Schuster v. Blue Cross and Blue Shield of Fla., Inc., 4D01-4523.
| Decision Date | 19 February 2003 |
| Docket Number | No. 4D01-4523.,4D01-4523. |
| Citation | 843 So.2d 909 |
| Parties | Ned SCHUSTER and Suzanne Schuster, Appellants, v. BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC., a corporation, Appellee. |
| Court | Florida District Court of Appeals |
Jeffrey M. Liggio and Jene P. Williams of Liggio, Benrubi & Williams, P.A., West Palm Beach, and Richard A. Barnett of
Richard A. Barnett, P.A., Hollywood, for appellants.
Nancy W. Gregoire and W. Edward McIntyre of Bunnell, Woulfe, Kirschbaum, Keller, McIntyre & Gregoire, P.A., Fort Lauderdale, for appellee.
The instant appeal arises from a dispute between the Schusters and Blue Cross and Blue Shield of Florida, Inc. (BCBSF) under a health insurance policy. Following a bench trial, the trial court entered final judgment in favor of the insurer, finding that the insureds simply could not prevail as they had assigned their right to benefits to the health care providers and, consequently, had sustained no damages. We affirm.
In 1997, Suzanne Schuster was diagnosed with a "stomach paralysis condition." Following her diagnosis, Suzanne underwent numerous surgical procedures and, ultimately, her stomach was removed and she received a multi-visceral transplant of the stomach, small bowel, and pancreas. Suzanne and her husband, Ned, are insured under a health insurance policy issued by BCBSF. In June of 2000, the Schusters sued BCBSF, alleging that it had breached the insurance contract by delaying and denying payment of Suzanne's medical bills. The Schusters alleged as damages unpaid medical expenses, impairment of their credit, mental distress, and out-of-pocket expenses. At the time the litigation was commenced, the disputed claims numbered in the hundreds. Thereafter, the Schusters narrowed their claims and alleged that twenty-seven claims had not been timely processed and paid by BCBSF. The twenty-seven claims totaled approximately $51,000 and involved seven health care providers, the St. Lucie Fire District, Gastroenterology Consultants (Drs. Baskin and Kumar), Shands Hospital, Housecall Home Health, Housecall Infusion Services, Martin Memorial Hospital, and Lab Corp.
Before the trial could get underway, but after the Schusters filed suit, BCBSF paid all of the disputed, outstanding claims. The Schusters then filed a motion seeking the entry of judgment in their favor on the issue of BCBSF's liability, arguing that the payment of the disputed claims was the "functional equivalent" of a confession of judgment. The Schusters deferred seeking a ruling on their motion, however, and the case proceeded to trial.
At the very outset of the bench trial, counsel for the Schusters acknowledged that all of the outstanding claims had been paid, but asserted that BCBSF had nonetheless breached the insurance contract because it failed to pay the claims within the time limits prescribed by the insurance contract and Florida statute. It was the Schusters' position that while BCBSF pointed to inaccurate provider numbers and missing authorization codes to support the delay in payment, these were simply not matters that excused BCBSF's obligation to meet the time frames set forth by contract and statute. For its part, from opening statements, BCBSF took the position that it had not breached the contract by failure to make timely payment and, even if it had, the Schusters still could not prevail in their suit because they had sustained no damages. In his opening statement, counsel for BCBSF pointed out that the Schusters had assigned their right to benefits to the health care providers for each of the disputed claims; that, as consequence of such assignment, the claims were submitted by the providers to BCBSF; that payment went directly from BCBSF to the providers; and that there would be no evidence that the Schusters had been required to pay any out-of-pocket expenses. Between opening statements and closing arguments, some eight witnesses testified. Seven of those witnesses were either BCBSF employees or representatives of one of the seven health care providers involved in the disputed claims. The testimony of these witnesses centered around how claims are processed by BCBSF, what kind of information a health care provider is required to submit, and the submission of the various claims by the providers. The eighth witness was Ned Schuster. Schuster confirmed that he and his wife had assigned their right to benefits to the providers for each of the twenty-seven claims at issue.
By the time of closing arguments, counsel for the Schusters conceded that the Schusters' damages "for the purposes of this case are going to be the statutory interest or the contractual interest on the 627.613." BCBSF continued to insist that the Schusters could not prevail because damages was an element of a cause of action for breach of contract and the Schusters had not sustained any damages. As for any interest that was owed as the result of untimely payment, BCBSF's counsel argued that such interest would be owed to the provider—not the Schusters.
In his final judgment, the judge expressed doubt over whether BCBSF's billing procedures complied with the provisions set forth in the insurance contract and Florida statute. Despite these concerns, the judge agreed that in light of the assignment of the claims to the providers, the Schusters could not prevail. Specifically, the judge found that:
It appears to this Court that the Schusters voluntarily took it upon themselves to pursue the payments owed by Blue Cross to the health care providers pursuant to the various provider agreements in this case.... The various health care providers, whose claims are at issue in this case, may have had valid causes of action against Blue Cross for failure to pay legitimate bills incurred by their insured in a reasonable and timely manner. However, none of the health care providers brought suit against Blue Cross and that is not the issue before the Court. Any interest on damages owed in this case would be owed to the health care providers and not the Schusters. Where the Schusters assigned their contract rights to the health care providers at issue in this case, they assigned away their right to bring this cause of action for breach of...
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