Case Title: Custer Medical Center A/A/O Maximo Masis v. United Automobile Insurance Company

Citation: 

Docket Number: SC08-2036

State: florida

Court: Florida Supreme Court

Date: 2010-11-04T00:00:00Z

Document:
Supreme Court of Florida 
 
 
____________ 
 
No. SC08-2036 
____________ 
 
CUSTER MEDICAL CENTER a/a/o MAXIMO MASIS, 
Petitioner, 
 
vs. 
 
UNITED AUTOMOBILE INSURANCE COMPANY, 
Respondent. 
 
[November 4, 2010] 
 
PER CURIAM. 
 
Custer Medical Center seeks review of the decision of the Third District 
Court of Appeal in United Automobile Insurance Co. v. Custer Medical Center, 
990 So. 2d 633, 635 (Fla. 3d DCA 2008), on the basis that it expressly and directly 
conflicts with the decisions of this Court in Allstate Insurance Co. v. Kaklamanos, 
843 So. 2d 885 (Fla. 2003), U.S. Security Insurance Co. v. Cimino, 754 So. 2d 697 
(Fla. 2000), and Dorse v. Armstrong World Industries, Inc., 513 So. 2d 1265 (Fla. 
1987).  We have jurisdiction.  See art. V, § 3(b)(3), Fla. Const.  We quash the 
decision below and remand for reinstatement of the decision of the circuit court 
appellate division.  The Third District‟s decision misapplied the standard of review 
 
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for second-tier certiorari review and in doing so erroneously created new appellate 
jurisdiction that expressly and directly conflicts with multiple decisions involving 
various areas of Florida law.   
FACTS AND PROCEDURAL HISTORY 
On January 4, 2002, the insured, Maximo Masis, was injured in an 
automobile accident in Miami.  Masis was a passenger in a vehicle that was 
involved in a collision with a second vehicle that had failed to halt at a stop sign.  
He sought treatment from Custer Medical Center (Custer) for pain in his neck, 
shoulder, and lower back.  Masis received medical treatment at Custer from 
January 8 through March 1, 2002, for which he incurred $4,250 in charges.     
On January 8, 2002, Masis also completed and submitted an application for 
personal injury protection (PIP) benefits.  Subsequently, on January 11, 2002, a 
law firm submitted an attorney representation letter to Masis‟s insurer, United 
Automobile Insurance Company (United), which notified United that Masis would 
be making a claim for PIP benefits under his policy.  In response, United 
established a claim file.   
Upon the termination of Masis‟s treatment on March 1, 2002, Custer 
submitted a final bill of $4,250 to United which was admittedly received by United 
on March 26, 2002, according to a United internal claim register and also reflected 
on an acknowledgment of claim letter from United dated March 26, 2002.  After 
 
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all medical treatment had been completed and all the respective bills submitted, 
United sent certified letters to Masis and his counsel dated March 27, 2002, which 
notified them that United had scheduled a medical examination of Masis for April 
11, 2002, a date long after completion of both treatment and submission of all bills.  
Masis did not appear for the medical examination or answer United‟s letter.  
United sent another request on April 12, 2002, for Masis to attend a medical 
examination scheduled for April 29, 2009.  Masis also did not appear or answer 
United‟s letter.  As a result, on May 10, 2002, United suspended or denied Masis‟s 
PIP benefits, effective as of April 11, 2002.1   
                                          
 
 
1.  Although the district court of appeal mentions a letter of September 9, 
2002, that letter is related to a purported verbal examination under oath with a 
prohibition of the presence of counsel for an insured, not a medical exam.  The 
concept of a verbal examination under oath is not relevant due to the posture of this 
case and positions of the parties.  The only argument in this case at the trial court, 
circuit court, and district court of appeal was based upon medical exams and the 
failure to attend medical exams.  A purported verbal exam under oath without 
counsel in the PIP context is invalid and more restrictive than permitted by the 
statutorily mandated coverage and the terms and limitations permitted under the 
statutory provisions.  The prohibition of policy exclusions, limitations, and non-
statutory conditions on coverage controlled by statute is clear.  See Flores v. 
Allstate Ins. Co., 819 So. 2d 740, 745 (Fla. 2002) (noting that courts have an 
obligation to invalidate exclusions on coverage that are inconsistent with the 
purpose of the statute that mandates the coverage); Salas v. Liberty Mut. Fire. Ins. 
Co., 272 So. 2d 1, 5 (Fla. 1972) (recognizing that insurance coverage that is a 
creature of statute is not susceptible to the attempts of the insurer to limit or negate 
the protection afforded by the law); Mullis v. State Farm Mut. Auto. Ins. Co., 252 
So. 2d 229, 232-34 (Fla. 1971) (stating that automobile liability insurance and 
uninsured motorist coverage obtained to comply with or conform to the law cannot 
be narrowed by the insurer through exclusions and exceptions contrary to the law); 
Diaz-Hernandez v. State Farm Fire & Casualty Co., 19 So. 3d 996, 1000 (Fla. 3d 
 
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In June of 2002, Masis‟s attorney notified United that the firm had 
withdrawn from representation of Masis.  Thereafter, as Masis‟s assignee, Custer 
filed an action in the County Court of Miami-Dade County for reimbursement of 
the $1,250 in medical treatment expenses that were in excess of Masis‟s policy 
deductible.  United asserted the affirmative defense that Masis‟s failure to appear 
for the scheduled medical examination was “unreasonable” as a matter of law 
under section 627.736(7), Florida Statutes (2001).  The relevant portion of this 
statute provides:   
If a person unreasonably refuses to submit to an examination, the 
personal injury protection carrier is no longer liable for subsequent 
personal injury protection benefits. 
§ 627.736(7)(b) (emphasis supplied).  There were no claims for “subsequent” PIP 
benefits.  All treatment was completed by March 1, 2002, and all bills and claims 
for benefits for this treatment were submitted before any exams were scheduled 
and long before the purported denial date of April 12, 2002, established by United.    
                                                                                                                                        
