PIP Denied In Florida: Understand Mandatory Reconsideration By DWP & Legal Options
When you’re in an accident, you expect the insurance company to pay your PIP claim fairly. After all, you dutifully paid your premiums, and Florida has a no-fault car insurance system.
But what do you do if your PIP claim is denied? Do you need to work with a Miami car accident attorney to get your rightful benefits? Fortunately, you have rights, and you have options. Here’s what you need to know about appealing a PIP insurance claim denial in Florida.
What to Do If Your PIP Claim Is Denied in Florida
If your PIP claim is denied in Florida, file a demand for an internal review. Be sure to carefully review the reasons for the initial denial so that you can fix any mistakes or provide additional information that the insurance company needs to process your claim. If your PIP claim is still denied in Florida, you may bring a legal action to force the insurance company to pay your claim.
Fighting a PIP Denial in Florida
When the insurance company denies your PIP claim in Florida, there are several things that you can do to fight the decision. You may be surprised to learn that a significant percentage of PIP appeals are successful. If you think your claim is denied in error, don’t give up! There are several steps that you can take to fight back and get the payment that you deserve.
Appealing a PIP Denial
You should start by pursuing an internal appeal through the insurance company. When you demand an internal appeal, your case goes to a different person than the person who initially denied coverage. Sometimes a fresh set of eyes is all it takes to get to the right answer.
To make your appeal successful, you should carefully study the denial letter. The insurance company should have given you a reason for the denial. You can see if there is something that the insurance company isn’t understanding or didn’t get right. Sometimes, it’s just a matter of clarifying something for the insurance company or providing the additional information that they need to make the correct decision and in more complex cases, understanding when you need a personal injury lawyer can be critical to protecting your rights.
It’s also essential to file your appeal correctly. Your denial letter should contain information about how to file an appeal. You should follow the instructions and file your appeal within the stated time frames.
Understanding Your PIP Decision Letter
When your PIP decision arrives, the decision letter explains why your claim was refused. Many claimants feel frustrated because the letter often lacks detail or misrepresents their daily life struggles. It’s crucial to read the letter carefully, highlight inaccuracies and gather medical evidence or medical reports to challenge the decision. Supporting statements from family or carers can strengthen your claim and help you earn more points during reconsideration.
What Is a PIP Lawsuit?
A PIP lawsuit is a lawsuit that an insured person brings against their insurance company. If the insurance company unfairly denies an insured person the benefit that they deserve, the person can bring a lawsuit against the insurance company because of the denial. The person may recover the amount that they should have gotten, and they may recover additional amounts to cover the costs of litigation or any losses that they incur because of the wrongful denial.
Mandatory Reconsideration – First Step in Challenging a PIP Decision
If your PIP claim is denied, the first step is to request a mandatory reconsideration from the DWP. You can request this normally within one month of the decision date, though late requests up to 13 months may be accepted if you explain the delay. During reconsideration, a new decision maker reviews your case.
Providing medical evidence, detailed accounts of how your condition affects daily life, and correcting errors in your PIP form or telephone assessment support can be crucial. Many claimants feel defeated after being refused PIP, but mandatory reconsideration often results in a better outcome.
How Long Does Mandatory Reconsideration Take PIP
When you submit your PIP claim for a mandatory reconsideration, you should have a decision within 60 days. If your reconsideration is for services already received, the insurance company has 60 days to decide the appeal. If you are still waiting to get the medical treatment in the future, they must decide your request for a mandatory reconsideration within 30 days. The insurance company should give you an answer in writing.
Why Was My Florida PIP Claim Denied?
Here are some reasons that your Florida PIP claim may be denied:
1. You didn’t provide the information the insurance company needs
When you make a PIP claim, you need to give the insurance company the information that they need to process your claim. For example, you might submit a claim for miles traveled to and from medical appointments. But you might only list a number of miles traveled or a dollar amount when the insurance company needs the addresses you traveled to and from your medical appointments. Simple errors and omissions can lead to a frustrating denial of your claim.
If your PIP claim has incomplete or inaccurate information, the insurance company may need more information to process your claim. You may need to correct details or supplement to file a complete claim. Review your denial letter from the insurance company to see what information you can correct or add to submit a complete claim.
2. You didn’t seek care within 14 days
Florida PIP laws require you to seek medical treatment within 14 days. If you miss the 14-day window, the insurance company may deny/refuse your claim. Be sure to seek medical care immediately if you have any signs of car accident injuries.
3. The insurance company doesn’t know the law
In 2018, the Florida Supreme Court issued a major ruling about PIP insurance. The decision said that the insurance company has to take the PIP deductible from the total amount of the medical bills. They can’t base their deductible on reduced charges from the PIP insurance schedule of payments.
Although it can be confusing, the 2018 Florida Hospital Medical Center v. Progressive Select Insurance Company decision was a win for PIP patients. If the insurance company denies your claim or doesn’t pay it in full, they may be billing under the old deductible rules. You may need to point out to them that you’re aware of the 2018 Florida Supreme Court ruling and that they need to revise their process for applying the deductible.
4. The case meets coverage limits
Your PIP claim is subject to the coverage limits in your insurance policy. For example, if you have a $10,000 PIP claim, the insurance company has to pay only up to $10,000 in claims. In addition, if you don’t have an emergency medical condition, the policy maximum may be as low as $2,500. You should double check your policy limits to ensure that your coverage amounts are covered in full.
5. The insurance company isn’t being fair
Sometimes, insurance companies just aren’t fair. When the insurance company denies your claim to try and save a buck, you have the right to bring a lawsuit to demand fair compensation. Unfortunately, when you need them the most, some insurance companies try to pad their profit margins at the expense of consumers. But you can fight back by bringing a PIP lawsuit.
Common Struggles Claimants Face During PIP Appeals
Many claimants report feeling invalidated by the assessment process. Inaccuracies in reports often mean genuine difficulties are overlooked. People sometimes understate their struggles, leading to fewer points or a lower rate award. Keeping a diary of how your condition affects your life, documenting how you manage medication, and gathering support from carers can make a difference. Remember, pip appeals are not just about conditions—they focus on how those conditions affect your ability to function daily.
Next Steps After Mandatory Reconsideration
If your mandatory reconsideration is unsuccessful, you can appeal to a tribunal. You must normally appeal within one month of the reconsideration decision date. At this stage, you can submit additional evidence, including medical reports, diaries of your daily life, and statements from friends or carers. The tribunal hearing is independent of the DWP and can overturn unfair or rejected claims. Many claimants find tribunals support services or pip advocacy groups helpful during this stage.
Florida Car Accident Attorneys for PIP Denials
Have you been unfairly denied PIP benefits? Did the insurance company deny your benefits, and you’re wondering if you were treated fairly? Our attorneys can help.
The legal team at Bernstein & Maryanoff Injury Attorneys is an aggressive, fully-equipped legal team representing car accident victims. Let us do battle with the insurance company for you. Call us today for a friendly, free, and confidential review of your claim.