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Tuesday, 06 August 2013 17:57

GEICO Loses PIP Dispute in Divided Florida Supreme Court

A divided Florida Supreme Court has ruled that GEICO Corp. could not require a woman to give a statement under oath as a condition of receiving injury benefits after an auto accident.

The 5-2 ruling concluded that Florida’s personal-injury-protection insurance laws did not allow the insurer to place such a requirement on plaintiff Merly Nunez and other people like her, calling it “unreasonable and unnecessary.” The majority pointed out that a primary goal of PIP, or no-fault, insurance coverage is to resolve injury claims quickly.

The ruling, written by Justice James E.C. Perry, said the Nunez case and other examples show that enforcing such conditions “clearly can and do cause delay and denial of benefits in contravention of the purpose of the PIP statute.” Joining Perry in the opinion were justices Jorge Labarga, R. Fred Lewis, Barbara Pariente and Peggy Quince.

The dissenters were Chief Justice Ricky Polston and Justice Charles Canady, who wrote that state law allowed insurers to include such a requirement—known in the industry as an “examination under oath”—in PIP policies. Canady also referred to insurance-industry arguments that such statements under oath help prevent fraud.

“The right to a ‘swift and virtually automatic’ recovery of benefits is a right properly enjoyed by those who in fact meet the legal requirements for the receipt of benefits and comply with the legal obligations of an insured,” Canady wrote. “The EUO [examination under oath] provision of the policy is simply designed to ensure that the ‘swift and virtually automatic’ payment of benefits is made only to those who are entitled to those benefits under the law.”

Florida lawmakers in 2012 revamped the state’s PIP laws and specifically included a provision that customers’ auto policies could require examinations under oath. But the Supreme Court majority said that change does not apply to cases that arose before the new laws took effect on Jan. 1 of this year.

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