AFTER YOUR FIRST VISIT

What happens next — and the two ways people lose their benefits

Getting seen inside 14 days is the first hurdle. It isn't the last one. Most people who lose PIP benefits don't lose them because they were hurt too little or treated too much. They lose them by missing an appointment the insurance company scheduled.

1. Your insurer can require you to be examined — and skipping it ends everything

Florida law lets your own insurance company send you to a doctor of its choosing to look at your injuries. The insurer pays for it. That part is routine and nothing to be alarmed about.

What is not routine is what happens if you don't go. Under the statute, if you unreasonably refuse or fail to appear, your carrier is no longer liable for any further PIP benefits. Not reduced. Done. And if you miss two, the law presumes your failure was unreasonable and puts the burden on you to prove otherwise.

So: if a letter arrives scheduling you for an examination, go. If the date genuinely doesn't work, call and move it in writing rather than simply not showing up. This is the single most common self-inflicted wound in a Florida PIP claim.

2. You may be asked to answer questions under oath

Your policy can require you to sit for an examination under oath, and the statute makes complying a condition of receiving benefits. The questions are supposed to stay within what's relevant to the claim.

If you're asked for one, that's a reasonable point to talk to an attorney — not because you've done anything wrong, but because it's a formal legal proceeding and you're entitled to understand it before you sit down. We can refer you if you'd like.

Your insurer has 30 days to pay

Once the carrier has proper written notice of the loss and the amount, benefits are overdue if they go unpaid past 30 days — and overdue payments carry interest by statute. You don't have to accept indefinite silence as normal.

We have 35 days to bill — and if we miss it, you cannot be charged

This one is in your favor and almost nobody tells patients about it. Florida law requires a provider to get its bill to the insurer within 35 days of treating you — up to 75 days if the provider gave notice of treatment in the first 21. Blow the deadline and the statute is blunt about who eats it: the injured party is not liable for those charges, the provider may not bill you for them, and any agreement you signed saying otherwise is unenforceable.

In other words, keeping your claim on schedule is our job, not yours. If a clinic ever hands you a bill for charges it filed late, that bill is not valid.

Why $10,000 goes further than it sounds

People hear "$10,000" and assume it disappears in three visits. Florida caps what a PIP insurer must reimburse for most services at 200% of the Medicare Part B participating physicians fee schedule, and pays 80% of that. Care is reimbursed against that ceiling rather than at retail prices, so a full course of treatment usually fits inside the benefit with room left.

This page explains how Florida's PIP statute works in general. It isn't legal advice about your specific claim. If something about your claim doesn't look right, talk to us or to an attorney.

Questions about where your claim stands? Call us — we deal with these carriers every day.