In Gables Insurance Recovery, Inc. v. Seminole Casualty Insurance Company, 34 FLW D672 (Fla. 3rd DCA April 1, 2009), the PIP insured received medical care from Atlantic Medical Specialty, Inc. and executed a document titled "ASSIGNMENT OF BENEFITS/POLICY RIGHTS." This document purported to assign the insured’s rights and benefits under her PIP policy to Atlantic although it failed to expressly name Atlantic as the medical provider/assignee referred to in the document. Later, Atlantic assigned to Gables Insurance Recovery, Inc. any outstanding sums owed to Atlantic by the PIP insurer.
Gables then sued Seminole Casualty for outstanding amounts which Atlantic had billed to Seminole Casualty. Seminole Casualty moved for summary judgment on two grounds: 1) the initial Assignment of Benefits to Atlantic was legally inadequate because it failed to name the purported assigner, Atlantic; and 2) that PIP benefits are not payable to third parties who did not render medical services.
On second-tier certiori review, the 3rd DCA ruled in favor of Gables and against Seminole Casualty. The Court first determined that "any ambiguity regarding the identity of the initial assignee is easily rectified" by the fact that the insured submitted an affidavit confirming that she intended to assign the benefits to Atlantic, and that Atlantic was the provider to which the initial assignment refers. (An assignment is a contract controlled by the intent of the parties).
The Court then confirmed that the insured can assign the benefits of an insurance claim after a loss. The Court then noted that Atlantic, as assignee, received all of the insured’s rights including the right to further assign the policy proceeds. Accordingly, Atlantic, standing in the shoes of the insured, was free to assign anything which it received by assignment.
In its ruling, the Court cited a number of Florida cases allowing the assignment of insurance money after a loss, and recognizing that
a provision in a policy of insurance which prohibits assignment thereof except with consent of the insurer does not apply to prevent assignment of the claim or interest in the insurance money then due, after loss.
I pursue many cases on behalf of construction contractors, vendors, and medical providers under an assignment of benefits. The insurance companies frequently – wrongly – allege that such assignments are improper because the policy prohibits assignments without the consent of the insurer. This case, once again, confirms that such post loss assignments are valid.