16 Fla. L. Weekly Supp. 821a
Online Reference: FLWSUPP 169RODRI
Insurance — Personal injury protection — Coverage — Insured occupying vehicle not covered by policy — Where at time of accident insured was driving vehicle owned by insured’s resident wife who is named insured under policy, and policy excludes coverage for named insured while occupying vehicle owned by named insured and not covered under policy, insurer does not owe PIP benefits to insured or medical provider/assignee
QUALITY MEDICAL GROUP INC a/a/o PASTOR RODRIGUEZ, Appellant, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Appellee. Circuit Court, 11th Judicial Circuit (Appellate) in and for Miami-Dade County. Case No. 08-018 AP. L.C. Case No. 02-8607 CC 05. July 8, 2009. An Appeal from the County Court for Miami-Dade County, Bronwyn C. Miller, Judge. Counsel: Dean A. Mitchell; and Virginia Best, Lopez and Best, for Appellant. Melanie Smith and Lara Edelstein, United Automobile Insurance Company, for Appellee.
[Editor’s note: Lower court order published at 15 Fla. L. Weekly Supp. 98a]
(Before LOPEZ, WARD, and DIAZ, JJ.)
(PER CURIAM.) This is an appeal by Quality Medical Group Incorporated as assignee of Pastor Rodriguez (hereinafter referred to as “Quality Medical”) to reverse the trial court’s order granting final summary judgment in favor of United Automobile Insurance Company (hereinafter referral to as “United Auto”) and the denial of Quality Medical’s Motion for Rehearing. The standard of review governing a trial court’s ruling on a motion for summary judgment is de novo. Volusia County v. Aberdeen at Ormond Beach, L.P., 760 So. 2d 126 (Fla. 2000); Sierra v. Shevin, 767 So. 2d 524 (Fla. 3d DCA 2000).
On July 30, 2001, Pastor Rodriguez was involved in an automobile accident where he allegedly sustained injuries requiring treatment. At the time of the accident, Mr. Rodriguez was driving a 1993 Mitsubishi owned by and registered to his wife, Milada Rodriguez. Mr. Rodriguez received treatment from Quality Medical. Mr. Rodriguez assigned his personal injury protection benefits (hereinafter referred to as “PIP”) to Quality Medical. Quality Medical submitted bills for payment to United Auto pursuant to PIP. United Auto denied PIP coverage as Mr. and Mrs. Rodriguez were named insureds under policy UEP 000143110, but the policy did not insure the 1993 Mitsubishi that was involved in the accident. On August 15, 2007, the trial court granted United Auto’s Motion for Final Summary Judgment and denied Quality Medical’s Motion for Final Judgment Regarding Coverage. The trial court found that ‘named insured’ included Mr. and Mrs. Rodriguez. The trial court ruled that Mr. Rodriguez was precluded from PIP coverage when he was injured in the vehicle owned by his wife, a named insured, but the car was not insured under the United Auto insurance policy.
Florida Statute § 627.736(2)(a)
Florida Statute section 627.736(2)(a) provides that any insurer may exclude personal injury protection benefits:
For injury sustained by the named insured and relatives residing in the same household while occupying another motor vehicle owned by the named insured and not insured under the policy or for injury sustained by any person operating the insured motor vehicle without the express or implied consent of the insured.
Florida Statute section 627.732(4) defines a named insured as “a person, usually the owner of a vehicle, indentified in a policy by name as insured under the policy.” § 627.732(4), Fla. Stat. (2001). A owner is defined as “a person who holds the legal title to a motor vehicle. . .” § 627.732(5), Fla. Stat. (2001).
In Lopez v. Fidelity & Cas. Co. of N.Y., the injured, the step-son of the insured, sought PIP benefits as his step-father’s relative. Lopez v. Fidelity & Cas. Co. of N.Y., 384 So. 2d 680 (Fla. 3d DCA 1980). The car the step-son was injured in was not owned or insured under the step-father’s name. The insurer argued that section 627.736(2) excluded the step-son from recovering PIP benefits. The Appellate Court stated “[w]hile we he held this exclusion valid in Industrial Fire and Casualty Insurance Company v. Jones, . . . , it is not applicable to the present case because [the insured] did not own the vehicle occupied by [injured].” Id. at 681.
In Industrial Fire and Cas. Ins. Co. v. Jones, the injured step-son claimed PIP benefits under his step-father’s insurance policy with Industrial Fire and Casualty Insurance (hereinafter referred to as “Industrial Fire”). The step-son was injured in his mother’s car which was not insured by the step-father’s Industrial Fire policy. Industrial Fire denied the claim pursuant to section 627.736(2)(a). The Third District Court of Appeal upheld its prior ruling in Fidelity and Cas. Co. of N.Y. v. Fonesca, pointing out the same analysis is applicable to this case.
The Third District Appellate Court held that “the subject policy was not intended to cover, and did not in fact cover, a vehicle which [the wife] potentially could use on a regular basis, and that, as a matter of law, the clear language of the policy excludes liability on the facts before us.” Fidelity and Cas. Co. of N.Y. v. Fonesca, 358 So. 2d 569, 572 (Fla. 3d DCA 1978).
The rationale underlying such inclusion of both resident spouses within the definition of a named insured is clear and reasonable. It was intended to protect the insurer from assuming risks for which premium payments were not elicited in situations where such risks were likely to eventuate. Whether or not they actually use one another’s cars with any degree of regularity or frequency, husbands and wives who reside in the same household potentially have their spouse’s vehicles available for use on a regular basis. If inclusion of both spouses under the definition “named insured” were not given its plain meaning, two or more vehicles could be covered by payment of a single premium and the insurer would not only assume risks for which it was uncompensated, but also lose additional premiums it might otherwise receive. See Annot., 34 A.L.R.2d 936 (1954);Annot., 83 A.L.R.2d 926 (1962); 7 Am.Jur.2d, Automobile Insurance, Sections 103 and 107 (1963).
Id. at 575.
United Auto’s policy defines named insured as “the person or organization named in the Declarations of the Policy; and if an individual, shall include the spouse if a resident of the same household. If the spouse is a resident of another household, “you” must report the spouse to “us” on the application.” Florida Personal Auto Policy United Automobile Insurance p. 2. Owner is defined as “a person or organization who holds the legal title to a motor vehicle. . .” Id. at 1. Further, the policy uses the exclusionary language found in section 627.736(2)(a) to exclude coverage for PIP benefits “to the named insured or any relative while occupying a motor vehicle of which the named insured is the owner and which is not insured under this insurance.” Id. at 13. In the case herein, the trial court correctly found the language in the policy to be clear and unambiguous and properly denied PIP coverage pursuant to Florida Statute section 627.736(2)(a).
Affirmed.
