Personal Injury Protection Benefits (PIP): Can an Insurance Carrier Require You to Submit to an EUO to Secure PIP Benefits?

So you are seriously injured in a motor vehicle accident when your car or motorcycle is rear ended by a truck, and you put your car insurance carrier on notice.  Part of the benefits that you may be entitled to (assuming you have PIP insurance)  include your personal injury protection coverage (also known as PIP benefits), which are no fault benefits (can include a mix of lost wages and payments for medical bills) that your auto insurance carrier will provide whether you are at fault for the car accident or not.

The legislature recently amended the PIP statute in 2012, ie., section 627.736, and included a provision to include the requirement that insureds seeking benefits under the Florida Motor Vehicle No–Fault Law “comply with the terms of the policy, which include, but are not limited to, submitting to an examination under oath.” 627.736(6)(g).  For more information on the PIP statutory amendment in 2012, see my prior article on some of the relevant changes.  A majority of this amendment is effective starting January 1, 2013.

So the question becomes, what happens if your accident occurred prior to the effective date of the new statute.  Prior to this amendment, while an insurance policy may have stated that in order to secure coverage under the policy, the insured may have been required to submit to an EUO (examination under oath – an examination akin to a deposition where the carrier investigates the accident, the extent of your injuries, etc.),  the PIP statute did not have this provision requiring them to comply with the terms of their policy.  As such, prior to this amendment, if your policy required you to possibly submit to an EUO in order to secure benefit sunder your policy, did that mean that if you failed to submit to a requested EUO, that the insurance carrier could simply deny you PIP benefits under your auto policy.  According to the Florida Supreme Court, an injured person’s failure to submit to an EUO did not cancel his or hers PIP coverage under their policy in order to secure no-fault benefits.

In the case of Nunez v. Geico Gen. Ins. Co., — So.3d —-, 2013 WL 3214401 (Fla. 2013), the Florida Supreme Court answered the above question in the negative. In Nunez, an insured of Geico was injured in a car accident in September of 2008, to which she made a claim for personal injury protection benefits.  When Geico denied her claim after failing to submit to an EUO, Nunez filed suit for declaratory relief, seeking a judgment that Geico violated the 2008 version of 627.736, Florida’s PIP statute.  The Florida Supreme Court held that because Nunez’s policy with Geico was issued in 2008, her accident was in 2008, and she filed her class action complaint in 2009, and because the amendment did not take effect until 2013 and that the purpose of the no-fault statutory scheme is to provide swift and virtually automatic payment, the Florida Supreme Court ruled that EUO conditions in Nunez’s insurance policy were invalid as contrary to the terms of section 627.736 (2008).

Moral of the Story: whether you live in Miami, Fort Lauderdale, Palm Beach or any other area of Florida, should you sustain injuries in a motor vehicle accident, car accident, trucking accident, motorcycle accident, or are even walking or on a bicycle and struck by a car (ie, a pedestrian accident), and your accident occurred prior to the PIP amendment that was effective in January of 2013, you may wish to secure a PIP or injury lawyer to assist you with a potential claim for improper denial of your car insurance benefits if you have been denied personal injury protection benefits given your failure to attend an examination under oath (EUO).

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