21 Fla. L. Weekly Supp. 344b
Online Reference: FLWSUPP 2104PHILInsurance — Personal injury protection — Standing — Assignment — Where insured executed document assigning benefits to medical provider who rendered services, submitted bills to insurer, and filed suit against insurer, provider is real party in interest — There is no distinction between direction to pay and assignment of benefits — Even if express assignment did not exist, equitable assignment conveys standing to provider
ADVANCED 3D DIAGNOSTICS A/A/O NICUOLY JEAN PHILIPPE, Plaintiff, v. USAA CASUALTY INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 2012-SC-011324-O (70-6). July 12, 2013. Honorable Andrew Cameron, Judge. Counsel: Adam Saben, Shuster & Saben, Miami, for Plaintiff. Christopher Cavaliere, Hussein Law Group, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTIONFOR SUMMARY JUDGMENT AND DENYINGDEFENDANT’S MOTION FOR SUMMARYJUDGMENT AS TO STANDING
THIS CAUSE having come before the Court for hearing on June 5, 2013, on Plaintiff’s and Defendant’s Counter-Motions for Summary Judgment, and the Court having considered the motion, court file, applicable law and the arguments of counsel, finds as follows:
This is a case where the Plaintiff, a medical provider, performed medical services for the claimant and submitted its bill to the Defendant for payment. The Plaintiff disputes the amount paid. The Defendant’s position is that the Plaintiff has no standing to bring a cause of action for its bill at issue.
The Plaintiff seeks standing to bring this case through its Assignment of Benefits, contained within is the following language:
“The undersigned patient hereby assigns the benefits of insurance under the automobile insurance with [Defendant] to [Plaintiff], for services rendered to the undersigned patient and covered by Personal Injury Protection (P.I.P.) Coverage under [Nicouly Jean Phillippe’s] Policy with [Defendant].
The undersigned hereby accepts assignment of insurance benefits for services rendered to [Nicouly Jean Phillippe’s] Personal Injury Protection (P.I.P.) [sic] coverage with [Defendant] and in accordance with Florida Statute 267.736(5) [sic].”
The Defendant argues that the above language creates a “mere” direction to pay from the Defendant/insurer to the Plaintiff/provider, yet said language fails to create a right for said provider to enforce that right by failing to convey standing to bring a cause of action. Based on a review of the facts in the case and a review of the relevant case law, this Court finds that the Plaintiff has standing to bring this case. This ruling is based on the following legal and factual analysis:
THE PLAINTIFF IS THE REAL PARTY IN INTEREST
The following facts are not in dispute:
– Plaintiff rendered medical services on May 28, 2009;
– Plaintiff timely submitted its bill and seeks payment for services rendered;
– Plaintiff is the entity that brought this lawsuit and filed same on or about December 10, 2012.
In the same period of time, the Court also finds:
– Claimant/patient has not filed suit for payment of the Plaintiff’s bill;
– Claimant/patient has not objected to the Plaintiff filing suit for payment of its bill;
– Claimant/patient has no connection to the Plaintiff other than receiving the medical services at issue; and
– The direction to pay language of the assignment would result in any additional benefits going directly to the Plaintiff, ADVANCED 3D.
The party bringing the claim must be the real party in interest. That is, whether the best parties are before the Court to properly litigate the issues in a given case. The real party in interest 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, based on the above facts, the Plaintiff, ADVANCED 3D, is in the best position to litigate the merits of its case against the Defendant. The Plaintiff has a real interest in getting its bill paid. It is the one that submitted the claim and it is the one seeking its enforcement.
The Plaintiff can best argue that its services were medically necessary, reasonable, and/or medically related; its bills were timely submitted; and, any other relevant issues in this case. Further, the Plaintiff, not the claimant, is the one who took affirmative action to get its bill paid, by filing this lawsuit. Assuming that the claimant wanted to file suit, the benefits sought would be tendered to the Plaintiff since, according to the Defendant, the claimant signed a direction to pay. Therefore, the Court finds that the Plaintiff is the real party in interest and the proper litigant to prosecute this claim, Also see, Advanced MRI a/a/o Anthony Mayo v. State Farm Mutual Automobile Insurance Company, 20 Fla. L. Weekly Supp. 599a. (finding the MRI provider has standing with an identical assignment of benefits).
NO DISTINCTION BETWEEN A DIRECTIONTO PAY AND AN ASSIGNMENT
A review of the appellate case law reveals that there is no legal distinction between a direction to pay and an assignment of benefits.
