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Florida PIP law has made attorney fees a moving target for auto insurers and the medical practices that treat their policyholders. Under Section 86.121 of the Florida Statutes, an insured who wins a declaratory judgment on coverage after a total coverage denial is entitled to reasonable attorney fees. The problem is that the statute does not define “claim,” and trial judges in Hillsborough County have answered that question differently. Until an appellate court resolves the split, insurers and providers will each be negotiating with that uncertainty in mind.
Section 86.121: What the Fee Provision Says
Section 86.121 was enacted in 2023 (ch. 2023-15, Laws of Florida) as part of the tort reform package that largely eliminated one-way attorney fee awards against insurers. It kept one narrow path open. In an action for declaratory relief about insurance coverage, the court must award reasonable attorney fees to the named insured, an omnibus insured, or a named beneficiary if a declaratory judgment is rendered in their favor. That fee right cannot be transferred or assigned to anyone else. The statute excludes residential and commercial property policies, and it provides that an insurer’s defense under a reservation of rights is not, by itself, a coverage denial.
What Counts as a Total Coverage Denial
Because the statute is triggered by a “total coverage denial of a claim,” the meaning of “claim” decides how much exposure an insurer faces. Under a narrower reading, a claim is the insured’s entire PIP claim arising from the accident, so an insurer must stop paying benefits across the board before fees are triggered. Under a broader reading, each bill or payment request is its own claim. An insurer that refuses to pay one provider’s charges and says so in writing may have made a total denial of that claim, even while it keeps paying other providers.
How the Hillsborough County Orders Divide
Several Hillsborough County trial courts addressed this question between late 2024 and early 2026, and their orders have not lined up. In a 2025 order, the court read “claim” as the insured’s overall PIP claim. The insurer there had paid chiropractic bills through a set date, then suspended chiropractic payments after an independent medical examination without signaling that it would stop paying other categories of treatment. The court found no complete denial of coverage, and it also noted that the complaint did not plead facts showing one. The fee request was denied.
Other orders reached the opposite result. In a December 2024 order, an insurer told a specific provider that no payment was due, and the court held that was enough, rejecting the argument that the statute requires denial of all policy benefits. In two 2026 orders, insurers paid some bills, suspended others, and paid the suspended charges only after suit was filed. Those courts treated the post-suit payment as the equivalent of a judgment establishing coverage, which satisfied the statute’s requirement for declaratory relief. The most fully developed of these orders relied on the statute’s own wording: had the Legislature meant the whole policy, it could have stopped at “total coverage denial.” It also applied the rule that ambiguity in Florida’s No-Fault Act is construed in the insured’s favor.
Where the Law Stands Today
Trial court orders do not bind other judges, and no appellate court has resolved the split yet. The Second District Court of Appeal, which hears appeals from Hillsborough County, will likely settle the question, and its ruling will control cases within its territory. The Legislature has also looked at the issue. House Bill 1269, filed in January 2026, would have revised how attorney fees are awarded in insurance coverage declaratory actions. It died in a House subcommittee in March 2026, so Section 86.121 remains in effect as written. Until an appellate decision issues, the uncertainty will shape settlement leverage on both sides.
Why This Matters to Your Business
For insurers, the risk sits in how claim decisions are documented and communicated.
- Treat each bill decision as a potential fee event. A suspension limited to one provider or one category of care may be a total denial of a discrete claim under the broader reading, so each written determination should be specific, grounded in the policy and the medical record, and clear about what is being denied.
- Do not assume that paying after suit ends the exposure. Where courts treat post-suit payment as establishing coverage, a carrier may still face a fee award on a bill it ultimately paid.
- Audit suspension practices now. Decisions made by adjusters, bill reviewers, and independent medical examination vendors can each create fee exposure, and a single template letter can repeat the same problem across many files.
For medical practices and other providers, the statute cuts in a different direction.
- The fee right belongs to the insured. Because the right cannot be assigned, a provider treating under an assignment of benefits may not be able to recover these fees in its own name, even on its own denied bill. Provider leverage runs through the patient’s claim.
- Document every denial. Keep the carrier’s written determination for each bill, with dates and the reason given. Whether a particular bill was denied, and how, may decide whether the statute applies at all.
- Coordinate early with the patient’s counsel so that the denial, the bill, and the lawsuit line up on the same claim.
The “claim” question will not stay confined to Hillsborough County, and businesses that plan around it now will be better positioned when the appellate courts speak. If you have questions about how this affects your business, reach out to our team to inquire. We can review carrier denial letters, provider billing practices, and PIP files to help you understand where your exposure sits.
How Can Jimerson Birr Help With a Florida PIP Law Fee Dispute?
Facing a PIP fee dispute and unsure what counts as a claim under Florida PIP law? Jimerson Birr advises on insurance coverage disputes, including questions about when a denial triggers attorney fees. Call (904) 389-0050 or request a free consultation. Each written denial or suspension issued before your process is reviewed may carry fee exposure under the broader reading of the statute, so review it before the next letter goes out.