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CMEs and Insurance Coverage

Posted in Car Accident Law,Insurance Law,News,Personal Injury on April 7, 2014

According to the state Supreme Court, a car accident victim does not automatically forfeit insurance coverage or their right to policy payouts if they refuse to submit to a medical exam, personal injury lawyers in Fort Lauderdale report. In a recently settled court case, the Supreme Court justices determined whether a woman who refused to comply with a policy provision should give up her benefits provided by that policy after her car accident.  

In the case in question, State Farm Mutual Ins. Co. v. Curran, the woman who had been injured in a car accident reached a settlement with the other driver, who was responsible for the accident, and tried to procure her $100,000 underinsured motorist policy limit, provided through State Farm Insurance. The policy contained a stipulation that the woman had to visit her doctor or another physician as often as the insurer requested, within reason, to validate the extent of her injuries and the damage caused by the car accident. The policy went out to deny the woman access to any action against her insurance company until she complied with all terms, including the required doctors’ visits. 

In processing the victim’s claim, the insurance company tried to set up a compulsory medical examination (CME) for the woman, but she refused, and sent the company a reservation of rights letter. After State Farm did not provide the woman her insurance money, she filed a lawsuit against the company, in a court case that went back and forth between districts and appellate judges. Initially, a trial court ruled in favor of the woman, and awarded her more than $4.5 million in damages. 

When State Farm appealed the first decision, the Fifth District discovered that the woman had seen a doctor after the accident, although she waited to do so until after the trial court had made their ruling in her favor. The timeframe in which the examination was requested and was actually completed did not affect the validity of the examination, the Fifth District court ruled and turned the case over to the Florida Supreme Court. Although the judges were not in unanimous agreement, the final verdict returned in the woman’s favor. 

According to the state Supreme Court, submission to a CME is not a required step in seeking underinsured motorist coverage, and refusing to do so does not mean the injured party is immediately denied coverage or policy payout. The uninsured motorist statute does not authorize CMEs as a condition, personal injury attorneys in Florida say, and only an unreasonable refusal could be considered as a potential condition for forfeiting policy coverage. In this case, the Court found that the victim was not unreasonable in choosing not to see a doctor. 

If you are injured by another driver in a car accident, make sure that your insurance company is doing the most for you, rather than working against you. Contact a personal injury attorney at the Law Offices of David I Fuchs, a Fort Lauderdale-based firm, to discuss your accident, insurance coverage and policies, and legal options today.