NATALIE LEWIS, APPELLANT,
v.
LIBERTY MUTUAL INSURANCE COMPANY, APPELLEE

Fla. 4th DCA | 2013-09-11
No. 4D12-1554
CONNER, J., and LEVENSON, JEFFREY R., Associate Judge, concur.
121 So. 3d 1136 Florida District Court of Appeal, Fourth District (2013) Positive Treatment
Cited by 8 cases

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Synopsis

A Florida appellate court reversed a summary judgment for an insurance company that denied PIP benefits based on the insured's failure to attend an examination under oath (EUO). Following the Florida Supreme Court's decision in Nunez v. Geico, which invalidated EUO conditions for PIP benefits under Florida law, the court held that such requirements are unreasonable and contrary to statutory provisions.


Holding

The court reversed summary judgment, holding that EUO provisions as conditions precedent to PIP benefits are invalid under Florida law, consistent with Nunez v. Geico. Additionally, even absent the Nunez holding, a genuine issue of material fact existed regarding whether the insured's conditional refusal to attend the EUO was unreasonable, precluding summary judgment.


Headnotes

[1] An examination under oath provision as a condition precedent to the payment of PIP benefits is invalid under Florida law when the insured's cause of action accrued prior…

[2] An insured's failure to attend an examination under oath may present a question of fact for the jury regarding material breach of policy provisions when the insured coope…

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Key Quotes

“Nunez v. Geico General Insurance Company, 117 So.3d 388 (Fla.2013), held that a policy condition requiring an EUO was unreasonable and unnecessary under Florida law. Consistent with Nunez, we reverse.”

Establishes the primary holding and the controlling authority from the Florida Supreme Court invalidating EUO conditions for PIP benefits.

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Facts & Procedural History

Natalie Lewis was injured in an automobile accident and sought PIP and uninsured motorist benefits from Liberty Mutual. The insurer requested an EUO, …

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Opinion of the Court
WARNER, J.

WARNER, J.

The sole issue presented in this appeal is whether an examination under oath as a condition precedent to the payment of PIP benefits by an insurer is a valid policy provision, precluding recovery of benefits when the insured fails to attend an examination under oath (“EUO”). Nunez v. Geico General Insurance Company, 117 So.3d 388 (Fla.2013), held that a policy condition requiring an EUO was unreasonable and unnecessary under Florida law. Consistent with Nunez, we reverse.

*1137Appellant was injured in an automobile accident and sought both PIP benefits and uninsured motorist (“UM”) protection from appellee, Liberty Mutual, her insurer. Liberty requested that appellant appear for an EUO, to which her attorney agreed but only if it were conducted by telephone or in his office. Liberty refused and tried to reset the EUO. Appellant’s attorney continued to refuse unless the statement was taken in his office.

Appellant then filed suit for UM benefits. Liberty moved to dismiss for failure to comply with the policy provisions. While that motion was pending, appellant filed an amended complaint including a declaratory judgment count requesting a determination that the EUO was not a valid provision in the policy. Alternatively, she requested a determination that her failure to attend the EUO was reasonable. The trial court denied the motion to dismiss. Liberty answered the complaint, raising multiple affirmative defenses, and then moved for summary judgment. The trial court entered final summary judgment, finding that the EUO was a valid condition precedent to the insured’s duty to pay PIP benefits and that appellant’s failure to appear for the EUO was unreasonable.

After the trial court entered its ruling, our supreme court decided Nunez and held that an EUO provision as a condition precedent to the payment of PIP benefits was invalid and contrary to the PIP provisions of section 627.736, Florida Statutes (2009). Although the legislature had enacted an amendment to that section which permitted EUOs, that amendment was enacted after the cause of action in Nunez accrued and thus did not apply. Similarly, appellant’s cause of action accrued prior to the statutory amendment allowing EUOs. Therefore, based upon Nunez, the trial court’s final judgment must be reversed.

Even had Nunez not been decided and dispositive in this case, we would also reverse the final summary judgment, because an issue of fact remained as to whether appellant’s refusal to attend the EUO, under the conditions required by Liberty, was unreasonable. See Haiman v. Fed. Ins. Co., 798 So.2d 811, 812 (Fla. 4th DCA 2001) (where insured cooperates to some degree or provides an explanation for noncompliance with a policy provision, a fact issue exists for resolution by the jury as to whether the policy provision was materially breached).

Liberty suggests, however, that this action was not about PIP benefits but uninsured motorist benefits. Although appellant sought UM benefits through her complaint, the amended complaint also sought declaratory judgment on the PIP claim. Because the amendment was filed prior to Liberty filing its answer, appellant was entitled as a matter of course to amend her complaint, pursuant to Florida Rule of Civil Procedure 1.190(a), which allows a party to amend a pleading “as a matter of course at any time before a responsive pleading is served .... ” (emphasis added). Not only was the PIP claim part of the amended complaint, but the trial court explicitly ruled on summary judgment on the claim that the EUO was a condition precedent to payment of PIP benefits under the policy. While Liberty suggests that this was a mistake, it never sought rehearing or clarification of the order granting summary judgment.

For the foregoing reasons, we therefore reverse and remand for further proceedings.

CONNER, J., and LEVENSON, JEFFREY R., Associate Judge, concur.


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Citator

Cited By

  • Himmel v. Avatar Prop. & Cas. Ins. Co., 257 So. 3d 488 (Fla. 4th DCA 2018)
    …and/or provided an explanation for his noncompliance which in turn created a question of fact as to whether there was a willful and material breach of the EUO provision, thus precluding entry of summary judgment. See Lewis v. Liberty Mut. Ins. Co., 121 So. 3d 1136, 1136–37 (Fla. 4th DCA 2013) (whether insured’s refusal to attend EUO unless it was via telephone or at her attorney’s office constituted a willful and material breach was a fact issue precluding summary judgment based on insured’s failure to cooper…
  • Solano v. State Farm Fla. Ins. Co., 155 So. 3d 367 (Fla. 4th DCA 2014)
    …umentation, although apparently not all the documents demanded by the insurer. We said: “Whether the failure to produce documents requested is a material breach would be a question of fact for the jury.” Id.; see also Lewis v. Liberty Mut. Ins. Co., 121 So. 3d 1136, 1137 (Fla. 4th DCA 2013) (finding EUO requirement was barred by PIP statute but, even if it was not, “we would also reverse the final summary judgment, because an issue of fact remained as to whether [the insured’s] refusal to attend the EUO, under…
  • …. Ins. Co., 10 Fla. L. Weekly Supp. 865a, 865a (Fla. 11th Cir. Ct. Sept. 2, 2003) (“Whether an insured unreasonably refused to attend a scheduled IME is a factual question that should be determined by a jury.”); cf. Lewis v. Liberty Mut. Ins. Co., 121 So. 3d 1136, 1137 (Fla. 4th DCA 2013) (noting that even if reversal was not compelled by precedent, reversal of summary judgment for insurer was appropriate because issue of fact remained as to whether insured’s refusal to attend examination under oath under co…

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