20 Fla. L. Weekly Supp. 521b
Online Reference: FLWSUPP 2005MAYOInsurance — Personal injury protection — Standing — Assignment — There is no legal distinction between direction to pay and assignment of benefits — Document that “assigns benefits of insurance” confers standing on medical provider — Provider is real party in interest — Insurer has no standing to challenge assignment
ADVANCED MRI DIAGNOSTIC A/A/O ANTHONY MAYO, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 16-2012-SC-000674-XXXX-MA (A). December 14, 2012. Honorable Emmet F. Ferguson, III, Judge. Counsel: Adam Saben, Shuster & Saben, Miami, for Plaintiff. James C. Rinaman, III, James C. Rinaman, III & Associates, Jacksonville, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTION FORSUMMARY JUDGMENT AND DENYING DEFENDANT’SMOTION FOR SUMMARY JUDGMENT
THIS MATTER comes before the Court for hearing on October 15, 2012 on cross-motions for summary judgment by both parties on the issue of standing, and, more specifically, whether the assignment of benefits submitted by the Plaintiff confers standing to bring a claim for unpaid PIP benefits. The facts in this case are not in dispute and the parties have stipulated to the admission of the document entitled “Assignment of Benefits” in this case and the Court reviewed same. The document states the patient “assigns the benefits of insurance” to Advanced MRI Diagnostics. The document also states the “undersigned hereby accepts assignments of insurance benefits for services rendered to (Patient’s name)1. The Defendant argues that said language merely constitutes a direction to pay, while the Plaintiff argues that there is no legal distinction between an assignment of benefits and a “mere” direction to pay.
I. DIRECTION TO PAY AND ASSIGNMENT
Three of the five Florida District Courts of Appeal have addressed PIP assignments and agree that an unqualified instruction to pay the provider directly is a common law assignment or the statutory assignment contemplated by F.S.§627.736(5). The Appellate case law across the state is unequivocal and provides excellent guidance on the lack of distinction between a direction to pay and an assignment.
In State Farm Fire and Cas. Co. v. Ray, 556 So.2d 811 (Fla. 5th DCA 1990), an assignment was entered into between Halifax Hospital and Ray. The Court, in evaluating the assignment noted that the assignment “possesses all the classic features of an assignment. Not only is the document entitled ‘Irrevocable Assignment of Benefits,’ it sets forth the transfer of any proceeds accruing to Ray from State Farm under the policy stemming from Ray’s accident and subsequent hospitalization.” Id. (emphasis added). The Fifth DCA found that there was an assignment based on the “transfer of any proceeds accruing to Ray from State Farm under the policy stemming from Ray’s accident and subsequent hospitalization” Ray, at 813, that is, a direction to pay.
Like in the Ray case, the assignment of benefits in this case is a document entitled, “Assignment of Benefits” and contained therein is the instruction to pay directly to the provider any PIP benefits. Therefore, pursuant to the Ray case, there is a valid assignment to convey standing to the Plaintiff.
Similarly in Schuster v. Blue Cross & Blue Shield of Florida, Inc., 843 So.2d 909 (Fla. 4th DCA 2003) [28 Fla. L. Weekly D505a] the Schusters executed an assignment in favor of Martin Memorial Hospital. The language of the Martin Memorial Assignment authorized the insurer to make payment directly to the provider, but stated that the insured would remain financially responsible for any amounts not paid. The Fourth District Court of Appeals followed the Fifth District’s holding in Ray finding the Martin Memorial Assignment was an unqualified assignment and served to eliminate the insured’s standing to bring a claim against the insurer.” (emphasis added). Again, in our case, there is a direction to pay the provider directly, which under the line of cases presented by the Plaintiff, conveys standing.
In Oglesby v. State Farm Mut. Auto. Ins. Co., 781So.2d 469, 470 (Fla.5th DCA 2001) [26 Fla. L. Weekly D702a] the 5th District held that an assignment existed where provider agreed to perform services based on an unqualified assignment of medical benefits on the condition that patient would be ultimately responsible for any medical bills either not covered by policy or simply not paid by insurer. Like in Oglesby, the patient is placed under the same financial obligation and the Fifth DCA found, in Oglesby, there was a proper conveyance and standing sufficient for the provider to bring suit. The same rationale applies to the Plaintiff in this case.
Finally, in Orion Ins. Co. v. Magnetic Imaging Sytems I, 696 So.2d 475, (Fla.3d DCA 1997) [22 Fla. L. Weekly D1595c] the Third District Court of Appeals found an assignment existed where provider’s customers authorized direct payment of benefits to provider). In State Farm Mut. Auto. Ins. Co. v. Gonnella, 677 So.2d 1355 (Fla.5th DCA 1996) [21 Fla. L. Weekly D1799d] the Fifth District found assignment existed where insured allowed provider to receive direct payment of benefits from insurer. In Parkway General Hospital, Inc. v. Allstate Ins. Co., 393 So.2d 1171, 1172 (Fla.3d DCA 1981), the Third DCA found an assignment existed where insured authorized insurer to make direct payment to hospital of any benefits arising from policy). Again, looking at the assignment in this case, the same features are present which convey standing to the Plaintiff.
Relying on the above cases, this Court finds that there is no legal distinction between a “direction to pay” and an “assignment of benefits,” and that the document at issue confers standing to the Plaintiff.
