Court Hears PIP Claim Case

Dec 4, 2012

The Florida Supreme Court is deciding whether insurance companies can require policy holders to be questioned under oath in order to receive benefits from a Personal Injury Protection or PIP claim.The 11th U.S. circuit Court of Appeals has asked the state court whether the practice is allowed under Florida law.

Florida has had some trouble with Personal Injury Protection or PIP auto insurance fraud, which has lead to a number of efforts for cracking down on the issue. That’s why Florida Supreme Court Justice Charles Canady said it makes sense that an insurer might want to question a policy holder who files a PIP claim.

“There’s a lot of talk here in the case law about all the fraud connected with PIP claims and I think you’d have to be from other planet not to be aware of that. And it just seems to be that it would be a very strange thing for us to say that an insurer cannot take a step such as this to help prevent the fraud that is rife in this system,” Canady said.

But the lawyer for the appellant, Juan Montes, said the question isn’t whether the insurance company can ask policy holders to answer questions under oath, but whether that can be what’s called a condition precedent, meaning if the policy holder refuses to show up, they lose their right to get PIP benefits. The case arose from a class-action lawsuit against Geico, but revolves around one woman, who Montes says was willing to show up for Geico’s questioning. Geico sent the woman a time asking her to come for an examination under oath, but she asked the company to reschedule.

“ They ignored the letter. Sent another request for a different date where they chose the date, time, everything. They were sent another letter by the attorney again that said again we’re requesting that you reset it for another time that’s mutually convenient. They said, ‘we’re not paying PIP benefits,’” Montes said.

And that’s something that Justice Barbara Pariente said could have some far reaching consequences.

I mean it’s a big deal, because if it’s a  $100 bill and you make a decision, listen, I’m not getting, I’m sick, I’m still aching from this accident, I’m not going to this office. I need to go when I’m a little stronger. But if you say you don’t get out of bed and go you lose all $10,000 it’s a pretty significant forfeiture,” Pariente said.

The lawyer for Geico said she’s not certain what would happen in a case like that, although she didsay she suspects Geico  might allow a person to file another claim even if their first one had been denied because the person hadn’t shown up for the examination. There is no deadline for when the court must rule on the issue.

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