10 Fla. L. Weekly Supp. 53a
Insurance — Standing — Assignment — Validity
CHIROMED CHIROPRACTIC CENTER (Arlena Ottinger), Plaintiff, vs. STATE FARM AUTOMOBILE INSURANCE CO., Defendant. County Court, 13th Judicial Circuit in and for Hillsborough County. Case No. 2001-22257 CC. Division H. October 30, 2002. Cheryl K. Thomas, Judge. Counsel: Andrew D. Wyman, Marks & Fleischer, P.A., Ft. Lauderdale. Charles S. Spinner, Jr.
ORDER ON DEFENDANT’S AMENDEDMOTION FOR SUMMARY JUDGMENT
THIS CAUSE having come before the Court for a hearing on Defendant’s Amended Motion for Summary Judgment on August 14, 2002, and the Court having heard the argument of counsel and being fully otherwise advised in the premises, it is hereby
ORDERED AND ADJUDGED as follows:
1. The Court finds that Exhibit “A”* of Defendant’s Motion for Summary Judgment is a valid assignment of benefits;
2. The Court further finds that based on Exhibit “A” of Defendant’s Motion for Summary Judgment, that Plaintiff has standing in this action;
3. Based on the foregoing, Defendant’s Motion for Summary Judgment is hereby denied.
__________________
*[Editor’s note: Although the Assignment of Benefits document was not made part of the Order, it is included below for informational purposes.]Assignment of Benefits/Authorization ofDirect Payment to Doctor
“I irrevocably assign to CHIROMED CHIROPRACTIC, INC. to the extent of any services rendered to me by CHIROMED CHIROPRACTIC, INC., the proceeds of any settlement or judgment resulting from the exercise by myself of any rights of recovery I have against any person or organization legally responsible for the bodily injury for which I have been rendered treatment and/or the proceeds of my insurance policy under which such services are covered and against which I may make a claim for payment.
I further authorize and direct you: (a) my insurance company is potentially liable to me under coverage provisions of an insurance policy I hold with you (b) an insurance company which is potentially liable to me by virtue of the acts of its insured and/or (c) my attorney, to pay CHIROMED CHIROPRACTIC, INC. directly from any insurance benefits for which you are obligated to reimburse me or from any settlement, judgment or verdict which I receive against you, or my attorney may receive on my behalf.
I agree that CHIROMED CHIROPRACTIC, INC., be given power of attorney to endorse/sign my name on any and all checks for payments of my doctor’s bill. I also authorize the release of any information pertinent to my case to any insurance company, adjuster or attorney involved in this case. A photocopy of this Assignment shall be considered as effective and valid as the original.
This assignment is made in consideration of CHIROMED CHIROPRACTIC, INC’s awaiting payment for services rendered. I understand that this in no way relieves me of my primary obligation to pay for such services that the signing of this form does not prohibit customary billing by you.
I understand that I will be liable for any balance which remains unpaid after application of any payment under this assignment.
I expressly reserve any and all rights of suit to procure payment of any benefits to which I may be entitled.”
* * *