DCA 2009) (concluding that a provision in a policy was invalid because it was 
against the public policy of the statute); Vasques v. Mercury Cas. Co., 947 So. 2d 
1265, 1269 (Fla. 5th DCA 2007) (stating that restrictions on statutorily mandated 
coverage must be carefully examined because exclusions that are inconsistent with 
the purpose of the statute are invalid) (citing Flores, 819 So. 2d at 745).  PIP 
insurance is markedly different from homeowner‟s/tenants insurance, property 
insurance, life insurance, and fire insurance, which are not subject to statutory 
parameters and are simply a matter of contract not subject to statutory 
requirements. 
 
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During the jury trial, Custer presented the testimony of (1) a person who was 
in the vehicle with Masis when the accident occurred; (2) a doctor who treated 
Masis at Custer Medical Center; (3) the corporate representative and litigation 
adjuster for United; and (4) the corporate representative and records custodian for 
Custer.  After Custer rested its case, United moved for a directed verdict without 
having presented any evidence on its affirmative defense.   
The trial court granted United‟s motion on the basis that (1) two failures to 
appear for medical examinations without excuse or objection to the notices 
constituted an unreasonable refusal to submit to the requested medical 
examination, and (2) in U. S. Security Insurance Co. v. Silva, 693 So. 2d 593 (Fla. 
3d DCA 1997), the Third District held that an insurer is not liable for subsequent 
benefits after the time of an insured‟s unreasonable refusal to appear at a medical 
examination.2  Moreover, the trial court stated that the only basis upon which 
United prevailed was Masis‟s failure to appear at a medical examination, and that 
judgment would otherwise have been rendered in favor of Custer because it had 
satisfied all the elements of its claim (i.e., reasonable, related, and necessary 
                                          
 
 
2.  The trial court attempted to apply Silva, which is not applicable to these 
facts.  Silva addressed a claim based on bills submitted only “subsequent” to a 
medical examination.  Here, it is clear that all bills were incurred and submitted 
prior to the request for a medical examination, the date of such examination, and 
the date of denial established by United.  There were no bills to submit 
“subsequent” to that date. 
 
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medical expenses).  The trial court discharged the jury in light of its ruling on the 
motion for directed verdict.  Thereafter, the trial court entered a final judgment in 
favor of United.   
Custer appealed the judgment to the Circuit Court of the Eleventh Judicial 
Circuit.  The circuit court appellate division reversed the judgment entered 
pursuant to the directed verdict and remanded for a trial on the merits by reasoning 
that 
[m]otions for directed verdict should be resolved with extreme caution 
since the granting thereof holds that one side of the case is essentially 
devoid of probative evidence.  Perry v. Red Wing Shoe Co., 597 So. 
2d 821, 822 (Fla. 3d DCA 1992).  The trial judge is authorized to 
grant such a motion only if there is no evidence or reasonable 
inferences to support the opposing position.  Id.[;] see also Sal[a]m v. 
Benmelech, 590 So. 2d 1008 (Fla. 3d DCA 1991).  The evidence must 
be considered in the light most favorable to the nonmoving party.  Id. 
 
In this case, the trial judge failed to consider the evidence in a 
light most favorable to the non-moving party.  There is no legal 
authority supporting United‟s position that failure to appear is 
“unreasonable” as a matter of law.  United claimed the affirmative 
defense that the failure to appear was unreasonable.  United therefore 
had the burden to show, by evidence, that the failure to attend the 
[medical examination] was unreasonable.  Nor does the simple 
showing of failure to appear shift the burden of proof to the Plaintiff 
to prove why the insured failed to appear. . . . Therefore, in the 
absence of evidence supporting the affirmative defense, the directed 
verdict is premature. 
 
Custer Med. Ctr. v. United Auto. Ins. Co., No. 04-520 AP, at 2-3 (Fla. 11th Cir. Ct. 
Feb. 14, 2006) (amended opinion) (emphasis supplied).   
 
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On March 1, 2006, United petitioned the Third District Court of Appeal for a 
writ of certiorari, contending that the circuit court appellate division violated 
clearly established principles of law, resulting in a miscarriage of justice.  On 
September 5, 2007, the district court issued an initial opinion that quashed the 
circuit court‟s decision based solely on the authority of Griffin v. Stonewall 
Insurance Co., 346 So. 2d 97 (Fla. 3d DCA 1977), and Goldman v. State Farm 
General Insurance Co., 660 So. 2d 300 (Fla. 4th DCA 1995).  In Griffin, the Third 
District considered the 1975 version of the PIP statute, which did not include the 
“unreasonable refusal” provision, and held that an insured‟s failure to comply with 
the condition precedent of attendance at a medical examination constituted grounds 
to enter judgment for the insurer.  See 346 So. 2d at 98.  Goldman involved a 
homeowner‟s insurance policy and the insured‟s failure to attend an examination 
under oath pursuant to the contractual terms of the policy, which has no application 
in the statutorily required coverage context.  See 660 So. 2d at 301.  The Florida 
No-Fault statute is mandatory and does not recognize such a condition.  It is 
therefore invalid and contrary to the statutory terms.  Consequently, Custer filed a 
motion for rehearing or rehearing en banc on the grounds that (1) the decision 
rested on inapplicable authority (i.e., the distinction in the earlier statute at issue in 
Griffin); (2) the district court shifted the burden to the plaintiff to disprove the 
defendant‟s affirmative defense; and (3) the district court exercised certiorari 
 
