18 Fla. L. Weekly Supp. 1052a
Online Reference: FLWSUPP 1810JOYN
Insurance — Healthcare general liability — Coverage — Patient — Insurer’s motion for summary judgment ruling that plaintiff who fell while being escorted back to dressing room after performance of MRI at insured’s facility is patient excluded from coverage under healthcare general liability policy is denied where record is insufficient for court to determine that plaintiff remained patient after completion of MRI
JERI JOYNER, Plaintiff, vs. LEXINGTON INSURANCE COMPANY, a Foreign Insurance Corporation, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 11-005433 COCE (53). July 29, 2011. Robert W. Lee, Judge. Counsel: Lawrence Bohannon, Fort Lauderdale, for Plaintiff. Cynthia Ruiz, Miami, for Defendant.
ORDER DENYING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS CAUSE came before the Court on June 22, 2011 for hearing of the Defendant’s Motion for Final Summary Judgment, and the Court’s having reviewed the Motion and the entire Court file; heard argument; reviewed the relevant legal authorities; and been sufficiently advised in the premises, the Court finds as follows:
BACKGROUND
This case was brought before the Court by the Plaintiff, Jeri Joyner against the Defendant, Lexington Insurance Company, for injuries sustained by Plaintiff as a result of a fall at Signet Diagnostic Imaging Facility (Signet).
Following a routine MRI on December 14, 2009, Jeri Joyner was being escorted back to a dressing room at the MRI facility. She sustained injuries resulting from her fall. The Plaintiff filed this lawsuit seeking damages incurred for medical payments arising from the tumble, including all covered losses with interest on any overdue payments, costs, and attorney’s fees. The Plaintiff seeks recovery more than $500, but not exceeding $5000.1 The Plaintiff claims her injuries fall under the liability terms of Signet’s insurance policy, which is provided by the Defendant.
The following facts are undisputed:
1. On December 14, 2009, Plaintiff fell on a slippery floor while at Signet Diagnostic Imaging Facility located at [Editor’s Note: Address Omitted] in Plantation, Florida.
2. The Plaintiff fell, in an examination gown, while being escorted back to the dressing room, after the performance of the radiological study (MRI).
3. The Plaintiff incurred medical expenses as a result of her fall at Signet Diagnostic
4. Jeri Joyner filed a claim for Medical Payments under Signet’s liability insurance policy, underwritten by Defendant, Lexington Insurance Company.
5. The insurance coverage issued to Signet by Lexington Insurance Company consists of two separate but related policies: a Healthcare professional liability policy and a Healthcare general liability policy
6. The Healthcare general liability policy contains the insuring coverage agreements, which provides as follows:
1. INSURING AGREEMENTS
[subsections A and B omitted]
a. Medical Expenses
We will pay medical expenses as describe below for any bodily injury caused by an occurrence
i. On premises you own or rent;
ii. On ways next to premises you own or rent, or
iii. Because of your operations
1. Lexington Insurance Company denied the Plaintiff’s claims, based on its belief of the applicability of the exclusionary patient provision from section III of the policy, which provides:
III. EXCLUSIONS
This insurance does not apply to any occurrence, claim or suit arising out of:
O. Patients
Any bodily injury sustained by a patient of any Insured and any claims or suits by spouse, child, parent, grandparent, brother or sister of such patient arising out of such bodily injury.
2. Patient is defined in the policy under the Definitions sections, and is defined as follows
Q. Patient means a person seeking or receiving, either on an inpatient, outpatient, or emergency basis, any form of medical, surgical, dental or nursing care or any service or treatment.
QUESTION PRESENTED
Whether Jeri Joyner is a patient as defined by the insurance policy.
