9 Fla. L. Weekly Supp. 553a
Insurance — Personal injury protection — Standing — Assignment — Authorization for direct payment in which insured expressly reserved the right to file complaint is not an assignment — Where insured replaced unqualified assignment with new document retaining right to proceed to suit for insured, new document supercedes the assignment — Insurer’s motion for summary judgment denied
ARTHUR MITCHELL, Plaintiff, vs. ATLANTA CASUALTY COMPANY, Defendant. County Court, 1st Judicial Circuit in and for Escambia County. Case No. 2000-SC-2715, Division 5. April 22, 2002. Patricia A. Kinsey, Judge. Counsel: Robert Allen, McKenzie & Allen, LLP, Pensacola, for Plaintiff. Adrianna Miller Spain, Schofield & Wade, P.A., for Defendant.
ORDER DENYING DEFENDANT’S SECOND AMENDEDMOTION FOR PARTIAL SUMMARY JUDGMENT
On June 15, 2000, plaintiff filed a complaint against defendant to collect PIP benefits in the form of payment for medical services provided which remain unpaid today, nearly two years later. On January 4, 2002, the defendant filed its Second Amended Motion for Partial Summary Judgment claiming the plaintiff has no standing to proceed based on three documents signed by plaintiff allegedly assigning his insurance benefits to the medical providers. At a hearing in open court on April 16, 2002, the court heard argument of counsel, received their case authority, reviewed their memorandum of law and now finds as follows.
The issue before the court is whether or not an “unqualified assignment” of benefits has been made by the patient (insured-plaintiff) to his physician when he signed documents authorizing the medical provider’s staff to file for payment by the patient’s insurance company (defendant) for the care received.
Assignments of benefits are contemplated by §617.736, Florida Statutes, and should be enforced by the court. “It is to the advantage of the medical community and the insurance industry that assignments of benefits be utilized and honored.” Medical Specialists and Diagnostic Services v. American International South Insurance Company, 8 Fla. L. Weekly Supp. 311 (9th Judicial Cir. March 14, 2001). This important issue cannot be analyzed without looking at the intent of the parties.
Insurance companies have created a complex labyrinth which the insured must successfully negotiate before PIP benefits, e.g. medical bills, will be covered and paid. As a courtesy to their patients, and to expedite payment, nearly all physicians and care givers provide a service to their patients by filing their patient’s claim with insurance companies. It only makes sense. Medical providers have a staff which, out of necessity, have become efficient experts in filing the paperwork. They file hundreds of claims a week with the various insurance companies. Because of their expertise, they can save time and frustration on behalf of their patients, more quickly get payment for their physician-employer, and save the insurance companies the extra expense of multiple submittals for a single, ultimate payment of benefits. It just makes sense for everyone.
However, the defendant here argues that the plaintiff, by seeking and/or accepting help from his medical provider to file the claim, has created an unqualified assignment of benefits and therefore has no standing to proceed to lawsuit. “[O]nly the insured or the medical provider `owns’ the cause of action against the insurer at any one time. . .[a]nd the one that owns the claim must bring the action if an action is to be brought.” Oglesby v. State Farm Mutual Automobile Insurance Company, 781 So.2d 469, 470 (Fla. 5th DCA 2001). This basic tenant of the law is the real test as to whether or not an assignment has been made or whether a patient has merely provided a document which would allow a medical provider to use their expertise to expeditiously file for payment.
The authorization filed on August 13, 1999, by plaintiff with Complete Medical Services expressly reserves the right to file a Complaint for the plaintiff-patient. The words are clear: “[t]his authorization for direct payment should not be deemed an assignment of benefits in that the patient retains all rights to enforce the applicable insurance contract and transfers no right, title or interest in said contract, other than the right to receive direct payment. . .”
The documents signed by plaintiff with Clinical Health Services are more problematic. On November 29, 1999, plaintiff signed a “Release, Assignment & Provider’s Lien.” This appears to be an unqualified assignment as contemplated in Oglesby. However, plaintiff replaced this assignment with a new document signed on January 28, 2000. This clearly supersedes the original unqualified assignment and retains the right to proceed to suit for the plaintiff-patient. For example, it authorizes the filing of paperwork with the insurance company, endorsement and cashing of checks received, and release of medical information necessary to process the claim. It also authorizes release of the medical information to “my attorney” and directs “my attorney” to pay Clinical Heath Services from any “settlement, judgment or verdict. . .” This replacement document establishes that the plaintiff-patient “owns” the cause of action and that the medical provider is merely to process the payment of the bill(s) for services rendered.
Defendant argued that these documents are nothing more than an “attempt to avoid the consequences of an assignment.” By these very words, it is clear that the intent of the parties, that is, the plaintiff-patient and his medical providers, was to take advantage of the expertise and experience of the medical providers’ staff in completing the complex claim paperwork process to most efficiently obtain payment from defendant-insurer. Nothing more. Nothing less.
ORDERED AND ADJUDGED that defendant’s Second Amended Motion for Partial Summary Judgment is denied.
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