Denied or Underpaid PIP Claims Lawyer
Personal Injury Protection
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Share the basic facts and records you have so the firm can evaluate whether it may be able to assist.
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(954) 591-8099
Fight for the Benefits You Are Owed
A PIP payment that is smaller than expected does not explain whether the insurer applied a deductible, fee schedule, coding adjustment, coverage defense, policy limit, or medical-necessity position. A denial letter may identify a reason without showing whether the claim file actually supports it. Before responding, the insured or provider needs a precise account of what was billed, what was paid, what was rejected, and why.
The Costello Law Group reviews denied and underpaid Florida PIP claims for policyholders and medical providers. Attorney Joshua Costello works directly with clients to reconcile the numbers, examine the insurer’s explanation, identify missing documentation, and determine whether the dispute calls for a correction, response, statutory demand, negotiation, or litigation.
Review the Reasons Behind the Decision
Understanding the Insurer's Position
Florida law generally requires an insurer that pays only part of a claim or rejects it to provide an itemized specification of each item reduced, omitted, or declined and information supporting the stated reason. If the insurer identifies an alleged error in the claim, the claimant may choose to submit a revised claim within the statutory period without waiving other legal remedies.
The explanation of benefits should be compared with the claim form, billing ledger, medical record, policy, deductible, benefit log, and prior payments. A single denial code may not tell the whole story. For example, a claimed fee-schedule reduction raises different questions from a denial based on medical necessity, treatment timing, coverage, exhaustion, or an examination request.
Identify Problems That May Reduce Your Benefits
Frequent Denial and Underpayment Issues
The firm evaluates disputes involving:
- Treatment alleged to be unrelated, unreasonable, or medically unnecessary.
- Fee-schedule calculations, coding, bundling, modifiers, and payment methodology.
- Emergency medical condition findings and the applicable medical-benefit limit.
- Late-billing allegations, incomplete claim forms, missing records, or other compliance issues.
- Policy exclusions, coverage priority, deductibles, examinations under oath, or medical examinations.
- Exhausted benefits and whether the payment log supports the insurer's position.
Build and Present a Stronger Demand
The Pre-Suit Demand Process
A Florida PIP lawsuit generally cannot be filed until the claim is overdue and the insurer receives a written notice of intent to initiate litigation that complies with section 627.736. The notice must identify the insured, the claim or policy, the provider when applicable, and the exact amount, dates of service, and benefits claimed. An assignment must be included when required. The statute also specifies how the notice is delivered.
After receipt, the insurer has a statutory opportunity to pay the overdue amount with applicable interest and the prescribed penalty. A demand should not be treated as a generic collection letter. It should be based on a verified amount and complete record because mistakes can delay the matter or narrow the dispute incorrectly.
Review Your Claim and Plan Your Next Stepstation
Get a Direct Review of the Denial or Reduction
Send The Costello Law Group the denial, EOB, billing ledger, claim forms, medical records, policy information, payment history, and correspondence. Joshua can explain what the insurer did, what remains unknown, and the most practical next step.
- Direct communication with Joshua
- Focused case preparation
- Clear explanation of options
- South Florida representation
Get Answers About Denied PIP Claims
Frequently Asked Questions
Is a reduced payment automatically an underpayment?
No. The policy, deductible, benefit limits, applicable payment methodology, submitted charge, coding, and supporting records must be reviewed. A difference between the bill and payment is the start of the analysis, not the conclusion.
What if the insurer says benefits are exhausted?
Request and review the PIP payment log, claim chronology, reserve issues, and the timing of submitted bills. Exhaustion can be valid, but the underlying payments and priority should be verified.
Can a denied claim be corrected without a lawsuit?
Sometimes. A corrected bill, revised claim, additional record, or focused response may resolve an administrative or documentation problem. Other disputes may require the statutory demand process and litigation.
Based in Cooper City. Serving Davie, Pembroke Pines, and clients throughout Florida. Contact The Costello Law Group at (954) 591-8099 to discuss.
Free Consultation
Tell us what happened.
Share the basic facts and the records you have. The firm can evaluate whether the matter falls within its current services and explain what additional information may be needed.
Joshua Costello
The Costello Law Group
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