II. PLAINTIFF IS THE REAL PARTY IN INTEREST
The Court has an interest in seeing that issues are properly litigated. The claim must be brought by or on behalf of one who is recognized in law as a “real party in interest,” that is, “the person in whom rests, by substantive law, the claim sought to be enforced.” Weiss v. Johansen, 898 So.2d 1009 (Fla. . 4th DCA 2005) [30 Fla. L. Weekly D680a]. In this case, there is no dispute that the services were rendered by the Plaintiff; the bill was submitted by the Plaintiff; the demand letter was submitted on behalf of the Plaintiff; the case was chosen to be filed by the Plaintiff; the outstanding balance is owed to the Plaintiff; and party seeking to enforce its right is. . . . .the Plaintiff. The claimant never sought to file a lawsuit to get the bill at issue paid nor has the claimant objected to the filing of this suit by the Plaintiff.2 Even assuming the claimant wanted to file a suit, the benefits sought would be tendered anyway to this Plaintiff. Therefore, the Court is of the position that the Plaintiff is the real party in interest in this case and the litigant in the best position to prosecute this claim.
III. DEFENDANT HAS NO STANDINGTO CHALLENGE STANDING
There is no dispute that the assignment in this case rests between the claimant and the Plaintiff. The Defendant is not a party to the contract (assignment) in this case.
In Digital Medical Diagnostics v. Allstate, 15 Fla. L. Weekly Supp. 1147b (Fla. 11th Circuit Dade County, October 2, 2008), certiorari denied April 24, 2009, the Eleventh Judicial Circuit, Appellate Capacity, ruled that the insurance company, Allstate, had no standing to challenge the assignment of benefits between the claimant and the medical provider who brought the lawsuit for PIP benefits as said carrier had no privity to the assignment, and therefore, could not challenge its validity. Citing Gallagher v. Dupont, 918 So.2d 342 (Fla. 5th DCA 2005) [30 Fla. L. Weekly D2776b], the Eleventh agreed that “A person not a party to nor in privity with a contract has no right to enforce it”.
In Lugassy v. Independent Fire Insurance Company, 636 So.2d 1332 (Fla. 1994), the Florida Supreme Court ruled that a third-party insurance carrier had no standing to challenge a fee agreement between a lawyer and his clients because the insurance company was not a party or a third-party beneficiary to the contract. The Defendant in that case is in the “same shoes” as the Defendant in our case. It is not a party or a third-party beneficiary to the assignment of benefits. Therefore, the Defendant has no standing to challenge standing in this case.
In Progressive Express Insurance Company v. McGrath Community Chiropractic, 913 So.2d 1281 (Fla 2nd DCA 2005) [30 Fla. L. Weekly D2622b] the Second District Court of Appeal ruled that Progressive Insurance Company has no standing to challenge standing based on an Assignment of Benefits between a medical provider and a patient where the provider sought to collect PIP benefits. Progressive moved for summary judgment on standing and the Second DCA ruled that Progressive, as a third-party to the assignment is not entitled to challenge the assignment or standing. The Defendant in this case stands in the exact same position and, therefore, has no standing to challenge standing., Also see, White v. Exchange, 167 So.2d 324 (Fla. 3D 1964); Simkins Industries, Inc. v. Highlands Ins. Co., 795 So.2d 169 (Fla. 3rd DCA 2001) [26 Fla. L. Weekly D2151b]; Dr. Stephen Chase a/a/o Marie M. Geneus v. United Automobile Insurance Company, 12 Fla. L. Weekly Supp. 975a (Miami-Dade County Court Order of Judge Lawrence D. King, May 5, 2005); North Lauderdale Chiropractic Center a/a/o Marlon McKenzie v. United Automobile Insurance Company, 18 Fla. L. Weekly Supp. 210a (Miami-Dade County Court Order of Judge Myriam Lehr, May 26, 2009); Advance Health Center a/a/o Yolande Joseph v. United Automobile Insurance Company, 16 Fla. L. Weekly Supp. 959b (Miami-Dade County Court Order of Judge Myriam Lehr, August 11, 2009).
Therefore, on three separate theories: a) the assignment is valid and any attempt to limit the assignment as a mere direction to pay is not supported by the facts or case law; b) the Plaintiff is the real party in interest; and, c) the Defendant has no standing to challenge the assignment as it is not a party to the assignment,
It is hereby ORDERED and ADJUDGED that the Plaintiff’s Motion for Summary Judgment is GRANTED and the Defendant’s Motion for Summary Judgment is DENIED.
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1The Court acknowledges that the assignment states that the “undersigned hereby accepts” the assignment, which seemingly references an assignment from the patient back to the patient. However, the Court infers this merely as poor draftsmanship on the part of the Plaintiff. The document was clearly authored by the Plaintiff. The Plaintiff performed the services and submitted the bill to the Defendant for payment, and is the party who is bringing this lawsuit.
2In general, any instruction, document, or act that vests in one party the right to receive funds arguably due another party may operate as an equitable assignment. McClure v. Century Estates, Inc., 96 Fla. 568, 120 So. 4, 10 (1928). “No particular words or form of instrument is necessary to effect an equitable assignment[,] and any language, however informal, which shows an intention on one side to assign a right or chose in action and an intention on the other to receive, if there is a valuable consideration, will operate as an effective equitable assignment.” Giles v. Sun Bank, N.A., 450 So.2d 258, 260 (Fla. 5th DCA 1984); see also WM Specialty Mortgage, LLC, 874 So.2d 680. . The true test is “whether the debtor would be justified in paying the debt to the person claiming as assignee.” [emphasis added] McClure v. Century Estates, 96 Fla. 568, 120 So.4 (Fla. 1928).
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