How to File a Florida PIP Claim (14-Day Rule): Step-by-Step Guide

Every Florida driver pays for Personal Injury Protection (PIP) coverage as part of their required auto insurance. After a car accident, this mandatory coverage provides immediate medical and wage benefits regardless of fault. However, missing a single deadline or documentation requirement may eliminate your right to these benefits entirely, leaving you responsible for thousands in medical bills.

The most critical requirement is seeking medical treatment within 14 days of your accident. Florida Statute § 627.736 sets a firm 14-day deadline. Florida law does not permit extensions if you miss that window. Beyond this initial treatment window, the PIP claim process involves multiple steps, forms, and potential examinations that determine whether your medical bills and lost wages get paid.

Florida’s no-fault system aims to provide quick access to benefits without lengthy fault investigations. In practice, however, insurance carriers often deny or reduce PIP benefits based on technicalities, documentation issues, or disputes about medical necessity. Following each step protects your rights to the coverage you’ve already paid for through premiums.

Key Takeaways for How to File a Florida PIP Claim

• Initial medical treatment within 14 days of the accident preserves PIP eligibility under Florida Statute § 627.736.
• PIP covers 80% of necessary medical expenses and 60% of lost wages up to policy limits.
• Insurance carriers may request recorded statements, Examinations Under Oath, or Independent Medical Exams.
• Claims may proceed beyond PIP under § 95.11(2-year statute of limitations) and § 768.81 (51% comparative fault bar).
• Proper documentation throughout the process helps prevent claim denials and delays.

Florida PIP Basics

Personal Injury Protection in Florida is no-fault coverage that helps pay medical bills and lost wages after a crash. Under § 627.736, Florida requires minimum PIP coverage of $10,000. This coverage pays 80% of reasonable medical expenses, 60% of lost wages, replacement services, and $5,000 death benefits. These percentages appear in your policy declarations page.

What PIP Does Not Cover

PIP coverage has important limitations. The insurance does not pay for property damage, pain and suffering, or medical expenses exceeding policy limits. PIP statutorily excludes certain services like massage therapy and acupuncture. Once PIP is exhausted, other coverages like health insurance, MedPay, or bodily injury claims may apply.

Many accident victims discover their $10,000 PIP coverage runs out quickly with emergency room visits and follow-up care. Planning for coverage gaps prevents surprise medical bills later. PIP doesn’t pay pain and suffering damages, which arise through separate liability actions.

When PIP Coverage May Be Limited

Certain circumstances result in reduced PIP benefits even with timely treatment. If your care isn’t from qualifying providers, the insurer may deny those charges outright.

A chiropractor may provide your initial treatment within 14 days, but only an MD/DO, dentist, PA, or APRN can diagnose an Emergency Medical Condition (EMC). Without an EMC, PIP caps medical benefits at $2,500. These restrictions make provider selection crucial for maintaining full benefit eligibility.

Step-by-Step: How to File a Florida PIP Claim

Successfully filing a PIP claim requires following specific steps in the correct order. Missing deadlines or skipping requirements may result in denied benefits. Here’s the complete process from accident to claim resolution.

Step 1: Obtain Your Crash Report Number

Florida law enforcement provides a crash report number at the accident scene or shortly after. This number becomes your reference point for all insurance communications. The report contains essential details insurers need to open claims, including date, time, location, and involved parties.

Contact the investigating agency if you don’t have your report number. Most agencies provide online portals or phone systems for report requests. Having this number ready speeds up the claim process and helps medical providers bill correctly.

Step 2: Get Initial Treatment Within 14 Days

Florida Statute § 627.736 requires initial medical treatment within 14 days of the accident to preserve PIP benefits. This deadline is absolute. Initial services must occur within 14 days with a qualifying provider under § 627.736(1)(a), including physicians, APRNs, PAs, dentists, chiropractic physicians, hospitals, or facilities they direct.

Document your first medical visit carefully. The provider must record your accident-related complaints and diagnose specific injuries. General wellness checks don’t satisfy this requirement. Tell providers about all symptoms, even those that seem minor initially.