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jurisdiction despite United‟s failure to demonstrate any departure from the 
essential requirements of law.   
Thereafter, the district court ordered the parties to supplement the record 
with the trial exhibits, specifically the insurance policy, and the appendix to the 
initial brief filed in the circuit court.  In a corrected opinion, the Third District 
denied the motion for rehearing and rehearing en banc and elaborated on its basis 
for review.  See United Aut. Ins. Co. v. Custer Med. Ctr., 990 So. 2d 633, 635 (Fla. 
3d DCA 2008) (Custer II).  The Third District (1) granted the petition for writ of 
certiorari, (2) quashed the decision by the circuit court appellate division, and (3) 
remanded with directions to reinstate the directed verdict in favor of United.  See 
id.  In so holding, the Third District stated that the circuit court appellate division 
had departed from the essential requirements of law, but did not state the manner in 
which the circuit court had violated a clearly established legal principle by 
requiring United to present some proof of its affirmative defense before it could 
obtain a directed verdict in its favor on an affirmative defense.  In addition, the 
district court considered and relied upon, for the first time, a “Conditions” 
provision in the policy, which had not been advanced by the parties or analyzed in 
any prior decision or ruling in this matter.  See id. at 634. 
 
Custer invoked this Court‟s discretionary jurisdiction based on conflict 
between the decision below and this Court‟s decisions in Allstate Insurance Co. v. 
 
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Kaklamanos, 843 So. 2d 885 (Fla. 2003), U. S. Security Insurance Co. v. Cimino, 
754 So. 2d 697 (Fla. 2000), and Dorse v. Armstrong World Industries, Inc., 513 
So. 2d 1265 (Fla. 1987).     
ANALYSIS 
This Court has continually applied certain fundamental principles for the use 
of certiorari to review decisions rendered by the circuit court acting in its appellate 
capacity from the time common-law certiorari jurisdiction was first recognized in 
1855.  See, e.g., Allstate Ins. Co. v. Kaklamanos, 843 So. 2d 885 (Fla. 2003); Ivey 
v. Allstate Ins. Co., 774 So. 2d 679 (Fla. 2000); Haines City Cmty. Dev. v. Heggs, 
658 So. 2d 523 (Fla. 1995); Combs v. State, 436 So. 2d 93 (Fla. 1983); Halliday v. 
Jacksonville & Alligator Plank Rd. Co., 6 Fla. 304 (1855).  We have consistently 
observed that “[a]s a case travels up the judicial ladder, review should consistently 
become narrower, not broader.”  Haines, 658 So. 2d at 530.  Therefore, when a 
district court considers a petition for second-tier certiorari review, the “inquiry is 
limited to whether the circuit court afforded procedural due process and whether 
the circuit court applied the correct law,” or, as otherwise stated, departed from the 
essential requirements of law.  Id.; see also Kaklamanos, 843 So. 2d at 889-90.3  
The departure from the essential requirements of the law necessary for granting a 
                                          
 
 
3.  In Haines, this Court concluded that “ „applied the correct law‟ is 
synonymous with „observing the essential requirements of law.‟ ”  658 So. 2d at 
530. 
 
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writ of certiorari is something more than a simple legal error.  See Kaklamanos, 
843 So. 2d at 889 (citing Ivey, 774 So. 2d at 682).  Rather, a district court should 
exercise its discretion to grant review only when the lower tribunal has violated a 
clearly established principle of law resulting in a miscarriage of justice.  See id. 
(citing Ivey, 774 So. 2d at 682; Heggs, 658 So. 2d at 528).  In Haines City 
Community Development v. Heggs, this Court clarified and narrowed the scope of 
common law certiorari jurisdiction by clearly stating that  
[a] decision made according to the form of the law and the rules 
prescribed for rendering it, although it may be erroneous in its 
conclusion as applied to the facts, is not an illegal or irregular act or 
proceeding remedial by certiorari.   
658 So. 2d at 525 (quoting Basnet v. City of Jacksonville, 18 Fla. 523, 526-27 
(1882)).  
Furthermore, the district courts should consider the nature of the error and 
grant a petition for writ of certiorari “only when there has been a violation of a 
clearly established principle of law resulting in a miscarriage of justice.”  Combs, 
436 So. 2d at 96 (emphasis supplied).  Thus, the district court‟s exercise of its 
discretionary certiorari jurisdiction should  
depend on the court‟s assessment of the gravity of the error and the 
adequacy of other relief.  A judicious assessment by the appellate 
court will not usurp the authority of the trial judge or the role of any 
other appellate remedy, but will preserve the function of this great 
writ of review as a “backstop” to correct grievous errors that, for a 
variety of reasons, are not otherwise effectively subject to review. 
 
