12 Fla. L. Weekly Supp. 1104c
Insurance — Personal injury protection — Standing — Assignment — Insured who assigned benefits to medical providers had no standing to file suit — Explanation of benefits — Where insurer mailed EOBs, not only to providers, but also to insured at time any reductions were made as well as whenever any bill was processed regardless of whether reduction was taken, insurer went above and beyond statutory requirements and is not legally obligated to provide additional EOB copies requested by insured’s counsel
KELLY PURVIN, Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 18th Judicial Circuit (Civil Division) in and for Seminole County. Case No. 04-SC-3285. August 18, 2005. John R. Sloop, Judge. Counsel: Michael Tierney, for Plaintiff. Michael P. Liebgold, Reynolds & Stowell, St. Petersburg, for Defendant.
ORDER
THIS CAUSE having come on for hearing on the Defendant’s Motion for Summary Judgment and for 57.105 Fees, on August 1, 2005, and the Court being fully advised in the premises, it is hereby,
ORDERED and ADJUDGED:
ISSUE OF STANDING:
1.The Plaintiff/insured did not have standing to file this suit as she assigned her benefits to the subject policy of insurance to her medical providers.
2. An “assignment” is a transfer of property or some right or interest, from one person to another. State Farm Fire & Casualty v. Ray, 556 So.2d 811, 812-813 (Fla. 5th DCA l990).
3. An assignee stands in the shoes of its assignor. Professional Consulting Services, Inc. v. Hartford Life and Accident Insurance Company, 849 So.2d 446, 447 (Fla. 2nd DCA 2003).
4. It is well-settled that an assignor “has no right to make any claim on the contract once the assignment is complete. . . .” State Farm Fire and Casualty Company v. Ray, 556 So.2d 811, 813 (Fla. 5th DCA 1990), Superior Insurance Company v. Libert, 776 So.2d 360 (Fla. 5th DCA 2001).
5. A party lacks standing to file suit if it has assigned its rights under an insurance contract. Superior at 365.
6. In any cause of action, a Plaintiff must establish standing before the court has any authority to entertain the Plaintiff’s action. Standing cannot be created by waiver, acquiescence, agreement of the parties, by error inadvertence of the parties or their counsel, or by exercise of power by the court. State ex rel. Caraker v. Amidon, 68 So. 2d 403 (Fla. 1953); See also, Polk County v. Sofka, 702 So. 2d 1243 (Fla. 1997); Marion Correctional Institution v. Kriegel, 522 So. 2d 45 (Fla. 5th DCA 1998) rev. denied 531 So. 2d 1354 (Fla. 1988) citing Wilds v. Permenter, 228 So.2d 408 (Fla. 4th DCA 1969). It is well settled that standing is equated with subject matter jurisdiction. Askew v. Hold the Bulkhead Save Our Bays, Inc., 269 So. 2d 696 (Fla. 2d DCA 1972). Rogers & Ford Construction Corp. v. Carlandia Corp., 626 So.2d 1350, 1352 (Fla. 1993). Without subject matter jurisdiction, the court has no authority to hear the action placed before it.
7. “[t]he determination of standing to sue concerns a court’s exercise of jurisdiction to hear and decide the cause pled by a particular party.” In order for a court to have subject matter jurisdiction over a matter, the Plaintiff must have standing to file suit, and must have had standing at the time it filed its original complaint. Rogers and Ford Construction Corporation v. Carlandia Corporation, 626 So.2d 1350, 1352 (Fla. 1993).
8. Because the Plaintiff lacked the requisite standing, there exists no subject matter jurisdiction, and thus no authority, for this Court to hear the above styled action.
ISSUE OF PRODUCTION OF ADDITIONAL EXPLANATION OF BENEFITS FORMS
9. Fla. Stat. 627.736, the PIP statute, § (4)(b) states in pertinent part:
“. . . .When an insurer pays only a portion of a claim or rejects a claim, the insurer shall provide at the time of the partial payment or rejection an itemized specification of each item that the insurer had reduced, omitted, or declined to pay and any information that the insurer desires the claimant to consider related to the medical necessity of the denied treatment or to explain the reasonableness of the reduced charge. . . .” Emphasis added.
10. It is undisputed that at the time any of the reductions were made to all of the bills of any of Kelly Purvin’s medical providers making claims for Kelly Purvin’s PIP benefits, the Defendant mailed explanation of benefits forms, not only to the claimants (which are the providers that had been assigned benefits by Kelly Purvin as described above) but to the Defendant’s insured, Kelly Purvin. Fla. Stat. 627.736(4)(b) only requires a PIP insurer to send what amounts to an explanation of benefits form to a claimant and the Defendant PIP insurer went above and beyond what is required by Fla. Stat. 627.736(4)(b) by sending explanation of benefits forms to both the insured and her medical providers.
