In a blow to the insurance industry, a divided Florida Supreme Court on Thursday ruled that Geico could not require a woman to give a statement under oath as a condition of receiving injury benefits after an auto accident, reports Jim Saunders of the News Service of Florida.
The 5-2 ruling found that Florida’s personal-injury protection laws in the past 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 goal of the PIP, or no-fault, system 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 the 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 that 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 Jan. 1, 2013.
The Supreme Court opinion said examinations under oath typically involve insurance adjusters or attorneys questioning people who have been involved in accidents about the claims or other factors that might have a bearing on coverage.
As a measure of the industry interest in the issue, organizations such as the Property Casualty Insurers Association of America and the Florida Insurance Council and Allstate Insurance Co. signed onto briefs in the case. One of the briefs says that Allstate and members of the Property Casualty Insurers Association of America have “serious interests that would be affected by this decision because it would apply to a significant volume of claims for PIP coverage.”
Nunez, who had a policy with Geico, was injured in a September 2008 car accident and alleged she was denied coverage because she failed to attend the examination under oath, according to court records. She filed a class-action lawsuit in 2009.
A federal district judge granted Geico’s request to dismiss the case, prompting an appeal to the 11th U.S. Circuit Court of Appeals in Atlanta. But the appeals court last year said Florida law was unclear and asked the state Supreme Court to clarify the issue.