Reviewed by Mike Redondo, Founding Attorney, Redondo Law, P.A. • Updated October 2026
Redondo Law helps people whose PIP benefits were denied, cut off or underpaid after a car crash. If your insurance won’t pay PIP after a crash in Miami or anywhere in Miami-Dade County, we can review the denial, explain your options and deal with the insurer for you.
The consultation is free, and you pay no fee unless we win. Our phones are answered 24/7, and our staff is fully bilingual (Se habla español). You can meet us at our office at 2828 Coral Way, by phone or by video. Mike Redondo personally oversees every case.
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How PIP is supposed to work
Florida is a no-fault state. Your own personal injury protection (PIP) coverage pays first after a crash, no matter who caused it. PIP pays up to $10,000: 80% of reasonable medical bills and 60% of lost wages. It also includes a $5,000 death benefit. Every Florida driver must carry at least $10,000 in PIP.
PIP is meant to pay quickly. But insurers deny, reduce and cut off PIP benefits often, sometimes for good reasons and sometimes not. A denial letter is not the last word. Many denials can be challenged.
Common reasons PIP benefits are denied
- Late treatment. You did not get initial medical care within 14 days of the crash.
- No emergency medical condition. Without that finding, medical benefits are limited to $2,500.
- A missed or refused medical exam. The insurer asked for an exam and you did not attend.
- A missed examination under oath. The insurer asked you to answer questions under oath and you did not comply.
- An exam report against you. A doctor hired by the insurer says your care is not reasonable, related or necessary.
- Benefits used up. The $10,000 limit has been paid out.
- Coverage disputes. The insurer says the policy lapsed, or questions who is covered.
- Paperwork problems. Bills were late, incomplete or missing information.
The 14-day rule
To get PIP medical benefits, you must receive initial services within 14 days after the crash. Initial care must be given or ordered by certain licensed providers: a medical or osteopathic physician, a dentist, a chiropractic physician or an advanced practice registered nurse. Care in a hospital, or by emergency transport and treatment providers, also counts.
If you waited more than 14 days, PIP may refuse to pay for medical care. That does not end every claim you have. You may still have a claim against the at-fault driver. Do not assume you have no options until someone reviews the facts.
The emergency medical condition rule and the $2,500 limit
PIP medical benefits can reach $10,000 only if a qualified provider finds you had an emergency medical condition. That finding can be made by a medical or osteopathic physician, a dentist, a physician assistant or an advanced practice registered nurse. Chiropractors are not on that list.
If a provider decides you did not have an emergency medical condition, medical benefits are limited to $2,500. This is one of the most common reasons people run out of PIP early. If you are treating only with a chiropractor, ask whether a qualified provider has evaluated you.
Independent medical exams (IME)
When your condition matters to the claim, the insurer can require you to attend a medical exam with a doctor it chooses. People call this an IME. The insurer pays for it. The exam must be held where you are treated or in a reasonably accessible place, which generally means your city or within 10 road miles in the same county.
Do not skip it. If you unreasonably refuse or fail to attend, the insurer is no longer liable for later PIP benefits. Missing two exams creates a presumption that the refusal was unreasonable. After the exam, the insurer may try to cut off payment to your treating doctor, but only with a valid report from a Florida physician saying the care is not reasonable, related or necessary. You can request copies of the exam reports.
Examination under oath (EUO)
Your policy can also require an examination under oath. This is a formal question-and-answer session, usually with a lawyer for the insurer and a court reporter. Questions must be limited to relevant information. Under Florida law, complying with the EUO is a condition you must meet before benefits are paid. If you do not comply, you generally cannot receive benefits.
An EUO is not a casual call. What you say is recorded and can be used later. Prepare with someone who knows the claim, bring the documents requested and answer truthfully.
How long the insurer has to pay
PIP benefits become overdue if they are not paid within 30 days after the insurer receives written notice of the covered loss and the amount. Overdue benefits carry interest. There are special rules when only part of a claim is supported, so the 30 days does not always run in a straight line.
