11 Fla. L. Weekly Supp. 1009a
Insurance — Personal injury protection — Standing — Assignment — Where insurer created document, referred to it as assignment, and treated it as assignment by making payments to medical providers in accordance with insurer’s standard business practice of paying benefits directly to providers only if they have assignment or direction to pay, it would be inequitable to permit insurer to deny document is assignment as it seeks dismissal of provider’s action for PIP benefits based on lack of standing — Whether by construing ambiguity against insurer or by estoppel, document is assignment — Motion for summary judgment on standing issue denied
DREW MEDICAL, INC., as assignee of Mayra Reyes, Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. CCO 02-9446. August 2, 2004. Jerry L. Brewer, Judge. Counsel: Peter P. Hagood, Payas, Payas & Payas, Orlando, for Plaintiff. Brian Foreman, Kingsford & Rock, P.A., Maitland, for Defendant
ORDER DENYING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT REGARDING STANDING
THIS CAUSE, having come before this Honorable Court on Defendant’s Motion for Summary Judgment Regarding Standing, and the Court having reviewed the depositions, pleadings, documentary evidence and other items properly before the Court, having heard argument of counsel for the parties and otherwise being fully advised in the premises, the Court finds as follows:
The undisputed facts show:
1. PROGRESSIVE issued a policy of insurance for personal injury protection (PIP) benefits to Mayra Reyes (the insured) under policy number 20652894-0, which provided $10,000.00 in personal injury protection coverage, no deductible and no medical payments coverage.
2. On August 12, 2000, Mayra Reyes was involved in a motor vehicle accident wherein she sustained bodily injuries. As a result thereof, she sought treatment with various medical providers, including DREW.
3. On or about September 22, 2000, PROGRESSIVE generated several forms/letters which it sent to Mayra Reyes pursuant to PROGRESSIVE claim handling procedure. One of these forms has the title “ASSIGNMENT” with another portion of the same form entitled “ASSIGNMENT OF MEDICAL BENEFITS”.
4. It is undisputed that PROGRESSIVE created this document and sent the same to Mayra Reyes. Mayra Reyes executed the document and returned the same to PROGRESSIVE. Thereafter, PROGRESSIVE relied on said document and made payments to Mayra Reyes’ medical providers, including DREW.
5. PROGRESSIVE never advised Mayra Reyes or DREW that any additional documentation was needed to create an assignment of Mayra Reyes medical benefits under her PIP policy to DREW.
6. The only affirmative defense pled by the PROGRESSIVE in this matter is lack of standing.
RULING
The undisputed facts as stated above demonstrate that, while the body of the document in question does not use the term “assignment”, it contains the terms “ASSIGNMENT” and “ASSIGNMENT OF MEDICAL BENEFITS” as title headings of the two sections of the document. Further, these titles are completely capitalized and are also the largest print on the document. This document was created by PROGRESSIVE and was sent to Mayra Reyes. Mayra Reyes executed the document and returned it to PROGRESSIVE who in turn relied upon said document in making payments to Mayra Reyes’ medical providers, including DREW.
It is a fundamental principle of contract interpretation that any ambiguities in an insurance policy must be strictly construed against the insurer and in favor of the insured. While the document in question is not and insurance policy, it was created by the Defendant, an insurer, and intended for distribution to claimants in all PIP claims at the time of this claim. Thus, based upon the intended use of the document, there is no reason to differentiate in the rules of construction in this case between this document and ambiguous insurance policy. Clearly, PROGRESSIVE could have utilized any language it chose in creating this document and by its selection of the language used created any ambiguity. However, the term “assignment” is a well defined term which carries with it certain legal obligations/liabilities. An insurance company such as PROGRESSIVE has to be on notice of the legally accepted meaning of the term it chose to use in the documents it created for distribution to its insured in accordance with its standard claims handling procedure.
Thus, the discovery in this case and the course of business between the parties reveals that PROGRESSIVE does not come into Court with clean hands as PROGRESSIVE created and referred to the document in question as an assignment of benefits and treated the document signed by Mayra Reyes as an assignment of her medical benefits and made payments to DREW in accordance with its standard business policy of paying benefits directly to medical providers only if they have an assignment of benefits or a direction to pay. Based upon this course of business, it would be inequitable to permit PROGRESSIVE to now deny the document at issue is not an assignment of Mayra Reyes medical benefits. Had the medical provider drafted the document at issue the Court may have had a different opinion that is not the instant case. Accordingly, the Court hereby finds that whether construing the ambiguity in the PROGRESSIVE document against PROGRESSIVE or by estoppel, the document at issue is an assignment of benefits from Mayra Reyes to her medical providers, including DREW.
ORDERED and ADJUDGED that
Defendant’s Motion for Summary Judgment on the issue of standing is DENIED.
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