12 Fla. L. Weekly Supp. 774c
Insurance — Personal injury protection — Standing — Assignment — Validity — Document that assigns payment of benefits directly to hospital and “my physicians” without naming physicians is sufficient to confer standing on medical provider where there is agency contract between provider and hospital that allows provider to collect benefits and, in essence, assigns assignments to provider — Assignment is also sufficient to give provider, as contracted physicians for hospital, right to bring claim for declaratory relief and entitles provider to copy of policy and declarations page on pre-suit request
FLORIDA EMERGENCY PHYSICIANS KANG & ASSOCIATES, MD, PA as assignee of SHARNA ADDERLY, Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit, Orange County. Case No. 04-SC-10577. May 4, 2005. Leon B. Cheek, III, Judge. Counsel: Richard Oliver Hale, IV, Orlando. Sunita Beekharry, Orlando.
ORDER REGARDING PLAINTIFF’S ASSIGNMENT OF BENEFITS
Statement of Facts
1. This is a claim for PIP benefits arising out of a motor vehicle collision that occurred on or about 10/22/2003.
2. The Plaintiff in this matter, FLORIDA EMERGENCY PHYSICIANS KANG & ASSOCIATES, MD, PA, alleges it accepted an assignment of benefits from SHARNA ADDERLY.
3. On or about 11/07/03, the Plaintiff submitted its bill for care and treatment of the insured to the Defendant and the bill went unpaid.
4. Thereafter, on April 5, 2004, A Notice of Intent to Initiate Litigation was sent to the Defendant’s designated “designee” pursuant to Florida law and was signed for by the Defendant on April 13, 2004. Included in the Notice package was a request for a copy of the policy, declarations page and PIP log, as provided for in Florida statutes, § 627.736(6)(d), and § 627.4137.
5. In response to the Plaintiff’s demand letter, the Defendant sent correspondence indicating the bill had been applied to the patient’s deductible, but failed to provide a copy of the PIP log, declarations page or policy as requested.
6. The Plaintiff waited more than thirty days, but was left in doubt as to its rights under the policy and whether it had a viable claim for breach of contract, as the Defendant refused to provide the information required by Florida statutes.
7. Thereafter, the Plaintiff filed a two-count Complaint alleging breach of contract and seeking declaratory relief.
8. This matter comes before the Court on Plaintiff’s Motion for Summary Judgment on Count II of its Complaint.
9. The Defendant alleges that the assignment of benefits does not provide the Plaintiff standing to pursue this cause.
Analysis
Defendant’s contention that the assignment relied upon is not an assignment.
Attached to the Plaintiff’s pre-suit request was a document entitled Consent to Treatment and Authorizations and Guarantee. Inrelevant part, the document reads as follows, “I assign payment directly to the Hospital and my physician(s), the benefits otherwise available to me . . . THIS ASSIGNMENT OF BENEFITS IS IRREVOCABLE”. The Defendant asserts that this document is (1) not an assignment of benefits and (2) does not confer standing upon the Plaintiff, as the document fails to specifically name the Plaintiff. It remains uncontested that this document was executed by the patient and was attached to the Plaintiff’s Notice of Intent to Initiate Litigation.
The Court finds this document to be a valid, and legally enforceable, assignment of benefits and confers standing on the Plaintiff by virtue of the words “and my physicians”. It is noted that there is an agency contract between the Plaintiff and Florida Hospital that presumptively allows them to collect these benefits and in essence, assigns assignments to them. As a hospital based practice, the assignment in favor of the “Hospital and my physicians” is also sufficient to give the Plaintiff, as the contracted physicians for Florida Hospital, the right to bring a claim for declaratory relief. Additionally, the Court finds that this document entitles the Plaintiff to secure, pre-suit, a copy of the patient’s policy and declarations page upon lawful request. The Court specifically finds that this document constitutes an assignment of benefits, carrying with it all the rights and benefits afforded the assignee, and is not a direction to pay.
Ruling
1. The Plaintiff had standing to bring this claim pursuant to the Consent to Treatment and Authorizations and Guarantee form which constitutes an assignment of benefits issued in favor of the “Hospital and my physicians”. Said document constitutes a valid and enforceable assignment conferring all rights and benefits to the Plaintiff.
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