The pre-suit demand letter requirement
The Florida rule: Fla. Stat. 627.736(10)
Before anyone can sue for overdue PIP benefits, a written demand letter must be sent to the insurer. It can only be sent after the claim is overdue. It must say it is a “demand letter under s. 627.736” and list the insured’s name, the claim or policy number, and an itemized statement of the amounts, dates of service and type of benefits claimed. It must go by certified or registered mail, return receipt requested. The insurer then has 30 days to pay the overdue amount with interest and a 10% penalty, capped at $250. If it pays, no lawsuit can be filed.
Small mistakes in a demand letter can cause big delays. If you signed an assignment of benefits, your doctor or clinic may send the demand letter for its own bills. We coordinate with your providers so that nothing is missed.
PIP does not cover motorcycle riders
PIP does not cover people injured while riding a motorcycle. If you were hurt on a motorcycle, a PIP denial may be correct, but you may have other coverage, such as medical payments coverage, health insurance, UM coverage or a claim against the at-fault driver. Read about Florida motorcycle insurance requirements and our Miami motorcycle accident lawyer page.
PIP vs. a bodily injury claim
A PIP claim is against your own insurer, and fault does not matter. A bodily injury claim is against the driver who caused the crash, and fault is everything. To seek pain-and-suffering damages from the at-fault driver, you generally must have a permanent injury, significant scarring or a similar threshold injury. Florida uses modified comparative fault: if you are found more than 50% at fault, you generally recover nothing.
Because Florida does not require most drivers to carry bodily injury coverage, the at-fault driver may have little or none. Your own uninsured motorist coverage may fill the gap. Read more about uninsured motorist claims. If the other driver was drunk, see our drunk driver accident page. For the full picture, see our Miami car accident lawyer page.
What to do if your PIP claim is denied
- Read the denial letter and write down the reason given.
- Collect your policy, your claim number and every letter from the insurer.
- Get records showing when and where you first got medical care.
- Ask your doctor whether an emergency medical condition finding was made.
- Attend any IME and EUO the insurer schedules, or reschedule in writing.
- Keep copies of all medical bills and proof of lost wages.
- Get the Miami-Dade crash report.
- Call us before the demand letter step, so it is done right.
How Redondo Law helps with denied PIP claims
Before founding Redondo Law in 2019, Mike spent six years at Holland & Knight defending major corporations in catastrophic injury and wrongful death cases. He knows how the other side reviews a claim and looks for reasons not to pay. Learn more about Mike Redondo, or see our case results.
We look at the PIP denial and at the bigger claim at the same time. A PIP dispute is often only one part of what you are owed after a crash. If you are not sure where you stand, contact us for a free review.
Frequently asked questions
Why was my PIP claim denied?
Common reasons include treatment that started more than 14 days after the crash, no emergency medical condition finding, a missed IME or EUO, a report from the insurer’s doctor saying care was not necessary, used-up benefits or paperwork problems. The denial letter should give a reason. That reason tells us where to start.
Can I still get PIP if I saw a doctor after 14 days?
Usually not for medical benefits, because Florida requires initial services within 14 days of the crash. But you may still have a claim against the at-fault driver or under other coverage. Talk with us before you give up on the claim.
Do I have to go to an independent medical exam?
Yes, if the insurer properly requests it and your condition is material to the claim. The insurer pays for the exam, and it must be held in a reasonably accessible place. If you unreasonably refuse or fail to attend, the insurer is no longer liable for later PIP benefits. If the date does not work, ask to reschedule in writing.
What is an examination under oath in a PIP claim?
It is a recorded question-and-answer session required by many policies, usually with the insurer’s lawyer and a court reporter. Under Florida law, complying with it is a condition for getting benefits. Questions must be limited to relevant information. Prepare ahead and answer truthfully.
Can I sue my insurance company for not paying PIP?
Yes, but first a written demand letter must be sent under Fla. Stat. 627.736(10), after the claim is overdue. The insurer has 30 days to pay the overdue amount with interest and a small penalty. If it pays, no lawsuit can be filed. If it does not, a lawsuit may follow.
Does PIP pay for pain and suffering?
No. PIP pays only part of your medical bills and lost wages, up to $10,000. Pain and suffering comes from a claim against the at-fault driver, or from your own uninsured motorist coverage, and generally requires a permanent injury, significant scarring or a similar threshold injury.
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