If you’ve come across this post, you probably already know a little bit about PIP exhaustion and demand letters.  However if you don’t, in a nutshell, Florida courts have ruled that once Personal Injury Protection (PIP) benefits reach their limits ($10,000.00), there can be no more claims for PIP benefits, absent a showing of bad faith by the insurer.  So even if you are in litigation claiming overdue PIP benefits, and the insurer pays a valid claim and hits the $10,000.00 limit, your case is over. 

With regards to demand letters, in order to file a lawsuit against an insurer for overdue PIP benefits, Fla. Stat. 627.736(10) outlines the requirements of a pre-suit demand letter that must be sent to the insurer.  Without that demand letter, a lawsuit is premature, and an insurer will not be liable for attorneys’ fees and costs. 

So let’s talk about Fla. Stat. 627.736(6)(f), 2018.  That portion of the statute reads

In a dispute between the insured and the insurer, or between an assignee of the insured’s rights and the insurer, upon request, the insurer must notify the insured or the assignee that the policy limits under this section have been reached within 15 days after the limits have been reached.

This language showed up in 2013 when the PIP statute received a major overhaul.  The language is pretty clear, but it not frequently used or addressed in PIP litigation.  In fact, as I type this, there are no cases on FLW Supp that address “627.736(6)(f).” 

If you are a PIP attorney, or even a provider or billing specialist, utilizing this in your correspondence to the insurers can save you time and money in the future if benefits exhaust. 

The first step is that there must be a dispute.  What is a dispute?  I had a judge (incorrectly in my opinion) tell me that a dispute, in this instance, is not triggered until the insurer is made aware of the lawsuit.  The judge ruled that once served, the insurer is aware of a dispute and then is when the 15 days starts. 

Logically speaking though, the language in (6)(f) was added to avoid litigation. The idea being that once benefits exhaust, the insurers should have an obligation to notify interested parties within 15 days of exhaustion.  That way, providers, attorneys and billing specialists wouldn’t file suit if they were told about exhaustion timely and pursuant to the statute.

Interpreting it like my judge did is counterintuitive because it would mean that you have to file a lawsuit and then request to be notified within 15 days of exhaustion, which is backwards from the logic of the language.

What does it mean for you?

Providers and billing specialists – put a coversheet with your bills and records with language related to (6)(f), and provide that to your PIP attorney if you send the file out for a PIP suit.  If the insurer doesn’t then notify you within 15 days, you/your attorney have a stronger argument as to extra-contractual benefits owed.  Some insurers have paid above the $10,000.00 on my cases to avoid further litigation.

Attorneys – add language to your demand letter related to (6)(f) and even add some language in your complaint that you put the insurers on notice in your demand letter and have not been notified as of the time of filing your complaint.  This could help you recover both extra-contractual benefits, as well as fees and costs.

I have successfully settled many of these cases where benefits have exhausted and the insurance companies have resolved without fighting the issue of (6)(f).  If you don’t put them on notice though, and request that they provide notification, they have a strong argument for not taking your benefits exhausted case seriously.

If you have any thoughts or questions further about this, please feel free to reach out to me.

-Nick