Case Update- Assignment of Benefits Form

Make sure you update your Assignment of Benefits form. This hospital has an old form that doesn’t cut it.

22 Fla. L. Weekly Supp. 1085b Online Reference: FLWSUPP 2209BETA
Insurance — Personal injury protection — Standing — Assignment — Validity — Medical provider must have written assignment of benefits in order to sue insurer for PIP benefits; equitable assignment is insufficient under PIP statute — Standing requirement must be met at inception of suit — Document which directs payment to provider but does not assign insured’s rights under PIP policy to provider is merely direction to pay — Motion to dismiss is grantedSARASOTA MEMORIAL HOSPTIAL (Patient: Raul Betancourth), Plaintiff, vs. AUTO-OWNERS INSURANCE COMPANY, Defendant. County Court, 12th Judicial Circuit in and for Sarasota County. Case No. 2014 SC 004832. February 18, 2015. David L. Denkin, Judge. Counsel: Chad L. Christensen and Joshua M. Paquette, Ellis, Ged & Bodden, P.A., Boca Raton, for Plaintiff. Birdy V. Vanasupa and Christopher J. Blain, Vernis & Bowling of the Gulf Coast, P.A., Tampa, for Defendant.

ORDER GRANTING DEFENDANT’S MOTION TO DISMISS WITH PREJUDICETHIS CAUSE, having come before the Court on Defendant, AUTO-OWNERS INSURANCE COMPANY’s (hereinafter “Auto-Owners”), Motion to Dismiss with Prejudice and Supporting Memorandum of Law, on Friday, February 6, 2015, beginning at 10:15 a.m., and the Court having heard arguments of each party’s respective counsels and having been otherwise fully advised in the premises, the Court FINDS, ORDERS, and ADJUDGES as follows:

FACTUAL BACKGROUNDPlaintiff, SARASOTA MEMORIAL HOSPITAL, filed suit against Auto-Owners for Personal Injury Protection (i.e. PIP) benefits on behalf of Auto-Owners’ Insured, Mr. Raul Betancourth. In Paragraph Ten (10) of its Amended Complaint, Plaintiff alleged that it had standing to sue Auto-Owners on Mr. Betancourth’s behalf because Mr. Betancourth allegedly assigned to it his PIP rights under an automobile insurance policy that was issued to him by Auto-Owners. Paragraph Ten (10) of Plaintiff’s Amended Complaint specifically alleged that it received a written assignment of benefits, an oral assignment of benefits, and/or an equitable assignment of benefits from Mr. Betancourth. Attached as Exhibit “A” to the Amended Complaint was a copy of the purported written Assignment of Benefits that Plaintiff relied upon to assert standing to sue Auto-Owners on Mr. Betancourth’s behalf. The purported written Assignment of Benefits at issue stated, in pertinent part, the following under the header “Financial Agreement”:

“In consideration of services rendered by SMHCS [i.e. Plaintiff] and any physician(s), I obligate myself and guarantee prompt payment of all charges incurred for services rendered to me . . . .* * * I shall be liable for attorney’s fees and/or collection fees and expenses.”

The purported written Assignment of Benefits also stated, in pertinent part, the following under the header “Assignment of Benefits”:

“In the event that I am entitled to hospital and/or physician benefits arising out of any insurance policy . . . I assign these benefits to SMHCS [i.e. Plaintiff] and/or the physician(s) for services rendered to me. Authorize [sic] payment directly to SMHCS [i.e. Plaintiff] and/or the physician(s) of all such insurance benefits payable to me. This includes . . . auto/liability insurance . . . .”

Plaintiff also alleged in its Amended Complaint that Auto-Owners owed additional PIP benefits for medical treatment it rendered to Mr. Betancourth on January 20, 2008. Said medical treatment was in connection with a motor vehicle accident that occurred that same day.

In response to Plaintiff’s Amended Complaint, Auto-Owners filed and served its Motion to Dismiss with Prejudice and Supporting Memorandum of Law. The basis of Auto-Owners’ Motion to Dismiss with Prejudice is that Plaintiff lacks standing to sue Auto-Owners on Mr. Betancourth’s behalf. It is Auto-Owners’ contention that: (1) the purported written Assignment of Benefits does not assign Mr. Betancourth’s PIP rights under the subject policy to Plaintiff and, therefore, is merely a direction to pay; (2) lack of standing may not be cured after suit is filed; and (3) Plaintiff may not maintain a PIP suit via an equitable assignment of benefits because it was never the intent of the Florida Legislature to allow for PIP suits under an equitable assignment, as evidenced by the pre-suit demand requirements of the Florida PIP Statute.

