Many moons ago (on October 26, 2012, to be precise), I blogged about compliance with examination conditions. That blog noted conflicting views as to what is required of a policyholder under the policy’s condition for examination under oath (in the property insurance context) or compulsory medical examination (in the health, disability, or long-term care insurance contexts).
On the one hand, we had the carrier-friendly view of the Fourth District Court of Appeal – Goldman v. State Farm.1 On the other hand, we had the policyholder-friendly view of the Fifth District Court of Appeal – State Farm v. Curran.2 In my October 26, 2012, blog, I noted that the Curran court certified conflict between the Fourth DCA and Fifth DCA views for the Supreme Court of Florida’s consideration. Well, a little over two years after the Supreme Court of Florida granted review of the Fifth DCA’s certified questions, we have the Supreme Court of Florida’s ruling:
[W]e clarify the issue presented by rephrasing the certified question as follows:
When an insured breaches a compulsory medical examination provision in an uninsured motorist contract, does the insured forfeit benefits under the contract without regard to prejudice? If prejudice must be considered, who bears the burden of pleading and proving that issue?
We answer the first portion of the certified question in the negative. As to the second portion of the certified question, we hold that the insurer as the defensive party pleading an affirmative defense has the burden of pleading and proving prejudice. For the reasons explained below, we approve the [Curran] decision of the Fifth District.3
Well done, Supremes, and hurray, policyholders … a well-reasoned and just result!
1 Goldman v. State Farm Fire Gen. Ins. Co., 660 So. 2d 300 (Fla. 4th DCA 1995).
2 State Farm Mut. Auto. Ins. Co. v. Curran, 83 So. 3d 793 (Fla. 5th DCA 2011).
3 State Farm Mut. Auto. Ins. Co. v. Curran, No. SC12-157 (Fla. Mar. 13, 2014).