9 Fla. L. Weekly Supp. 553b

Insurance — Personal injury protection — Standing — Assignment — Where both insured and medical provider affirm that “Direct Payment Authorization Without Assignment of Benefits” was not an assignment of benefits, and insurer has not shown that arrangement is illegal, contrary to public policy or prohibited by insurer’s contract with insured, document is not assignment — Insurer’s motion for summary judgment denied

AUDRA HAYES, Plaintiff, vs. ATLANTA CASUALTY COMPANY, Defendant. County Court, 1st Judicial Circuit in and for Escambia County. Case No. 2001 SC 004014. June 4, 2002. William P. White, Jr., Judge. Counsel: Cass L. Wilson, McKenzie & Allen, LLP, Pensacola, for Plaintiff. Gregory M. Shoemaker, Schofield & Wade, P.A., for Defendant.

ORDER ON DEFENDANT’S MOTIONFOR SUMMARY JUDGMENT

THIS MATTER came on for hearing in chambers on June 3, 2002 and the Court, having considered the exhibits, authorities and arguments of the parties, concludes that the Defendant’s Motion for Summary Judgment should be denied.

This is another of the continuing disputes between insurance companies and their insureds over whether the insured has assigned benefits to the medical provider in PIP cases, thereby preventing the insured from directly suing the company. There has been a split in the decisions of the trial courts and circuit courts acting in their appellate capacity with respect to these issues. In fact, two different divisions of this court have entered differing opinions on the topic (copies attached). The parties attempt to distinguish the decisions unfavorable to their position in the present case.

Here, the Plaintiff insured and the medical provider (See the Affidavit of Dr. Laurie Moore) claim that although the document entitled “Direct Payment Authorization Without Assignment of Benefits” may look and act very much like an assignment, it is not one. In light of the development of the case law, the Court must conclude that the document in question is a fairly transparent attempt by the medical provider to secure the main benefit of an assignment (direct payment from the insurer) without the negative aspects (having to contend with the insurance company if payment is declined under the insurance agreement). Apparently, the Defendant insurance company wishes to dispute with the medical provider rather than the insured for tactical or strategic reasons.¹ The bottom line is whether the Court, at the behest of a third party, should declare that the arrangement between the insured and the medical provider constitutes a particular type of contract when both of the parties to the contract disclaim that intent. In essence, the Defendant in this case is arguing that the insured may not contractually agree with the medical provider to process and submit claims and receive payments directly without an assignment of benefits. The fundamental principle of contractual interpretation is to effectuate the intent of the parties to the contract unless it is illegal. Here the parties to that contract are the Plaintiff and the medical provider. They both affirm, as indicated in the title of the document relied upon by the Defendant, that the contractual agreement was not an assignment of benefits. Neither has it been shown by the Defendant that the arrangement is illegal, contrary to public policy or prohibited somehow by Defendant’s contract with the Plaintiff.

Accordingly, the Court finds that the document must be interpreted according to the intent of the parties to the contract and that it is thus in the form of an authorization for the provider to act as agent of Plaintiff, not an assignment. In the alternative, there is dispute as to a critical factual matter, the parties’ intent, and the motion must be denied on that basis.

The Defendant’s Motion for Summary Judgment is hereby denied.

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¹Possibly a desire to engage the medical provider in arbitration process and/or avoid the payment of attorney’s fees called for in the statute when a proper claim made directly by the insured is not timely paid.

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