UNITED AUTOMOBILE INSURANCE COMPANY
v.
LFC MEDICAL CENTER, INC., ETC.
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United Automobile Insurance Company appeals summary judgment entered in favor of LFC Medical Center on an insurance dispute. The Third District Court of Appeal reversed, finding that genuine issues of material fact existed regarding the insured's breach of a policy condition requiring an examination under oath and regarding potential anticipatory breach by the insurer.
The court reversed summary judgment, holding that United presented sufficient evidence of the insured's breach of the EUO requirement and that genuine issues of material fact remained precluding summary judgment. However, the court affirmed the trial court's determination that LFC's bills were reasonable, related, and necessary, as United failed to cite specific materials creating a genuine dispute on this point.
[1] An insurer may be entitled to summary judgment if an insured fails to submit to an examination under oath as required by the policy.
[2] A genuine issue of material fact regarding anticipatory breach precludes summary judgment.
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Establishes the legal standard for post-loss policy condition breaches and shifts burden to insured once insurer proves material breach
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Join FLexlaw to unlock all legal intelligenceUnited sought to deny coverage for LFC's medical bills following an automobile-related injury claim. United alleged the insured failed to submit to a …
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Third District Court of Appeal
State of Florida
Opinion filed June 5, 2024. Not final until disposition of timely filed motion for rehearing.
________________
No. 3D22-1547 Lower Tribunal No. 16-5512 CC
________________
United Automobile Insurance Company,
Appellant,
vs.
LFC Medical Center, Inc., etc.,
Appellee.
An Appeal from the County Court for Miami-Dade County, Lawrence D. King, Judge. Cole, Scott & Kissane, P.A., and Scott A. Cole, and Francesca M. Stein, for appellant. Christian Carrazana, P.A., and Christian Carrazana, for appellee. Before FERNANDEZ, GORDO and LOBREE, JJ.
GORDO, J.
United Automobile Insurance Company (“United”) appeals an order
entering final judgment in favor of LFC Medical Center, Inc. (“LFC”). We
have jurisdiction. Fla. R. App. P. 9.030(b)(1)(A). We reverse.
United alleges the trial court erred in granting LFC’s motion for
summary judgment because: (1) the insured failed to submit to an
examination under oath (“EUO”), a condition precedent under the policy; (2)
United did not anticipatorily breach the policy; and (3) the Independent
Medical Examination Report created a genuine issue of material fact as to
whether LFC’s bills were reasonable, related and necessary. Based on the
record before us, we find the trial court erred1 in granting summary judgment
in favor of the insured as United put forward sufficient evidence that the
insured breached the policy by not attending the EUO,2 and there remained
[W]hen an insurer has alleged, as an affirmative defense to coverage, and thereafter has subsequently established, that an insured has failed to substantially comply with a contractually
genuine issues of material fact. See Fla. R. Civ. P. 1.510(a); see also
Himmel v. Avatar Prop. & Cas. Ins. Co., 257 So. 3d 488, 492 (Fla. 4th DCA
2018) (“If . . . the insured . . . provides an explanation for its noncompliance,
a fact question is presented for resolution by a jury.” (quoting Haiman v. Fed.
Ins. Co., 798 So. 2d 811, 812 (Fla. 4th DCA 2001))); Morley v. Trafalgar
Devs. of Fla., Ltd., 455 So. 2d 391, 394 (Fla. 3d DCA 1984) (noting whether
the party claiming anticipatory repudiation “was in fact ready, willing and able
to perform is a question of fact which precludes final summary adjudication
of the issue.”); Est. of Wolfe through Maass v. 224 Via Marila, LLC, 338 So. 3d 912, 917-18 (Fla. 4th DCA 2022) (holding the trial court’s conclusion on
whether there was an anticipatory breach “was a factual determination for
the trier of fact, and, . . . it was not appropriate for summary judgment, as
disputed issues of fact remain”).
Reversed and remanded for further proceedings consistent with this
opinion.
mandated post-loss obligation, prejudice to the insurer from the insured’s material breach is presumed, and the burden then shifts to the insured to show that any breach of post-loss obligations did not prejudice the insurer. See Am. Integrity Ins. Co. v. Estrada, 276 So. 3d 905, 916 (Fla. 3d DCA 2019).
Cases With Similar Vibessemantic neighbors from the corpus
Citator
Authorities Cited
- Haiman v. Fed. Ins. Co., 798 So. 2d 811 (Fla. 4th DCA 2001)
- People's Tr. Ins. Co. v. Socarras, 276 So. 3d 905 (Fla. 3d DCA 2020)
- Himmel v. Avatar Prop. & Cas. Ins. Co., 257 So. 3d 488 (Fla. 4th DCA 2018)
- Morley v. Trafalgar Developers OF Fla., Ltd., 455 So. 2d 391 (Fla. 3d DCA 1984)