WILLIE MAE AUGUSTIN, APPELLANT,
v.
HEALTH OPTIONS OF SOUTH FLORIDA, INC., APPELLEE
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Willie Mae Augustin appealed an adverse summary judgment in her action against Health Options of South Florida, an HMO that refused to pay for medical services rendered by a specialist physician without a prior referral. The appellate court reversed, finding that Augustin had standing to sue and that the HMO's subsequent full payment of the disputed bill entitled her to attorney's fees as the prevailing party.
Augustin had standing to bring the action because the specialist physician sought to collect from her, creating a direct interest she needed to protect. The HMO's full payment during the action constituted a functional equivalent of judgment in her favor, entitling her to attorney's fees under Florida Statute § 641.28 as the prevailing party.
[1] A health maintenance organization subscriber has standing to sue to compel payment for medical services when the specialist physician seeks to collect the bill from the s…
[2] A health maintenance organization's subsequent full payment to a medical provider, after litigation has commenced, moots the action and entitles the subscriber to attorne…
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“Because the specialist physician thereafter sought to collect his bill from the plaintiff by asserting a claim against the plaintiffs tort recovery from a third party, it is clear that (1) the plaintiff had standing to bring the instant action to protect her interests, and (2) the trial court's determination to the contrary was in error.”
Establishes the basis for finding standing—the specialist's attempt to collect from Augustin created a direct interest she needed to protect.
Previewing 1 of 2 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceAugustin was a subscriber to an HMO contract with Health Options. She sought non-emergency treatment from a specialized orthopedic physician without o…
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PER CURIAM.
This is an appeal by the plaintiff Willie Mae Augustin from an adverse final summary judgment in an action brought against the defendant Health Options of South Florida, Inc. [Health Options], a health maintenance organization, to compel payment for medical services rendered to the plaintiff by an orthopedic surgeon [a member physician of the defendant HMO]. We reverse based on the following briefly stated legal analysis.
First, the defendant Health Options refused to pay the medical bill in question on the ground that the plaintiff had unilaterally sought non-emergency treatment from a specialized physician, without a pri-or referral by the plaintiffs primary care physician in alleged violation of the terms of the HMO contract to which the plaintiff was a party subscriber. Because the specialist physician thereafter sought to collect his bill from the plaintiff by asserting a claim against the plaintiffs tort recovery from a third party, it is clear that (1) the plaintiff had standing to 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 necessarily mooted the instant action. This was the functional equivalent of a judgment or verdict in favor of the plaintiff and therefore entitled the plaintiff to an award of attorney’s fees under § 641.28, Fla.Stat. (1989), as the prevailing party below. Wollard v. Lloyd's and Companies of Lloyd’s, 439 So. 2d 217, 218 (Fla.1983); Ginsberg v. Keehn, 550 So. 2d 1145, 1147 (Fla. 3d DCA 1989); Avila v. Latin American Property & Casualty Ins. Co., 548 So. 2d 894 (Fla. 3d DCA 1989); Fortune Ins. Co. v. Brito, 522 So. 2d 1028 (Fla. 3d DCA 1988); Gibson v. Walker, 380 So. 2d 531, 533 (Fla. 5th DCA 1980).
The final summary judgment under review is therefore reversed, and the cause is remanded to the trial court with directions to dismiss the instant action as moot and to award attorney’s fees to the plaintiff as the prevailing party below.
Reversed and remanded.
Cases With Similar Vibessemantic neighbors from the corpus
Citator
Cited By (11 total)
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Smith v. Adler, 596 So. 2d 696 (Fla. 4th DCA 1992)…al court controlled the procedure which secured the relief. Furthermore, the fact that no final judgment was entered is also not controlling where there is a functional equivalent of a judgment. See Augustin v. Health Options of South Florida, Inc., 580 So. 2d 314 (Fla. 3d DCA 1991). However, we affirm that part of the award which denied recovery of costs and attorney’s fees against the homeowner’s association itself. There were no pleadings filed against the homeowner’s association and thus no request for…
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Kook C. DO v. GEICO Gen. Ins. Co., 137 So. 3d 1039 (Fla. 3d DCA 2014)…led but before a judgment has been rendered, “the payment of the claim is, indeed, the functional equivalent of a confession of judgment or a verdict in favor of the insured.” Id. (emphasis added); accord Augustin v. Health Options of S. Fla., Inc., 580 So. 2d 314, 315 (Fla. 3d DCA 1991); Amador v. Latin Am. Prop. & Cas. Ins. Co., 552 So. 2d 1132,1133 (Fla. 3d DCA 1989); Avila, 548 So. 2d at 894-95; Fortune Ins. Co. v. Brito, 522 So. 2d 1028,1029 (Fla. 3d DCA 1988). As a result, when an insurer voluntarily p…
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Payne v. Cudjoe Gardens Prop. Owners Ass'n, Inc., 875 So. 2d 669 (Fla. 3d DCA 2004)…ons was the functional equivalent of a judgment or verdict in favor of the plaintiff/association, thus making the association entitled to an award of attorney’s fees and costs as the prevailing party. See Augustin v. Health Options of S. Fla., Inc., 580 So. 2d 314, 315 (Fla. 3d DCA 1991) (holding that when defendant made full payment to physician during pendency of action as prayed for in the complaint, it necessarily mooted out the action and was the functional equivalent of a plaintiffs verdict or judgment…
Previewing 3 of 11 citing cases — full citator treatment, depth of discussion, and citing context are member features.
Join FLexlaw to unlock all legal intelligenceAuthorities Cited
- Wollard v. Lloyd's & Cos. OF Lloyd's, 439 So. 2d 217 (Fla. 1983)
- Gibson v. Walker, 380 So. 2d 531 (Fla. 5th DCA 1980)
- Med. Ctr. Health Plan v. Brick, 572 So. 2d 548 (Fla. 1st DCA 1990)
- Ashley v. State, 522 So. 2d 1028 (Fla. 3d DCA 1988)
- Lucio Avila v. Latin Am. Prop. & Cas. Ins. Co., 548 So. 2d 894 (Fla. 3d DCA 1989)
- Ginsberg v. Keehn, 550 So. 2d 1145 (Fla. 3d DCA 1989)
- Schoninger v. K Mart Corp. & Levitz Furniture Corp., 543 So. 2d 372 (Fla. 3d DCA 1989)
- Riera v. Finlay Med. Ctrs. Hmo Corp., 543 So. 2d 372 (Fla. 3d DCA 1989)