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Heggs, 658 So. 2d at 532 n.14 (emphasis supplied) (quoting William A. Haddad, 
The Common Law Writ of Certiorari in Florida, 29 U. Fla. L. Rev. 207, 228 
(1977)).  In other words, this Court has definitively expressed that certiorari cannot 
be used to grant a second appeal to correct the existence of mere legal error.  See, 
e.g., Ivey, 774 So. 2d at 682-83.  This is necessary because, unlike an appeal, 
common-law certiorari is an entirely discretionary exercise of jurisdiction by the 
court and is not taken as a matter of right.  See G-W Dev. Corp. v. Village of N. 
Palm Bch. Zoning Bd. of Adjustment, 317 So. 2d 828, 830 (Fla. 4th DCA 1975).  
A reviewing court on appeal may correct any and all errors below, whether 
jurisdictional, procedural, or substantive, and may modify, reverse, or remand a 
judgment.  See Haines, 658 So. 2d at 526 n.3.  In contrast, a district court cannot 
correct just any error that may have occurred below through a second-tier certiorari 
proceeding.  This proceeding is considered original in the sense that the subject-
matter of the action or proceeding before the court is not to be reinvestigated, tried, 
and determined upon the merits generally as upon appeal at law or writ of error.  
See id. at 525-26 (quoting Basnet v. City of Jacksonville, 18 Fla. 523, 527 (1882)).  
Hence, a circuit court appellate decision made according to the forms of law and 
the rules prescribed for rendering it, although it may be erroneous in its conclusion 
as to what the law is as applied to facts, is not a departure from the essential 
 
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requirements of law remediable by certiorari.  See Ivey, 774 So. 2d at 682 (quoting 
Haines City, 658 So. 2d at 525).  
The policy behind prohibiting certiorari to function as a second appeal is that 
the circuit court possesses final appellate jurisdiction in cases originating in the 
county court.  See art. V, § 5, Fla. Const.  As this Court articulated in Haines, if the 
role of certiorari were expanded to review the correctness of the circuit court‟s 
decision, it would amount to a second appeal that usurps the final appellate 
jurisdiction of the circuit court in contravention of the Florida Constitution.  See id. 
at 526 n.4.  This would deprive litigants of final judgments obtained in the circuit 
court and ignore “societal interests in ending litigation within a reasonable length 
of time and eliminating the amount of judicial labors involved in multiple appeals.”  
Id.  A more expansive review would also afford a litigant two appeals from a court 
of limited jurisdiction, while limiting a litigant to only one appeal in cases 
originating in a trial court of general jurisdiction.  See id. (citing Flash Bonded 
Storage Co. v. Ades, 12 So. 2d 164, 165 (Fla. 1943)).  
In Ivey, this Court expressed that before a district court may exercise 
certiorari jurisdiction to review a decision of a circuit court acting in its appellate 
capacity, the district court must analyze and develop “why the [relevant] circuit 
court‟s decision constituted a denial of procedural due process, application of 
incorrect law, or a miscarriage of justice.”  Ivey, 774 So. 2d at 683; see also 
 
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Kaklamanos, 843 So. 2d at 889-90 (reaffirming Ivey).  Here, a three-judge panel of 
the circuit court issued a well-reasoned, written opinion that relied on well-
established principles of law which mandate that a motion for directed verdict 
should only be granted if there is no evidence or reasonable inference to support 
the opposing position, and that the evidence must be considered in a light most 
favorable to the nonmoving party.  See Custer Med. Ctr. v. United Auto. Ins. Co., 
No. 04-520 AP, at 2-3 (Fla. 11th Cir. Ct. Feb. 14, 2006) (citing Perry v. Red Wing 
Shoe Co., 597 So. 2d 821, 822 (Fla. 3d DCA 1992)); see also Salam v. Benmelech, 
590 So. 2d 1008, 1009 (Fla. 3d DCA 1991).  The circuit court also thoroughly 
supported its analysis with appropriate reference to Florida decisions.  Cf. Ivey, 
774 So. 2d at 683.  In addition, the circuit court‟s opinion did nothing more than 
reverse a county court‟s final judgment entered following a directed verdict and 
remand for a new trial based on well-established law with regard to directed 
verdicts and burdens of proof for affirmative defenses.  Cf. Haines City 
Community Dev. v. Heggs, 647 So. 2d 855, 856 (Fla. 2d DCA 1994), approved 
658 So. 2d 523 (Fla. 1995).  Hence, the decision of the circuit court did not deprive 
the parties of their day in court, and did not foreclose United from proving its 
affirmative defense on remand.  See id.  Accordingly, to quash the decision on 
review, the Third District was required to determine and support that this is one of 
 
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“those few extreme cases where the appellate court‟s decision is so erroneous that 
justice requires that it be corrected.”  Combs, 436 So. 2d at 95. 
The Third District premised its exercise of certiorari jurisdiction on the 
assertion that the circuit court appellate division “departed from the essential 
requirements of the law.”  However, similar to its decision in Ivey, the district 
court did not supply any correct requisite analysis or sufficient rationale with 
regard to the manner in which the circuit court departed from the essential 
requirements of law in its application of the law with regard to directed verdicts.  
The Third District neither clarified what the circuit court held below nor did it 
analyze or address why this holding departed from the essential requirements of 
the law.  The district court opinion contains no determination that a denial of 
procedural due process occurred, and the district court did not express the manner 
in which the circuit court applied an incorrect principle of law or that the decision 
constituted a miscarriage of justice, “as required by this Court‟s precedents.”  Ivey, 
774 So. 2d at 683; see also Educ. Dev. Ctr., Inc. v. City of W. Palm Beach Zoning 
Bd., 541 So. 2d 106, 108-09 (Fla. 1989).   
Instead, the decision below conveys that the district court of appeal simply 
disagreed with the circuit court‟s determination and interpretation of the applicable 
law.  See Ivey, 774 So. 2d at 683; Educ. Dev. Ctr., Inc., 541 So. 2d at 108-09.  This 
disagreement is evidenced by the district court‟s reliance on clearly distinguishable 
 
