Opinion ID: 1901616
Heading Depth: 1
Heading Rank: 1

Heading: facts

Text: Ruben Flores (Flores) and his son Bobby Flores were passengers in a vehicle owed by Antonio Meza (Meza) and operated by Norma Flores, the wife of Flores and mother of Bobby Flores. The vehicle was involved in an accident in which Flores sustained facial injuries upon impacting the front windshield. As a result of the accident, the Flores family, as additional insureds, filed a four-count complaint against Meza's insurer, Allstate Insurance Company (Allstate) for UM coverage. [1] The Allstate policy is a divisible automobile insurance policy with separate coverages and separate premiums charged for PIP and UM coverage. [2] The policy provides that the policy limit for PIP insurance was an aggregate total of $10,000 each person. The policy limit for UM coverage is $100,000 each person $300,000 each accident. The policy provision at issue in this case appears under the section entitled General, and provides as follows: Fraud or Misrepresentation Your policy was issued in reliance on the information you provided on your Auto Insurance Application concerning autos and persons insured by the policy. Allstate will not provide coverage for any loss which occurs in connection with any material misrepresentation, fraud, or concealment of material facts, or if any material misrepresentation or omission was made on your Auto Insurance Application. In its answer, Allstate raised affirmative defenses, including that Flores failed to use an operational and available seatbelt and that Flores perpetrated fraud and misrepresentation in his PIP claims by presenting altered physician and prescription billing statements to Allstate. Flores moved for summary judgment, arguing that Allstate's fraud and misrepresentation affirmative defense was legally insufficient as a defense to a UM claim because the fraud related only to the claim for PIP benefits. The trial court denied Flores' motion. To support its affirmative defense, Allstate presented evidence at trial that Flores, who worked in a pharmacy, submitted three claims for reimbursement under the PIP coverage for three prescription bills that Flores received at no cost from his employer. The amounts of the three bills were $5, $10 and $27.50. Allstate also presented evidence of a physician's bill that had been altered from $30 to $130 by the insertion of a 1. The jury verdict form contained special interrogatories. As to the fraud defense, the verdict contained the following question: Did the Plaintiff, RUBEN FLORES, make a material misrepresentation, false statement, commit fraud, or otherwise conceal material facts in connection with his claim against the Defendant, ALLSTATE INSURANCE COMPANY? (YES or NO). The jury checked YES. Regarding Allstate's affirmative defense that Flores failed to wear a seat belt, the jury also answered YES to a special interrogatory that there was negligence on the part of the Plaintiff, RUBEN FLORES, in failing to wear a seat belt, which was a legal cause of loss, injury or damage to RUBEN FLORES. The jury found that Flores' negligence was 100% the cause of his damages. [3] The trial court entered final judgment in favor of Allstate and taxed costs against Flores. On appeal, the Second District framed the core issue as whether evidence of Ruben Flores' fraudulent acts was sufficiently egregious to justify trial by jury with respect to whether Allstate was relieved of paying any sums under the policy. Flores, 772 So.2d at 5. In affirming the judgment for Allstate, the Second District reasoned that the law in Florida is clear that a policy provision which voids the insurance policy for misrepresentation of a material fact is given full force and effect. Id. at 6.