22 Fla. L. Weekly Supp. 709a
Online Reference: FLWSUPP 2206BOOMInsurance — Personal injury protection — Standing — Assignment — Document signed by insured that directs payment from insurer directly to medical provider is valid assignment conferring standing on provider — Qualifying language stating that insured remains financially responsible for all charges including attorney’s fees and costs does not invalidate otherwise proper assignment
FIRST COAST IMAGING D/B/A JACKSONVILLE UPRIGHT MRI A/A/O OF CATRINA M. BOOM, (“JACKSONVILLE UPRIGHT MRI”), Plaintiff, v. STATE FARM FIRE & CASUALTY COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 16-2013-SC-004312-XXXX-MA (CC-G). December 30, 2014. Scott Mitchell, Judge. Counsel: Melissa Winer, Shuster & Saben, LLC, Jacksonville, for Plaintiff. David Gagnon, Taylor, Day, Grimm & Boyd, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTION FORSUMMARY JUDGMENT AND DENYING DEFENDANT’SMOTION FOR SUMMARY JUDGMENT AS TO STANDING
THIS MATTER comes before this Court for hearing on December 18, 2014 on Plaintiff’s and Defendant’s Motion for Summary Judgment as to the issue of standing. This Court, having reviewed the Court file and having heard argument of counsel and being otherwise fully advised in the premises GRANTS the Plaintiff’s Motion for Summary Judgment and DENIES the Defendant’s Motion for Summary Judgment as to Standing and states as grounds:
LEGAL ANALYSIS
This is a case for unpaid personal injury protection benefits brought by the Plaintiff, JACKSONVILLE UPRIGHT MRI, based on an assignment of benefits tendered by the assignor, Catrina Boom, to the assignee/medical provider. Said assignment was executed on the date of service at issue in this case, September 27, 2009, by the patient/assignor on a one-page document that has a paragraph entitled “Assignment of Benefits”, which states, in pertinent part:
“I hereby give authorization of payment of insurance benefits to be made directly to Jacksonville Upright MRI for services rendered. I understand that I am financially responsible for all charges whether or not they are covered by insurance. In the event of default, I agree to pay all costs of collection and reasonable attorney’s fees. I hereby authorize the healthcare provider to release all information necessary to secure the payment benefits. I further agree that a photocopy of this agreement shall be as valid as the original”1
ASSIGNMENT v. DIRECTION TO PAY
In Shuster v. Blue Cross, 843 So.2d 909 (Fla. 4th DCA 2003) [28 Fla. L. Weekly D505a], the patient, Schuster, not the provider, Martin Memorial Hospital, attempted to file a lawsuit for unpaid health insurance benefits against Blue Cross.2 The Fourth District Court of Appeal ruled that an “Assignment of Benefits” that directed payment to go directly from Blue Cross to the providers to whom the assignments were given conveyed standing to the providers, and not to the insureds to bring a suit for unpaid benefits. “Under Florida law, an insured may assign his right to benefits under a contract of insurance. 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. See Oglesby v. State Farm Mut. Auto. Ins. Co., 781 So.2d 469 (Fla. 5th DCA 2001) [26 Fla. L. Weekly D702a](emphasis added). Therefore, since the language of the document and the actions of the parties show that they intended to convey and accept the right to receive payment directly from the Defendant, the provider is the entity that has standing to bring this case.
The Defendant presents no cases at oral argument from a District Court of Appeal or higher, to support its position that the language is a mere direction-to-pay. In its motion, Defendant relies on Health Application Svs., Inc. v. Hartford Life & Acc. Ins. Co., 381 So.2d 294 (Fla. lst DCA 1980) for the proposition that the mere word “assignment” or an “agreement to pay a debt out of a designated fund does not operate as a legal or equitable assignment”. However, as the First District points out, the assignment in Health Application was merely a “promise to pay” and not an “intention on the part of the assignor to give, and of the assignee, to receive, present ownership of the fund.” In our case, all the facts show such an intent: the provider submitted its bill to the Defendant in reliance on its assignment of benefits; the payment was directly made to the provider; the assignee never took issue with the payment going to the provider; and, the provider filed suit on its alleged improper payment against the carrier at issue.
The Plaintiff also relies on State Farm Fire and Casualty Company v. Ray, 556 So.2d 811 (Fla. 5th DCA 1990) for its position that the assignment of benefits in this case conveyed standing to the Plaintiff.3 In Ray, the assignment of benefits set forth the transfer of any proceeds accruing to Ray (the patient) from State Farm directly to Halifax Hospital (i.e. a direction to pay). When State Farm paid the Halifax Hospital bill in disregard of Ray’s written instruction to State Farm to limit such payment, Ray sued State Farm for making such unauthorized payments instead of reserving PIP benefits for his lost wages. The trial court agreed and ruled in favor of Ray. The Fifth District reversed, stating:
“An assignee may enforce payments or the performance of an obligation due under an assigned contract. Because an unqualified assignment transfers to the assignee all the interest of the assignor under the assigned contract, the assignor has no right to make any claim on the contract once the assignment is complete, unless authorized to do so by the assignee. 4 Fla.Jur.2d, Assignments § 23 (1978); see also Howard v. Pensacola & A.R. Company, 24 Fla. 560, 5 So. 356 (1886).”
State Farm v. Ray, at 813.
