25 Fla. L. Weekly Supp. 865b
Online Reference: FLWSUPP 2510AHUMInsurance — Personal injury protection — Coverage — Medical expenses — Settlement — Trial court erred in entering summary judgment in favor of insurer on its affirmative defense of accord and satisfaction after previously finding that genuine issues of material fact were created by handwritten notations made by provider’s representative on settlement letter, beneath representative’s signature, indicating that representative understood once all payments were made, benefits would be exhausted; whereas, at time replacement settlement check had been sent to provider and deposited, insured had withdrawn his intention to pursue a lost wages claim which had figured into insurer’s pre-settlement discussion of the amount of policy benefits that would be available to pay provider
LUIS AHUMADA, Appellant, v. IMPERIAL FIRE & CASUALTY COMPANY, Appellee. Circuit Court, 11th Judicial Circuit (Appellate) in and for Miami-Dade County. Case No. 15-205 AP. L.T. Case No. 12-7972 SP 26. November 27, 2017. An appeal from the County Court for Miami-Dade County, Lawrence King, Judge. Counsel: Marlene S. Reiss, for Appellant. Douglas H. Stein, for Appellee.
(Before MARIA ESPINOSA DENNIS, RODOLFO RUIZ, and DAVID YOUNG, JJ.)
(YOUNG, J.) The Appellant, Luis Ahumada, is a PIP insured of Appellee, Imperial Fire & Casualty Insurance Co. He was treated for injuries by Custer Medical Center, accruing $15,040 in medical bills, which Custer submitted to Imperial. Mr. Ahumada’s attorney notified Imperial that Mr. Ahumada also planned on making a PIP claim for lost wages. In January 2012, Custer and Imperial entered into talks regarding Ms. Ahumada’s bills. Imperial conveyed to Custer that once it paid a certain portion of Mr. Ahumada’s PIP benefits to another medical provider, as well as settled Mr. Ahumada’s lost wages claim, it would have only $5500 left to satisfy Custer’s claim.
In January 2012, Imperial sent Custer a settlement agreement letter in which Imperial stated that Custer agreed to a reduction of bills in the amount of $5500 as full and final settlement, and that Custer agreed it would not bill the patient, Mr. Ahumada, for the amount of the reduction. Custer’s representative, Esther Garcia, signed the document on behalf of Custer and, at the bottom of the letter, beneath her signature, she hand-wrote: “I understand once all payments are made, benefits will be exhausted.” Two days later, Imperial forwarded Custer a check for $5500. Custer did not immediately deposit the check.
In February 2012, Mr. Ahumada’s attorney informed Imperial that Mr. Ahumada would not be pursuing a lost wages claim. Several months later, Custer returned the $5500 check as it had not timely deposited it. Imperial sent a replacement check, which Custer promptly deposited. Imperial did not disclose that Mr. Ahumada had withdrawn his intention to pursue a lost wages claim.
In August 2012, Mr. Ahumada’s attorney sent Imperial a pre-suit demand letter seeking $4500 in benefits. Imperial responded that it had paid and settled all of Mr. Ahumada’s medical bills. In November 2012, Mr. Ahumada filed a complaint against Imperial seeking $4500 in expenses incurred as a result of being treated at Custer. Imperial’s answer put forth the affirmative defense of settlement — attaching the January 2012 agreement as evidence.
In July 2013, Mr. Ahumada filed a motion for summary judgment on Imperial’s settlement defense arguing that the hand-written note Ms. Garcia left on the settlement letter constituted an unaccepted counteroffer, or condition precedent that was never satisfied, or otherwise constituted evidence that there was no meeting of the minds between the parties. The trial court denied the motion, stating there were “issues of fact in dispute as to the purported settlement agreement.” Approximately ten days later, Imperial amended its answer and affirmative defenses to include an accord and satisfaction defense. In support, Imperial attached a copy of the July 23, 2012 check Imperial sent to Custer, as well as the memorandum attached to the check with what it characterized as a “conspicuous statement” as to the payment being a full and final settlement for all services rendered to Mr. Ahumada.
In November 2014, Imperial filed a motion for summary judgment based on accord and satisfaction. The lower court granted Imperial’s motion, but the order contained no findings of fact or conclusions of law, and did not otherwise explain the court’s reasoning. For the reasons set forth in additional detail below, this Court reverses the lower court’s decision.
The standard of review applicable to a lower court’s ruling on a motion for summary judgment is de novo. Volusia County v. Aberdeen at Ormond Beach, 760 So. 2d 126, 130 (Fla. 2000) [25 Fla. L. Weekly S390a]. According to the Florida Rules of Civil procedure, a motion for summary judgment may be granted only “if the pleadings, depositions, answers to interrogatories, admissions, affidavits, and other materials. . . show there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law.” Fla. R. Civ. P. 1.510(c). Further, the court must view every possible inference in favor of the non-moving party. Building Educ. Corp. v. Ocean Bank, 982 So. 2d 37, 40 (Fla. 3d DCA 2008) [33 Fla. L. Weekly D987a].
The lower court’s first ruling denying summary judgment was predicated on the existence of factual issues in dispute. Specifically, the lower court took issue with the settlement letter stating:
Yes, factually, I think there are genuine issues of material fact created by the execution of the agreement and certain things that I see in the agreement that otherwise make it difficult for me, after the fact, meaning after execution and settlement of the case as known by the parties, to have changed what happened.
(Hearing Transcript p. 33)
This Court agrees that the meaning behind the settlement letter and the hand-written notations made on it constitute a factual issue precluding summary judgment. These fact issues did not cease to exist at the moment Imperial amended its pleadings to include the affirmative defense of accord and satisfaction. The factually disputed settlement letter is at the root of the accord and satisfaction defense, and, as such, summary judgment was not proper below.
REVERSED AND REMANDED for proceedings consistent with this Opinion. Appellant’s motion for fees is GRANTED; Appellee’s fees motion is DENIED. (ESPINOSA DENNIS and RUIZ, JJ., concur.)