Step 3: Open Your Florida PIP Claim

Contact your insurance carrier promptly after the accident. Most insurers offer 24-hour claim hotlines and online reporting systems. Have your policy number, crash report number, and basic accident details ready. The insurer assigns a claim number and adjuster to handle your case.

During initial contact, insurers typically ask about injuries, treatment received, and other insurance coverage. Answer factually but avoid speculating about long-term effects or accepting blame. The carrier sends claim forms and explains their specific procedures for submitting bills and documentation.

Once you’ve met the 14-day requirement, continue documenting your treatment and submitting bills promptly. Maintain consistent treatment schedules, as gaps may trigger coverage questions. Keep all medical records organized and accessible for insurer requests.

Step 4: Complete the Carrier’s PIP Application/Benefits Form

Insurance companies require completed PIP applications to process benefits. These forms collect information about the accident circumstances, your injuries, treating providers, and employment for wage loss claims. Complete all sections accurately and return forms within specified deadlines.

Common form sections include accident details, medical information, and employment data. Missing information delays benefit payments. Keep copies of all submitted documents.

Step 5: Route Medical Bills and Records

Medical providers who are familiar with PIP often bill insurance directly. However, you remain responsible for ensuring bills reach your carrier. Provide your PIP claim number to all treating providers. Some carriers require specific billing forms or codes for PIP claims.

For bills you receive directly, submit them promptly with the required documentation. Include treatment records showing medical necessity and accident relationship. Carriers may request additional documentation before approving payment. Track submissions and follow up on unpaid bills.

Successful claims require complete documentation from the start. Essential documents include the police report, medical records from all providers, employment verification for wage claims, and insurance correspondence. Organized records prevent delays and support your right to benefits.

Step 6: Document Wage Loss

PIP wage loss benefits require proof of income and missed work. Your employer must verify your normal wages and actual time missed due to accident injuries. Most carriers provide specific wage verification forms for employers to complete.

Submit pay stubs from before the accident showing regular earnings. Self-employed individuals need tax returns or profit/loss statements. PIP pays 60% of gross lost wages, issued at least every two weeks during disability.

Step 7: Statements, EUOs, and IMEs

Insurance carriers may request additional information to evaluate claims. Here are common requests you may encounter during the claim process:

• Recorded statements about accident circumstances and injuries
• Examinations Under Oath (EUOs) involving sworn testimony with a court reporter
• Independent Medical Exams (IMEs) by carrier-selected doctors
• Medical record authorizations for past treatment history
• Proof of residency or vehicle ownership documentation

Per policy and § 627.736, examinations under oath and independent medical exams are authorized. Refusing may jeopardize benefits.

Step 8: Track Payments, Denials, and Benefit Limits

Monitor PIP payments through Explanation of Benefits (EOB) forms sent after each processed bill. EOBs show amounts billed, approved, paid, and remaining benefits. Question any denials or reductions promptly. Common reasons for reduced payments include billing errors, policy limits, or reasonableness disputes.

PIP benefits “exhaust” when total payments reach your policy limit. After exhaustion, providers may bill you directly for unpaid balances. Some providers accept reduced PIP payments as full payment, while others pursue remaining amounts. Understand each provider’s policy before treatment.

Emergency room visits satisfy the 14-day requirement and often diagnose Emergency Medical Conditions. Submit ER records promptly, as they establish injury severity. Follow up with referred specialists to maintain continuous treatment documentation. ER bills exhaust PIP quickly, so plan for ongoing care coverage.

Step 9: When Claims Move Beyond PIP

Serious accidents often involve damages exceeding PIP coverage. Florida Statute § 95.11 provides a two-year deadline for filing negligence lawsuits from the accident date. Under § 768.81, you may recover damages if you bear 50% or less fault for the accident.

Moving beyond PIP typically involves claims against at-fault drivers or your uninsured motorist coverage. These claims may compensate you for pain and suffering, excess medical bills, and full wage losses. The process differs significantly from PIP claims, often requiring legal representation to navigate successfully.