DISCUSSION AND CONCLUSIONS OF LAW Standard for Dismissal
When considering a party’s motion to dismiss, Florida courts are limited to consideration of the allegations contained within the four corners of the complaint. Al-Hakim v. Holder, 787 So.2d 939, 941 (Fla. 2nd DCA 2001) [26 Fla. L. Weekly D1380d] (internal citation omitted). When exhibits are attached to a complaint, however, the exhibit’s contents control over the allegations in the complaint. Khan v. Bank of America, N.A., 58 So.3d 927, 928 (Fla. 5th DCA 2011) [36 Fla. L. Weekly D738a]; see also Chiang v. Wildcat Groves, Inc., 703 So.2d 1083, 1087 (Fla. 2nd DCA 1997) [22 Fla. L. Weekly D2425a] (stating that Florida courts are authorized to consider any exhibits attached to the complaint when deciding a motion to dismiss). Florida courts are also authorized to dismiss a complaint via a motion to dismiss that is based on an affirmative defense, if that affirmative defense and its applicability are clearly shown on the face of the complaint. Williams v. Gaffin Industrial Services, Inc., 88 So.3d 1027, 1030 (Fla. 2nd DCA 2012) [37 Fla. L. Weekly D1261a].

In the instant matter, Plaintiff specifically alleged in Paragraph Ten (10) of its Amended Complaint to have standing to sue Auto-Owners as Mr. Betancourth’s Assignee. This allegation specifically stated that Plaintiff received a written assignment of benefits, an oral assignment of benefits, and/or an equitable assignment of benefits from Mr. Betancourth. Furthermore, Plaintiff attached as Exhibit “A” to its Amended Complaint the purported written Assignment of Benefits upon which it relied to assert standing. Accordingly, this Court finds that, in ruling on Auto-Owners’ Motion to Dismiss with Prejudice, the Court is authorized to consider the purported written Assignment of Benefits attached as Exhibit “A” to Plaintiff’s Amended Complaint. Additionally, this Court also finds that it is authorized to consider the defense of lack of standing, in ruling on Auto-Owners’ Motion to Dismiss with Prejudice, since this affirmative defense and its applicability are clearly shown on the face of the Amended Complaint.

Florida’s Rules on Standing
Standing Requirement to bring Suit
A medical provider in a PIP action may not bring suit on the insured’s behalf against an insurer unless it first obtains an assignment of the insured’s rights under the policy issued by the carrier. Hartford Ins. Co. of the Southeast v. St. Mary’s Hospital, Inc., 771 So.2d 1210, 1212 (Fla. 4th DCA 2000) [25 Fla. L. Weekly D2523a] (internal citations omitted). Lack of standing may not be cured if a plaintiff in a PIP suit lacks standing at the inception of the case. Progressive Exp. Ins. Co. v. McGrath Community Chiropractic, 913 So.2d 1281, 1285 (Fla. 2nd 2005) [30 Fla. L. Weekly D2622b]. As such, the Court finds that Plaintiff must have standing at the inception of this matter.

Plaintiff must have a Written Assignment of Benefits
To have standing to sue an insurer for PIP benefits on behalf of the insurer’s insured, a medical provider must have a written assignment of benefits. See, e.g., Ins. Corp. of New York v. M & J Health Center, Inc., 13 Fla. L. Weekly Supp. 682a (11th Cir. Ct. 2006); citing Progressive Exp. Ins. Co. v. McGrath Community Chiropractic, 913 So.2d 1281 (Fla. 2nd DCA 2005) [30 Fla. L. Weekly D2622b] (Davis, J. specially concurring) (Judge Davis specially concurring by stating that an equitable assignment is insufficient under Florida’s PIP Statute); see also Bell v. Allstate Ins. Co., 2003 WL 21246394 (Fla. 13th Cir. Ct. 2003) [10 Fla. L. Weekly Supp. 298a] (stating, in the Circuit Court’s Appellate capacity, that “[e]ven when a claim form submitted by the healthcare provider indicates that an assignment has been accepted . . . there must be a formal assignment to divest an insured of standing”) (internal citation omitted). This requirement is also evidenced by the intent of the Florida Legislature, as shown in the pre-suit demand requirements within Florida’s PIP Statute, stating that a demand must be accompanied by a copy of the assignment giving rights to the claimant if the claimant is not the insured. Legislative intent is the polestar that guides a court’s inquiry under the PIP Statute. See, e.g., GEICO Gen. Ins. Co. v. Virtual Imaging Services, Inc., 141 So.3d 147, 154 (Fla. 2013) [38 Fla. L. Weekly S517a]; see also Allstate Ins. Co. v. Holy Cross Hospital, Inc., et al., 961 So.2d 328, 334 (Fla. 2000) [32 Fla. L. Weekly S453a] (stating that “legislative intent is the polestar that guides the court’s inquiry under the No-Fault Law”).

