insurer to enforce payment.
In some situations, Florida law provides up to five years after a denial to bring legal action on a denied or underpaid PIP benefit.
How to Avoid a PIP Denial in the First Place
To help prevent your PIP claim from being denied:
- Seek medical treatment right away — within 14 days of the crash.
- Make sure your provider is a qualified medical professional under Florida’s PIP rules.
- Submit complete and accurate documentation, including bills and medical records.
- Keep detailed records of your medical care, lost wages, and correspondence with insurers.
Don’t delay — insurers may use delays as a reason to deny.
Can You Still Pursue Compensation Beyond PIP?
Yes. A PIP denial does not eliminate all legal avenues.
- If you have a serious injury that meets Florida’s threshold (such as significant or permanent loss of an important bodily function), you may pursue a liability claim against the at-fault driver’s insurer for additional compensation like pain and suffering.
- You may also seek recovery for losses PIP didn’t cover — such as full wage loss, ongoing treatment, and non-economic damages — through a third-party liability claim.
Contact Lowman Law Firm If Your PIP Claim Is Denied
If your Florida PIP claim has been denied, or you’re worried it might be, you don’t have to handle it alone.
At Lowman Law Firm, we help car accident victims:
✔ Understand why a PIP claim was denied
✔ Gather missing documentation or correct errors
✔ File appeals or legal actions against insurers
✔ Protect your rights and pursue full compensation
👉 Contact Lowman Law Firm today for a free consultation. We’ll review your insurance denial, explain your options under Florida law, and help you pursue the benefits and compensation you deserve — with no fees unless we win.
