UNION BANKERS INSURANCE COMPANY, APPELLANT/CROSS APPELLEE,
v.
CHRISTINA DIPAOLO, A MINOR, BY AND THROUGH HER GUARDIAN HAZEL DIPAOLO AND HAZEL DIPAOLO, INDIVIDUALLY AND AS PARENT AND NATURAL GUARDIAN, APPELLEE/CROSS APPELLANT

Fla. 4th DCA | 1993-12-01
Nos. 91-1418, 91-2658
DELL, C.J., and STONE, J., concur.
627 So. 2d 1207 Florida District Court of Appeal, Fourth District (1993) Positive Treatment
Cited by 2 cases

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Synopsis

Union Bankers Insurance Company appealed a decision requiring it to pay health insurance benefits for a minor's medical expenses, arguing that a prior settlement with the tortfeasor barred its subrogation claim. The Florida appellate court affirmed, holding that the settlement release expressly excluded claims against the insurance carrier and that the policy lacked a subrogation provision.


Holding

The court affirmed that the insured's claim against the health insurance carrier was not legally barred. The express exclusion in the release for the insurance claim left open the possibility of bringing such a claim, and the carrier cannot rely on subrogation when its policy contains no subrogation provision.


Headnotes

[1] A release of a tortfeasor that expressly excludes first-party insurance claims does not bar an insured's claim against their own health insurance carrier.

[2] A health insurance carrier cannot rely on a subrogation claim to deny benefits when its policy lacks a subrogation provision.

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Key Quotes

“It is agreed between the parties that this Release does not include first party insurance claims, specifically any claim against Union Bankers Insurance Company.”

The express language of the settlement release that preserved the insured's right to claim benefits from their health insurance carrier.

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Facts & Procedural History

The DiPaolo family's minor daughter received medical treatment. The family previously settled with the tortfeasor responsible for the injury, obtainin…

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Opinion of the Court
FARMER, Judge.

FARMER, Judge.

We affirm on all issues but write to explain our reasoning on only one. In this suit by the insured against their health insurance carrier for unpaid medical expenses arising from their minor daughter’s care and treatment, the carrier argues that no benefits are payable. It contends that the insured previously sued the tortfeasor and obtained a settlement compensating them for their minor child’s medical expenses attributable to the tortfeasor’s conduct. It argues that the release given by the insured to the tortfeasor barred any subrogation claim by the carrier against the tortfeasor to recover benefits paid under the policy. In fact, the release actually stated: “It is agreed between the parties that this Release does not include first party insurance claims, specifically any claim against Union Bankers Insurance Company.” [e.o.]

The carrier places primary reliance on Connecticut General Life Ins. Co. v. Dyess, 569 So. 2d 1293 (Fla. 5th DCA 1990), rev. denied, 581 So. 2d 1307 (Fla.1991), but there are important differences between that case and this one. First, there the plaintiffs received payment in full for their medical expenses from the tortfeasor; here there is no such finding. Second, there the release extinguished the medical expense claims; here the release expressly does not include the insured’s claim against their own health insurance carrier. Third, there the policy contained a “conditioned claim payment” provision designed to prevent the carrier from having to pay medical expenses recovered by the insured from a tortfeasor; here the policy has no such provision.1 We simply find Dyess inapposite.

We also note that this carrier’s policy does not even contain a subrogation provision. Hence the carrier can hardly be heard to argue that it should not be penalized by the absence of such a routine provision. As this is a mine-run breach of contract action, the rights and liabilities of the parties to the contract should be determined by the contract language itself, and not by missing text that the drafter of the contract did not think to include.

We also do not think ourselves called upon to determine whether there is an equitable right to subrogation for health insurance carriers who have neglected to insert such provisions in their policies. We leave that to the judge in any action in subrogation brought by this carrier against the tortfeasor. It is sufficient for this case that we decide merely that the express exclusion in the release for this claim left open the possibility of bringing such a claim if it were otherwise available.

Thus we affirm the trial judge’s conclusion that there was no legal impediment to this insured’s claim against this health insurance carrier for the medical expenses arising from their daughter’s care and treatment for the condition in suit.

AFFIRMED.

DELL, C.J., and STONE, J., concur. . This policy should be contrasted with the policy in Union Central Life Ins. Co. v. Carlisle, 593 So. 2d 505 (Fla.1992), which contained a specific provision ("right of refund”) requiring the insured to reimburse the carrier for any medical expenses recovered from a tortfeasor. 593 So. 2d at 506.


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  • Usameribank v. Klepal, 100 So. 3d 56 (Fla. 2d DCA 2011)
    …der the guise of contract construction, insert language into a contact that the drafter did not include. Discover Prop. & Cas. Ins. Co. v. Beach Cars of West Palm, Inc., 929 So. 2d 729, 732 (Fla. 4th DCA 2006); see Union Bankers Ins. Co. v. DiPaolo, 627 So. 2d 1207, 1208 (Fla. 4th DCA 1993) (“[T]he rights and liabilities of the parties to the contract should be determined by the contract language itself, and not by missing text that the drafter of the contract did not think to include.”). As this court has re…

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