UNIVERSAL MEDICAL CENTER OF SOUTH FLORIDA, A FLORIDA CORPORATION, AND ADVANCED DIAGNOSTIC TESTING, INC., APPELLANTS,
v.
FORTUNE INSURANCE COMPANY, APPELLEE

Fla. 3d DCA | 2000-05-03
No. 3D98-3294
Before GERSTEN, GODERICH and SHEVIN, JJ.
761 So. 2d 386 Florida District Court of Appeal, Third District (2000) Caution
Cited by 3 cases

AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.

Synopsis

Universal Medical Center and Advanced Diagnostic Testing, assignees of PIP benefits, appealed a judgment in favor of Fortune Insurance that denied benefits based on alleged unreasonable refusal to submit to an independent medical examination. The court reversed, holding that there was no competent substantial evidence that the insured unreasonably refused the IME where the insured's counsel requested cancellation and the insurer failed to respond timely.


Holding

There is no competent substantial evidence that the insured unreasonably refused to attend the IME. The insured sought to cancel the examination, and the insurer failed to respond timely to that request, which does not constitute a refusal to submit to examination.


Headnotes

[1] An insurer cannot deny benefits based on an insured's failure to attend an independent medical examination when the insurer fails to respond timely to the insured's reque…

[2] An insured's request to cancel an independent medical examination does not constitute an unreasonable refusal to submit to the examination.

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Key Quotes

“There is no competent substantial evidence that the insured unreasonably refused to attend his first scheduled IME.”

States the core holding that reversal is required because the record lacks evidence of unreasonable refusal.

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Facts & Procedural History

The insured's counsel requested that Fortune cancel a scheduled May 10, 1995 independent medical examination (IME) because the insured had finished tr…

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Opinion of the Court
SHEVIN, Judge.

SHEVIN, Judge.

Universal Medical Center of South Florida and Advanced Diagnostic Testing, Inc., assignees of an insured’s personal injury protection [PIP] benefits, appeal a final judgment in favor of Fortune Insurance Co. We reverse.

Assignees sought payment from Fortune for its insured’s medical expenses. Fortune refused to pay the benefits asserting that the insured breached the policy by unreasonably refusing to submit to an independent medical examination [IME], Following a bench trial, the court entered judgment in Fortune’s favor, finding that the insured unreasonably refused to attend an IME and denying assignees’ request to compel Fortune to arbitrate the claims. We agree with assignees’ contention that the judgment must be reversed: There is no competent substantial evidence that the insured unreasonably refused to attend his first scheduled IME.

It is undisputed that insured’s counsel requested that Fortune cancel the May 10, 1995, IME because the insured had finished treatment. Fortune did not respond to that letter until the date of the examination, and insured’s counsel did not receive notification of insurer’s refusal to cancel timely.1 Under these circumstances, there is no evidence of a refusal to submit to the examination. Instead, insured sought to cancel the IME, and insurer failed to respond timely to that request.

Fortune’s reliance on U.S. Sec. Ins. Co. v. Silva, 693 So. 2d 593 (Fla. 3d DCA), review denied, 700 So. 2d 687 (Fla.1997), is misplaced. Silva is readily distinguishable from this case: it does not address the issue whether an insured’s request to cancel an IME was an unreasonable refusal; the insurer in Silva responded promptly to insured’s notifications concerning the IME’s; and the insurer clearly informed insured that failure to submit to the IME would result in canceled benefits. In contrast, Fortune did not promptly respond to insured’s first and only request to cancel the IME, and Fortune failed to notify the insured timely that it would not cancel the IME, or to clearly inform insured that failure to submit to the IME would result in canceled benefits.

In addition, the cases relied on by the insurer to establish that insured refused to attend are distinguishable; in the cited cases the insured either expressly refused to attend or failed to attend without explanation. See U.S. Sec. Ins. Co. v. Silva, 693 So. 2d at 593(insured failed to appear for third scheduled IME without explanation); De Ferrari v. Government Employees Ins. Co., 613 So. 2d 101 (Fla. 3d DCA)(insured expressly refused to attend IME on objection to examining doctor’s specialty), review denied, 620 So. 2d 760 (Fla.1993); Allstate Ins. Co. v. Graham, 541 So. 2d 160 (Fla. 2d DCA 1989)(insured refused to attend IME on advice of counsel after objection to examining doctor); Tindall v. Allstate Ins. Co., 472 So. 2d 1291 (Fla. 2d DCA 1985)(insured refused to attend based on concern whether insurer would pay benefits), review denied, 484 So. 2d 10 (Fla.1986); Griffin v. Stonewall Ins. Co., 346 So. 2d 97 (Fla. 3d DCA 1977)(insured refused to be examined without reason or excuse). Cf. U.S. Sec. Ins. Co. v. Cimino, 754 So. 2d 697 (Fla.2000)(court permitted insured to condition IME upon presence of counsel, stating that use of term ‘unreasonably refuses to submit’ envisions scenarios where insured’s refusal may be reasonable). Because the record does not demonstrate that insured unreasonably re fused to attend an IME, we reverse the judgment and remand for further proceedings. See Nationwide Mut. Fire Ins. Co. v. Pinnacle Med., Inc., 753 So. 2d 55 (Fla.2000).

Reversed and remanded.

. The trial court found that the insurer's response to counsel's letter was untimely.


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Citator

Cited By

  • United Auto. INS. Co. v. Custer Med. Ctr. (, 990 So. 2d 633 (Fla. 3d DCA 2008)
    …tments automatically forfeits PIP coverage, the panel is deleting the word “unreasonable” from the statute. In fact, the panel opinion ignores contrary precedent from our Court. In Universal Medical Center of South Florida v. Fortune Insurance Co., 761 So. 2d 386 (Fla. 3d DCA 2000), we reversed a final judgment in favor of an insurer after a bench trial on the same issue, where the trial court found that the insured had unreasonably refused to attend a medical examination. The only distinction between our ca…
  • …unsel received valid notice via certified mail, it is not a reasonable excuse for non-attendance if counsel did not tell the claimant, just the same as would be an unexplained failure to attend.”); Universal Med. Ctr. of S. Fla. v. Fortune Ins. Co., 761 So. 2d 386 (Fla. 3d DCA 2000) (reversing judgment in favor of insurer and holding there was no substantial competent evidence that insured unreasonably refused to attend IME where it was undisputed insurer did not promptly respond to insured’s first and only…

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