FPCA Auto Division: Supreme Court Opinion May Dramatically Impact PIP Carriers
Nov 10, 2010
PRIVILEGED & CONFIDENTIAL – ATTORNEY/CLIENT COMMUNICATION
ATTORNEY WORK PRODUCT
As you may already be aware, the Florida Supreme Court issued a decision in Custer Medical Center v. UAIC last week that may have a significant impact on PIP insurers in the State. The language of the opinion may be interpreted to mean that:
- PIP policy provisions that do not directly mirror the PIP statutes may be unenforceable.
- Unless otherwise provided by statute, a PIP carrier may not deny payment of medical expenses incurred and submitted by the insured prior to the date of a scheduled independent medical exam (IME), even if an insured does not attend the IME.
- Unless otherwise provided by statute, a PIP carrier may only deny payment of an insured’s medical expenses incurred and submitted after the date of the IME if the carrier can affirmatively prove the unreasonableness of an insured’s failure to attend an IME. Thus, the burden of proving the unreasonableness of the insured’s action/non-action rests with the insurer.
- Denial of benefits for an insured’s failure to submit to an examination under oath without counsel (EUO) may no longer be permissible, as the Court points out that EUO’s are not expressly permitted under the PIP statutes.
Attached for your review is an analysis that we have prepared to better help you understand the potential ramifications of the Custer decision. We encourage you to read the enclosed; however, ask that you refrain from forwarding the document outside of your organization, as it is privileged and confidential.
