18 Fla. L. Weekly Supp. 774a
Online Reference: FLWSUPP 1809DIAZ
Insurance — Personal injury protection — Res judicata — Error to conclude that res judicata barred suit for second set of medical bills discovered during pendency of suit for another set of bills where medical treatment, procedures, CPT codes, dates of service and amounts charged for second set of bills were different from set of bills litigated in prior case such that facts and evidence necessary to maintain second suit and identify thing sued for are not same as in prior suit — Moreover, dismissing suit based on res judicata was not equitable or just where insured was barred from amending complaint in prior suit to include newly discovered bills by freeze order imposed when insurer failed to appear at summary judgment hearing
LIDIA DIAZ, Appellant, v. UNITED AUTOMOBILE INSURANCE COMPANY, Appellee. Circuit Court, 11th Judicial Circuit (Appellate) in and for Miami-Dade County. Case No. 09-553 AP. L.C. Case No. 08-018075 SP 25. Hearing On: April 28, 2011. Opinion filed: July 13, 2011. On Appeal from the County Court for Miami-Dade County. Andrew Hague, Judge. Counsel: Mark J. Feldman, for Appellant. Michael J. Neimand, General Counsel, Office of the General Counsel of United Automobile Insurance Company, for Appellee.
(Before TRAWICK, ZABEL, and BLOOM, JJ.)
(ZABEL, Judge.) The Plaintiff/Appellant, Lidia Diaz (“Ms. Diaz”) appeals the underlying order of dismissal of her complaint against Defendant/Appellee, United Automobile Insurance Company, Inc. (“United Auto”), based on the doctrine of res judicata. This appeal hinges on an understanding of two cases: 1) the case which is presently being appealed before the Appellate court, and 2) a previous case that had been resolved, involving the same parties.
The Automobile Accident and Total Costs of Medical Services Rendered
On October 2, 2007 Ms. Diaz was allegedly injured in an automobile accident, and received medical treatment for her injuries from RC Medical Group (“Provider”) for dates of service rendered between October 5, 2007 through December 21, 2007, at a cost totaling $10,050.00. Ms. Diaz did not assign her benefits to the Provider, R.C. Medical Group. However, the Provider timely provided all of its medical bills to United Auto. United Auto did not pay any of the bills submitted.
Initiation of Previous Case for First Set of Bills
Prior to the initiation of the instant case at the trial level, Ms. Diaz was only aware of the fact that United Auto had not paid her medical bills from November 2, 2007 to December 5, 2007 (“first group of bills”). Thus on December 17, 2007, she provided United Auto with a statutory pre-suit demand letter informing the insurance company of the need to pay the outstanding bills for services rendered from November 2-December 5, 2007, or litigate the right to payment. United Auto did not pay the bills. Therefore, on January 24, 2008, Ms. Diaz filed a lawsuit against United Auto, Case Number 08-1321 SP 05, seeking payment of PIP benefits, totaling $5,000, for services rendered by the Provider for the first group of bills.
Freeze Order in Previous Case
On May 6, 2008, the trial court entered a freeze order in the previous case, when it continued a summary judgment hearing due to United Auto’s failure to appear. The freeze order froze the pleadings relating to Ms. Diaz’s motion for summary judgment. Freezing the pleadings would have the effect of preventing Ms. Diaz from taking any further action on her pleadings, if needed.
Discovery of the Second Set of Bills During Pendency of Previous Case
On May 7, 2008, Ms. Diaz learned that United Auto had not paid her bills for services rendered between October 5, 2007 to November 2, 2007 (“second group of bills”). In an effort to resolve the issue regarding payment of the second group of bills, Ms. Diaz served a pre-suit statutory notice demand letter on May 7, 2008, to United Auto requesting payment of bills, or in the alternative, defense against a second lawsuit. This second pre-suit demand letter was submitted to United Auto, while the pleadings were frozen.
According to Ms. Diaz, the freeze order allegedly prevented her from amending her pleadings to add the second set of bills to the case which was, at that time, pending. Meanwhile, on July 1, 2008, the PIP statute enacted sub-section (15) of Florida Statute, section 627.736, which mandates all claims be brought in a single action, except for “good cause.” On August 25, 2008, with the freeze order still in effect, a Final Judgment was entered in the pending/previous case in favor of Ms. Diaz for the amount of $3,365.00, which was then paid by United Auto.
Initiation of Instant Case at Trial Court Level to Pay Pending Second Set of Bills
After waiting seven months for United Auto to pay the second group of bills, Ms. Diaz filed the instant case on December 30, 2008, seeking payment of the second group of bills, for services rendered October 5-November 2, 2007, totaling an additional $5,250.00. This was the second complaint instituted against United Auto to recover PIP benefits for medical treatment provided by R. C. Medical Group, the same Provider, for injuries allegedly sustained from the same automobile accident.
Dismissal of the Instant Case based on the Doctrine of Res Judicata
In response to the second initiated action, the case presently before the appellate court, United Auto filed its “Motion to Dismiss or in the Alternative, Motion for Final Summary Judgment” on March 2, 2009. In its motion United Auto argued that under the doctrine of res judicata, the final judgment entered in the previous case is conclusive, and puts to rest every justifiable issue that could have been litigated in the matter.
