CONNECTICUT GENERAL LIFE INSURANCE, APPELLANT,
v.
WILLIE E. DYESS, ET AL., APPELLEES
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Connecticut General Life Insurance appeals a summary judgment requiring it to pay medical benefits to Margaret and Tracey Dyess despite their settlement with the tortfeasor that included a release of medical expense claims. The court reverses, holding that the Dyesses cannot recover duplicate benefits from both the tortfeasor and the insurance provider when they have released their claims against the tortfeasor.
The court held that the Dyesses cannot recover medical benefits from Connecticut General because they released their claims against the tortfeasor and are therefore estopped from collecting duplicate damages. The injured parties' failure to assert subrogation rights against the health care provider when they elected to collect from the tortfeasor bars recovery from the insurance company.
[1] An injured party who settles with a tortfeasor and releases claims for medical expenses is estopped from later seeking those same expenses from their health insurance pro…
[2] A settlement with a tortfeasor that includes a release for all medical expenses prevents the injured party from recovering those expenses from a collateral source.
Previewing 2 of 4 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.
Join FLexlaw to unlock all legal intelligence“Once the injured party receives these expenses from his health care provider, his rights to these expenses from the tort-feasor are subrogated to the health care provider.”
Establishes the principle that subrogation rights arise when an injured party receives medical expenses from their provider, preventing subsequent recovery from the tortfeasor.
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Join FLexlaw to unlock all legal intelligenceTracey Dyess was severely injured in a 1986 automobile accident allegedly caused by a defective tire manufactured by Uniroyal Tire Company. The Dyesse…
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HARRIS, Judge.
Connecticut General Insurance Company appeals a summary judgment which determined that Margaret Dyess and her son Tracey are entitled to benefits under a group medical insurance policy issued by Connecticut General. Tracey was severely injured in 1986 in an automobile accident allegedly caused by a defective tire manufactured by Uniroyal Tire Company. The Dyesses later settled with Uniroyal for $2,000,000. As a condition of settlement, the Dyesses executed a release which covered “any and all claims ... for ... hospital and medical expenses ... arising ... out of the accident....”
After settling with Uniroyal, the Dyesses filed a claim with Connecticut General to recover medical benefits under a group medical insurance policy issued to Martin Marietta, Margaret’s employer. Connecticut General claimed that since the Uniroyal release provided that the Dyesses had received full payment for medical expenses, no benefits were available pursuant to a “conditioned claim payment” provision in its policy which purports to deny a double recovery to a claimant. The Dyesses then filed this action for breach of contract. The trial court concluded that the Dyesses were entitled to receive benefits under the insurance policy because the language of the conditioned claim payment provision is ambiguous.
Without deciding whether the contract is ambiguous, we nevertheless find that the trial court erred and reverse.
The trial court, relying on Molyett v. Society National Life Insurance Co., 452 So. 2d 1114 (Fla. 2d DCA 1984) and Prince v. American Indemnity Co., 431 So. 2d 270 (Fla. 5th DCA 1983), held that an injured party is “not entitled to recover medical expenses already paid by a collateral source from the tortfeasor.” While this is a correct statement of the law, the trial court has misapplied it in this case. First, the issue at the hearing on summary judgment should not have been whether appellees were entitled to recover medical and hospital expenses from Uniroyal, but whether they did, in fact, receive them. Second, the court overlooked the reason for denying recovery of these prepaid collateral source expenses to the injured party. Once the injured party receives these ex penses from his health care provider, his rights to these expenses from the tortfeasor are subrogated to the health care provider. Blue Cross and Blue Shield of Florida v. Matthews, 498 So. 2d 421 (Fla.1986).
