ROBERT N. CROTTS, APPELLANT,
v.
BANKERS AND SHIPPERS INSURANCE COMPANY OF NEW YORK, A CORPORATION, AND FORT MYERS COMMUNITY HOSPITAL, INC., APPELLEES

Fla. 2d DCA | 1985-10-16
No. 84-2726
OTT, A.C.J., and HALL, J., concur.
476 So. 2d 1357 Florida District Court of Appeal, Second District (1985) Caution
Cited by 12 cases

AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.

Synopsis

Plaintiff Crotts successfully recovered disability insurance benefits from Bankers and Shippers Insurance Company but was denied attorney's fees. The court affirmed the denial of attorney's fees because the insurance company faced legitimate conflicting claims it could not reasonably resolve, but reversed the summary judgment for the Hospital on its counterclaim for unpaid medical bills due to insufficient evidence of the amount owed.


Holding

The insurance company was not required to pay attorney's fees because the conflicting claims involved factual and legal issues the company could not reasonably resolve on its own. The Hospital's summary judgment was reversed because there was no evidence establishing the amount owed for services rendered, but the Hospital may prove its claims on remand.


Headnotes

[1] An insurance company is not obligated to pay the insured's attorney's fees when the litigation arises from legitimate conflicting claims that the insurer cannot reasonabl…

[2] An insurance company may be liable for attorney's fees if it wrongfully causes parties to resort to litigation by failing to resolve a conflict within its reasonable powe…

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Key Quotes

“the insurance company must pay those attorney's fees if the company wrongfully caused the parties to resort to litigation by not resolving the conflict when it was reasonably within the company's power to do so.”

Establishes the general rule for when an insurance company is obligated to pay attorney's fees under section 627.428(1)

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Facts & Procedural History

Crotts was severely injured in a motorcycle accident and hospitalized. He signed hospital assignment forms (though claimed no recollection) assigning …

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Opinion of the Court
LEHAN, Judge.

LEHAN, Judge.

Plaintiff appeals the trial court’s denial of attorney’s fees under section 627.428(1), Florida Statutes (1983), in plaintiff’s successful suit against Bankers and Shippers Insurance Company of New York (“Bankers”) for the recovery of disability insurance benefits. Plaintiff also appeals the summary judgment awarded to Fort Myers Community Hospital, Inc. (“Hospital”) on its counterclaim for unpaid hospital bills. We affirm the denial of attorney’s fees and reverse the Hospital’s summary judgment.

On May 8, 1982, plaintiff was severely injured while riding a motorcycle. He was transported immediately to the Hospital. The next day plaintiff apparently signed a hospital form which included an assignment to the Hospital of “the insurance hospital benefits and major medical benefits due me.... ” Plaintiff later stated he had no recollection of signing the form. Upon readmission to the Hospital on July 25, 1982, plaintiff apparently signed an identical form. Again plaintiff stated that he did not recall doing so but admitted that the signature on the second form is his.

On June 14, 1982, plaintiff’s attorneys notified Bankers that plaintiff was requesting that the entire $10,000 no-fault insurance benefits available to him be reserved to pay disability benefits, rather than medical benefits, as provided by section 627.-736(l)(b), Florida Statutes (1981). Bankers began making biweekly disability payments to plaintiff.

In approximately January 1983, Bankers was requested to pay plaintiff the entire remaining $5,920 balance of the available disability benefit because plaintiff was by then considered to be permanently disabled. However, before Bankers made the lump sum payment, the Hospital notified Bankers of its claim for the remainder of the benefits based on the two assignments and other supporting documents not relevant to this discussion. Bankers eventually forwarded a draft for the remaining benefits payable jointly to plaintiff and the Hospital.

Plaintiff then sued Bankers for the benefits. Bankers filed a third-party complaint against the Hospital for interpleader and declaratory relief. The Hospital counterclaimed against plaintiff for unpaid hospital bills. The trial court, on motions for summary judgment, awarded plaintiff the insurance benefits plus interest but denied plaintiff’s request for attorney’s fees from Bankers. The court also granted summary judgment to the Hospital on its claim against plaintiff for unpaid bills.

On appeal, the first issue concerns the question of when an insurance company is obligated to pay attorney’s fees under section 627.428(1), Florida Statutes (1983), if it is faced with conflicting claims to the insurance policy proceeds. The general rule is to the effect that an insurance company must pay those attorney’s fees if the company wrongfully caused the parties to resort to litigation by not resolving the conflict when it was reasonably within the company’s power to do so. For example, the insurance company was required to pay the beneficiary’s attorney’s fees in Kurz v. New York Life Insurance Co., 168 So. 2d 564 (Fla. 1st DCA 1964), where the litigation resulted from the insurance company’s failure to give effect to a provision in its own policy.

In contrast, the insurance company was not required to pay the beneficiaries’ attorney’s fees in either New York Life Insurance Co. v. Shuster, 373 So. 2d 916 (Fla.1979), or Manufacturers Life Insurance Co. v. Cave, 295 So. 2d 103 (Fla.1974), where the litigation resulted from beneficiaries’ claims that change of beneficiary forms were forged, a type of claim that the insurance company could reasonably be expected to be resolved by a court.

