Summary: White received physical therapy services from Valir Physical Therapy following an automobile accident. Valir then billed the insurance of the other party involved in the accident directly, rather than billing White's medical insurance. White alleged that this resulted in Valir sidestepping pricing agreements with White's medical insurance provider that would have resulted in Valir receiving a smaller billed recovery. White alleged that the net result was that Valir took a larger portion of the third-party insurance proceeds than if Valir billed White's medical insurance. Valir argued that pursuant to the Assignment of Benefits entered into by the parties that Valir had the option of obtaining payment from White's medical insurance or from the third-party insurance. Valir moved for and was granted summary judgment at the trial court.
Legal Issues: Both parties admit that the Assignment of Benefits was entered into by the parties in this case. The Court looked to the language of the Assignment of Benefits and found that ambiguities existed. In particular, the Court looked to language that required White to remit payments made directly to her on behalf of Valir and for White to make good on amounts billed to but not paid by her medical insurance provider.
The Court ruled that reasonable minds could disagree regarding the effect of the Assignment of Benefits. As such, a question of material fact existed on the contract claim. The Court remanded this action to the trial court for action consistent with its ruling.
Discussion: While White was provided the opportunity to go forward with a claim of breach of contract, concurrent claims for fraud and "tort" remain dismissed. White will have the opportunity to conduct discovery and proceed with a breach of contract claim at the trial court level.
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