In the case at bar, appellees elected not to file a claim against their health care provider (thus no subrogation) but to collect these expenses from the tortfeasor.1 They then released any claim to such expenses from the tortfeasor in their settlement. After releasing their claim against the tortfeasor (thus preventing subrogation),2 appellees sought to recover double damages by filing a claim against their health care provider. Not only are appellees estopped to file such claim (having waived their right to insurance by electing to collect such damages “in full” from Uniroyal), but even if they were permitted to collect such damages from appellant, the damages previously received from Uniroyal would be “held in trust” for appellant. See 16 G. Couch, Cyclopedia of Insurance Law, § 61:29 (2d ed.1983).
While this action is controlled by Section 627.7372, Florida Statutes (1985), the statute as amended effective July 1, 1986 3 would require the same result. Section 768.76(1) would permit the injured party to receive the damages from the tortfeasor and Section 768.76(4) would permit reimbursement to the paying health care provider from the injured party.
REVERSED for further action consistent with this opinion.
W. SHARP, J., and DANIEL, Judge, Retired, concur. . There is nothing in the law which prevents injured persons from waiving their rights to receive insurance benefits and suing the tortfeasor for the full amount of their damages. Purdy v. Gulf Breeze Enterprises, Inc., 403 So. 2d 1325 (Fla.1981).
. See 16 G. Couch, Cyclopedia of Insurance Law, § 61.203 2d ed. (1983); see also National Surety Corporation v. Bimonte, 143 So. 2d 709 (Fla. 3d DCA 1962).
. § 768.76, Fla.Stat. (1986 Supp.).
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Mansfield v. Rivero, 620 So. 2d 987 (Fla. 1993)…ot consider the language at issue mere dicta when it wrote Purdy or decided Matthews. Additionally, the district courts of appeal have understood that this language was substantive and not mere dicta. See Connecticut General Life Insurance v. Dyess, 569 So. 2d 1293 (Fla. 5th DCA 1990), review denied, 581 So. 2d 1307 (Fla.1991). The majority’s further attempt to distinguish Purdy by stating that it related only to a discussion of the collateral source rule, contained in section 627.7372, is equally unpersuasiv…
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Dryden v. Pedemonti, 910 So. 2d 854 (Fla. 5th DCA 2005)…ubrogation to itself by the inclusion of such a provision in the health insurance contract. The record is unclear whether appellee’s insurance policies, in this case, contain such subrogation clauses. 3. Connecticut General Life Insurance v. Dyess, 569 So. 2d 1293 (Fla. 5th DCA 1990), rev. denied, 581 So. 2d 1307 (Fla.1991). The injured parties executed a general release in favor of the tortfeasor which provided they released “any and all claims ... for ... hospital and medical expenses ... arising ... out of…1 / 2
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Pomerantz v. Nationwide Mut. Fire Ins. Co., 575 So. 2d 1311 (Fla. 3d DCA 1991)…to cause the condition which produces the injury, but must, itself, produce the injury. [*1313] Race, 542 So. 2d at 349, quoting 6B J. Appleman, Insurance Law and Practice, § 4317 (Buckley ed. 1979). See also Connecticut General Life Ins. v. Dyess, 569 So. 2d 1293 (Fla. 5th DCA 1990) (coverage found pursuant to underinsured motorist clause where injuries caused by enraged bulls that had escaped from trailer towed by uninsured vehicle; incident arose from ownership, maintenance, or use of that vehicle). In th…
Previewing 3 of 6 citing cases — full citator treatment, depth of discussion, and citing context are member features.
Join FLexlaw to unlock all legal intelligenceAuthorities Cited
- Blue Cross & Blue Shield OF Fla., Inc. v. Matthews, 498 So. 2d 421 (Fla. 1986)
- John M. Purdy and his wife v. Gulf Breeze Enters., Inc., 403 So. 2d 1325 (Fla. 1981)
- Nat'l Sur. Corp. v. Myron S. Bimonte, 143 So. 2d 709 (Fla. 3d DCA 1962)
- Prince v. Am. Indem. Co., 431 So. 2d 270 (Fla. 5th DCA 1983)
- Molyett v. Soc'y Nat'l Life Ins. Co., 452 So. 2d 1114 (Fla. 2d DCA 1984)