Under section 627.727(1) of the Florida Statutes (2007), car insurers must offer uninsured motorist coverage unless an insured expressly rejects coverage. This includes coverage for an underinsured motor vehicle. This coverage is intended to protect those that are legally entitled to recover damages for injuries caused by uninsured or underinsured motorists.
In a recent case, the Florida Supreme Court weighed in on the question of whether an insured person forfeits benefits without regard to prejudice under an uninsured motorist insurance contract if he breaches a compulsory medical examination provision. It also answered the secondary question of who has the burden of pleading and proving prejudice.
The case arose out of a 2006 traffic accident involving Robin Curran and an underinsured motorist. Curran and the motorist settled their case and the settlement was approved by Curran’s insurer State Farm. Curran asked State Farm for her $100,000 underinsured motorist policy limits and offered to settle with State Farm if it tendered the policy limits by a specific date. The plaintiff noted her damages were actually about $3.5 million because she had reflex sympathetic dystrophy syndrome. State Farm tried to schedule a compulsory medical exam based on a provision of the policy requiring it.
Curran and State Farm disagreed about whether she had to comply with this provision in the policy. State Farm sent her a reservation of rights letter stating she could be denied coverage for her failure to assist and cooperate. Curran sued State Farm.
State Farm answered that she wasn’t entitled to coverage because of her refusal to cooperate with scheduling the medical exam. Both filed for summary judgment. Curran argued that she didn’t refuse to submit to the exam, only asked for reasonable accommodations based on her own interests. The court granted summary judgment in favor of Curran.
Curran went to trial and obtained an award of $4,650,589. The court took a judgment against State Farm for $100,000 of this. State Farm appealed. The appellate court found the plaintiff hadn’t acted reasonably in failing to attend an exam. However, it also found that State Farm had to plead and prove a material breach, one that caused prejudice, in order to avoid liability.
The appellate court held that State Farm had failed to meet its burden. There was no evidence of prejudice because right before filing suit, the plaintiff had offered to submit to the exam. State Farm chose to defer the exam until after the court made its ruling. After the ruling, State Farm didn’t call the doctor that examined the plaintiff as a witness. The effect of Curran’s breach didn’t have consequences in connection with her claim for underinsured motorist benefits.
The appellate court certified its question to the Florida Supreme Court. State Farm argued that the plaintiff’s failure to submit to the exam was a breach of a condition precedent to her bringing suit or coverage being found. It also argued that it should have the opportunity to prove her breach resulted in actual prejudice.
The Florida Supreme Court ruled that the intermediate appellate court was right that forfeiting benefits wasn’t the automatic result of an insured’s breach of the compulsory medical examination provision. The insurer had to plead and prove actual prejudice as part of its affirmative defenses.
If you have been hurt due to another person or entity’s negligence, contact the experienced Florida personal injury attorneys at Friedman, Rodman & Frank toll-free for a free consultation at (877) 448-8585. We work hard to recover compensation from all possible sources for our clients.
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