Background
Manuel V. Feijoo, M.D., P.A., as assignee of Roberto Gonzalez, pursued a claim against Infinity Indemnity Insurance Company arising from personal-injury-protection benefits. The appeal came from the County Court for Miami-Dade County.
The Third District’s brief per curiam opinion does not describe the underlying treatment, the amount claimed, or the county court’s reasoning. Its cited authorities show that the dispute concerned an insured’s failure to comply with an examination-under-oath requirement and the effect of that failure on entitlement to PIP benefits.
The Court’s Holding
The Third District affirmed the county court’s judgment without further factual analysis. Relying on Infinity Auto Insurance Co. v. Miami Open MRI, LLC, the court indicated that failure to attend a properly noticed examination under oath required by the policy’s PIP endorsement and section 627.736(6)(g), Florida Statutes, bars receipt of benefits because attendance is a condition precedent. Under that authority, the insurer need not separately prove prejudice.
The court also cited decisions holding that a material failure to comply with a contractual post-loss obligation creates a presumption of prejudice, which the insured must rebut, and that an insurer does not waive an examination-under-oath defense merely by acknowledging coverage and issuing a payment.
Key Takeaways
- Failure to attend a properly noticed examination under oath may bar recovery of PIP benefits.
- When the examination is a condition precedent under the statute and policy, the insurer need not prove prejudice as an element of its defense.
- Acknowledging coverage or making a payment does not necessarily waive a defense based on failure to satisfy an examination-under-oath obligation.
Why It Matters
The decision reinforces the Third District’s treatment of examination-under-oath requirements as enforceable prerequisites to PIP recovery. Medical providers pursuing assigned PIP claims may therefore be bound by the insured’s failure to satisfy that obligation.
Although the opinion is summary and supplies few case-specific facts, its affirmance confirms that an insurer may rely on noncompliance with an examination-under-oath requirement without showing separate prejudice under the cited PIP precedent.