Dawson v. Blue Cross Ass'n

• Decision Date: 07 March 1974
• Docket Number: No. S-302,S-302
• Citation: 293 So.2d 90
• Parties: Timothy DAWSON, a minor, By and Through Robert Dawson, his father and next friend, and Robert Dawson, Individually, Appellants, v. BLUE CROSS ASSOCIATION et al., Appellees.
• Court: Florida District Court of Appeals

Page 90

293 So.2d 90

Timothy DAWSON, a minor, By and Through Robert Dawson, his father and next friend, and Robert Dawson, Individually, Appellants, v. BLUE CROSS ASSOCIATION et al., Appellees.

No. S-302.

District Court of Appeal of Florida, First District.

March 7, 1974.

On Rehearing May 7, 1974.

Rehearing Denied May 7, 1974.

Paul R. Stern, of Stern, Bernardini & Chiumento, and S. LaRue Williams, of Kinsey, Vincent & Pyle, Daytona Beach, for appellants.

J. Compton French, of Landis, Graham, French, Husfeld, Sherman & Ford, Daytona Beach, for appellees.

BOYER, Judge.

The plaintiffs below, appellants here, filed a complaint in the Circuit Court of Volusia County against the defendants below, appellees here. The original complaint was not divided into counts but nevertheless prayed for declaratory relief and for a money judgment. The complaint alleged a contract of insurance, in full force and effect, issued by the defendants under which the plaintiffs were insured. It further alleged that the minor plaintiff was a patient of the Devereux Foundation in Glenmore, Pennsylvania; that demand had been made upon defendants to make payment of benefits under the terms of the policy of insurance which was attached as an exhibit to the complaint and that the defendants had failed and refused so to do. The complaint also alleged that the defendants had 'taken the position that the Devereux Foundation at Glenmore, Pennsylvania is not a hospital within the meaning of the insurance contract.'; that plaintiffs were in doubt as whether they were entitled to hospital benefits under the terms of said contract, and that they prayed for a declaratory judgment, and, as aforesaid, for a money judgment. Although the complaint alleged that the minor plaintiff was receiving 'treatment and therapy' administered Plaintiffs perfected this appeal, assigning as errors dismissal of the complaint, amended complaint and second amended complaint.

at the Devereux Foundation, it did not allege any payment or obligation for payment therefor. An order of dismissal, with right to amend, was entered by the trial court. Plaintiffs thereupon filed an amended complaint specifically alleging that the Devereux Foundation in Glenmore, Pennsylvania was a 'non-member hospital' as defined in the policy of insurance, reciting specific portions of the policy under which they claimed to be entitled to benefits. The amended complaint specifically alleged that expenses had been incurred by the plaintiffs 'at the aforesaid non-member hospital for room and board, special diets and general nursing services and (that the plaintiffs) will continue to incur such expenses at the rate of $1,000.00 per month, and said expenses now total or approach or surpass the amount of $9,000.00, and these expenses are covered by the policy as aforesaid.' The amended complaint further alleged that other medical expenses had been incurred and that the plaintiffs had complied with all conditions precedent to the enforcement of the contract of insurance, but that the defendants had denied and refused to honor the terms of said contract and had refused to make any payment of any kind. There was no allegation in the amended complaint of any doubt as to any coverage, right of recovery or other question incident to the contract of insurance; however, there was a prayer for a declaratory judgment and for a money judgment. The trial court granted a motion to dismiss the amended complaint with right to amend. The plaintiffs thereupon filed a second amended complaint, in two counts, alleging the contract of insurance, coverage, that the minor plaintiff was a patient at the Devereux Foundation in Glenmore, Pennsylvania, that the Devereux Foundation in Glenmore, Pennsylvania is a non-member hospital as defined in the policy, specifically quoting pertinent portions of the policy, reciting various alleged facts relative to the Devereux Foundation, its facilities, etc., the incurring of expenses, compliance with all of the conditions precedent to the enforcement of the contract, denial of liability on the part of the defendants and prayed for a declaratory judgment and a money judgment. Again, the second amended complaint is devoid of any allegation of any doubt as to any right or circumstance. In due course the trial court again dismissed both counts of the complaint and entered a final judgment in favor of the defendants.

The sole question to be determined on this appeal is whether the various orders of dismissal were properly entered by the trial court.

At the outset we emphasize that there is a clear distinction between a motion to dismiss, a motion for summary judgment, a motion for judgment on the pleadings, a motion for directed verdict and post trial motions.

Although all persons, including pleaders, should constantly strive for perfection, it is not requisite that every complaint be a model pleading. It is not necessary, nor indeed desirable, that a plaintiff allege evidence. Aside from allegations as to jurisdiction and demand for judgment for relief the rule only requires 'a short and plain statement of the ultimate facts showing that the pleader is entitled to relief.' (Rule 1.110, Florida Rules of Civil Procedure, 30 F.S.A.). If the complaint contains sufficient allegations to inform the defendant of the charges of wrongdoing which constitutes the real basis for the plaintiff's complaint so that the defendant may intelligently answer, it should be held sufficient. (Cohn v. Florida-Georgia Television Company, Fla.App. 1st 1969, 218 So.2d 787.) The allegations must, of course, be sufficient to inform the defendant of the nature of the cause against him. (Naples Builders Supply Co. v. Clutter Constr. Corp., Fla.App. 3rd 1963, 152 So.2d 478.)

A motion to dismiss may not act as a substitute for a motion for summary judgment, and a court may not properly go beyond the four corners of the allegations of the complaint when considering a motion to dismiss it. This court held in Thompson v. City of Jacksonville, Fla.App. 1st 1961, 130 So.2d 105, that:

'Under our rules of procedure and adjudication, when a court is considering the validity of a plaintiff's complaint upon the filing by the defendant of a motion to dismiss on the grounds of failure to state a cause of action, one of the most important principles for a court to keep in mind is that in such consideration the court must confine itself strictly to the allegations within the four corners of the complaint itself. For the purpose of this consideration, also, the court must accept as true the allegations of fact contained in the complaint, and the court is without authority to speculate as to what the true facts may be or what facts will be ultimately proved in the trial of the cause. The consideration of an appellate court when reviewing the trial court's ruling on the validity of the complaint as against such motion to dismiss, is circumscribed by the same limitations. * * *' (At page 107)

The applicable law was again enunciated by this court in Hopke v. O'Byrne, Fla.App. 1st 1963, 148 So.2d 755, wherein the writer of that opinion stated:

'The sole question to be determined on this appeal is whether in the present action the trial court properly granted the defendant's ...