Those injured in vehicle crashes with uninsured or underinsured motorists could be required by their own insurer, under underinsured motorist coverage, to submit to a “compulsory medical exam.”
While the stated purpose is to verify the nature and extent of a plaintiff’s injuries, the insurer’s true purpose is always to minimize their own liability. Miami car accident lawyers know courts have imposed strict standards for the scope of these exams, and you should seek the counsel of an attorney before submitting to one.
When an insurer’s requests in this regard go beyond what may be fair or reasonable, you are entitled to object and ask for certain limitations. Recently, the Florida Supreme Court held in State Farm v. Curran that insurers could not deny coverage based on the procedure under which a compulsory medical exam was requested. Historically, insurers have indicated that when an insured making a claim refuses to submit to such an exam, he or she has violated the provisions of the contract and as a result, forfeited the right to coverage.
But in the Curran case, the court ruled the insurer failed to prove the injured woman violated any provision of the auto insurance contract by refusing to submit to an exam.
Even more recently, that same logic was applied by Florida’s 2nd DCA in Bush v. State Farm. According to the case file, the plaintiff was rear-ended by another vehicle and sought uninsured/underinsured motorist benefits under her policy. The claim was denied, and the plaintiff sued. Specifically, she wanted to be reimbursed for medical expenses accrued from her orthopedic injuries.
The insurer then served her with a notice of exam, and supplied her with the date, time, location and surgeon who would conduct the exam. The plaintiff objected to the notice, and asked for a number of protections. The insurer refused to agree to her demands.
The insured did not appear for the exam. Based on this, the insurer filed a defense of “no coverage” in the litigation, arguing that because she breached the terms of the policy, she gave up her right to coverage.
The trial court issued summary judgment in favor of the defendant insurer.
The injured woman appealed, arguing she had a right to object to the insurer’s notice of exam under Florida’s Rule of Civil Procedure 1.360, and that the insurer had the burden of seeking a hearing in order to compel an exam. Further, she asserted the insurer was not prejudiced by the delay caused by her objections.
The insurer countered that even if it was required to show prejudice, it didn’t matter because her refusal to submit to the exam breached the terms of the contract, which permitted a reasonable request for medical examination without conflict or litigation.
While this case was pending, the state supreme court issued its decision in Curran. Essentially, the court indicated that refusal to submit to an exam for collection of UM coverage is a post-loss obligation of the injured party – not a precondition to coverage. That means the insurer can still argue refusal was prejudicial to its case, but it bears the burden of proof, and it can’t simply deny coverage on these grounds.
It is common for insurers to throw up multiple roadblocks in an effort to deny claims, even those that are clearly legitimate. Having an attorney who is knowledgeable about the required tests and treatments to which are you are entitled and required to undergo – and who should pay for them – is key to a successful claim.
If you have been the victim of a Miami car accident, contact the Law Offices of Jose M. Francisco.
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