Insurance — Personal injury protection — Standing —
Assignment — Where insured executed document assigning benefits to medical
provider who rendered services, submitted bills to insurer, and filed suit
against insurer, provider is real party in interest — There is no distinction
between direction to pay and assignment of benefits — Even if express
assignment did not exist, equitable assignment conveys standing to provider

ADVANCED 3D DIAGNOSTICS A/A/O NICUOLY JEAN PHILIPPE, Plaintiff, v. USAA
CASUALTY INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and
for Orange County. Case No. 2012-SC-011324-O (70-6). July 12, 2013. Honorable
Andrew Cameron, Judge. Counsel: Adam Saben, Shuster & Saben, Miami, for
Plaintiff. Christopher Cavaliere, Hussein Law Group, for Defendant.

THIS CAUSE having come before the Court for hearing on June 5, 2013, on
Plaintiff’s and Defendant’s Counter-Motions for Summary Judgment, and the Court
having considered the motion, court file, applicable law and the arguments of
counsel, finds as follows:

This is a case where the Plaintiff, a medical provider, performed medical
services for the claimant and submitted its bill to the Defendant for payment.
The Plaintiff disputes the amount paid. The Defendant’s position is that the
Plaintiff has no standing to bring a cause of action for its bill at issue.

The Plaintiff seeks standing to bring this case through its Assignment of
Benefits, contained within is the following language:

The Defendant argues that the above language creates a “mere” direction to
pay from the Defendant/insurer to the Plaintiff/provider, yet said language
fails to create a right for said provider to enforce that right by failing to
convey standing to bring a cause of action. Based on a review of the facts in
the case and a review of the relevant case law, this Court finds that the
Plaintiff has standing to bring this case. This ruling is based on the following
legal and factual analysis:

The following facts are not in dispute:

In the same period of time, the Court also finds:

The party bringing the claim must be the real party in interest. That is,
whether the best parties are before the Court to properly litigate the issues in
a given case. The real party in interest is “the person in whom rests, by
substantive law, the claim sought to be enforced” Weiss v. Johnson, 898
So.2d 1009 (Fla. 4th DCA 2005) [30 Fla. L. Weekly D680a]. In this case, based on
the above facts, the Plaintiff, ADVANCED 3D, is in the best position to litigate
the merits of its case against the Defendant. The Plaintiff has a real interest
in getting its bill paid. It is the one that submitted the claim and it is the
one seeking its enforcement.

The Plaintiff can best argue that its services were medically necessary,
reasonable, and/or medically related; its bills were timely submitted; and, any
other relevant issues in this case. Further, the Plaintiff, not the claimant, is
the one who took affirmative action to get its bill paid, by filing this
lawsuit. Assuming that the claimant wanted to file suit, the benefits sought
would be tendered to the Plaintiff since, according to the Defendant, the
claimant signed a direction to pay. Therefore, the Court finds that the
Plaintiff is the real party in interest and the proper litigant to prosecute
this claim, Also see, Advanced MRI a/a/o Anthony Mayo v. State Farm Mutual
Automobile Insurance Company, 20 Fla. L. Weekly Supp. 599a. (finding the MRI
provider has standing with an identical assignment of benefits).

A review of the appellate case law reveals that there is no legal distinction
between a direction to pay and an assignment of benefits.