Step 10: Common Documentation Pitfalls

Avoiding documentation mistakes helps prevent claim delays and denials. Key issues include missing the 14-day initial treatment window, gaps in follow-up care, incomplete application forms, and missing wage verification documents.

Florida PIP Claim Timing Requirements

Florida law establishes specific deadlines that affect your benefits. Following these statutory timeframes helps avoid claim problems:

• Insurer payment: Due within 30 days after written notice of covered loss per § 627.736(4)(b)
• Provider billing: Generally 35 days from service date; extends to 75 days with proper notice per § 627.736(5)(c)
• Initial treatment: Must occur within 14 days of the accident
• Wage loss payments: Paid at least every two weeks during disability

These deadlines create the framework for successful PIP claims. Missing any deadline may result in reduced or denied benefits.

Common Reasons for PIP Claim Issues

Insurance carriers scrutinize PIP claims for various reasons that may delay or reduce benefits. Late initial treatment remains the most common reason for complete PIP denials. The 14-day deadline has no exceptions.

Documentation gaps create significant problems even with timely treatment. Missing medical records, incomplete forms, or inconsistent injury descriptions provide reasons for carriers to question claims. Gaps in treatment or switching providers without explanation raises red flags during claim reviews.

Pre-existing condition disputes frequently arise when carriers review past medical records. Clear documentation distinguishing accident injuries from prior conditions becomes essential for maintaining benefits.

FAQ for How to File a Florida PIP Claim

Does urgent care or telehealth count for the 14-day rule?

Urgent care visits satisfy the 14-day requirement when provided by licensed medical professionals. Under § 627.736(1)(a), qualified providers include licensed physicians, dentists, physician assistants, and advanced practice registered nurses. For virtual visits, confirm with your provider and carrier that the service meets statutory requirements for initial services.

Can I see a chiropractor under Florida PIP?

Chiropractors may provide your initial PIP treatment within 14 days. However, only physicians, osteopaths, dentists, physician assistants, or advanced practice registered nurses can diagnose an Emergency Medical Condition. Without an EMC diagnosis from these providers, PIP benefits cap at $2,500 regardless of treatment needs.

How are wage-loss claims documented under PIP?

Employers must complete wage verification forms confirming your salary and time missed. Submit recent pay stubs showing pre-accident earnings patterns. Self-employed individuals provide tax returns or business records. PIP pays 60% of gross lost wages with payments issued at least every two weeks. Benefits continue until you return to work or exhaust coverage limits.

What happens if PIP denies treatment as “not reasonable or necessary”?

Carriers must provide specific reasons for denying treatment as unreasonable or unnecessary. Your treating physician may submit additional documentation supporting medical necessity. Some denials involve billing code errors rather than treatment disputes. Review denial letters carefully and respond within stated deadlines to preserve appeal rights.

Can I use MedPay with PIP in Florida?

Medical Payments (MedPay) coverage may supplement PIP if it is included in your policy. MedPay typically covers the 20% patient responsibility that PIP doesn’t pay. Some policies allow “stacking” MedPay on top of exhausted PIP benefits. Review both coverages to understand the coordination of benefits provisions and make the most of your available coverage.

Next Steps

Filing a Florida PIP claim correctly protects your right to immediate medical coverage after an accident. Following the 14-day treatment rule and submitting complete documentation helps prevent unnecessary denials. When PIP benefits exhaust or carriers deny valid claims, additional legal options exist under § 95.11 and § 768.81.

Following the complete PIP process empowers you to navigate Florida’s no-fault system effectively. From initial treatment through final benefit payments, each step requires attention to deadlines and documentation requirements. Proper handling of your PIP claim provides crucial financial protection during recovery while preserving your rights to pursue additional compensation when appropriate.

Hale Law only handles personal injury cases in Florida and has six offices across Southwest Florida; we handle PIP issues daily as part of claims. Questions about filing a Florida PIP claim? Hale Law offers free consultations for Florida crash victims. Call (941) 735-4529. We work on a contingency fee. You owe no attorney’s fee unless we obtain a recovery.