16 Fla. L. Weekly Supp. 675b

Online Reference: FLWSUPP 167GEORG

Insurance — Personal injury protection — Standing — Assignment — Document that authorizes insurer to release information regarding insured to medical provider and to make payment directly to provider, but which does not transfer insured’s legal rights to provider, is not valid assignment — Coverage — Medical bills — Exhaustion of policy limits — Where provider’s initial bill sent to insurer was received without assignment of benefits, and insurer thereafter received and paid bill from hospital that is lien facility, insurer properly exhausted PIP benefits through payment to hospital

GEORGE J. HAEDICKE, M.D. P.A., A Florida Corporation, Plaintiff, vs. JESSICA REINSMITH, and SEMINOLE CASUALTY INSURANCE COMPANY, A Florida Corporation, Defendants. County Court, 13th Judicial Circuit in and for Hillsborough County. Case No. 07-19081, Div-H. May 4, 2009. Eric R. Myers, Judge. Counsel: Thomas J. Dandar. Susan P. Brown, Don Mathews & Associates, P.A., Ft. Myers.

FINAL ORDER GRANTING SUMMARY JUDGMENT IN FAVOR OF DEFENDANT

THIS CAUSE came before this Court at a Hearing on April 14, 2009, upon two Motions for Summary Judgment by Defendant Seminole Casualty Insurance Company (Seminole) regarding standing and exhaustion of benefits in a PIP action. The following facts were in evidence at the time of the Hearing:

UNDISPUTED FACTS

1. On July 25, 2006, Jessica Reinsmith had a policy of insurance with Seminole which provided Reinsmith with $10,000.00 in PIP benefits, subject to a $1,000.00 deductible.

2. On August 3, 2006, Seminole received a CMS-1500 form from Plaintiff in the amount of $5,850.00 for reimbursement of PIP benefits relative to services rendered to Jessica Reinsmith on July 25, 2006, for injuries she sustained in a motor vehicle accident while insured with Seminole.

3. Plaintiff did not submit an assignment of benefits with its July 25, 2006 billing.

4. On August 14, 2006, prior to processing Plaintiff’s claim, Seminole received a bill from St. Joseph’s Hospital for $18,046.73. St. Joseph’s bill indicated the hospital was a lien facility.

5. A business decision was made by Seminole to process the bill for St. Joseph’s Hospital, and on September 11, 2006, after applying Reinsmith’s deductible, Seminole rendered payment to the hospital for $10,000.00, thereby exhausting the available PIP limits.

6. Seminole paid nothing to Plaintiff.

7. On October 5, 2006, Seminole received Plaintiff’s demand letter, with two attached CMS-1500 forms and an alleged assignment of benefits for Reinsmith dated August 4, 2006, which stated as follows:

“AUTORIZATION TO RELEASE INFORMATION AND ASSIGNMENT OF BENEFITS: I hereby authorized George J. Haedicke, DMD,MD,PA to release any information acquired in the course of my examination or treatment and further authorize payment directly to the physicians of the surgical and/or medical benefits. I understand I am financially responsible for all charges. . . .

**I agree to pay for all costs of collection, including reasonable attorney fees**”

8. On October 19, 2006, Seminole sent a timely response to Plaintiff’s demand letter, advising that Reinsmith’s PIP benefits were exhausted.

9. Reinsmith’s PIP benefits were exhausted prior to Seminole’s receipt of the alleged assignment of benefits from Plaintiff, and Seminole provided this information to Attorney Dander on October 19, 2006 when responding to Plaintiff’s presuit demand.

10. In July 2007, Plaintiff initiated this action against Seminole.FINDINGS

This Court, having considered arguments, case law, and the evidence of record, finds the following:

11. As to the Plaintiff’s lack of standing, this Court reviewed the document Plaintiff asserted as its Assignment of Benefits. Having carefully examined the plain and unambiguous language of the purported assignment, the Court finds that the document: 1) authorizes Seminole to release information to Plaintiff regarding Seminole’s insured, Jessica Reinsmith, and 2) directs Seminole to issue payment directly to Plaintiff for treatment Plaintiff rendered to Reinsmith. The Court further finds said document does not properly transfer Reinsmith’s legal rights to Plaintiff and is therefore not a valid assignment of benefits. Accordingly, Plaintiff lacks standing to bring this cause of action against Seminole.

12. The Court also considered, in the alternative, the exhaustion of benefits issue. The Court reviewed the Affidavit of Carmen Osorio and the timeline of events described therein, and determined the following:

a) Plaintiff’s initial bill to Seminole was received without an assignment of benefits;

b) After receiving (but prior to processing) Plaintiff’s initial bill, Seminole received a bill from St. Joseph’s Hospital, which indicated the hospital was a lien facility;

c) Seminole made a business decision to pay the hospital bill, which exhausted Reinsmith’s available PIP benefits under her policy with Seminole.

13. This Court expressly considered Plaintiff’s arguments concerning Physical Medicine Center (a/a/o Timothy Baitinger, Donald Jackson, Michelle Davison, and Thomas Dickson, and Mary Sommer) v. Progressive Express Ins. Co., 12 Fla. L. Weekly Supp. 210c (13th Cir. App. Ct. 2004) and finds no evidence of improper preferential payment. Moreover, Seminole properly exhausted Reinsmith’s available PIP benefits; there is no showing Seminole conducted itself inappropriately in any way. Specifically, Seminole did not pay benefits out of turn, improperly pick and choose payees, or otherwise conduct itself in bad faith.

It is thereby ORDERED and ADJUDGED as follows:

1. Plaintiff does not have standing to bring the instant action.

2. Seminole Casualty Insurance Company properly exhausted the insured’s available PIP benefits under the subject policy of insurance.

3. Defendant Seminole Casualty Insurance Company’s Motions for Summary Judgment are GRANTED.