21 Fla. L. Weekly Supp. 303a
Online Reference: FLWSUPP 2104VALDInsurance — Personal injury protection — Exclusions — Provision excluding coverage for injury sustained by named insured or relative while occupying motor vehicle owned by named insured but not insured under policy is allowable under Florida law — Exclusion applied in instant case in which wife was injured while riding in car owned by her husband but not insured under wife’s policy where wife’s policy identified wife as “named insured,” but also provided that “named insured” included a spouse if a resident of the same household
HIALEAH MEDICAL ASSOCIATES, A/A/O MARITZA VALDES, Appellant, v. UNITED AUTOMOBILE INSURANCE COMPANY, Appellee. Circuit Court, 11th Judicial Circuit (Appellate) in and for Miami-Dade County. Case No. 12-086-AP. L.T. Case No. 07-09321 CC-05. December 2, 2013. Counsel: Virginia M. Best, Lopez & Best, for Appellant. Michael J. Neimand, Office of the General Counsel for United Automobile Insurance Company (Trial Division), for Appellee.
(Before LEDERMAN, COHEN and HERSCH, JJ.)
(HERSCH, Judge.) This is an appeal by Hialeah Medical Associates as assignee of Maritza Valdez (hereinafter referred to as “Hialeah Medical”) seeking reversal of the trial court’s order granting final summary judgment in favor of United Automobile Insurance Company (hereinafter referred to as “United”). Our review of the trial court’s summary judgment is de novo. Volusia County v. Aberdeen at Ormond Beach, L.P., 760 So. 2d 126 (Fla. 2000) [25 Fla. L. Weekly S390a]; Hope v. Citizen’s Property Ins. Corp., 114 So. 3d 457 (Fla. 3d DCA 2013) [38 Fla. L. Weekly D1230a].
Maritza Valdes was injured in an automobile accident while a passenger in a vehicle owned by her husband, Roberto Valdes. While Maritza owned another car, insured by United, Roberto’s car was insured by a different company, U.S. Security. Both parties agree that Maritza and Roberto are married, residing in the same household, and that the policies of United and U.S. Security are identical in their coverage and exclusions. Maritza received treatment from Appellant Hialeah Medical, ultimately assigning to Appellant her personal injury protection benefits (PIP). Hialeah Medical initially submitted the bills for treatment to Roberto’s insurer, U.S. Security, which denied coverage.1 Upon subsequent submission of the bills to United, payment was declined and coverage denied, citing to the exclusions contained in Maritza’s policy.
In June of 2007, Appellant Hialeah Medical filed a complaint naming only United as Defendant and seeking payment of PIP benefits. Appellant later successfully sought amendment to include a declaratory action raising an equal protection violation. In September 2011, United filed an Amended Motion for Final Summary Judgment bringing to issue the exclusions in Maritza’s policy. Appellant Hialeah Medical’s response addressed the exclusions under both contractual and constitutional bases.2 The trial court granted United’s Motion for Summary Judgment. This Court affirms.
The Exclusion.
The operative exclusion in the PIP section of United’s policy states in pertinent part:
This insurance does not apply:
(a) to the named insured or any relative while occupying a motor vehicle of which the named insured is the owner and which is not an insured motor vehicle under this insurance; . . .
This language tracks that directly provided in section 627.736(2)(a) of the Florida Statute, making the existing exclusion in the PIP section of Maritza’s United policy allowable under Florida law.
Important to United’s argument here is that while Maritza is a “named insured” in the United policy (the policy covers Maritza’s car and she is identified as the NAMED INSURED on the declarations page), Roberto is also a “named insured”. On page two of the United policy “named insured” is defined as “the person or organization named in the Declarations policy; and if an individual, shall include the spouse if a resident of the same household.” Thus, United argues that although Maritza is a “named insured”, she was injured while a passenger in a vehicle owned by a “named insured” (Roberto, the resident husband) which was not insured under the United policy. Hialeah Medical contests such a construction of this exclusion.
The language at issue has previously been examined by the Third District Court of Appeal under similar facts. In Industrial Fire and Cas. Ins. Co. v. Jones, 363 So. 2d 1168 (Fla. 3d DCA 1978), Calvin Jones lived with his mother and stepfather. The mother maintained a policy on her car with Industrial. However, Calvin was injured in an automobile accident while driving his stepfather’s car, one not insured under the Industrial policy. In reversing the trial court’s summary judgment for Jones and upholding the exact exclusion found in the United policy sub judice, the Jones Court stated:
We hold. . .that a person described as a spouse of a policyholder may properly be included as a named insured even though the given name and surname of such spouse are not stated in the policy. We think this interpretation is necessary to preserve the intentions of the act and that any other interpretation would bring about the ridiculous result of allowing the insurance of one automobile and the coverage on several unnamed automobiles. See Fidelity & Casualty Company of New York v. Fonseca, 358 So. 2d 569 (Fla. 3d DCA 1978).
Id. at 1170. (footnote omitted). Thus, Calvin’s stepfather was a “named insured” and the injury occurred in a vehicle owned by a “named insured” but not covered under the Industrial policy.
In Fonseca, the Third District found a similar exclusion authorized the denial of coverage and more fully explained the policy:
The rationale underlying such inclusion of both resident spouses with 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).
358 So. 2d at 575. At least one other panel of the Eleventh Circuit, sitting in an appellate capacity, has come to the same conclusion as the Third District and this Appellate Court. Quality Medical Group Inc. a/a/o Pastor Rodriguez v. United Automobile Insurance Company, 16 Fla. L. Weekly Supp. 821a (Fla. 11th Cir. Ct. July 8, 2009) (trial court found that policy correctly uses the exclusionary language found in section 627.736(2)(a) to exclude coverage for PIP benefits to named insured while occupying a motor vehicle of which the named insured is the owner, but is not insured under insurance policy at issue).
Under the instant policy, Maritza was a named insured and her injuries arose while she was the passenger in a vehicle owned by a named insured (Roberto), but the vehicle was not insured by United. Consequently, the language allowing exclusion that exists in both Section 627.736(2)(a) and the policy applies. The trial court’s granting of United’s Motion for Summary Judgment is AFFIRMED.
Appellee’s Motion for Appellate Attorney’s Fees is Granted. (LEDERMAN and COHEN, JJ., concur.)
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1A representative for U.S. Security later admitted in deposition that the decision to deny coverage was in error. While Hialeah Medical asserts in their briefs that Maritza Valdes is foreclosed from coverage under either policy, such is not the case. The U.S. Security policy clearly provides PIP benefits to Maritza Valdes as a named insured injured in a vehicle owned by a named insured.
2The constitutional argument does not appear to be presented in any response of Hialeah Medical to United’s Amended Motion for Summary Judgment (No Coverage). However, this argument was made in their Motion for Reconsideration, Clarification, and if Applicable, Rehearing. R/A. 1500-1816.
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