Interestingly, both the Plaintiff and the Defendant rely on Progressive Express Insurance Company v. McGrath, 913 So.2d 1281 (Fla. 2nd DCA 2005) [30 Fla. L. Weekly D2622b]. In McGrath, the medical provider filed a claim for unpaid PIP benefits. However, the assignment of benefits was not executed until after the provider filed suit. For that reason, the Second District agreed with the trial court that the provider had no standing to file suit. Presumably, for this reason, the Defendant states that Advanced 3D has no standing in this case. However, there is no dispute that the assignment of benefits was executed at the time services were rendered and well before Advanced 3D filed this suit. In McGrath, the Second District, in addressing the language of the assignment, looked at the language of the assignment which stated, in pertinent part, the “Assignment of Benefits Form assigned to the Provider benefits payable under the policy for services rendered by the Provider. The form also authorized Progressive to pay such benefits directly to the Provider.” McGrath, at 1283 (emphasis added). This Court finds that the language in the Assignment on Benefits in McGrath is the same as the one in this case with respect to its silence on anything other than there being a direction to pay. The Second District drew no distinction between a “mere” direction to pay and an assignment giving a provider the right to bring a suit for unpaid PIP benefits. In fact, the Second District found the provider could bring suit if it had the executed assignment of benefits prior to filing suit. In our case, this is not an issue. Therefore, this Court relies on McGrath in finding that the distinction between a direction to pay and an assignment of benefits with an inherent right to bring suit is artificial and the Defendant’s argument is not supported by McGrath, and that the Plaintiff’s argument is consistent with McGrath.
In Schuster v. Blue Cross and Blue Shield of Florida. Inc. 843 So.2d 909 (Fla. 4th DCA 2003) [28 Fla. L. Weekly D505a], the Plaintiff’s Ned and Suzanne Schuster, attempted to bring a lawsuit for unpaid health insurance benefits. There was no dispute that the Schusters signed assignments of benefits to various medical providers which merely directed payment from the insurance company to the various providers. In fact, the Fourth District states that the Plaintiff assigned “their right to benefits to the health care providers, and consequently, had sustained no damages” Schuster at 910.1 The Fourth District also states, “Where the Schusters assigned their contract rights to the health care providers at issue in this case, they assigned away their right to bring this cause of action for breach of contract against Blue Cross and for any resulting damages.” Schuster at 911. Again, the assignment in Schuster was a direction to pay, which is the language of the assignment in our case. Therefore, under Schuster, the Plaintiff, ADVANCED 3D, has standing in this case. Also see Hartford Ins. Co. of Southeast v. St. Mary’s Hosp., Inc. 771 So.2d 1210, 1212, (Fla. 4th DCA 2000) [25 Fla. L. Weekly D2523a] (“Courts have recognized that medical service providers can assert claims for PIP benefits against insurers when an insured has assigned them the right to the benefits.”). The effect of such an assignment is to place the insured’s cause of action for such benefits in the provider.
EQUITABLE ASSIGNMENT
“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 valuable consideration, will operate as an effective equitable assignment.” Giles v. Sun Bank, N.A., 450 So.2d 258, 260 (Fla. 5th DCA 1984). In this case, the facts indicate that there is an equitable assignment of benefits (assuming an express assignment didn’t exist) for the facts as stated above. Defendant relies on Open MRI of Orlando, inc., a/a/o Raquel Ramos v. State Farm, 17 Fla. L. Weekly Supp. 731a (9th Jud Cir. App. 2010) in finding that there is no assignment in this case, however, the Ninth Judicial Circuit found that the Plaintiff in Ramos never pled equitable assignment in its Complaint. In our case, the Plaintiff pled, in the alternative of an express assignment of benefits, there was, at least, an equitable assignment of benefits. Therefore, this Court finds that there is an express assignment of benefits that conveys standing, and, further, even if one did not exist, there is, at least, an equitable assignment, which conveys standing to the Plaintiff.
THEREFORE, it is 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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1Although this goes to an earlier argument regarding real party in interest, the fact that the Fourth District finds that the Schusters suffered no damages shows that the claimant who signs an assignment of benefits that includes language directing payment to a provider cannot be a real party in interest since that claimant suffers no damages as a result of the failure to pay the proper amount. Like the Schusters, where the Fourth District found they suffered no damages, in our case, the claimant suffered no damages, which also is why Advanced 3D, and not the claimant is the Plaintiff in this case, the real party in interest, and the only entity that can have standing.
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