In Great Southwest Fire Insurance Co. v. DeWitt, 458 So. 2d 398 (Fla. 1st DCA 1984), the conflicting claims revolved around the question of whether a deceased mortgagee had held the mortgage in a tenancy by the entireties with his wife so that upon his death his wife became sole holder of the mortgage. The house on which the mortgage was held was destroyed by fire. In attempting to pay the insurance proceeds jointly to the mortgagors and mortgagees, the insurance company was unable to determine who the proper mortgagees were, i.e., who inherited the deceased mortgagee’s interest. During the litigation, however, the mortgage was apparently paid off and a satisfaction of mortgage was executed. The court found that prior to the execution of the satisfaction of mortgage, the insurance company was not liable for attorney’s fees because the legal question concerning the deceased mortgagee’s heirs presented the company with legitimate conflicting claims.

However, the court found that the execution of the satisfaction of mortgage relieved the company of any obligation to persons claiming an interest in the mortgage. It was concluded that the insurance company “improperly withheld payment of the proceeds past that point in time.” 458 So. 2d at 400.

Accordingly, attorney’s fees were properly awarded for the work done after the satisfaction of mortgage was presented to the insurance company.

In the case now before us, we agree with the trial court’s denial of the insured’s claim for attorney’s fees. Because the conflict in this case involved the resolution of factual and legal issues which the insurance company could not reasonably be expected to resolve on its own, the insurance company was not wrongful in withholding payment and forcing the conflict into court. The factual issue involved whether the insured’s assignments of benefits to the hospital were valid so as to divest the insured of his privilege under the policy to request that the insurance proceeds be paid as disability, rather than medical, benefits. The legal question involved the effect of section 222.18, Florida Statutes (1983), which exempts disability payments from legal process.

Accordingly, we affirm the trial court's ruling on the plaintiffs claim for attorney’s fees.

As to point (2), the Hospital concedes that the trial court erred in entering summary judgment in its favor because there was no evidence to establish the amount owed by plaintiff to the Hospital.

Plaintiff contends, in opposition, that no judgment can be entered in this lawsuit in favor of the Hospital against plaintiff for that amount because the Hospital in its counterclaim based its entire cause of action upon the assignments of benefits, not upon services rendered and amounts owed.

We agree with the hospital’s concession and disagree with plaintiff’s contention. There was no evidence before the trial court establishing the amount owed to the Hospital for its services rendered to plaintiff.

Therefore, the summary judgment in favor of the Hospital is reversed. But the Hospital is entitled to undertake to prove the allegations in the counterclaim that it is owed sums for hospital services provided to plaintiff.

Reversed and remanded for proceedings consistent herewith.

OTT, A.C.J., and HALL, J., concur.


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Citator

Cited By

  • Gov't Emps. Ins. Co. v. Lazara E. Gonzalez, 512 So. 2d 269 (Fla. 3d DCA 1987)
    …ees when, but only when, it has wrongfully withheld the proceeds of the policy. See New York Life Ins. Co. v. Shuster, 373 So. 2d 916 (Fla.1979); Ray v. Travelers Ins. Co., 477 So. 2d 634 (Fla. 5th DCA 1985); Crotts v. Bankers and Shippers Ins. Co., 476 So. 2d 1357 (Fla. 2d DCA 1985), review denied, 486 So. 2d 595 (Fla. 1986). That condition is satisfied on these facts: (a) Even before the hospital had formally released its claim to the proceeds, when GEICO was supposedly faced with competing claims, it was f…
  • Gov't Emps. Ins. Co. v. Battaglia, 503 So. 2d 358 (Fla. 5th DCA 1987)
    …au. GIECO also argues that it cannot be penalized for a stay of arbitration entered by the trial court. The law in regard to the instant issue is succinctly summarized in a case relied on by GEICO, Crotts v. Bankers & Shippers Ins. Co. of New York, 476 So. 2d 1357 (Fla. 2d DCA 1985), review denied, 486 So. 2d 595 (Fla.1986): ... The general rule is to the effect that an insurance company must pay those attorney’s fees if the company wrongfully caused the parties to resort to litigation by not resolving the c…
  • Margiotta v. State Farm Mut. Auto. Ins. Co., 622 So. 2d 135 (Fla. 4th DCA 1993)
    …should have issued a joint check to the hospital and the insured or interpleaded the funds. Government Employees Ins. Co. v. Gonzalez, 512 So. 2d 269 (Fla. 3d DCA 1987). The trial court relied on Crotts v. Bankers and Shippers Ins. Co. of New York, 476 So. 2d 1357 (Fla. 2d DCA 1985); however, we find that case distinguishable. There, when met with the competing claims of the hospital and the insured, the insurer promptly responded by forwarding a draft of the remaining benefits payable jointly to the insured…

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