DOLORES RIERA, APPELLANT,
v.
FINLAY MEDICAL CENTERS HMO CORPORATION, APPELLEE
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Dolores Riera, an HMO member, appeals a declaratory decree in a dispute with her health insurance provider Finlay Medical Centers over payment of medical bills from an automobile accident and reimbursement rights from her tort settlement. The appellate court affirms the trial court's order requiring Finlay to pay medical bills and entitling it to reimbursement from the plaintiff's $100,000 settlement, but reverses the limitation on attorney's fees.
The court affirmed that Finlay must pay medical bills directly to providers as required by the HMO contract; that Finlay is entitled to reimbursement (not subrogation) from the plaintiff's $100,000 tort recovery up to that amount; that no prejudgment interest is owed since Finlay was not legally obligated to pay the plaintiff directly; and reversed the trial court's time limitation on the plaintiff's attorney's fees award.
[1] A health maintenance organization is obligated to pay medical bills directly to medical care providers, not to the member, when such payment is contractually required.
[2] Prejudgment interest is not owed to a member when a health maintenance organization pays medical bills directly to providers as required by contract, as the member never…
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Establishes that payment obligations flow directly to medical providers under HMO contracts, not to the insured, eliminating prejudgment interest claims
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Join FLexlaw to unlock all legal intelligenceDolores Riera was an HMO member of Finlay Medical Centers HMO Corporation. She sustained injuries in an automobile accident and incurred medical bills…
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PER CURIAM.
The plaintiff Dolores Riera appeals from a partially adverse declaratory decree which (a) orders the defendant Finlay Medical Centers HMO Corp. [Finlay] to pay or settle all medical bills incurred by the plaintiff, an HMO member of Finlay, in connection with a particular automobile accident in which the plaintiff sustained certain injuries; (b) declares that Finlay will be entitled to a judgment from the plaintiff for whatever amounts it is required to pay on the above medical bills, so long as said payments do not exceed $100,000 [the amount the plaintiff received in settlement from the tortfeasor in an action arising out of the above-stated accident]; and (c) declares that the plaintiff is entitled to attorney’s fees and costs as the prevailing party in this action, but limits such award to those fees and costs incurred before the plaintiff settled her lawsuit against the tortfeasor, which settlement occurred during the pendency of this declaratory decree action. We affirm, save for the aforesaid limitation on the attorney’s fee award.
First, we see no error in the trial court’s decree that Finlay pay the plaintiff’s medical bills directly to the plaintiff’s medical care providers, rather than to the plaintiff directly, because this is what Fin-lay was legally obligated to do under the HMO contractual arrangement with the plaintiff. This being so, no prejudgment interest is required to be paid to plaintiff, as urged, because Finlay was never legally obligated to pay the plaintiff directly for the above medical bills. Beyond that, at best such payment represented nothing more than a “pass through” the plaintiff to the ultimate medical care providers, and, clearly, prejudgment interest to the plaintiff is inappropriate in such a case. See Parker v. Brinson Constr. Co., 78 So. 2d 873, 874 (Fla.1955) (“[I]f it is finally determined that the debt was due, the person to whom it was due is entitled ... to interest at the lawful rate from the due date thereof.”) (emphasis added); Cooper v. Alford, 477 So. 2d 31 (Fla. 1st DCA 1985) (same); Ray v. Travelers Ins. Co., 477 So. 2d 634, 636 (Fla. 5th DCA 1985) (same).
Second, the trial court properly declared that Finlay was entitled to a reimbursement on all medical bills paid from the plaintiff’s above-stated $100,000 tort recovery, so long as said reimbursement does not exceed such recovery. § 641.31(9), Fla.Stat. (1985). We reject the plaintiff’s contrary arguments because they proceed on the erroneous assumption that the above statute affords a subrogation remedy to Finlay; the said statute affords a reimbursement, not a subrogation remedy to Finlay, and, accordingly, the conditions precedent necessary to maintain a subrogation remedy need not be shown.
Finally, the plaintiff, without dispute, was entitled to an award of attorney’s fees and costs as the prevailing party in this action. § 641.28, Fla.Stat. (1985). This being so, we see no basis for the time limitation placed on the entitlement to fees and costs by the trial court, and, accordingly, said limitation is stricken.
Affirmed as modified.
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Ned Schuster and Suzanne Schuster v. Blue Cross & Blue Shield OF Fla., Inc., 843 So. 2d 909 (Fla. 4th DCA 2003)…money, or for the loss of money by one who is entitled to its use .... ” Black’s Law DICTIONARY 816 (7th ed.1999). Here, it was the providers' — not the Schusters— who lost the use of their money for a time. Cf. Riera v. Finlay Med. Ctrs. HMO Corp., 543 So. 2d 372, 373 (Fla. 3d DCA 1989). Confession of Judgment Finally, the Schusters assert that they were entitled to judgment in their favor because BCBSF’s payment of the outstanding claims after the commencement of litigation was tantamount to a confession…
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Humana Health Plans v. Lawton, 675 So. 2d 1382 (Fla. 5th DCA 1996)…agreement provided that his recovery was for non-economic damages, and even though, under common law, an insurer cannot collect against an insured who does not make a full recovery. Humana relies on Riera v. Finlay Medical Centers HMO Corporation, 543 So. 2d 372 (Fla. 3d DCA 1989), in which the plaintiff-subscriber sued the HMO claiming that it should have paid certain medical bills. During the pendency of the suit the plaintiff settled with the tortfeasor for $100,000, and [*1384] the HMO apparently amende…
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Augustin v. Health Options OF S. Fla., Inc., 580 So. 2d 314 (Fla. 3d DCA 1991)…o bring the instant action to protect her interests, and (2) the trial court’s determination to the contrary was in error. See, e.g., Medical Center Health Plan v. Brick, 572 So. 2d 548 (Fla. 1st DCA 1990); Riera v. Finlay Medical Centers HMO Corp., 543 So. 2d 372 (Fla. 3d DCA 1989). Second, the defendant Health Options, during the pendency of this action, eventually changed its entire position in this matter and made full payment to the specialized physician as prayed for in the plaintiffs complaint, which…
Authorities Cited
- Parker v. Brinson Constr. Co. & Fla. Indus. Comm'n, 78 So. 2d 873 (Fla. 1955)
- Wendy M.L. Cooper v. Alford, 477 So. 2d 31 (Fla. 1st DCA 1985)
- State v. Gary Fronrath Chevrolet, Inc., 477 So. 2d 634 (Fla. 4th DCA 1985)
- Clote RAY v. Travelers Ins. Co., 477 So. 2d 634 (Fla. 5th DCA 1985)