8 Fla. L. Weekly Supp. 464a
Contracts — Insurance — Coverage — Promissory estoppel — Based on theory of promissory estoppel, insured is entitled to payment of medical bills incurred after telephone conversation with insurer wherein, by mutual mistake, insurer and insured agreed that benefits would be extended to certain date — Plaintiff proved by clear and convincing evidence action for promissory estoppel where insurer made definite and substantial promise, insured detrimentally relied on that promise and continued to seek medical treatment, and insurer should have reasonably expected the promise to induce reliance on part of insured — Unclean hands — There exists bona fide dispute between parties, and neither party has come to court with unclean hands
SHARON WORRELL, Plaintiff, vs. ALLSTATE INSURANCE COMPANY, Defendant. County Court, 15th Judicial Circuit in and for Palm Beach County, Civil Division. Case No. MC-99-4685-RL. March 20, 2001. Krista Marx, Judge. Counsel: John W. Carroll, Palm Beach Gardens, for Plaintiff. Rafael I. Katz, Hollywood, for Defendant.
FINAL JUDGMENT
THIS CAUSE having came before the Court for a bifurcated non-jury trial on March 16, 2001 on Count III, promissory estoppel. Plaintiff and Defendant were present and well represented by John Carroll, Esq., and Rafael Katz, Esq. The Court having considered all of the facts, testimony, evidence and arguments presented by counsel, and reviewing the Court file and case law provided by counsel makes the following findings:
Plaintiff Sharon Worrell (Worrell) was in an accident on October 5, 1997. Thereafter, she received chiropractic care. On January 9, 1998 after an independent medical examination was performed by Dr. Joseph Costello, D.C., Worrell received a letter indicating that her benefits for chiropractic care were being terminated by Defendant, Allstate Insurance Company (Allstate) effective January 13, 1998. A second letter regarding the benefits cut off date was sent effective January 20, 1998. On January 23, 1998 Worrell signed a certified mail receipt for the letter.
Worrell alleged that she suffered an exacerbation of her injuries, on June 17, 1998. Worrell began chiropractic treatment with Dr. Ken Platt, D.C. Worrell testified that she contacted Allstate and requested authorization for additional chiropractic care. Allstate disputes getting any such call from Worrell. The Court finds that based on all the facts, that Worrell was told by Allstate that she still had benefits available but was given no guarantee that any particular type of care would be covered under the contract.
On January 23, 1998 Dr. Platt’s office contacted Allstate and alleged through testimony that their office also received information that Worrell still had benefits remaining on her policy. The Court further finds that at no time was Dr. Platt’s office guaranteed that any particular type of care would be covered under the policy.
Worrell continued to treat with Dr. Platt from June 17 through August 5, 1998. Dr. Platt’s office notified Worrell that they had not been receiving payment on submitted bills. The parties stipulate that on July 29, 1998 Worrell contacted Allstate about the unpaid bills. At that time Worrell testified that she informed Allstate that she had no recollection of receiving a certified letter indicating benefits termination in January of 1998. The claims adjustor, upon review of the file could not locate a certified mail return receipt. Upon this mutual mistake Allstate extended benefits to Worrell through August 11, 1998.
Thereafter, Worrell treated with Dr. Platt on two more occasions. Worrell received a letter on August 10, 1998 indicating that Allstate had located the certified mail receipt and that their representation that they would extend benefits until August 11, 1998 was revoked. Allstate’s letter indicated that based on the fact that Plaintiff signed for the letter on January 23, 1998 the termination of benefits would be effective from the January date.
While claims for breach of contract and promissory estoppel are alternatives for each other; the doctrine of promissory estoppel comes into play where requisites of contract are not met, yet the promise should be enforced to avoid injustice. Doe v. Univision Television Group, Inc., 717 So.2d 63 (Fla. 3d DCA 1998). Here, there is an express contract between the parties; same being the policy of insurance issued to Plaintiff by Defendant. However, the factual dispute giving rise to this cause of action is not one which is contemplated nor can be decided by the express contract. Accordingly, the general rule in Florida that where there is an adequate remedy of law, there is no jurisdiction in equity is inapplicable. H.L. McNorton v. Pan American Bank of Orlando, 387 So.2d 393 (Fla. 5th DCA 1980). The bifurcation of this trial vests this court with jurisdiction to decide the equitable issues between the parties which arise from a factual dispute as to payment of benefits pursuant to the parties’ stipulated policy of insurance.
As a further challenge to jurisdiction, Defendant maintains that Plaintiff has brought this action with unclean hands. See Malkus v. Gaines, 476 So.2d 220, (Fla. 3d DCA 1985). The court finds there exists a bona fide dispute between the parties and that neither party to this action has come to court with unclean hands.
Worrell argues that Allstate should pay for the bills based on the theory of promissory estoppel. For Plaintiff to succeed on this theory the Court must find that a promise was made by Defendant, that Plaintiff detrimentally relied on the promise, and the Defendant should have reasonably expected the promise to induce reliance on the part of the Plaintiff in the form of action or forbearance and finally, injustice can be avoided only by enforcement of the promise against Defendant. (W.R. Townsend Contracting v. Jensen Civil Construction, 728 So. 2d 297, (Fla 1st DCA 1999).
There can be no promissory estoppel when the Plaintiff’s detrimental reliance is caused by its own mistake in judgment. Arena Parking v. Lon Worth Crow Insurance Agency, 25 Fla. L. Weekly D1551a (Fla. 3DCA 2000). Such was the case prior to the July 29, 1998 phone call. However, based on that telephone conversation wherein by mutual mistake Allstate and the Plaintiff came to an agreement that benefits would be extended to August 11, 1998 the Court finds that Allstate made a definite and substantial promise. Plaintiff detrimentally relied on that promise and continued to seek treatment from Dr. Platt on June 31, 1998 and August 5, 1998. Allstate should have reasonably expected the promise to induce reliance on the part of the Plaintiff.
Wherefore, the Court finds in favor of Plaintiff as to Count III for those bills incurred after July 29, 1998. Specifically, the treatment that was received on July 31, 1998 and August 5, 1998. Plaintiff’s action for promissory estoppel as to all bills prior to July 29, 1998 fails. The Court finds in favor of the Defendant as to each bill prior to July 29, 1998 as Plaintiff has not proven by clear and convincing evidence an action for promissory estoppel.
Wherefore, the Court reserves jurisdiction for a determination of the principal amount, and prejudgment interest as to the two bills ruled upon herein.
* * *