In opposition to United Auto’s motion, Ms. Diaz argued that the instant case is proper because it involves different medical services, which produced a different set of bills, and is therefore a separate transaction. She also argues that due to mistake, the health care provider failed to notify her of the second set of bills, when she filed the complaint in the previous lawsuit.
On October 8, 2009, the trial court entered the underlying Order Granting Defendant’s Motion to Dismiss ruling in favor of United Auto, while citing the doctrine of res judicata as a basis for its ruling. The trial court held that:
[i]n this case, the facts arose out of the same accident, the parties were identical, there was privity of contract and therefore, there was no reason that these second set of bills could not have been raised in the first case . . . as a matter of fact, based on res judicata, they should have been brought based on Gomez-Ortega v. Dorten, Inc., 670 So. 2d 1107 (Fla. 3d DCA 1996) [21 Fla. L. Weekly D759d]. It is for all of the above considerations, that the Defendant’s Motion for Summary Judgment is Hereby Granted.
This Appellate Court respectfully disagrees with the trial court on this matter because the facts do not support barring the instant suit.
The Florida Supreme Court explained the concept of res judicata, and the requirements for its application, in Albrecht v. State:
The general principal behind the doctrine of res judicata is that a final judgment by a court of competent jurisdiction is absolute and puts to rest every justifiable, as well as every actually litigated, issue. . . . However, this principle only applies where the elements of res judicata are present and the doctrine is properly applied. . . . Where the second suit is upon the same cause of action and between the same parties as the first, res judicata applies. The first judgment is conclusive as to all matters which were or could have been determined. . . . It has been well settled by this Court that several conditions must occur simultaneously if a matter is to be made res judicata: identity of the thing sued for; identity of the cause of action; identity of the parties; identity of the quality in the person for or against whom the claim is made.
444 So. 2d 8, 11-12 (Fla. 1984).
The Florida Supreme Court further held that
The doctrine of res judicata bars relitigation in a subsequent cause of action not only of claims raised, but also claims that could have been raised. . . . The idea underlying res judicata is that if a matter has already been decided, the petitioner has already had his or her day in court, and for purposes of judicial economy, that matter generally will not be reexamined again in any court . . . . The doctrine of res judicata applies when four identities are present: (1) identity of the thing sued for; (2) identity of the cause of action; (3) identity of persons and parties to the action; and (4) identity of the quality of the persons for or against whom the claim is made.
Topps v. State, 865 So. 2d 1253, 1255 (Fla. 2004) [29 Fla. L. Weekly S21a] (internal citations omitted, emphasis in original).
The factor to consider when determining whether the cause of action is the same, is whether the facts or evidence necessary to maintain the action, are the same in both cases. Albrecht, 444 So.2d at 12. In the instant case, the medical treatment, procedures, CPT codes, dates of service, and amounts charged for such service, were not the same as that litigated in the prior case. Thus, the facts or evidence necessary to maintain the suit, or the identity of the thing sued for are not the same.
The Florida Supreme Court has long recognized that res judicata will not be invoked where it would defeat the ends of justice. State v. McBride, 848 So. 2d 287, 291 (Fla. 2003) [28 Fla. L. Weekly S401a]; citing deCancino v. E. Airlines, Inc., 283 So. 2d 97, 98 (Fla. 1973); Universal Constr. Co. v. City of Fort Lauderdale, 68 So. 2d 366, 369 (Fla. 1953). Here, we find that the freeze order denied Ms. Diaz the ability to amend the complaint in the prior case once the second group of bills was discovered. The inability to amend the prior complaint allowed United Auto to profit from its own misconduct. Thus, we find that such circumstance, created by the lower court, rises to the level of manifest injustice.
It is alleged that United Auto was placed on notice of the existence of all of the bills, when it received both groups of medical bills from the Provider, prior to litigation of either action. This Court finds that it was excusable neglect/error that resulted in the absence of the second group of bills’ inclusion in the prior complaint. Consequently, Ms. Diaz is innocent of any wrongdoing in the previous case. She demonstrated good faith when she served a demand letter for the second group of bills, during the course of litigation of the previous case.
The procedural history of both cases generates questions regarding whether the trial court acted properly during the course of litigation in both cases. The freeze order in the previous case seems unjust in that it punished Ms. Diaz for the failed appearance of United Auto.
In the case presently before the Appellate Court, the trial court granted the motion for summary judgment and motion to dismiss, which in fact dismissed the case, based on the doctrine of res judicata. When doing so, the trial court admitted that it did not have enough facts before it to properly address the issue of res judicata, regardless, it ruled on this issue. As a consequence, the underlying order, which addresses both motions, is inappropriate. The trial court incorrectly interpreted, and thus, misapplied Florida Statute subsection 627.736(15), to the motions for summary judgment and dismissal. Furthermore, it incorrectly held that Ms. Diaz did not have “good cause” for failing to include the second set of bills when litigating the previous case.
This Appellate Court finds that the facts in the instant case do not trigger the doctrine of res judicata. Therefore, the barring of the instant suit by the trial court was not equitable or just. More importantly after examining the elements of res judicata, this Court finds that no identity of the causes of action exist between the previous and instant case, because the facts and evidence necessary to maintain the actions are not the same.
As such, this matter is REVERSED and REMANDED to the trial court for proceedings consistent with this opinion.
Appellant’s Motion for Attorney’s Fees, pursuant to section 627.428(1) is GRANTED. (TRAWICK and BLOOM, JJ., concur.)
