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PLAINTIFF’S Insurance – Wrongful denial of PIP benefits – Spanish-speaking claimant unable to understand request for medical examination written in English.

Broward County, FL

The plaintiff, a medical rehabilitation facility, brought this suit against the defendant, United Automobile Insurance Company, alleging wrongful denial of PIP benefits. The defendant countered that the claimant failed to meet the policy requirements by refusing to attend a mandatory medical examination. The plaintiff was granted summary judgment on the medical necessity of the treatment at issue. The plaintiff testified, through a Spanish interpreter, that he did not understand English. Evidence showed that the request for a medical examination did not contain the name of the defendant insurance carrier; but rather was sent to the claimant by a third-party vender, which scheduled the examinations. The claimant testified that he threw the notice away because he did not understand what it was, or that it was from his insurance company. Evidence showed that the claimant had previously responded when the defendant provided a telephone number for Spanish-speaking policy holders. The medical treatment at issue was approximately $________. The defendant argued that the claimant had an obligation to determine the nature of the notice sent to him. The defense maintained that the claimant breached the insurance policy by unreasonably refusing to attend the requested medical examination.The jury found that the claimant did not unreasonably refuse the medical examination, and a plaintiff’s verdict was entered. The defendant was previously granted summary judgment on the examination refusal issue, but that ruling was overturned on appeal. The plaintiff’s motion for attorney fees and costs is currently pending.

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