After a car accident, many people rely on Personal Injury Protection (PIP) benefits from their auto insurance to help pay for medical treatment. Those benefits can flow to healthcare providers who treat the injured person and take an assignment of the claim.
But auto policies often include conditions that must be met before benefits are paid. One common condition is that the insured person sit for an examination under oath — a formal, recorded questioning by the insurer. When that step is skipped, questions arise about whether the benefits can still be collected.
That is the backdrop for Feijoo v. Infinity Indemnity Insurance Company, a recent decision from Florida’s Third District Court of Appeal.
Key Takeaway
Under Florida law, submitting to a properly noticed examination under oath can be a condition that must be met before PIP benefits are owed, and the court affirmed the ruling against the provider seeking those benefits.
What was this case about?
A medical provider sought PIP benefits as the assignee of an injured person’s claim against the insurer. In plain terms, the provider stepped into the patient’s shoes to pursue payment for treatment.
The trial court ruled in the insurer’s favor, and the provider appealed to the Third District Court of Appeal.
What is an examination under oath, and why did it matter?
An examination under oath is a policy requirement that lets the insurer question the insured under oath about the claim. Florida law addresses this obligation in section 627.736(6)(g), Florida Statutes, as part of the PIP framework.
The court pointed to precedent holding that failing to submit to a properly noticed examination under oath, in line with the policy and that statute, can bar receipt of PIP benefits.
Does the insurer have to prove it was harmed?
The court’s cited authority explains that when the examination under oath is treated as a condition precedent to receiving PIP benefits, the insurer does not have to prove prejudice as part of that defense.
Related precedent also describes how, when an insured fails to substantially comply with a required post-loss obligation, prejudice to the insurer is presumed, shifting the burden to the insured to show no prejudice resulted.
Condition precedent, in plain terms
A condition precedent is a step that generally must happen before a duty — here, paying benefits — is triggered. When a step is treated this way, the analysis can focus on whether the step was completed, not on whether skipping it caused harm.
What did the court decide?
The Third District affirmed the trial court’s decision. The court issued a brief opinion resting on prior decisions rather than writing an extended analysis.
The cited authority also addressed a related point: acknowledging coverage and issuing payment does not necessarily waive the defense that the insured failed to comply with the post-loss obligation of an examination under oath.
Why does this matter to people relying on PIP?
This decision illustrates how policy conditions and statutory requirements can affect whether PIP benefits are ultimately paid. It also shows that a provider taking an assignment may face the same conditions the insured would have faced.
Because the ruling turned on the specific facts, policy language, and precedent involved, it is an explanation of how these rules have been applied — not a prediction about any other claim.
Disclaimer: This post is for general information only, is not legal advice, does not create an attorney-client relationship, and does not predict or guarantee any result. The hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before deciding, ask for free written information about the lawyer’s qualifications and experience.