By Prosper Shaked, Florida personal injury attorney. Published: October 27, 2026.
A letter of protection lets you get medical treatment after an injury now and pay for it later, out of the settlement or verdict, usually when no insurance will pay for the care. It is mainly for people with no coverage that will pay: motorcycle riders, who have no PIP, people whose PIP has run out, and people with no health insurance, though many people with health insurance use one too. Since 2023, Florida law requires anyone who treated on a letter of protection to disclose the letter, the bills, any sale of the bill to another company and any referral to the doctor before claiming those bills in a lawsuit. The bill is still yours if the case is lost or the recovery is small, which is why I go over it with you, before you sign whenever I can.
Key terms
The five terms this article uses
Letter of protection. An arrangement in which a doctor, clinic or other provider treats you in exchange for a promise to be paid from the settlement or judgment in your injury case. Florida law counts any such arrangement, whatever it is called.
Health care coverage. The law’s term for health insurance and the other programs that pay for medical care, including Medicare, Medicaid, workers’ compensation and PIP. Whether you had it, and what it would have paid, shapes what a jury hears about your bills.
Factoring company. A company that buys a provider’s unpaid bills for less than the amount billed. If your provider sells your bill, the buyer and the price must be disclosed.
Balance. What you still owe a provider for your care, before any reduction.
Reduction. An amount a provider agrees to take off its balance at the end of the case. It is a request the provider can refuse.
What is a letter of protection, and who signs it?
A letter of protection is an agreement about your bills with one provider. It usually starts at the provider’s office: you sign the provider’s letter of protection there, agreeing that you owe the bill and that it will be paid from your settlement or verdict, and the provider sends it to your attorney, who usually signs it as well. Sometimes the attorney writes the letter instead. Either way, the provider treats you now and waits to be paid until your case ends, and you stay responsible for the bill: the letter postpones it, it does not cancel it. When the case resolves, the provider’s bill is paid out of the settlement or verdict before the rest of the money reaches you.
A letter of protection is not insurance, and it is not a promise that the case will cover the whole bill. The provider is waiting on the outcome of your case along with you, which is why a provider will want an attorney involved before treating on a letter of protection.
When do people in Florida treat on a letter of protection?
If you are not sure who pays your medical bills after a car accident, start there: a letter of protection is mainly for the care nobody else will pay for. It usually comes up in one of these situations:
- You were hurt on a motorcycle. PIP covers vehicles with four or more wheels, so a rider in a motorcycle accident has no PIP to pay the first medical bills.
- Your PIP ran out after a car accident. Personal injury protection (PIP) has a $10,000 limit for medical and disability benefits together, pays 80 percent of covered medical bills, and limits medical care to $2,500 if a doctor finds no emergency medical condition. An MRI and a few specialist visits can use up much of that.
- Your provider bills PIP but wants the balance protected. PIP pays 80 percent of covered medical bills after any deductible, so there is almost always a balance. Many providers who bill PIP, chiropractors among them, still ask for a letter of protection to cover what PIP leaves.
- You have no health insurance.
- Your health plan will not cover the care, or the specialist you need is out of network.
- The provider will not bill health insurance for an injury someone else caused. Some providers refuse to.
- The driver who hit you had no insurance. Your own PIP and health coverage still apply, but the rest of the claim may run through your own uninsured motorist coverage, and that takes time.
Having health insurance does not rule out a letter of protection, and many of my clients who have it still treat on one. In my clients’ cases, plans have been slow to approve injury care: referrals, prior authorizations and long waits for a specialist or an MRI. Some in-network providers have treated the symptoms without working up the injury, and some have refused to treat a patient at all once they learned there was an injury case. Sometimes the provider who treats on a letter of protection has been the one who got the care moving. The trade-off is cost. With health insurance, the plan pays the provider its contracted rate for covered care and you owe only your share; on a letter of protection, you carry the full bill on the outcome of the case. And since 2023, when someone with health care coverage treats on a letter of protection instead, the evidence of what that care is worth includes what the plan would have paid had it been used, plus your share. A plan that pays may ask to be repaid from a settlement, and that is handled at the end of the case, apart from the providers’ bills.
Which doctors treat on a letter of protection, and who chooses them?
Orthopedic and pain management practices, neurologists, chiropractors, physical therapists and imaging centers are among the providers that commonly treat on a letter of protection in Florida.
Many clients ask me to recommend a doctor. When a client needs a provider who treats on a letter of protection, I can help them find one, but the choice of doctor is the client’s, and so is the decision to sign. Since 2023, if I referred you to a provider you treat with on a letter of protection, that referral is disclosed in the case, and the other side can use it to argue that the doctor has a stake in the outcome. I tell clients that before they choose, so the choice is made with open eyes.
When a client asks me about a letter of protection before signing, I go over three more things: the bill is theirs whatever happens in the case, the provider’s charges can be compared with figures based on insurance or Medicare rates, and the letter and the bills will be disclosed to the other side.
What changed in 2023 under HB 837?
House Bill 837, the 2023 law that changed many Florida injury rules, added section 768.0427 to the Florida Statutes. It applies to lawsuits filed after March 24, 2023 (ch. 2023-15, § 30, Laws of Fla.), and it changes a case where you treated on a letter of protection in three ways.