Not only does the Fifth District in Ray support the Plaintiff’s position that the “transfer of any proceeds” also conveys the right to bring a lawsuit for the non-payment of those proceeds, but the facts in Ray show the danger of a legal finding that there is a dichotomy between an assignment and a “mere” direction-to-pay, as suggested by the Defendant. In Ray, the positions between the assignor, Ray, and the assignee, Halifax Hospital, were diametrically opposed. Halifax Hospital wanted its bill paid pursuant to F.S. 627.736 and its assignment of benefits, while Ray wanted the same PIP benefits withheld for his lost wages. Since the hospital was the real party in interest for payment of its bill, Halifax Hospital was the only entity that could have standing to bring a lawsuit for its position that it had a right to get paid over Ray’s instruction to not pay that bill. Also see, Hartford v. O’Connor, 855 So.2d 189 (Fla. 5th DCA 2003) [28 Fla. L. Weekly D2140a]. Further, in Ray, the language of the assignment was limited to a direction to pay. However, the Fifth District found that the conveyance of the right to receive payment directly from the insurer carries with it the right to enforce non-payment of that debt, which is the Plaintiff’s position in this case.
Like in Ray, in our case, the real party in interest is the entity that seeks to have its bill paid, which is Jacksonville Upright MRI. Since the date of service, the assignor, Catrina Boom, filed no lawsuit for the Plaintiff’s unpaid balance, nor has she filed any objection in this case. Further, the statute of limitations has now run on the filing of this case and if the Court ruled that the Plaintiff was not the real party in interest, the Plaintiff would have no further recourse with the Court to seek payment.
In addition to the binding appellate case law cited above, the Plaintiff submits to this Court at least two Orders from sister courts in Duval County finding that a medical provider has standing to bring a claim for unpaid PIP benefits when the patient signs an assignment of benefits that directs payment from the insurer directly to the provider without the additional verbiage of a right to bring such a cause of action. See, Advanced MRI Diagnostic a/a/o Anthony Mayo v. State Farm Mut. Auto. Ins. Co., 20 Fla. L. Weekly Supp. 599a (Order of Duval County Court Judge Emmet F. Ferguson, III, December 14, 2012); Advanced MRI Diagnostic a/a/o Benita Ciment v. State Farm Mut. Auto. Ins. Co., 20 Fla. L. Weekly Supp. 422a (Order of Duval County Court Judge Sharon H. Tanner, December 13, 2012).
Therefore, based on the binding case law presented by the Plaintiff, the persuasive orders from sister courts of Duval County, and a logical analysis of the facts in this case, this Court find that the Plaintiff has standing.“QUALIFYING LANGUAGE”
The Defendant argues that the assignment is invalid because of “qualifying language” that the patient remains “financially responsible” for all charges, including “costs of collection and attorney’s fees”. The Court in Schuster addressed such language and ruled that same is a non-factor in finding that the direction-to-pay was enough to convey standing. In Schuster, the Court reviewed two separate assignments from Martin Memorial Hospital and Housecall, authorizing payment directly to the providers, but containing qualifying language that the insured would remain financially responsible for any amounts not paid. The Fourth District rejected the Schuster’s argument that this kept standing with the assignors, stating:
“In Oglesby v. State Farm Mutual Automobile Insurance Co., 781 So.2d 469 (Fla. 5th DCA 2001) [26 Fla. L. Weekly D702a], the Fifth District held that language similar to that included in the Martin Memorial and Housecall assignments, and that described by Mr. Schuster, was an unqualified assignment and served to eliminate the insured’s standing to bring a claim against the insurer. While Oglesby admittedly involved the assignment of PIP benefits to a medical provider, we see no reason to reach a different conclusion where the benefits arise under a health insurance policy.”
Schuster at 912.
The Fourth District relied on Olgesby, which involved an assignment on a PIP case, in a non-PIP context. In our case, Oglesby (and Schuster) are even more compelling since we are reviewing an assignment in a PIP context. Also see, Hartford v. O’Connor, 855 So.2d 189 (Fla. 5th DCA 2003) [28 Fla. L. Weekly D2140a] (an assignment to “receive payment” coveys standing to the medical provider/assignee and not the assignor/patient).
The Defendant asserts that the fact that the assignor may be responsible for attorney’s fees and costs in the future somehow makes her a real party in interest. Again, in Schuster, the Fourth District rejected that argument. Blue Cross argued that the Schusters had no standing to enforce the non-payments because there was no evidence that they had been required to pay any out-of-pocket expenses. In our case, there is no evidence presented that Catrina Boom had been required to actually pay any expenses that would have been paid by State Farm. In fact, under F.S. 627.736, the provider is prohibited from seeking payment from the insured that is otherwise payable by the insurer prior to benefits being exhausted.4
The qualifying language in the assignment that the Defendant points to not only fails to invalidate an otherwise proper assignment, but said language is unenforceable. Moreover, there is no evidence that the Plaintiff attempted to enforce the provision at issue. At best, the Defendant’s concerns are speculative. However, if this Court denies the Plaintiff’s motion for summary judgment, the affect is real, which is dismissing a case that is now beyond the statute of limitations. Therefore, applying the above analysis, the Court’s position is unchanged.
THEREFORE, it is the ruling of this Court that the Defendant’s Motion for Summary Judgment is DENIED and the Plaintiff’s Motion for Summary Judgment is GRANTED.
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1The assignment at issue in this case was filed with the Court through the affidavit of the claims representative of the Defendant, which was attached to its motion and accepted by the Court without objection.
2In Schuster, there were actually twenty-seven different claims at issue, but the parties agreed that the assignments in each claim were, essentially, the same, and the same analysis for one provider would apply to the remaining providers. See, Schuster at 912.
3The Defendant also relies on the Ray case in its Motion for Summary Judgment at page 5, thereby warranting discussion and analysis by this Court.
4F.S. 627.736(5)(a)(5)
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