Interestingly, both the Plaintiff and the Defendant rely on Progressive
Express Insurance Company v. McGrath, 913 So.2d 1281 (Fla. 2nd DCA 2005) [30
Fla. L. Weekly D2622b]. In McGrath, the medical provider filed a claim
for unpaid PIP benefits. However, the assignment of benefits was not executed
until after the provider filed suit. For that reason, the Second District agreed
with the trial court that the provider had no standing to file suit. Presumably,
for this reason, the Defendant states that Advanced 3D has no standing in this
case. However, there is no dispute that the assignment of benefits was executed
at the time services were rendered and well before Advanced 3D filed this suit.
In McGrath, the Second District, in addressing the language of the
assignment, looked at the language of the assignment which stated, in pertinent
part, the “Assignment of Benefits Form assigned to the Provider benefits payable
under the policy for services rendered by the Provider. The form also authorized
Progressive to pay such benefits directly to the Provider.” McGrath, at
1283 (emphasis added). This Court finds that the language in the Assignment on
Benefits in McGrath is the same as the one in this case with respect to
its silence on anything other than there being a direction to pay. The Second
District drew no distinction between a “mere” direction to pay and an assignment
giving a provider the right to bring a suit for unpaid PIP benefits. In fact,
the Second District found the provider could bring suit if it had the executed
assignment of benefits prior to filing suit. In our case, this is not an
issue. Therefore, this Court relies on McGrath in finding that the
distinction between a direction to pay and an assignment of benefits with an
inherent right to bring suit is artificial and the Defendant’s argument is not
supported by McGrath, and that the Plaintiff’s argument is consistent
with McGrath.

In Schuster v. Blue Cross and Blue Shield of Florida. Inc. 843
So.2d 909 (Fla. 4th DCA 2003) [28 Fla. L. Weekly D505a], the Plaintiff’s Ned and
Suzanne Schuster, attempted to bring a lawsuit for unpaid health insurance
benefits. There was no dispute that the Schusters signed assignments of benefits
to various medical providers which merely directed payment from the insurance
company to the various providers. In fact, the Fourth District states that the
Plaintiff assigned “their right to benefits to the health care providers, and
consequently, had sustained no damages” Schuster at 910.1 The Fourth District also states, “Where the
Schusters assigned their contract rights to the health care providers at issue
in this case, they assigned away their right to bring this cause of action for
breach of contract against Blue Cross and for any resulting damages.”
Schuster at 911. Again, the assignment in Schuster was a direction
to pay, which is the language of the assignment in our case. Therefore, under
Schuster, the Plaintiff, ADVANCED 3D, has standing in this case. Also see
Hanford Ins. Co. of Southeast v. St. Mary’s Hosp., Inc. 771 So.2d 1210,
1212, (Fla. 4th DCA 2000) [25 Fla. L. Weekly D2523a] (“Courts have recognized
that medical service providers can assert claims for PIP benefits against
insurers when an insured has assigned them the right to the benefits.”). The
effect of such an assignment is to place the insured’s cause of action for such
benefits in the provider.

“No particular words or form of instrument is necessary to effect an
equitable assignment and any language, however informal, which shows an
intention on one side to assign a right or chose in action and an intention on
the other to receive, if there is valuable consideration, will operate as an
effective equitable assignment.” Giles v. Sun Bank, N.A., 450 So.2d 258,
260 (Fla. 5th DCA 1984). In this case, the facts indicate that there is an
equitable assignment of benefits (assuming an express assignment didn’t exist)
for the facts as stated above. Defendant relies on Open MRI of Orlando, inc.,
a/a/o Raquel Ramos v. State Farm, 17 Fla. L. Weekly Supp. 731a (9th Jud Cir.
App. 2010) in finding that there is no assignment in this case, however, the
Ninth Judicial Circuit found that the Plaintiff in Ramos never pled
equitable assignment in its Complaint. In our case, the Plaintiff pled, in the
alternative of an express assignment of benefits, there was, at least, an
equitable assignment of benefits. Therefore, this Court finds that there is an
express assignment of benefits that conveys standing, and, further, even if one
did not exist, there is, at least, an equitable assignment, which conveys
standing to the Plaintiff.

THEREFORE, it is ORDERED and ADJUDGED that the Plaintiff’s Motion for Summary
Judgment is GRANTED and the Defendant’s Motion for Summary Judgment is DENIED.

__________________

1Although this goes to an earlier argument
regarding real party in interest, the fact that the Fourth District finds that
the Schusters suffered no damages shows that the claimant who signs an
assignment of benefits that includes language directing payment to a provider
cannot be a real party in interest since that claimant suffers no damages as a
result of the failure to pay the proper amount. Like the Schusters, where the
Fourth District found they suffered no damages, in our case, the claimant
suffered no damages, which also is why Advanced 3D, and not the claimant is the
Plaintiff in this case, the real party in interest, and the only entity that can
have standing.