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and inapposite precedent to hold that an insured‟s attendance at a medical 
examination is a condition precedent to the existence of an auto insurance policy 
that provides PIP benefits and that, consequently, the insured rather than the 
insurer has the burden of proof on this issue.  See Custer II, 990 So. 2d at 634-35.  
Logically, the circuit court could not have violated the essential requirements of 
law when that principle of law had never existed.   
In addition, the district court improperly considered and incorrectly relied on 
language in United‟s policy which was contrary to existing statutory provisions, 
had not been advanced by the parties below, and was never involved in the 
consideration of the lower tribunals in the prior proceedings.  After issuing an 
initial opinion that lacked any reference to the conditions provision in United‟s 
policy, the Third District ordered the record to be supplemented on rehearing with 
the trial transcript and evidence.  The district court specifically requested that the 
parties provide the relevant insurance policy.  The Third District then altered the 
fundamental underpinnings of its analysis to include a contractual provision which 
had not been advanced as dispositive to any issue in the proceedings below.  
Moreover, to support its analysis that attendance at a medical examination was a 
condition precedent to coverage, the district court incorrectly characterized a letter 
concerning Masis‟s failure to attend a testimonial examination under oath in 
August, not a medical exam, as referencing Masis‟s failure to attend the medical 
 
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examinations scheduled in April.  Of note, the letter does not support the Third 
District‟s condition precedent analysis because the relevant quote in the letter is 
from the policy, which designates attendance at a testimonial examination under 
oath, not a medical examination, as a condition precedent to receiving PIP benefits.  
In contrast, the medical examinations provision, which immediately 
precedes the verbal exam provision, does not contain any reference to a “condition 
precedent,” as follows:   
Proof of Claim; Medical Reports and Examinations; Payment of 
Claim Withheld. A soon as practicable, the person making claim, 
(including any assignees of the injured party) shall give to “us” 
written proof of claim, under oath.  Such person shall submit to 
mental or physical examinations at “our” expense when and as often 
as “we” may reasonably require.  A copy of the medical report shall 
be forwarded to such a person if requested in writing.  If the person 
unreasonably refuses to submit to an examination “we” will not be 
liable for subsequent personal injury protection benefits.  
 
(Emphasis supplied.)  Moreover, the letter relied upon by the Third District was 
not advanced by the parties as relevant to consideration of the circuit court‟s 
decision and is contrary to the statutory provisions of mandatory PIP coverage.   
Thus, the district court‟s actions and analysis are simply an improper de 
novo review in a “second appeal” rather than the limited review permitted on 
second-tier certiorari and incorrect in both substance and approach.  By expanding 
its scope of review, the Third District again  
created a new category of appellate review never before recognized 
under Florida law and in express and direct conflict with authority to 
 
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the contrary.  District courts have never been allowed to review 
decisions, under the guise of certiorari jurisdiction, simply because 
they are dissatisfied with the result of a decision of a circuit court 
sitting in its appellate capacity.  Certiorari relief should not be 
afforded so differently in our various appellate courts. 
Ivey, 774 So. 2d at 683.  
In sum, the Third District did not consider or set forth a sufficient correct 
legal basis and analysis with regard to the manner in which the relevant circuit 
court decision denied procedural due process or departed from the essential 
requirements of the law resulting in a miscarriage of justice, which is a 
jurisdictional prerequisite to review a circuit court‟s appellate decision through a 
petition for writ of certiorari.  Instead, the Third District merely disagreed with the 
result of the circuit court without supplying a proper and sufficient legal basis for 
second-tier certiorari review under Haines, Ivey, and Kaklamanos.  Accordingly, 
the district court misapplied the standard of review for second-tier certiorari review 
and therefore inappropriately exercised its discretionary jurisdiction.   
As in Ivey, the Third District not only “incorrectly expand[ed] the scope of 
certiorari by permitting what, in essence, amounted to a second appeal,” but also 
rendered a result that is “contrary to well established and recognized principles of 
existing PIP law” and general civil procedure.  Ivey, 774 So. 2d at 683.  
Specifically, the Third District held that attendance at a medical examination and 
testimonial exam without counsel are conditions precedent to coverage not merely 
benefits.  This is contrary to the general principles of law concerning affirmative 
 
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defenses and conditions precedent, as well as the principles underlying the PIP 
statute.   
The purpose of the no-fault statutory scheme is to “provide swift and 
virtually automatic payment so that the injured insured may get on with his life 
without undue financial interruption.”  Ivey, 774 So. 2d at 683-84 (quoting Gov‟t 
Emps. Ins. Co. v. Gonzalez, 512 So. 2d 269, 271 (Fla. 3d DCA 1987)).  To this 
end, section 627.736(4)(b) provides that PIP insurance benefits “shall be overdue if 
not paid within 30 days after the insurer is furnished written notice of the fact of a 
covered loss and of the amount of same.”  After an insurance company receives 
notice of a claim, the insurer has the opportunity to evaluate a claim through 
procedures such as a medical examination.  In pertinent part, section 627.736(7), 
Florida Statutes (2001), provides: 
(a) Whenever the mental or physical condition of an injured person 
covered by personal injury protection is material to any claim that has 
been or may be made for past or future personal injury protection 
insurance benefits, such person shall, upon the request of an insurer, 
submit to mental or physical examination by a physician or 
physicians. . . .  Personal protection insurers are authorized to include 
reasonable provisions in personal injury protection insurance policies 
for mental and physical examination of those claiming personal injury 
protection insurance benefits. . . .  
(b) . . . If a person unreasonably refuses to submit to an 
examination, the personal injury protection carrier is no longer liable 
for subsequent personal injury protection benefits. 
 
