10 Fla. L. Weekly Supp. 724a
Insurance — Personal injury protection — Standing — Assignment — Validity — Document that provides that insured is transferring and conveying all his rights, title, and interest in medical expense reimbursement is assignment — Inclusion of terminology of direction to pay does not negate existence of assignment — Medical provider’s affidavit stating that assignment was accepted for limited purpose of collecting payment does not indicate that document was mere direction to pay but, rather, indicates that assignment was meant to convey insured’s rights in regard to reimbursement without conveying insured’s obligations under policy
MULTICARE MEDICAL CENTER, INC., Plaintiff, v. STATE FARM FIRE AND CASUALTY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 01-10080. June 25, 2003. Wendell M. Graham, Judge. Counsel: Lewis J. Mertz, Jr., Mario S. Profeta & Associates, P.A., Miami, for Plaintiff. James Murphy, Green, Murphy, Wilke & Murphy, P.A., Ft. Lauderdale, for Defendant.
ORDER DENYING MOTION TO DISMISS
THIS CAUSE came on to be heard Tuesday, June 24, 2003, upon State Farm Fire and Casualty’s Motion to Dismiss. This court having considered the record, the arguments of the parties, and being fully advised in the premises, makes the following findings of fact and conclusions of law:
A. The insurance company is arguing that the health care provider does not have standing because Alvarez, the insured, did not provide it with an assignment of benefits, but instead, just a direction to pay. The document at issue provides, in part:
I hereby assign, transfer and convey to [blank line] (Hereinafter “the Provider) all of my rights, title and interest in and to medical expense reimbursement in whatever form . . . . I further authorize the Provider to negotiate, collect and settle any claims with any insurance carrier or other third party payer with regard to these services . . . . I further direct my insurer to direct all payments for services rendered by the Provider to: ADVANCED DIAGNOSTIC TESTING, INC. . . . . THIS IS A DIRECT AND IRREVOCABLE ASSIGNMENT OF MY RIGHTS AND BENEFITS UNDER MY POLICY OF INSURANCE WHICH SHALL BECOME EFFECTIVE UPON ACCEPTANCE BY THE PROVIDER.
B. For its argument that the document is only a direction to pay, the insurance company relies, in part, upon an affidavit which was submitted by the health care provider when the insurance company attempted to obtain an examination under oath of one of the provider’s physicians arguing that, as assignee, the health care provider incurred all of the insured’s obligations, as well as his rights. The affidavit states, in relevant part, that:
3. Mr. Alvarez signed an assignment of benefits that assigned his right to recover medical expense reimbursement to Plaintiff, Multicare Medical Center. Multicare Medical Center accepted the assignment of benefits as consideration for the providing of healthcare and medical treatment.
4. The assignment of benefits accepted from the patient was for the limited purpose of collecting payment from the patient’s personal injury protection insurance carrier for medical bills incurred as a result of medical care and treatment rendered.
5. The assignment accepted by Multicare Medical Center only grants the right to collect payment directly from the patient’s insurance company. This assignment did not relieve the patient from her duties under her policy of insurance nor did it delegate any duties to Multicare Medical Center.
6. It was not the intention of Multicare Medical Center to incur any responsibility or duty under the patient’s policy of insurance, as such, the assignment contains no language regarding same.
The insurance company asserts that this affidavit indicates that the document in question is a direction to pay, not an assignment, and that the health care provider should be held to the statements in the affidavit indicating such.
C. Whether a particular document is an assignment or a direction to pay is often at issue because such documents often contain ambiguous wording, and even may be titled “Assignment,” but contain only the language of a direction to pay. Furthermore, the general idea behind both a direction to pay or an assignment is for the insurance company to give the medical reimbursement proceeds to the health care provider instead of the insured. In addition, the documents are similar and related. In Advanced Orthopedic & Sports Medicine v. Metropolitan General Insurance Company, the 13th Circuit Court noted that authorizations for direct payment may exist in the absence of an assignment, but “typically, an assignment does not exist without a direct payment provision.” 10 Fla. L. Weekly Supp. 160a (13th Circuit Court 2002). Since assignments typically contain language relating to direct payment, it is inherently problematic to determine whether any particular document is an assignment or direction to pay.
