4 Fla. L. Weekly Supp. 438c
Insurance — Personal injury protection — Trial court erred in finding that insured had validly assigned rights under policy to medical providers where plain language of policy prohibited assignment without written consent of insurer, and record revealed that insurer had not given written consent
PEDRO CASTRO, Appellant, v. FORTUNE INSURANCE CO., Appellee. 11th Judicial Circuit in and for Dade County, Appellate Division. Case No. 96-026AP. Opinion filed December 20, 1996. An Appeal from County Court, Jeffrey D. Swartz, Judge, in and for Dade County. Counsel: Michael J. Feldman & Mark J. Feldman, for Appellant. Dianne H. Tutt, for Appellee.
(Before DONNER, J.) This is an appeal from a summary judgment entered against the appellant. In December, 1994, Pedro Castro was injured in an automobile accident. He had Personal Injury Protection (PIP) coverage with Fortune Insurance Company.
In August, 1995, after having submitted medical bills for payment, and waiting more than 30 days (as is required by Florida Statute § 627.736(4)(b) (1995)), Mr. Castro filed suit against Fortune Insurance Company for payment of medical bills in the amount of $7,020.00.
Defendant, Fortune Insurance Company, filed a motion to dismiss and to compel arbitration, arguing that Plaintiff had assigned his rights to PIP benefits under his insurance policy to his treating doctors. Any dispute, therefore, was between the medical providers and the insurance company, and pursuant to § 627.736(5) Fla. Stat. (1995), the dispute was covered by arbitration. Defendant then filed copies of Plaintiff’s assignments of medical benefits with the court.
In November, 1995, the parties entered into an agreed order which denied Defendant’s Motion to Dismiss without prejudice, and gave Defendant 10 days to answer the complaint. On November 27, 1995, Defendant filed a Motion for Summary Judgment reiterating the argument of its Motion to Dismiss. Defendant argued that Plaintiff had assigned his PIP benefits to his medical providers and therefore had lost his standing to sue Fortune. On November 30, 1995, Defendant filed its Answer and Affirmative Defenses to the Complaint.
On January 17, 1996, Judge Jeffrey D. Swartz of the County Court granted Defendant’s Motion for Summary Judgment, and found that Plaintiff had no standing to pursue the action against Fortune Insurance because he had assigned his rights under his insurance policy to his medical providers. The order made no specific determination on the issue of arbitration. Plaintiff filed this appeal.
In order to sustain a summary judgment on appeal, the appellee must be able to demonstrate that there is no question of material fact, and that appellee is entitled to a favorable judgment as a matter of law. If the record demonstrates otherwise, the appellate court must reverse and allow the cause to proceed below, most likely to trial where disputed material fact issues are resolved by the fact-finder. The trial court which entered the summary judgment is entitled to a presumption of correctness, only if the record supports his or her ruling.
Watson v. Hahn, 664 So. 2d 1083, 1083 (Fla. 5th DCA 1995).
Appellate review is confined to the record on appeal. Thornber v. City of Fort Walton Beach, 534 So.2d 754, 755 (Fla. 1st DCA 1988). The record on appeal contains a copy of Appellant’s insurance policy and copies of the assignments of benefits Appellant made to his medical providers. Defendant’s insurance policy expressly states that “Your rights and duties under this policy may not be assigned without our written consent.” The record is devoid of any indication that Defendant gave written consent to the medical providers.
“Generally, interpretation of an insurance contract is a question of law to be decided by the trial court. Where, as here, the facts are essentially undisputed, whether those facts fit within the policy definition is a question of law that may be decided on appellate review.” State Farm Fire and Casualty Co. v. Nickelson, 21 Fla. L. Weekly D1544 (Fla. 1st DCA 1996).
The material facts in this case are essentially undisputed. Both parties agree that the insurance contract in the record is identical to the one that appellant signed. Both agree that appellant signed assignments of benefits to his medical providers. Therefore, the question remains specifically, whether appellant’s assignment to his medical providers is valid without Fortune Insurance Company’s written consent. This is a question of law which this court may review de novo. This court may examine the language of the PIP contract between Mr. Castro and Fortune, and, if appropriate, reach a different conclusion from that of the trial court. See Royal Oak Landing Homeowner’s Association v. Pelletier, 620 So. 2d 786 (Fla. 4th DCA 1993).
“A provision in a contract against assignment without consent has generally been held to be a valid and effective restriction of the right to assign.” Troup v. Meyer, 116 So. 2d 467, 469 (Fla. 3d DCA 1959) (citations omitted). The clause within Mr. Castro’s insurance policy is a valid restriction on his right to assign.
It is well settled in Florida law that “. . .contracts of insurance should be construed so as to give effect to the intent of the parties and if uncertainty is present in a policy, it should be construed against the insurer and in favor of the insured.” Stuyvesant Insurance Co. v. Butler, 314 So. 2d 567, 570 (Fla. 1975) (citations omitted). See also Thomas v. Prudential Property and Casualty, 673 So. 2d 141, 142 (Fla. 5th DCA 1996) citing Linheimer v. St. Paul Fire and Marine Insurance Co., 643 So. 2d 636 (Fla. 3d DCA 1994), rev. denied, 651 So. 2d 1194 (Fla. 1995) (“. . . insurance contracts must be read in light of the skill and experience of ordinary people, and given their everyday meaning as understood by the `man on the street’.”); Mitchel v. Cigna Property & Casualty Ins. Co., 625 So. 2d 862, 864 (Fla. 3d DCA 1993) (“. . . insurance policies in general, and exclusions in particular, are interpreted strictly against the carrier.”).
In this case, the plain language of the insurance policy states, “Your rights and duties under this policy may not be assigned without our written consent.” There is no distinction made, nor is there any other provision in the policy, which would allow this court to determine that the “rights and duties” discussed, do not include the right to receive medical payments.1
Construing the insurance policy against the drafter, this contract for Personal Injury Protection does not allow an insured to assign his or her rights to medical providers without written consent of the insurer.
The language of the contract is clearly in conflict with the assignments of medical benefits. Because the record reveals that Fortune did not give written consent, the conflict found within the record is resolved in favor of a plain reading of the insurance policy. As a matter of law, Fortune needed to give written consent in order for there to be a valid assignment of medical benefits under Mr. Castro’s policy. As this did not occur, the trial court erred as a matter of law in determining that Mr. Castro validly assigned his rights to his medical providers. The record does not support the trial court’s conclusion. Because there was no assignment, Mr. Castro has standing to pursue his action against Fortune Insurance. As there was no assignment, this court need not address the issue of arbitration.
As a result, the judgment of the lower court is REVERSED AND REMANDED. (SHAPIRO, B., J. and MILLER, L., J., concur.)
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1Defendant claims that if one reads the assignment provision in conjunction with the arbitration provision in the contract, it clearly indicates that the provision against assignment without written consent did not include assignments of medical benefits. This claim is without merit. The arbitration provision simply compels arbitration if benefits have been assigned to medical providers. This in no way alters the plain meaning of the words in the assignment provision which allows assignment only if the insurer gives written consent.
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