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(Emphasis supplied.)  If an insured unreasonably refuses to submit to a medical 
examination under this statute, the insurer is no longer liable for subsequent PIP 
benefits.  See De Ferrari v. Gov‟t Emps. Ins. Co., 613 So. 2d 101, 103 (Fla. 3d 
DCA 1993).  The medical reports and medical examination provision of Masis‟s 
policy tracked the statutory language but the testimonial exam without counsel 
provision did not.  Further, the Third District relied on a conditions provision in the 
personal injury protection section of the policy which is in conflict with the PIP 
statute and the medical exam provisions of both the PIP statute and the policy.   
An affirmative defense is an assertion of facts or law by the defendant that, 
if true, would avoid the action and the plaintiff is not bound to prove that the 
affirmative defense does not exist.  See Langford v. McCormick, 552 So. 2d 964, 
967 (Fla. 1st DCA 1989); see also Storchwerke, GMBH v. Mr. Thiessen‟s 
Wallpapering  Supplies, Inc., 538 So. 2d 1382, 1383 (Fla. 5th DCA 1989); Black‟s 
Law Dictionary 482 (9th ed. 2009).  The defendant has the burden of proving an 
affirmative defense.  See Hough v. Menses, 95 So. 2d 410, 412 (Fla. 1957).  
Specifically, a defending party‟s assertion that a plaintiff has failed to satisfy 
conditions precedent necessary to trigger contractual duties under an existing 
agreement is generally viewed as an affirmative defense, for which the defensive 
pleader has the burden of pleading and persuasion.  See, e.g., United Auto. Ins. Co. 
v. Rousseau, 682 So. 2d 1229, 1230 (Fla. 4th DCA 1996) (identifying “failure to 
 
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comply with conditions precedent” as an affirmative defense); United Auto Ins. 
Co. v. Zulma, 661 So. 2d 947, 948 (Fla. 4th DCA 1995) (similar); see also Fla. R. 
Civ. P. 1.120(c) (“In pleading the performance or occurrence of conditions 
precedent, it is sufficient to aver generally that all conditions precedent have been 
performed or have occurred.  A denial of performance or occurrence shall be made 
specifically and with particularity.”).  Furthermore, in Dorse v. Armstrong World 
Industries, Inc., 513 So. 2d 1265, 1269 n.5 (Fla. 1987), this Court recognized that 
the burden of proving each element of an affirmative defense rests on the party that 
asserts the defense.  See also Hough v. Menses, 95 So. 2d 410, 412 (Fla. 1957); 
Cullum v. Packo, 947 So. 2d 533, 536 (Fla. 1st DCA 2006); Braid Sales & Mktg., 
Inc. v. R & L Carriers, Inc., 838 So. 2d 590, 592 (Fla. 5th DCA 2003); Pierson v. 
State Farm Mut. Auto. Ins. Co., 621 So. 2d 576, 578 (Fla. 2d DCA 1993); 
Henderson Dev. Co. v. Gerrits, 340 So. 2d 1205, 1206 (Fla. 3d DCA 1976). 
Based on the above, under Florida law, the circuit court was correct that 
United clearly had the burden of pleading and proving its affirmative defense; 
therefore, it was required to present evidence to the fact-finder that Masis 
unreasonably failed to attend a medical examination without explanation after 
having received proper notice.  Initially, a failure to attend a medical examination 
is not automatically considered a “refusal” under the statute.  See Lamora v. United 
Auto. Ins. Co., No. 00-031 AP, 8 Fla. L. Weekly. Supp. 542, 542 (Fla. 11th Cir. Ct. 
 
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June 19, 2001) (“Assuming arguendo that her failure to appear could be 
determined as a matter of law to be a „refusal‟. . . .”).  In addition, there are 
scenarios in which an insured could reasonably refuse to submit to an examination.  
See § 627.736(7)(b), Fla. Stat. (2001); Cimino, 754 So. 2d at 701-02.  Thus, the 
failure to attend a medical examination may or may not be unreasonable depending 
upon the evidence presented by the insurer.  Additionally the status of both prior 
and subsequent benefits must be considered.  See Tindall v. Allstate Ins. Co., 472 
So. 2d 1291, 1293-94 (Fla. 2d DCA 1985) (summary judgment limited to only 
subsequent benefits).  United concedes that it has the burden of proving its 
affirmative defense, but contends that it did so through the evidence presented 
during Custer‟s case-in-chief.  United advances an incorrect principle that once it 
presented evidence of notice and the insured‟s failure to attend the medical 
examination without explanation or objection, the burden of proof allegedly shifted 
to Custer to demonstrate a reasonable reason for Masis‟s failure to attend.  Further, 
even if correct, which it is not, an unreasonable refusal would apply to only 
subsequent benefits, not the facts of this case.   
During the examination of United‟s litigation adjuster, a letter sent by 
United on May 10, 2002, to Masis‟s attorneys was placed in evidence.  The letter 
notified the attorneys that United was suspending or terminating benefits as of 
April 11, 2003, based on Masis‟s failure to attend the medical examinations 
 