D. The distinction between assignments and directions to pay is vitally important, since only one entity can “own” the rights to an insurance payment, and whether a document merely directs an insurance provider to pay a health care provider, or whether it actually transfers the rights to payment from the insured to the health care provider, determines which entity (the insured or the health care provider) “owns” those rights and can, therefore, sue on a cause of action. See, Oglesby v. State Farm Mutual Automobile Insurance Company, 781 So. 2d 469, 470 (Fla. 5th DCA 2001) (explaining that “only the insured or the medical provider ‘owns’ the cause of action against the insurer at any one time. And the one that owns the claim must bring the action if an action is to be brought.”); see also, Superior Insurance Company v. Libert, 776 So. 2d 360 (Fla. 5th DCA 2001) (“If a party assigns his rights, he has no standing to file suit.”); Livingston v. State Farm Mutual Auto Insurance Company, 774 So. 2d 716, 718 (Fla. 2d DCA 2000) (“assignor has no right to make any claim on the contract once the assignment is complete, unless authorized to do so by the assignee.”); State Farm Fire and Casualty Company v. Ray, 556 So. 2d 811, 813 (Fla. 5th DCA 1990) (“Because an unqualified assignment transfers to the assignee all the interest of the assignor under the assigned contract, the assignor has no right to make any claim on the contract once the assignment is complete, unless authorized to do so by the assignee.”).
E. According to State Farm Fire and Casualty v. Ray, “An assignment is defined as ‘a transfer or setting over of property or of some right or interest therein, from one person to another. It is the act by which one person transfers to another, or causes to vest in another, his right of property or interest therein.’ ” 556 So. 2d 811, 812 (Fla. 5th DCA 1990) (quoting 4 Fla. Jur. 2d, Assignments § 1 (1978)). In contrast, a “direction to pay,” which is also often referred to as a “direct payment authorization,” directs the insurance provider to pay claims to the health care provider instead of the insured, but it does not transfer any rights to the health care provider.
F. The distinguishing factor between an assignment and a direction to pay is that, through an assignment, the insured gives up his or her rights in, and control over, the subject matter, while, through a direction to pay, the insured does not give up his or her rights and control. See, Health Application Systems, Inc. v. Hartford Life and Accident Insurance Company, 381 So. 2d 294, 297 (Fla. 1st DCA 1980) (finding that a contractual provision did not constitute an assignment because the purported assignor retained control over the subject matter); Physician’s Injury Center v. Progressive Express Insurance Company, 9 Fla. L. Weekly Supp. 169a (13th Judicial Circuit 2002) (finding that a document was not an assignment, in part because it contained nothing stating that the appellant was giving up her rights to her PIP benefits).
G. This court finds that the document at issue is an assignment, and not merely a direction to pay. It provides that the insured is transferring and conveying all of his rights, title and interest in his medical expense reimbursement. By doing so, the insured gave up his rights to the reimbursement and his control over the reimbursement proceeds. As such, the document fits within the parameters of an assignment. See, Ray, 556 So. 2d at 812; Health Application Systems, Inc., 381 So. 2d at 297; Physician’s Injury Center, 9 Fla. L. Weekly Supp. 169a. The document also contains the terminology of a direction to pay (“I further direct my insurer to direct all payments for services rendered by the Provider to: ADVANCED DIAGNOSTIC TESTING, INC. . . .”). However, as noted above, this does not negate the existence of an assignment. Advanced Orthopedic & Sports Medicine v. Metropolitan General Insurance Company, 10 Fla. L. Weekly Supp. 160a.
H. The health provider’s affidavit does not change this conclusion. The insurance company focuses on those portions of the affidavit which sound like they might indicate that the document was a direction to pay (for example, “The assignment of benefits accepted from the patient was for the limited purpose of collecting payment from the patient’s personal injury protection insurance carrier for medical bills incurred as a result of medical care and treatment rendered.”). However, as noted above, the confusion between directions to pay and assignments arises, in part, out of the similarity between the two types of documents, and the fact that the general idea behind both is for the insurance company to give the medical reimbursement proceeds to the health care provider instead of the insured. Thus, when the affidavit states that the assignment was “for the limited purpose of collecting payment” it does not preclude that the payment would be collected by means of an assignment. In short, the ambiguity of portions of the affidavit should not prevent the Court from determining the true nature of the document, just as the ambiguity of many documents themselves does not preclude courts from discerning their true meaning.
I. When read in full, the affidavit does not indicate that the document was merely a direction to pay rather than an assignment. Instead, when the affidavit uses language about the purpose of the assignment being limited to collecting payments, the actual meaning is that the assignment was meant to convey the insured’s rights in regard to reimbursement (the most important one being the right to collect payment, but also included would be the right to bring an action against the insurance company) without conveying the insured’s obligations (in particular the obligation to attend an examination under oath). This can be seen readily in paragraph 5 of the affidavit, which provides that “The assignment accepted by Multicare Medical Center only grants the right to collect payment directly from the patient’s insurance company. This assignment did not relieve the patient from her duties under her policy of insurance nor did it delegate any duties to Multicare Medical Center.” This court rejects Defendant’s argument that the health care provider’s affidavit establishes that the document in question is merely a direction to pay rather than an assignment. Accordingly, it is hereby
ORDERED AND ADJUDGED that State Farm Fire and Casualty’s Motion to Dismiss is one and the same DENIED.
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