9 Fla. L. Weekly Supp. 878a
Insurance — Personal injury protection — Assignment — PIP portion of provider’s financial policy form did not transfer any rights or interests in PIP policy to provider or authorize provider to act on behalf of insured to collect any unpaid balances, but actually placed responsibility for payment of unpaid balance on insured — Further, neither party to financial policy considered document to be an assignment of benefits — Insurer’s motion for summary judgment in action brought by insured for amounts not paid to provider denied
CARLOS CALDERON, Plaintiff, v. LIBERTY MUTUAL INSURANCE COMPANY, a corporation authorized and doing business in the State of Florida, Defendant. County Court, 18th Judicial Circuit in and for Seminole County. Case No. 01-CC-1247-20-U. October 9, 2002. Donald Marblestone, Judge. Counsel: Michael B. Brehne, Law Offices of Michael B. Brehne, P.A., Maitland. Michael Truax.
ORDER ON DEFENDANT’SMOTION FOR SUMMARY JUDGEMENT
THIS CAUSE came on for hearing on Defendant’s Motion for Summary Judgment on Tuesday August 20, 2002, the Court having heard argument of counsel and being otherwise fully advised in the premises makes the following findings of facts and conclusions of law:FINDINGS OF FACT
1. Plaintiff was injured in an automobile accident that occurred on or about December 8, 1999. Plaintiff was a named insured under a standard automobile insurance policy issued by Defendant that included personal injury protection benefits (PIP) and medical payment benefits.
2. After the accident, Mr. Calderon sought the care and treatment of Dr. Gary Grossman at the Kirkman Chiropractic Clinic.
3. At the time Mr. Calderon was treated at their office, Kirkman Chiropractic had a “financial policy form” that was designed to cover all types of insurance billing situations such as major medical, automobile, workers’ compensation, Medicare and cash payments. Each situation described above had a financial policy corresponding with it.
4. At that time, Kirkman Chiropractic’s policy was not to accept assignment of benefits for automobile insurance policies in order to avoid the statutorily imposed arbitration provisions that existed at the time. Instead, Kirkman Chiropractic had automobile insurance patients sign a financial responsibility agreement that specifically omitted the word “assignment” in the PIP portion of the agreement.
5. The PIP portion of the Kirkman Chiropractic financial policy does not transfer any rights or interests in the policy nor does it authorize Kirkman Chiropractic to act on behalf of Carlos Calderon to collect any unpaid balances. It actually places the responsibility for payment of the unpaid balance on Carlos Calderon.
6. The Defendant contends that on the financial policy form, a check mark was made under the section “Insurance Assignment of Benefits”. According to Kirkman Chiropractic representative, Julie Springham, this insurance assignment of benefits section on the financial policy form applies “only to major medical insurance and not to automobile insurance.” She explains that it was Kirkman Chiropractic’s policy that the box be checked in the event that automobile insurance exhausted and major medical insurance had to be billed. In the case of Carlos Calderon, the box was checked specifically for this purpose but was not necessary. Julie Springham testified that this section does not apply to automobile insurance benefits and further, that the form signed by Carlos Calderon is not an assignment of automobile insurance benefits and not intended to be construed as one.
7. Carlos Calderon testified that while treating at Kirkman Chiropractic, he did not assign any rights or benefits to the clinic. He further did not authorize Kirkman Chiropractic to act on his behalf in the event that his insurance company did not pay for any medically necessary treatment and understood that at the time of signing the financial policy agreement he would be solely responsible for all the bills incurred by him for his treatment.
8. Subsequent to incurring expenses for medical services provided by this entity, Carlos Calderon, through the provider, submitted bills to Defendant for payment and Defendant reduced payments on multiple charges and denied payment on others.
9. Specifically, Defendant has relied on a contract with Beech Street Corporation to unilaterally reduce payments to Kirkman Chiropractic for dates of service December 8, 1999 through August 27, 2001 as well as the results of an independent medical examination to deny benefits to Carlos Calderon regarding his October 25, 2000 date of service with Kirkman Chiropractic.
10. After being notified of the reductions and/or denials in payment of his medically necessary expenses related to the injuries sustained in the accident, Carlos Calderon filed a lawsuit to recover benefits owed by him to Kirkman Chiropractic on or about April 19, 2001.