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scheduled for April 11, 2002, and April 29, 2002.  This is the only evidence 
concerning the failure to attend a medical examination that was in evidence prior to 
United‟s motion for directed verdict after Custer rested.  Thus, there was no 
evidence of a “refusal,” which has been characterized as distinct from evidence 
that establishes only that an insured failed to attend a medical examination.  See 
Lamora, 8 Fla. L. Weekly. Supp. at 542.  In addition, the trial court reviewed, and 
the record contains, two notices scheduling medical examinations.  However, these 
documents were neither in evidence nor used for identification purposes during 
trial.  Accordingly, the trier of fact was not presented with affirmative evidence 
that Masis actually received notice of the scheduled medical examinations or that 
any failure was unreasonable.  Consequently, the Third District affirmed the grant 
of a directed verdict in favor of a defendant based upon an affirmative defense for 
which the defendant had not presented any evidence whatsoever and with regard to 
benefits sought in connection with medical expenses incurred and claims submitted 
prior to the medical examination at issue. 
Even if United could prove its affirmative defense through evidence 
presented during Custer‟s case-in-chief, the record does not establish that United 
presented sufficient evidence to support a directed verdict based on its affirmative 
defense.  As correctly articulated by the circuit court, motions for direct verdict 
should only be granted when there is no evidence or reasonable inference to 
 
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support the opposing position.  See Perry, 597 So. 2d at 822.  Moreover, it is the 
function of the jury to weigh and evaluate the evidence.  See id.  “Unless the 
evidence as a whole with all reasonable deductions to be drawn therefrom points to 
only one possible conclusion, the trial judge is not warranted in withdrawing the 
case from the jury and substituting her own evaluation of the weight of the 
evidence.”  Id.  As the movant, United had the burden of demonstrating the 
absence of any material issue of fact.  See Lamora, 8 Fla. L. Weekly Supp. 542 
(reversing directed verdict that was based solely on the trial court‟s determination 
that an insured‟s failure to appear to two scheduled medical examinations 
constituted an unreasonable refusal as a matter of law).  In Lamora, the circuit 
court held that the reasonableness of an insured‟s conduct is a question of fact for 
the jury, not a question of law for the court.  See id.; see also Montero v. Oak Cas. 
Ins. Co., Nos. 99-435 AP & 00-008 AP, 8 Fla. L. Weekly Supp. 601, (Fla. 11th 
Cir. Ct. July 24, 2001) (holding that where the insured presented substantial 
evidence from which the jury could have concluded that he had not received 
notification of the medical examination, and therefore did not unreasonably fail to 
attend, it was error for “the trial judge to „sit as a seventh juror‟ and set aside the 
jury‟s verdict”) (quoting Perry, 597 So. 2d at 822).  Consequently, the directed 
verdict was premature because United had not demonstrated the absence of any 
 
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material issue of fact for the jury (i.e., the reasonableness of the failure or 
application to prior benefits).     
Lastly, the Third District held that an insured‟s attendance at a medical 
examination is a condition precedent to the existence of an auto insurance policy 
that provides PIP benefits and that, consequently, the insured rather than the 
insurer has the burden of proof on this issue.  To support this holding, the district 
court misapplied clearly distinguishable and inapposite precedent.  For example, 
the primary case that the Third District relied upon below was Griffin v. American 
General Life & Accident Insurance Co., 752 So. 2d 621 (Fla. 2d DCA 1999), 
which involved a life insurance policy.  The context of life insurance is materially 
distinguishable from the PIP context because medical examinations are actually 
conditions precedent to the issuance and existence of life insurance policies.  In 
other words, a life insurer may not enter into an insurance contract with a 
prospective insured until the insured submits to a medical examination to explore 
whether there exists any disqualifying pre-existing medical conditions.   
In contrast, medical examinations in the context of PIP benefits are not 
scheduled prior to the existence of a policy or prior to an injury but instead occur 
only after an insured has sustained an accident and submits notice to an insurer 
after a policy has been issued and injuries have been sustained.  Attendance at a 
medical examination may be a condition precedent to the payment of subsequent 
 
- 25 - 
PIP benefits or, perhaps more accurately, an “unreasonable” failure to attend a 
requested medical examination may be a condition subsequent that divests the 
insured‟s right to receive further subsequent PIP benefits.  See U.S. Sec. Ins. Co. v. 
Cimino, 754 So. 2d 697, 699, 701-02 (Fla. 2000) (indicating that attendance at a 
PIP medical examination is a condition precedent to the receipt of subsequent PIP 
benefits and that section 627.736 contemplates “a situation . . . where the insured 
„reasonably refuses to submit‟ ” to a medical examination).  The plain text of 
section 627.736(7)(b), Florida Statutes (2001), supports the analysis presented in 
Cimino:  “If a person unreasonably refuses to submit to an examination, the [PIP] 
carrier is no longer liable for subsequent [PIP] benefits.”  § 627.736(7)(b), Fla. 
Stat. (2001) (emphasis supplied).  Accordingly, when parties to an auto insurance 
policy dispute attendance at a medical examination, neither the insurer nor the 
insured is contesting the policy‟s existence, as the Third District incorrectly stated 
in its decision below.  See Custer II, 990 So. 2d at 635 (quoting and relying upon 
Griffin, 752 So. 2d at 623).  To the contrary, these parties are simply in a dispute 
with regard to the insured‟s continued right to receive subsequent PIP benefits 
under an existing insurance policy. 
 