It requires disclosure. Before you can claim the medical bills for treatment under a letter of protection, you must disclose (Fla. Stat. § 768.0427(3)):
- A copy of the letter of protection.
- Every bill, itemized and coded with the standard medical billing codes where they apply.
- If the provider sold your bill to a factoring company or anyone else, who bought it and how much they paid.
- Whether you had health care coverage when you were treated, and if so, which.
- Whether you were referred for treatment under a letter of protection, and by whom. If your attorney made the referral, it can be used in court even though it would otherwise be protected by the attorney-client privilege, and the financial relationship between the law firm and the provider can be used to argue that a testifying doctor is biased.
It changes the evidence about the bills (§ 768.0427(2)). For bills already paid, the evidence is limited to what was actually paid. For bills still unpaid, the evidence includes:
- with health care coverage, what the coverage pays or would have paid, plus your share;
- with no coverage, or with Medicare or Medicaid, 120 percent of the Medicare rate on the date of treatment, or 170 percent of the Medicaid rate where Medicare has no rate;
- if the provider sold the bill, what the buyer paid or agreed to pay for it.
The provider’s reasonable charges for necessary care can still come in, so the bill is not cut to the Medicare figure automatically, but the other side can now put those figures beside it. Future care has parallel rules, measured by the coverage you have or are eligible for, or by the Medicare rate at the time of trial.
It limits the damages (§ 768.0427(4)). The medical damages you recover cannot be more than the evidence admitted under those rules, and cannot exceed what was paid, what is still owed and what reasonable and necessary future care will cost.
So a letter of protection bill now comes with its own disclosure and evidence rules. I build the medical side of a case expecting the other side to see the letter, the bills and every disclosure the law requires.
What are the risks of treating on a letter of protection?
- You owe the bill whatever happens. Under the usual terms, if the case is lost, or the recovery is smaller than the bills, the provider can still collect the balance from you like any other debt.
- The other side will see it and use it. The letter, the bills, any sale of the account and any referral are disclosed, and the defense can use them to argue that the doctor has a stake in the outcome.
- The jury may hear a smaller number than the bill. Insurance and Medicare-based figures can come in beside the provider’s charges, and a jury may award less than the full balance, which is still owed unless the provider reduces it.
- Your bill may be sold. A provider can sell your account to a factoring company. The buyer then collects it, and the price it paid becomes evidence.
- A reduction is a request, not a right. No provider has to lower its bill at the end of the case.
For many people the alternative is no treatment at all, which is worse for their health and for their case. The risks are a reason to go in informed, not always a reason to say no.
What happens to the balances when the case ends?
When a case settles, I ask every provider who treated you on a letter of protection to reduce the balance, and I show them why: what the case recovered and what other bills it has to cover. A provider does not have to agree, so a reduction is a request, not a right. I confirm each provider’s balance in writing, one provider at a time, because a zero balance at one office does not mean the others are settled. Before any money moves, you sign a closing statement that shows the settlement, my fee, the case costs, each provider’s bill and any reduction that provider agreed to, each on its own line, and what is left for you.
Frequently asked questions
Do I still owe the bill if I lose my case?
Under the usual letter of protection, yes. It postpones the bill; it does not cancel it. If the case is lost, the provider can collect the balance from you.
Can I treat on a letter of protection if I have health insurance?
You can, and many of my clients do. In my clients’ cases, a letter of protection has made sense when the plan was slow to approve care, when in-network providers were not treating the injury, or when a provider would not treat because there was an injury case. If you claim those bills in a lawsuit, your coverage is disclosed either way, and the evidence of what your care is worth includes what your plan would have paid, plus your share. I explain that difference before you decide, so the decision is yours and you make it knowing the cost.
Will the other side find out my lawyer sent me to the doctor?
Yes, if your lawyer referred you. Since 2023, that referral is disclosed in a case where you treated on a letter of protection, and the other side can use it to argue that the doctor has a stake in the outcome.
What if the settlement is smaller than my medical bills?
That is when reductions matter most. The bills are still owed unless the providers agree to reduce them, which is why I ask every provider for a reduction and show you each result on the closing statement before you sign.
Can I change doctors after I sign?
Yes. Each letter of protection covers care from the provider you signed it with. A new provider will want its own letter, and the first provider’s balance for the care already given is still owed.
Do I need a lawyer to get a letter of protection?
Not by law. The letter is your promise to the provider, and it is your signature that binds you to it. In practice, providers want an attorney on the case, and the attorney usually signs the letter as well, agreeing to pay the provider from the settlement or verdict. If you sign a letter of protection at a provider’s office, tell your attorney, so that bill is accounted for when the case ends.
If you were hurt and are not sure how your medical care will be paid for, I will go over your options with you myself, including a letter of protection, and if you have already signed one, bring it. You can reach me through my attorney page or the form on this page.
Reviewed by Prosper Shaked, Florida personal injury attorney, who represents injured people in car, truck and motorcycle accident, premises liability, medical malpractice and wrongful death cases from his office in North Miami Beach.
Statutes cited: § 768.0427, Florida Statutes; ch. 2023-15, § 30, Laws of Florida. Checked against the 2026 Florida Statutes on October 26, 2026.