My Florida PIP claim for physical therapy was denied as not medically necessary. What are my appeal grounds?

Car insuranceDeniedFloridaChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: Florida Legislature · 2026 Florida Statutes, s. 627.736 · § 627.736(1)(a) View original ↗

In short

In Florida, PIP needs a doctor's report to stop paying your doctor.
Ask for that report and the list of cut items in writing.
Before you can sue, you must send a "demand letter."

What this means

Florida PIP pays 80 percent of reasonable costs for care that is medically necessary. The limit is $10,000 for medical and disability benefits [1].

What to check first. The insurer may not stop paying your own doctor unless you agree, or it first gets a "valid report." That report must come from a Florida doctor with the same kind of license as your doctor. It must say the care was not reasonable, related, or necessary. The doctor who saw you or read your records must sign it. The records must back it up, and no one else may change it [2]. If the insurer pays only part or says no, it must list each item it cut or denied [3]. Ask for that list and the report.

Timing. PIP money is late if not paid within 30 days after the insurer gets written notice of the loss and the amount [3]. Before you can sue, you must send a written "demand letter under s. 627.736." If the insurer then pays within 30 days, with interest and a 10 percent penalty (up to $250), no lawsuit may be brought [4]. This page is not legal advice.

Your next step

Ask the insurer in writing for the doctor's report it used. Ask for the list of each item it cut [2] [3]. A demand letter gives it 30 more days [4].

Deadline: the insurer must pay within 30 days after written notice of the loss and amount 3.

Check it yourself

Read Fla. Stat. 627.736 sections (4), (7), and (10) at the link above. Check your policy's declarations page for your PIP deductible. Whether your report meets the "valid report" rule is a legal question — "Don't know yet".

Where this comes from (4)

[1] Florida Legislature · 2026 Florida Statutes, s. 627.736 · § 627.736(1)(a) · checked 2026-11-06
to a limit of $10,000 in medical and disability benefits and $5,000 in death benefits resulting from bodily injury, sickness, disease, or death arising out of the ownership, maintenance, or use of a motor vehicle as follows: (a) Medical benefits. - Eighty percent of all reasonable expenses for medically necessary medical, surgical, X-ray, dental, and rehabilitative services
[2] Florida Legislature · 2026 Florida Statutes, s. 627.736 · § 627.736(7)(a) · checked 2026-11-06
An insurer may not withdraw payment of a treating physician without the consent of the injured person covered by the personal injury protection, unless the insurer first obtains a valid report by a Florida physician licensed under the same chapter as the treating physician whose treatment authorization is sought to be withdrawn, stating that treatment was not reasonable, related, or necessary. A valid report is one t…
[3] Florida Legislature · 2026 Florida Statutes, s. 627.736 · § 627.736(4)(b) · checked 2026-11-06
Personal injury protection insurance benefits paid pursuant to this section are overdue if not paid within 30 days after the insurer is furnished written notice of the fact of a covered loss and of the amount of same. … If an insurer pays only a portion of a claim or rejects a claim, the insurer shall provide at the time of the partial payment or rejection an itemized specification of each item that the insurer had r…
[4] Florida Legislature · 2026 Florida Statutes, s. 627.736 · § 627.736(10)(a), (d) · checked 2026-11-06
As a condition precedent to filing any action for benefits under this section, written notice of an intent to initiate litigation must be provided to the insurer. Such notice may not be sent until the claim is overdue, including any additional time the insurer has to pay the claim pursuant to paragraph (4)(b). (b) The notice must state that it is a \"demand letter under s. 627.736 \" … If, within 30 days after receip…

How we found this

We matched your question to 4 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.

What we don’t know yet

Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.

Every answer is checked against the official rule it quotes.

Information only — not legal advice. Your plan, insurer or agency decides.

This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.

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