11. It is undisputed that the Defendant PIP insurer again went above and beyond what is required of it under Fla. Stat. 627.736(4)(b) by sending explanation of benefits forms whenever a bill is processed, irrespective of whether a denial or a partial payment is made. This is not a case where a PIP insurer never provided explanation of benefits forms to a claimant.
12. Plaintiff’s counsel sent the Defendant PIP insurer two letters requesting copies of the explanation of benefits forms which were already sent to the Plaintiff/the Defendant’s insured; and which were already sent to the Plaintiff’s healthcare providers. The Defendant did not provide additional copies of the explanation of benefits forms in response to those letters.
13. The Plaintiff also claims that additional explanation of benefits forms are required to be provided upon request pursuant to Fla. Stat. 627.736(6)(d), which states: “The injured person shall be furnished, upon request, a copy of all information obtained by the insurer under the provisions of this section, and shall pay a reasonable charge, if required by the insurer.”
14. However, Fla. Stat. 627.736(6) pertains to requests for information made by a PIP insurer to employers andhealthcare providers of its insured. Absolutely no evidence was presented, and it was not alleged, that the Defendant PIP insurer made any such request pursuant to Fla. Stat. 627.736(6). Therefore, Fla. Stat. 627.736(6)(d) is inapplicable.
15. The Defendant should not be penalized for the Plaintiff’s apparent lack of record keeping ability. See Tallahassee MRI, P.A., (Carter, Margie) v. Progressive Consumers Insurance Company, 11 Fla. L. Weekly Supp. 1004b (Fla. Broward County Ct. July 8, 2004), Tallahassee MRI, P.A. (Brooks, Angulean) v. Progressive Auto Pro Insurance Company, (Fla. Broward County Ct. July 8, 2004).
16. The Plaintiff is requesting this Court create a new obligation upon PIP insurers in this state to provide potentially unlimited additional copies of explanation of benefits forms upon request. It is not within the purview of this Court to create such a new obligation upon PIP insurers in Florida, but within the authority of the legislature to do so if it sees fit. Since 1971 the legislature has not seen fit to impose such an obligation upon this state’s PIP insurers and it is an ultra vires act for this Court to do so. Recently, the 18th Circuit Court, Appellate Division ruled in an analogous situation in New Hampshire Indemnity Insurance Company v. Rural Metro Ambulance a/a/o William Zaniboni, Appellate Case No. 04-72-AP (Fla. 18th Circ. Appellate July 19, 2005). In New Hampshire, the appellate Court reversed the trial Court’s granting of a PIP insured’s healthcare provider’s Motion for Summary Judgment on its declaratory action for production of a PIP Log, declarations page, and policy. The appellate Court held that while “sound public policy” might support a requirement that a PIP Log, declarations page, and policy be produced upon presuit request to avoid increased litigation, the fact remains that the legislature chosen not to implement such a requirement in the PIP statute and that there is nothing precluding the legislature from doing so.
17. “When the language of the statute is clear and unambiguous and conveys a clear and definite meaning, there is no occasion for resorting to the rules of statutory interpretation and construction; the statute must be given its plain and obvious meaning.” Holly v. Auld, 450 So.2d 217, 219 (Fla. 1984) citing A.R. Douglass, Inc. v. McRainey, 102 Fla. 1141, 1144, 137 So.2d 157, 159 (Fla. 1931) emphasis added. “It has also been accurately stated that courts of this state are without power to construe an unambiguous statute in a way which would extend, modify, or limit, its express terms or its reasonable and obvious implications. To do so would be an abrogation of legislative power.” Id., emphasis supplied, citing American Bankers Life Insurance of Florida v. Williams, 212 So.2d 777, 778 (Fla. 1st DCA 1968). Here, both Fla. Stat. 627.736(4)(b) and (6)(d) are clear on their face and must therefore be given their plain and obvious meaning.
18. Accordingly, this Court will not read into those sections of the PIP statute a requirement for a PIP insurer to produce additional copies of explanation of benefits forms once they were initially provided pursuant to the PIP statute. Otherwise, would be an abrogation of legislative power and the legislature has thus far chosen not to implement that requirement.
WHEREFORE, for the reasons stated above, the Defendant’s Motion for Summary Judgment and for 57.105 Fees is hereby GRANTED with the Court reserving jurisdiction on the issue of the Defendant’s attorney’s fees and costs.
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