Common Mistakes Floridians Make When Filing PIP Claims That Lead to Denials

Florida’s Personal Injury Protection (PIP) insurance is designed to help accident victims cover medical expenses and lost wages, regardless of who was at fault. However, many people assume having PIP coverage guarantees payment after an accident. In reality, filing a PIP claim is a complex process, and small errors can lead to delays or outright denials. Many Floridians make simple but costly mistakes when submitting claims, from missing deadlines to providing incomplete information.

When insurance companies deny PIP claims, accident victims are often left struggling to cover medical bills and other financial losses. While Florida law requires PIP coverage for all drivers, insurers frequently look for reasons to reject claims. Understanding common pitfalls can help you avoid unnecessary denials. If you’ve already had a claim denied or are unsure how to navigate the process, we may be able to help.

Missing the 14-Day Medical Treatment Deadline

Florida law requires accident victims to seek medical treatment within 14 days of the crash to qualify for PIP benefits. This rule is strict—if you miss the deadline, your insurer can deny your claim entirely. Many people assume they can wait to see if their injuries worsen before seeking medical attention, but waiting too long can cost them access to coverage.

Even if you feel fine immediately after an accident, symptoms of injuries like whiplash or internal damage can take days to appear. Seeking medical attention promptly not only helps ensure your claim is approved but also provides a medical record linking your injuries to the accident. Insurance companies often use gaps in treatment as a reason to argue that injuries were not caused by the crash.

Additionally, Florida PIP law distinguishes between emergency and non-emergency conditions. If a healthcare provider determines your condition is an “emergency medical condition” (EMC), you may be eligible for the full $10,000 in benefits. If not, your benefits may be capped at $2,500. Failing to see the right medical provider or not receiving an EMC diagnosis can significantly reduce your claim amount.

Providing Incomplete or Inaccurate Information

Many PIP claims are denied due to simple paperwork errors. Insurance companies require detailed documentation, including accident reports, medical records, and billing statements. Missing or incorrect information can delay your claim or lead to a denial.

Common mistakes include submitting inconsistent statements about the accident, providing incorrect personal information, or failing to include required medical documentation. Even minor discrepancies—such as a doctor’s office listing a slightly different injury description than what was reported to the insurer—can give an insurance company grounds to dispute your claim.

Another frequent error is failing to disclose pre-existing conditions. While having a prior injury does not automatically disqualify you from PIP benefits, insurers often use undisclosed medical histories as a reason to deny coverage. If you have a prior injury worsened by the accident, your doctor should document how the crash aggravated the condition to help support your claim.

Accepting Insurer Requests Without Question

Insurance adjusters may ask for recorded statements or additional medical examinations as part of the claims process. Many claimants comply without realizing insurers often use these requests to look for reasons to deny or limit payouts.

For instance, recorded statements can be used against you if your account of the accident differs in any way from your medical records or police reports. Even an innocent misstatement can be interpreted as an inconsistency. You are not legally required to provide a recorded statement, and in many cases, it is best to decline or consult a lawyer before agreeing to one.

Additionally, insurers may request you undergo an independent medical examination (IME) with a doctor of their choosing. While the term “independent” suggests neutrality, these doctors are often selected by the insurance company and may downplay your injuries. If your PIP insurer schedules an IME, it’s essential to be aware of your rights and seek legal advice if needed.

How Can The Law Offices of Scott Sobol Help?

Dealing with a denied PIP claim can be frustrating and financially overwhelming, especially when you are already recovering from an accident. We understand how insurance companies operate and the tactics they use to avoid paying claims. If your claim has been denied or delayed, we may be able to step in and fight for the benefits you deserve.

With years of experience handling PIP claims in Florida, we know what it takes to challenge wrongful denials. Whether you need help gathering proper documentation, disputing an insurance company’s decision, or negotiating for a fair payout, we are ready to advocate for you. Contact us today at (954) 440-2000 or fill out our contact form to discuss your case.