Florida HB 837: What the 2023 Tort Reform Means for PIP Medical Providers

What HB 837 Actually Changed

The Repeal of One-Way Attorney Fees (§627.428)

The most consequential change for PIP providers is the elimination of §627.428, which previously allowed a prevailing insured — or an assignee like a medical provider — to recover attorney fees from the insurer in a coverage dispute. This provision was the engine that made PIP litigation economically feasible for plaintiff attorneys handling relatively small-dollar claims.

Without it, an attorney taking a $1,200 PIP underpayment case now bears the full risk of litigation costs with no guaranteed fee recovery even if they win. For many firms, the math simply does not work. The result: attorneys have stepped back from smaller PIP collection cases in large numbers, leaving providers to pursue those claims through their own billing and denial management processes — or write them off.

The Limited New Path: §86.121

HB 837 did create a narrow new avenue under §86.121 — a declaratory relief action for total coverage denials. In theory, a provider or insured can seek attorney fees through this route. In practice, it applies only to complete coverage denials (not underpayments or partial denials), and the procedural requirements make it difficult to use for the routine billing disputes that make up the bulk of PIP collection work. Most billing professionals and attorneys view it as a limited remedy at best.

New Evidence Rules: §768.0427

HB 837 also created Florida Statute §768.0427, which governs what evidence of medical expenses is admissible in personal injury actions. Under this statute, the amount of medical expenses a plaintiff can present to a jury in a PI lawsuit is now limited — generally to the amount actually paid or payable, rather than the full billed amount. This has downstream effects on Letters of Protection (LOPs) and the billing practices of providers who treat PI patients on a lien basis.

What Did Not Change: §627.736 Is Intact

The benefits your patients are entitled to have not changed. What has changed is how aggressively carriers know those benefits will be pursued when they underpay or deny.

Specific Impact on Chiropractors

Chiropractic practices have historically been among the most active PIP providers in Florida, and they are feeling the effects of HB 837 acutely. The typical chiropractic PIP claim — adjustments, exams, modalities over a course of care — often involves multiple small-dollar line items that, when underpaid, might total a few hundred to a few thousand dollars per patient. These were exactly the cases that plaintiff attorneys used to handle efficiently under the old fee-shifting regime.

Now, when a carrier reduces a chiropractic claim by 20% or denies a handful of modality codes, there is often no attorney willing to litigate it. The carrier knows this. The result is a quiet but real increase in underpayments and denials that go unchallenged — not because providers have no legal right to the money, but because the economics of pursuing it through litigation have changed.

What This Means Practically

• EMC documentation is non-negotiable. The Emergency Medical Condition certification is what unlocks the full $10,000 in PIP benefits. A weak or missing EMC determination gives carriers an easy basis for limiting reimbursement to $2,500. Every chiropractic patient treated under PIP needs a clear, well-documented EMC finding from a qualifying physician.
• Coding precision matters more than ever. Carriers scrutinize chiropractic CPT codes closely. Upcoding, unbundling errors, or missing modifiers are denial triggers that, post-HB 837, are less likely to be corrected through litigation. Getting the coding right the first time is the most reliable way to protect reimbursement.
• Denial management must be internal and proactive. Waiting for an attorney to resolve a denied claim is no longer a viable strategy for most chiropractic practices. Practices need a billing partner with the expertise to appeal denials, respond to requests for additional documentation, and escalate disputes through the carrier's internal processes — before the claim ages out.
• The 35-day submission window is unforgiving. PIP claims must be submitted within 35 days of the date of service. Late submissions are routinely denied, and post-HB 837, those denials are harder to challenge. Clean, timely submission is the foundation of a healthy PIP revenue cycle.

Specific Impact on MRI & Imaging Facilities

MRI and imaging facilities occupy a unique position in the Florida PI ecosystem. A single MRI study can represent a significant portion of a patient's PIP benefits, and imaging results often serve as the clinical foundation for EMC determinations that unlock the full $10,000 limit. That makes imaging centers both high-value providers and high-scrutiny targets for carriers looking to manage costs.

The LOP Landscape Has Shifted

Many imaging facilities treating PI patients do so under Letters of Protection — agreements where the provider agrees to defer billing until the patient's personal injury case settles. HB 837's new §768.0427 limits the medical expense evidence admissible in PI trials, which affects how LOPs are valued in settlement negotiations. Carriers and defense attorneys now have a stronger argument for limiting the recoverable amount to what was actually paid or payable under PIP, rather than the full billed charge.

This does not eliminate LOPs as a billing mechanism, but it does increase the importance of defensible billing practices. Imaging facilities that bill at rates clearly tied to the Florida PIP fee schedule — and that maintain clean referral documentation — are in a much stronger position than those billing at arbitrary rates with weak paper trails.

Referral Documentation and EMC Support

For PIP-covered imaging, the referral documentation from the treating physician is critical. Carriers routinely challenge MRI claims on the grounds that the study was not medically necessary or was not properly ordered. Post-HB 837, with fewer attorneys willing to litigate those disputes, imaging centers need to ensure that every PIP study is supported by a clear referral, a documented clinical indication, and a proper EMC finding in the patient's record.

The billing side matters equally. Imaging CPT codes — particularly for MRI of the spine and extremities — are among the most frequently audited in PIP. Modifier usage, facility vs. professional component billing, and compliance with the Florida fee schedule all require expertise that general medical billing companies often lack.

The New Reality for Florida PIP Providers

The post-HB 837 environment is not a crisis — PIP benefits still exist, patients still have coverage, and providers are still entitled to reimbursement for reasonable and necessary care. But the informal enforcement mechanism that kept carriers honest on smaller claims has been significantly weakened.

Carriers are sophisticated actors. They track litigation trends, and they know that the volume of PIP lawsuits has dropped sharply since HB 837 took effect. Some have responded by tightening their audit processes, increasing documentation requests, and applying more aggressive fee schedule interpretations — knowing that the probability of a lawsuit over a $500 underpayment is now very low.

For providers, the response has to be operational. The practices that are protecting their PIP revenue in this environment share a few common traits:

• They submit clean claims the first time, with complete documentation and correct coding
• They respond to carrier requests for additional information quickly and completely
• They track denial patterns and identify carrier-specific tactics early
• They appeal underpayments systematically, not just when the dollar amount is large
• They work with billing specialists who understand Florida PIP specifically — not general medical billing generalists

The practices that are struggling are the ones that relied on attorneys to clean up billing problems after the fact — and have not yet adjusted their revenue cycle to account for the fact that backstop is no longer reliably available.

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