Eleventh Circuit Bars Insurer’s $449K Recovery, Finding Unjust Enrichment Inapplicable Where Insurance Contract Governs

The insurer sought to recover nearly $449,000 it had paid to ophthalmologist Dr. Bernard Perez, alleging he misrepresented his disability and committed fraud. A jury initially sided with the insurer and awarded full restitution under an unjust enrichment theory. 

On appeal, however, the Eleventh Circuit reversed, holding that Florida law does not allow an unjust enrichment claim when the subject matter is governed by an express contract, such as an insurance policy. 

The ruling emphasized that the insurer could have included a clawback provision in its contract or sued Perez in tort for fraud or misrepresentation. 

This decision limits recovery avenues and underscores the need for precise policy language of a clawback provision as well as addressing fraud and misrepresentation. It also highlights the importance of asserting viable contract-based defenses and remedies from the outset. 

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