Furthermore, the parties’ respective counsels stipulated on the record that, based on the foregoing, as argued in Auto-Owners’ Memorandum of Law in support of its Motion to Dismiss with Prejudice, Plaintiff in the instant matter must have a written assignment of benefits from Mr. Betancourth in order to sue Auto-Owners in this matter.

Written Assignment of Benefits must assign to the Provider the Insured’s PIP RightsTo confer standing upon a medical provider to sue the insurance carrier for PIP benefits, the written assignment of benefits upon which the medical provider relies to assert standing must assign to the provider the insured’s PIP rights under the insurance contract. See, e.g., Advanced 3-D Diagnostic, a/a/o Ziky Jeannestin v. State Farm Fire and Cas. Ins. Co., 20 Fla. L. Weekly Supp. 1082a (Fla. Orange Cty. Ct. 2013) (granting the defendant carrier with dismissal after finding that the phrase “[t]he undersigned patient hereby assigns the benefits of insurance under the automobile insurance with . . . State Farm to Advanced 3-D Imaging for services rendered to the undersigned patient and covered by Personal Injury Protection (P.I.P.) Coverage” was insufficient to assign the insured’s PIP rights to the provider and, therefore, the provider lacked standing); see also South Brevard Chiropractic & Wellness, a/a/o Teka Reed v. Progressive Southeastern Ins. Co., 12 Fla. L. Weekly Supp. 260a (Fla. Brevard Cty. Ct. 2004) (granting the defendant carrier with dismissal after finding that the phrase “I hereby grant assignment of benefits to South Brevard Chiropractic and Wellness Center so that any amount authorized to be paid directly to this office will be credited to my account upon receipt” is clear and unambiguous and failed to assign the insured’s PIP rights to the medical provider); St. Joseph’s Hospital, Inc., a/a/o Elizabeth Vocke v. Progressive Select Ins. Co., 20 Fla. L. Weekly Supp. 1093a (Fla. Hillsborough Cty. Ct. 2013) (granting the insurance carrier with judgment on the pleadings after finding that the phrase “I hereby authorize, request and direct any and all assigned insurance companies to pay directly to the Hospital/Facility and/or any treating physician(s) the amount due me in my pending claims for hospital/facility benefits under the respective policies” was insufficient to assign the insured’s PIP rights to the plaintiff hospital); Axcess Diagnostics Point West, LLC, d/b/a Bowes Imaging Center, a/a/o Kyle Lee v. First Acceptance Ins. Co., Inc., 21 Fla. L. Weekly Supp. 2667a (Fla. Pinellas Cty. Ct. 2013) (granting the defendant carrier with final summary judgment after finding that the phrase “patient hereby assigns to Axcess Diagnostics benefits under any insurance policy . . . in consideration for services rendered by Axcess Diagnostics” was insufficient to assign the insured’s rights, thereby leaving the plaintiff provider without standing to sue on the insured’s behalf, and that lack of standing cannot be cured post suit).

Furthermore, a written assignment of benefits that qualifiedly assigned the insured’s PIP rights to a medical provider does not constitute a valid assignment. See, e.g., Mary Crowell v. Nationwide Mut. Ins. Co., 7 Fla. L. Weekly Supp. 21l b (Fla. Escambia Cty. Ct. 1999) (denying the defendant carrier’s motion to dismiss based on lack of standing, after finding that the phrase “I understand that I am financially responsible for all charges whether or not paid by insurance” was a qualified assignment that left the insured liable for charges incurred for treatment received by the insured’s medical provider and, therefore, the insured had standing to sue the carrier).

Based on the foregoing cases and the language of the written assignments of benefits at issue in said cases, the Court finds that the language in the purported written Assignment of Benefits in the instant matter failed to assign Mr. Betancourth’s PIP rights under the subject policy to Plaintiff. The plain language of the purported written Assignment of Benefits is clear and unambiguous and cannot be rewritten by the Court. City of Tampa v. City of Port Tampa, 127 So.2d 119, 120 (Fla. 2nd DCA 1961). The plain language in question was merely a direction to pay. Furthermore, the attempted assignment of benefits was a qualified assignment as the language regarding financial responsibility left Mr. Betancourth liable for charges incurred for treatment he received from Plaintiff. As such, Plaintiff lacks standing to sue Auto-Owners on Mr. Betancourth’s behalf in this matter. Accordingly, it is hereby:


ORDERED AND ADJUDGED that Defendant, AUTO-OWNERS INSURANCE COMPANY’s, Motion to Dismiss with Prejudice is hereby GRANTED.* * *

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