CONCLUSIONS OF LAW2
The primary issue which must be adjudicated is, simply put, does the Plaintiff, Jeri Joyner, meet the criteria to satisfy the definition of “patient” as authored by the Defendant, Lexington Insurance Company in its policy provided to Signet Diagnostic Imaging. To prevail on its Motion, the Defendant would have to demonstrate to the Court that the Plaintiff was, without dispute a “patient” as defined in the policy at the time she fell, and therefore not covered under the subject policy.
The Supreme Court of Florida in Garcia v. Federal Insurance Co., 969 So.2d 288, 291 (Fla. 2007) [32 Fla. L. Weekly S657a], crystallized the standard for interpreting insurance contracts in Florida. Courts must construe insurance contracts according to their plain meaning. Taurus Holdings, Inc v. United States Fidelity & Guaranty Co., 913 So.2d 528, 532 (Fla. 2005) [30 Fla. L. Weekly S633a]. This standard also applies when only particular provisions of an insurance policy are at issue. Id. However, courts may only enforce an insurance contract on its terms if the contract meets two elements: (1) the contract must be clear, and (2) the contract must be unambiguous. Id at 532. For an insurance contract or provisions to be clear means that when read as a whole, and considered in context, the terms of the contract leave no doubt as to their intending meaning. Garcia, 969 So.2d at 292. Ambiguous insurance contracts and provisions are those which “relevant policy language is susceptible to more than one reasonable interpretation, one providing coverage and another limiting coverage.” Auto-Owners Ins. Co. v. Anderson, 756 So.2d 29, 34 (Fla. 2000) [25 Fla. L. Weekly S211a]. A provision is not ambiguous simply because it is complex or requires analysis, Taurus Holdings, 913 So.2d at 532. In this case, the exclusionary provision leaves no doubt as to the definition of the word “patient” as it is defined with certainty (definition of “patient” reproduced above). A policy is not ambiguous merely because it requires analysis to determine the meaning; in this case a meaning of the definition of “patient” can easily be derived from the policy because the definition is analogous with both the common conception of patient and the dictionary definition of a patient. Therefore the definition of patient as “one seeking or receiving treatment” is both clear and unambiguous.
Unfortunately, a relative understanding of an insurance provision by the Court does not a summary judgment make. For summary judgment to be granted in this instance, the Plaintiff would have to fit, without dispute, into the policy’s definition of “patient.” The nature of physician-patient relationships is such that varying medical services and treatments require differing lengths at which people may be subject to professional care. In the case before the Court, both parties agree that Jeri Joyner had completed her MRI at Signet Diagnostics, but the material fact remains to be determined whether the mere completion of services rendered to the Plaintiff ends her role as a “patient” with Signet Diagnostic Imaging. The Court cannot find, without more, that the mere ending of particular diagnostic test terminates the patient relationship, or that one remains a patient until out of a dressing gown. There are simply insufficient facts developed on the argued record for the Court to so conclude. For instance, who was escorting Ms. Joyner to the dressing room? Why was she being escorted? What were they discussing? Who would be reading the MRI and preparing the report? When would this be done? Did Ms. Joyner have to await any further instructions from the facility after getting dressed? Did she need to provide any further paperwork before departing? If summary judgment were to be granted without a clearer record, it would potentially create a slippery slope whereby any person referred for a diagnostic test is no longer considered a patient the precise moment the actual test is completed. Accordingly, it is hereby
ORDERED AND ADJUDGED that the Defendant’s Motion is hereby DENIED. Pursuant to Rule 1.510(d), however, the Court finds the material facts set forth in Paragraphs 1-8 have been established without further controversy, and at any further hearing or trial in this case, these facts shall be deemed established without the necessity of any further evidence or argument.
__________________
1The parties agreed to invoke the rules of civil procedure, which the Court allowed by order dated May 4, 2011. See Rule 7.020(c), Fla. Sm. Cl. R.
2THE COURT THANKS NOVA SOUTHEASTERN UNIVERSITY LEGAL INTERN DAVID SHOLL FOR HIS RESEARCH ASSISTANCE IN THIS MATTER.