11. On or about June 13, 2002, Defendant filed a Motion for Summary Judgment indicating that: Plaintiff lacks standing to pursue this action to recover benefits owed to Kirkman Chiropractic because he “assigned his Personal Injury Protection insurance benefits to the provider as witnessed by his check mark and signature on the financial policy.”CONCLUSIONS OF LAW
A contract is created when there is mutual assent between the parties to be bound to the agreement. An assignment of benefits is essentially a contract between two parties assigning or giving a right or benefit to the other party. It follows that in order to create a binding assignment of benefits contract, the parties must mutually assent or agree to the terms of the contract. There must be a meeting of the minds. See, Florida v. Bank of Hallandale, 623 So. 2d 474, 479 (Fla. 1993) (contract between the parties did not exist because “in order to form a binding contract, there must be a common or mutual intention of the parties….mutual assent is an absolute condition precedent to the formation of a contract”); Gibson v. Courtois, 539 So. 2d 459, 460 (Fla. 1989) (absent mutual assent, neither the contract nor any of its provisions come into an existence); Long Term Management Inc. v. University Nursing Care Center, Inc., 704 So. 2d 669 (Fla. 1 DCA 1997) (mutual assent and a meeting of the minds is required for a binding agreement).
An assignment is properly defined as a “transfer or a setting over of property or some right or interest 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 and Casualty Co. v. Ray, 556 So. 2d 813 (Fla. 5 DCA 1990) citing, 4 Fla Jur. 2nd Assignments, 1 (1978). An equitable assignment will be recognized where it is necessary to affect 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. 5 DCA 1984).
The trial court’s role in considering whether a written agreement is an assignment is to determine whether or not a valid agreement exists and whether an assignment has occurred. See, Garcia v. State Farm Mutual Automobile Ins. Co., 766 So. 2d 430 (Fla. 5 DCA 2000). It is the court’s responsibility to scrutinize the alleged assignment of benefits contract and make the proper determinations.
The alleged assignment of benefits in the present case fails to qualify under the most basic contract law as an assignment of benefits. It is merely a “financial policy” statement and was never intended to be an assignment of rights and benefits by any party to the contract. According to Julie Springham, the financial manager for Kirkman Chiropractic, the clinic’s policy was not to accept assignment of benefits for automobile insurance policies in order to avoid the statutorily imposed arbitration provisions that existed at the time. Instead, Kirkman Chiropractic had automobile insurance patients sign a financial responsibility agreement that specifically omitted the word “assignment” in the PIP portion of the agreement.
The PIP portion of the Kirkman Chiropractic financial policy does not transfer any rights or interests in the policy nor does it authorize Kirkman Chiropractic to act on behalf of Carlos Calderon to collect any unpaid balances. It actually places the responsibility for payment of the unpaid balance on Carlos Calderon. This is hardly a transfer of any rights or benefits or authority as alleged by Defendant. The mere allegation by Defendant that this document constitutes as an assignment must fail, as Defendant was not a party to the agreement and could not assent to its terms or conditions.
Mr. Calderon testified that when he became aware that outstanding sums were owed to Kirkman Chiropractic, he authorized his attorney to pursue litigation against Liberty Mutual Insurance Company. Plaintiff’s course of conduct in making partial payments, seeking representation and his testimony regarding the non-existence of an assignment of benefits shows conclusively that Plaintiff did not intend to assign his rights under the contract with Defendant.
Because the document itself does not transfer some right or interest from one person to another or authorize Kirkman Chiropractic to act on behalf of Carlos Calderon, it does not contain the essential elements of an assignment. Further, because neither party to the financial policy considers the document to be an assignment of benefits and because basic contract law require mutuality of the parties to the contract to consider this document to be an assignment, this document cannot be considered an assignment of benefits. It is merely a financial policy with specific terms and conditions applicable to different insurance situations which did not contemplate assignment of Personal Injury Protection benefits.
WHEREFORE IT IS ORDERED AND ADJUDGED:
Defendant’s Motion for Summary Judgment is hereby DENIED.
This Court finds as a matter of law, the Financial Policy of Kirkman Chiropractic is not an assignment of benefits.
Carlos Calderon maintains standing to bring this action.
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