5 Fla. L. Weekly Supp. 284b
Insurance — Personal injury protection — Error to abate insured’s action against insurer pending arbitration — Statute requiring arbitration of dispute between insurer and health care provider who has accepted assignment of PIP benefits does not apply to dispute between insured and insurer — Neither “Authorization to Pay Provider” executed by insured nor health insurance claim form constituted assignment — Fact that health care provider filled out claim form and sent it to insurance company not sufficient to establish assignment
JOEANN F. WALLACE, Appellant, v. OMNI INSURANCE COMPANY, Appellee. 6th Judicial Circuit in and for Pinellas County. Case No. 96-6229 CI – 88B. Opinion filed February 2, 1998. Appeal from a decision of the Pinellas County Court — County Judge Karl Grube. Counsel: Carl Ohall, for appellant. Penny Hendrix, for appellee.
ORDER AND OPINION
THIS MATTER is before the Court on Joeann Wallace’s appeal from a decision of the Pinellas County Court. After reviewing the briefs, record, and having oral argument on the matter, this Court reverses the decision of the trial court.
The appellant was injured in an auto accident, and she subsequently sought medical treatment. The appellant claimed her insurance company failed to pay 80% of her medical bills
pursuant to the personal injury protection (“PIP”) portion of her policy, so she filed suit. The appellee insurance company responded by filing a Motion to Dismiss or Abate Pending Arbitration, claiming that arbitration was required. The trial court agreed with the insurance company and granted the motion.
Omni Insurance Company’s motion was based upon §627.736, Fla. Stat. (1995), which requires that a health care provider who has accepted an assignment must submit any claims to arbitration. This case does not involve a claim between a health care provider and an insurer; therefore, the statute does not apply.
In this case the insured (“Wallace”) seeks to receive benefits from the insurer (“Omni”). Omni argues that Wallace has no standing to bring this action because she assigned her benefits. Since there was no evidentiary hearing, the trial court apparently found as a matter of law that Wallace did assign her right to receive payment to a medical provider. In reaching its decision the trial court reviewed two documents: the “Authorization to Pay Provider” and a health insurance claims form. The trial court found that the documents constituted an assignment of benefits.
The interpretation of an unambiguous contract is a matter of law. Therefore, an appellate court may make an assessment of the document independent of the trial court. Florida Mining & Materials Corp. v. Standard Gypsum Corp., 550 So. 2d 47, 49 (Fla. 2d DCA 1989). This Court has reviewed the document entitled “Authorization to Pay Provider” and finds that it is not an assignment.
In carrying out this task the Court has considered the nature of an assignment. The courts have defined an assignment as “a transfer or setting over of property or of some right or interest therein, from one person to another. It is the act by which one person transfers to another, or causes to vest in another, his right of property or interest therein.” State Farm Fire & Casualty Co. v. Ray, 556 So. 2d 811, 812 (Fla. 5th DCA 1990). An equitable assignment will be recognized where it is necessary to effectuate the plain intent of the parties or where to hold otherwise would be unjust. Giles v. Sun Bank, N.A., 450 So. 2d 258 (Fla. 5th DCA 1984). Any words or transactions showing an intention on one side to assign and on the other side to receive, if supported by valuable consideration, will operate as an effective equitable assignment. Asphalt Paving Inc. v. Ulery, 149 So. 2d 370 (Fla. 1st DCA 1963). The intent of the parties will be determined first from the language used in the contract. Terex Trailer Corp. v. McIlwain, 593 So. 2d 237 (Fla. 1st DCA 1991).
There is nothing in the “Authorization to Pay Provider” stating that Wallace is giving up her right to her PIP benefits, or that the medical provider is accepting an assignment. In fact, the language in the document itself states: “(t)his is not an assignment of my benefits nor of any cause of action(s) for such insurance benefit; and Mosca Chiropractic Center does not construe nor accept this request as an assignment of benefits.” The language of the document indicates in certain terms that no assignment was intended. The document is only an authorization and request for the insurance company to pay the medical provider directly, rather than have the insurer send the payments to the insured. It is for administrative purposes, and does not rise to the level of an assignment of benefits.
It should be noted that the “Authorization to Pay Provider” says in the last sentence that “… the assignment shall be considered as effective… .” This reference does not change the result for the previously stated reasons. Moreover, in interpreting documents the more specific language governs the more general statement. Flowers v. Miskoff, 233 So.2d 201 (Fla. 4th DCA 1970). Thus, in this case the specific detailed statement explaining that the document is not an assignment prevails over the sole general reference to the document as an assignment.
The trial court also considered a health insurance claim form. Nowhere in that document does it state that the insured is transferring her rights to the medical provider. Although the medical provider apparently filled out the form and sent it to the insurance company, that is not sufficient evidence to conclude that an assignment was made. In addition, the reference in the document that an assignment has been accepted is not applicable to this case because that reference was “For Government Claims Only.” This is not a government claims case.
Accordingly, the order abating the matter is reversed, and this matter is remanded so it may proceed. Since Omni’s argument below was based solely upon the two documents, and they were reviewed by this Court and found not to be an assignment, the issue of whether there was an assignment is resolved. This Court does not address whether there may be other grounds for concluding there was an assignment that the defense could plead and prove. That has not been raised and is a matter for the trial judge. Wallace raises several other issues, but in light of this Court’s decision on the issue of assignment, the other issues are moot. Therefore, this Court need not address them.
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