Volume 18

18 Fla. L. Weekly Supp. 399c

Online Reference: FLWSUPP 1804JEWE Insurance — Personal injury protection — Coverage — Medical expenses — Exhaustion of policy limits — In absence of any allegation of bad faith, where benefits were exhausted in payment to other medical providers after plaintiff medical provider filed suit, insurer is entitled to summary judgment

18 Fla. L. Weekly Supp. 1180c

Online Reference: FLWSUPP 1811BROT

nsurance — Personal injury protection — Coverage — False statements in claim — Where insurer has presented substantial competent evidence that medical provider knowingly submitted false and misleading statements in claims, neither insurer nor insured owes provider compensation for services included in claims

18 Fla. L. Weekly Supp. 1173a

Online Reference: FLWSUPP 1811EXCL Insurance — Personal injury protection — Coverage — Conditions precedent — Examination under oath is not valid condition precedent to coverage under PIP policy

18 Fla. L. Weekly Supp. 1115a

Online Reference: FLWSUPP 1811SMAL

NOT FINAL VERSION OF OPINION
Subsequent Changes at 19 Fla. L. Weekly Supp. 83bInsurance — Personal injury protection — Examination under oath — Failure to attend — Because EUO is not condition precedent to coverage, but condition subsequent, insured’s failure to attend EUO, if proven to be unreasonable, would divest insured of future PIP benefits — However, where insurer failed to plead affirmative defense of breach of condition subsequent, insurer is precluded from relying on defense — Even if insurer’s pleadings could be amended to allege breach of condition subsequent, defense is fatally flawed, as policy provision requiring insured to submit to EUO without counsel is invalid

18 Fla. L. Weekly Supp. 776a

Online Reference: FLWSUPP 1809HENR Insurance — Personal injury protection — Examination under oath — EUO provision in PIP contract operates as valid condition precedent to coverage — Claims representative’s testimony that letter requesting insured’s attendance at EUO was mailed to insured and that letter was not returned by post office raised presumption that insured received letter, and medical provider did not rebut presumption by sworn affidavit — Although trial court did not determine whether insurer reasonably requested EUO within 30 days of receipt of claim, appellate court determines from undisputed evidence that it did so — No action clause in PIP contract bars claim until insured complies with condition precedent of attending EUO — Abatement of premature action until insured complies with condition precedent is not appropriate where more than six years passed between date of loss and filing of provider’s complaint

18 Fla. L. Weekly Supp. 764a

Online Reference: FLWSUPP 1809SMAL

NOT FINAL VERSION OF OPINION
Subsequent Changes at 18 Fla. L. Weekly Supp. 1115aInsurance — Personal injury protection — Examination under oath — Failure to attend — Error to grant medical provider’s motion for summary judgment on EUO no-show affirmative defense where there were disputed issues of material fact — Because EUO is not condition precedent to coverage, but condition subsequent, insured’s failure to attend EUO, if proven to be unreasonable, would divest insured of future PIP benefits — Further, trial court must determine whether insurer’s request that insured attend IME after she failed to attend EUO constituted waiver of EUO defense

18 Fla. L. Weekly Supp. 348a

Online Reference: FLWSUPP 1804DIAZ Insurance — Personal injury protection — Examination under oath — Failure to attend — No error in excluding adjuster’s testimony regarding EUO department’s mailing procedures where proffered testimony was cumulative to that of EUO department supervisor — Evidence was insufficient to prove that insured unreasonably refused to submit to EUO — Attendance at EUO is not condition precedent to PIP coverage — Further, insurer suffered no prejudice as result of missed EUO where all information sought through EUO was provided in other documents — Directed verdict in favor of insured is affirmed

18 Fla. L. Weekly Supp. 1197a

Online Reference: FLWSUPP 1811METE Insurance — Personal injury protection — Coverage — Affirmative defenses — Insurer cannot raise alleged violation of administrative rules related to enforcement of and compliance with Health Care Clinic Act as affirmative defense

18 Fla. L. Weekly Supp. 693d

Online Reference: FLWSUPP 1808BULI Insurance — Personal injury protection — Examination under oath — Attendance at EUO is not condition precedent to recovery of PIP benefits

18 Fla. L. Weekly Supp. 599b

Online Reference: FLWSUPP 1807TORR Insurance — Personal injury protection — Examination under oath — Failure to attend — Attendance at EUO is not condition precedent to PIP coverage