In addition, United Automobile Insurance Co. v. Zulma, 661 So. 2d 947 
(Fla. 4th DCA 1995), and De Ferrari v. Government Employees Ins. Co., 613 So. 
2d 101 (Fla. 3d DCA 1993), which the Third District relied upon below, do not 
 
- 26 - 
support the decision in Custer II.  First, in Zulma, the Fourth District stated that 
attendance at a medical examination is a condition precedent to the receipt of 
subsequent PIP coverage or benefits (not a condition precedent to the policy‟s 
existence) and that pleading the failure to attend a PIP medical examination is an 
affirmative defense, which the defensive pleader must establish if the case 
progresses to trial.  See 661 So. 2d at 948-49.  Interestingly, United was also the 
insurer in Zulma and, in that case, this same insurer conceded that under section 
627.736(7), Florida Statutes, “[the insurer] would have to prove that [the insured] 
unreasonably refused to submit to an examination,” which is contrary to the 
position later adopted by the Third District in Custer II.  See Zulma, 661 So. 2d at 
948.  Second, De Ferrari is inapposite because in that decision (a) the district court 
expressly limited its holding to “uninsured motorist benefits,” and did not address 
PIP coverage, (b) the decision involved a summary judgment based upon 
undisputed facts, not a directed verdict entered immediately following the 
plaintiff‟s case, and (c) the insurer pled the unreasonable failure to attend a medical 
examination as an affirmative defense (not as a condition precedent to the policy‟s 
existence).  See 613 So. 2d at 102-03. 
Lastly, Cimino does not support the Third District‟s assertion in Custer II 
that attendance at a medical examination is a condition precedent to the existence 
of an auto insurance policy.  See Custer II, 990 So. 2d at 635 (quoting and relying 
 
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upon Griffin, 752 So. 2d at 623).  First, Cimino primarily established that an 
insured was entitled to have counsel present and a recording made during a PIP 
medical exam.  Second, Cimino established that attendance at a medical 
examination is a condition precedent to the receipt of only subsequent PIP benefits 
under an existing auto insurance policy or, perhaps more accurately, that the failure 
to “reasonably” attend a requested medical examination is a condition subsequent, 
which divests the insured of the right to receive subsequent PIP benefits.  See 754 
So. 2d at 701-02.   
In Tindall v. Allstate Ins. Co., 472 So. 2d 1291, 1293 (Fla. 2d DCA 1985), 
the district court reasoned that an unreasonable refusal of a claimant to submit to 
an examination would relieve the insurer only of future liability for PIP benefits, 
not medical expenses already incurred.  The court in Tindall specifically reversed a 
summary judgment in favor of an insurer and ordered that the trial court consider 
the benefits due before the failure to appear for a requested medical exam.  The 
failure to attend impacted only medical expenses incurred after the date of the 
requested exam.  Thus, contrary to the Third District‟s analysis in Custer II, 
Tindall and Cimino establish under a different statutory provision the principles 
that (1) because an insured may reasonably refuse to attend a medical examination, 
a mere allegation or demonstration of simple failure to attend is insufficient to 
prove that an insured unreasonably refused to submit to the medical examination, 
 
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and (2) attendance at a medical examination is not a condition precedent to the 
payment of benefits for prior antecedent PIP benefits under an existing auto 
insurance policy.  More importantly, Cimino is completely inapplicable to the 
circumstances of the decision below because Cimino considered the requirements 
for attendance at a medical examination when the  
insured is claiming an entitlement to continued benefits and the 
insurer is questioning the necessity for same.  In order to continue 
receiving benefits the insured must comply with the requirements of 
the insurance contract and section 627.736.  The insured is required to 
comply with a PIP examination in order to continue to receive the 
contractual benefits. 
752 So. 2d at 701 (emphasis supplied).  Here, Custer sought reimbursement for 
medical treatment that had already been completed and claims submitted before 
United requested a medical examination.  Moreover, the medical examination was 
scheduled for a date long after completion of treatment and submission of all bills.  
Thus, this is not in any way analogous to the factual circumstances of Cimino 
because the claim in the present case did not seek continued benefits, but rather 
benefits related to previously completed services and claims submitted.  
Accordingly, the district court relied on inapposite and distinguishable 
authority to incorrectly hold that an insured‟s attendance at a medical examination 
is a condition precedent to the existence of an auto insurance policy that provides 
PIP benefits and that, consequently, the insured rather than the insurer had the 
burden of proof on this issue.  In addition, the evidence does not establish that 
 
- 29 - 
United proved its affirmative defense, and consequently, United failed to establish 
that no material fact existed as to its affirmative defense, which was necessary to 
support a directed verdict on that defense.4  The circuit court in its appellate 
capacity afforded due process, applied the correct law, did not depart from the 
essential requirements of the law, and was eminently correct in the decision 
rendered.   
CONCLUSION 
Accordingly, we quash the decision below and remand for reinstatement of 
the circuit court‟s decision.   
 
It is so ordered.  
PARIENTE, LEWIS, QUINCE, LABARGA, and PERRY, JJ., concur. 
POLSTON, J., dissents with an opinion, in which CANADY, C.J., concurs. 
 
NOT FINAL UNTIL TIME EXPIRES TO FILE REHEARING MOTION, AND 
IF FILED, DETERMINED. 
 
POLSTON, J., dissenting. 
 
 
I would not exercise jurisdiction. 
 
CANADY, C.J., concurs. 
                                          
 
 
4.  The parties advance multiple arguments concerning factual issues and the 
underlying merits of this action.  However, the trial court is in the best position to 
determine the underlying merits during a new trial.  See Applegate v. Barnett Bank 
of Tallahassee, 377 So. 2d 1150, 1152 (Fla. 1979) (“When there are issues of fact 
the appellant necessarily asks the reviewing court to draw conclusions about the 
evidence.  Without a record of the trial proceedings, the appellate court can not 
properly resolve the underlying factual issues so as to conclude that the trial court's 
judgment is not supported by the evidence or by an alternative theory.”).   
 
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Application for Review of the Decision of the District Court of Appeal - Direct 
Conflict of Decisions 
 
 
Third District - Case No. 3D06-458 
 
 
(Dade County) 
 
Marlene S. Reiss, Miami, Florida, 
 
 
for Petitioner 
 
Michael J. Neimand, Miami, Florida, 
 
 
for Respondent