ROSONDALA OGLESBY, APPELLANT,
v.
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, APPELLEE
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An unqualified assignment of medical benefits under a PIP policy to a medical provider causes the insured to lose standing to maintain a direct action against the insurer.
[1] An unqualified assignment of personal injury protection medical benefits to a medical provider transfers the cause of action against the insurer to the provider, and the…
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Join FLexlaw to unlock all legal intelligence“only the insured or the medical provider "owns" the cause of action against the insurer at any one time. And the one that owns the claim must bring the action if an action is to be brought.”
Court explaining the principle that ownership of the cause of action is exclusive and determines who may sue.
An insured assigned medical benefits under a PIP insurance policy to a medical provider, with the insured remaining liable for any unpaid medical bill…
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[*470] HARRIS, J.
The county court granted summary judgment in favor of the insurer on a claim for medical benefits under a PIP policy, finding that the benefits under the policy had been assigned to the medical provider. The court certified and we accepted the following restated question:
WHETHER AN ASSIGNMENT OF BENEFITS BY AN INSURED TO A PROVIDER OF MEDICAL SERVICES UNDER A PERSONAL INJURY PROTECTION INSURANCE POLICY IN WHICH THE INSURED REMAINS LIABLE FOR ANY MEDICAL BILLS NOT PAID BY THE INSURER, CAUSES THE INSURED TO LOSE STANDING TO MAINTAIN A DIRECT ACTION AGAINST THE INSURER.
We answer the question in the affirmative. We do not find this to be a conditional or qualified assignment. It is an unqualified assignment of medical benefits accepted on condition. This is a ease, as is most often the case, in which the medical provider agrees to perform services based only on an unqualified assignment of medical benefits on the condition that the patient will be ultimately responsible for any medical bills either not covered by the policy or simply not paid by the insurer. If at some point the medical provider decides to forego a claim against the insurer and instead look to the insured, a condition precedent to such action should be the reassignment of the medical benefits under the insurance policy to the insured. Here, after almost four years, the medical provider has shown no interest in pursuing the insured or the insurer for anything. In any event, only the insured or the medical provider “owns” the cause of action against the insurer at any one time. And the one that owns the claim must bring the action if an action is to be brought. See Garcia v. State Farm Mut. Auto. Ins. Co., 766 So. 2d 430 (Fla. 5th DCA 2000); Livingston v. State Farm Mut. Auto. Ins. Co., 774 So. 2d 716 (Fla. 2d DCA 2000).
AFFIRMED.
SHARP, W., and PETERSON, JJ., concur.
Cases With Similar Vibessemantic neighbors from the corpus
Citator
Cited By (11 total)
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Allstate Ins. Co. v. Keely Kaklamanos, 843 So. 2d 885 (Fla. 2003)…ualified assignment which removes the insured’s standing to bring a direct action against the insurer, even though the insured remains liable for any medical bills [*893] not paid by the insurer. See, e.g., Oglesby v. State Farm Mut. Auto. Ins. Co., 781 So. 2d 469 (Fla. 5th DCA 2001); Livingston v. State Farm Mut. Auto. Ins. Co., 774 So. 2d 716, 717 (Fla. 2d DCA 2000) ("As a general rule, if an insured has assigned her right to receive personal injury protection (PIP) benefits to a health care provider, the i…
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Progressive Express Ins. Co. v. McGRATH Community Chiropractic, 913 So. 2d 1281 (Fla. 2d DCA 2005)…entertaining it.” Gen. Dev. Corp. v. Kirk, 251 So. 2d 284, 286 (Fla. 2d DCA 1971). At any one time, only the insured or the medical provider “owns” the cause of action against the insurer for PIP benefits. Oglesby v. State Farm Mut. Auto. Ins. Co., 781 So. 2d 469, 470 (Fla. 5th DCA 2001). For a medical provider to bring an action for PIP benefits, the insured must assign his or her right to such benefits under the policy to the medical provider. Thus the assignment of PIP benefits is not merely a condition…
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David Shaw, David G. Shaw D.C., P.A. v. State Farm Fire & Cas. Co., 37 So. 3d 329 (Fla. 5th DCA 2010)…d assignment which removes the insured’s standing to bring a direct action against the insurer, even though the insured remains liable for any medical bills not paid by the insurer.” Id. at 893 n. 3 (citing Oglesby v. State Farm Mut. Auto. Ins. Co., 781 So. 2d 469 (Fla. 5th DCA 2001); Livingston v. State Farm Mut. Auto. Ins. Co., 774 So. 2d 716, 717 (Fla. 2d DCA 2000) (“As a general rule, if an insured has assigned her right to receive personal injury protection (PIP) benefits to a health care provider, the i…
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
- Livingston v. State Farm Mut. Auto. Ins. Co., 774 So. 2d 716 (Fla. 2d DCA 2000)
- Garcia v. State Farm Mut. Auto. Ins. Co., 766 So. 2d 430 (Fla. 5th DCA 2000)