Third District Court of Appeal Upholds Trial Court Ruling, Issues Preliminary Opinion Regarding Insured’s Obligation To Comply With Policy Terms

Recently, the Third District Court of Appeal ruled on a case that benefits insurance companies and continues to support their contractual language when the insurance companies request examinations under oath, or EUO for short.

Many insurance carriers have written in their policy that any claimant, at the insurer’s option, must appear for questioning under oath or a make a statement under oath. Some insurers can require multiple EUOs or statements under oath.

This contractual language is supported by statutory language enacted in 2012:

An insured seeking benefits under ss. 627.730-627.7405, including an omnibus insured, must comply with the terms of the policy, which include, but are not limited to, submitting to an examination under oath. The scope of questioning during the examination under oath is limited to relevant information or information that could reasonably be expected to lead to relevant information. Compliance with this paragraph is a condition precedent to receiving benefits. An insurer that, as a general business practice as determined by the office, requests an examination under oath of an insured or an omnibus insured without a reasonable basis is subject to s. 626.9541.

Florida Statute Section 627.736(6)(g) (emphasis added)

What happens when a claimant does not appear to the scheduled EUO(s)? Provided the contractual language of the policy mandates the insured must submit to questioning under oath, the above statute applies and a personal injury protection claim may be denied.

The Third DCA determined when a claimant failed to appear for the first and subsequently scheduled second EUO, an insurance provider may deny PIP benefits to the claimant. In the case decided by the Third DCA, the claimant failed to appear for the first scheduled EUO. A second examination was subsequently scheduled for the claimant, in which she failed to appear again. The insurance carrier denied coverage to the claimant and a lawsuit commenced. The insurance carrier moved for summary judgment citing its contractual language and the statute referenced above. The trial court granted summary judgment in favor of the insurance company. The Plaintiff appealed.

The Third DCA reviewed the contractual language and Florida Statute 627.736(6)(g) and affirmed the trial court’s ruling. This shows courts are following the statutory and contractual language of automobile insurance contracts and properly denying benefits when the claimant does not fulfill their obligations.

While not yet final for publishing, you can read the Third DCA’s full opinion here: Miracle Health Services, Inc. a/a/o Kirenia Tamayo v. Progressive Select Insurance Company.

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