Page 1
IN THE SUPREME COURT OF FLORIDA TALLAHASSEE, FLORIDA CASE NO. 82,933 BARBARA A. SAVONA, Plaintiff-Appellant/Petitioner, versus PRUDENTIAL INSURANCE CO., Defendant-Appellee/Respondentd FILED StO J. WHITE MAR a1 1994 CLERK, SUPREME COURT CERTIFIED QUESTION FROM THE UNITED STATES COURT OF APPEALS BASED ON APPEAL FROM MAGISTRATE’S ORDER U.S. DISTRICT COURT ELEVENTH CIRCUIT, CASE # 93-2281 MIDDLE DISTRICT FLORIDA, CASE # 91-462-CIV-ORL-19 INITIAL BRIEF OF PLAINTIFF. SAVONA CHARLES E. DAVIS, ESQUIRE Charles E. Davis, P. A. P.O. Box 568569 Orlando, F132856 Florida Bar # 254959 Attorney for Savona (407) 293-1510
--------------------------------------------------------------------------------
Page 2
TABLE OF CONTENT$ PAGES STATEMENT OF THE ISSUES ...................... 1 CERTIFIED QUESTION: WHEmER. UNDER FLA . STAT . SEC . 627.6675 (1987). A CONVERSION INSURANCE POLICY MUST PROVIDE BENEFITS EQUAL TO THOSE PROVIDED UNDER THE ORIGINAL GROUP INSURANCE POLICY? STATEMENT OF THE CASE ........................ 2 STATEMENT OF THE FACTS ........................ 4 SUMMARY OF ARGUMENT ....................... 5 ARGUMENT AND CITATIONS OF AUTHORITY ....... 6 0 CONCLUSION .................................... 10 CERTIFICATE OF SERVICE ........................ 13i
--------------------------------------------------------------------------------
Page 3
TABLE OF CITATIONS CASES PAGES Blue Cross/Blue Shield v. Shufelt, 487 S0.26 1085 (Fla. 5th DCA 1986) .................... 3,4,5,6, 8 Flintkote Company v. Dravo Corporation, 678 F.2d 942, 945 (11th Cir. 1982) .................... .5, 6 Griffis v. State, 356 So.2d 297,299 (Fla. 1978) ........................ .9 Jett v. State, 605 So.2d 926 (Fla. 5th DCA 1992) ..................... 9 Northbrook Life Insurance v. Clark, 582 So.2d 1199 (Fla. 2nd DCA 1991) ................... .3,5,6, 8 Provau v. State Farm Mutual Ins. Co., 772 F.2d 817, 820 (11th Cir. 1985) ...................... 7 Silverberg v. Paine Weber. Jackson & Cu rtis Incorp., 710 F.2d, 678 (11th Cir. 1983). .6 0 ........................ Studstill v. Bow Warner Leasing, 806 F.2d 1005, 1007 (11th Cir. 1986) .................... 7 Chapter 92-33, Section 138, Laws of Florida. .............. 7 Chapter 92-318, Section 116, Laws of Florida. ............. 8 STATUTES 627.6675, Florida Stat., (1987). ..................... .1,4,5,6,7 $627.667S( lo), Florida St& , (1992). ................... . 7$627.6675(20), Florida Stat., (1992) ................... .7, 8 $86.001, Florida Stat., ............................... .4
--------------------------------------------------------------------------------
Page 4
STATEMENT OF THE ISSUES Whether, under Florida Statute section 627.6675 (1987), a conversion insurance policy must provide benefits equal to those provided under the original group insurance policy, and correspondingly whether the Magistrate at the Federal District Court was bound to follow and award Plaintiff $1,000,000 in lifetime health coverage according to the uncontroverted case law as set forth in two Florida appellate districts as well as statutory history. 1
--------------------------------------------------------------------------------
Page 5
STATEMENT OF THE CASE of Proceedings This suit was initiated by the filing of Plaintiffs Petition for Declaratory Relief in state court on June 14, 1991 (Rl-2). The Defendant filed a Notice of Removal of the Civil Action from the Circuit Court of the Ninth Judicial Circuit, in for Orange County, Florida, to the United States District Court, in and for the Middle District of Florida (Rl-1). The Notice of Removal and notification of new case number was entered on August 2,1991 (Rl- 7). On July 16, 1991, the Defendant filed an Answer to Count I of the Complaint, and a Motion to Dismiss and/or Strike Count TI of the Petitionq(Rl-3;R1-4) In opposition to Defendant's motions, the Plaintiff filed a Response to said motion (Rl-9). On August 27, 1991, the Plaintiff filed an Amended Petition for Declaratory Relief and Amended Complaint for Breach of Contract (Rl-13). Defendant filed a Motion to Dismiss, and/or Strike Amended Petition for Declaratory Relief and Complaint for Breach of Contract.( R 1- 16) a On December 10, 1991, the case was assigned to trial by Magistrate. Plaintiff filed her consent to that procedure on January 8, 1992. (Rl-19) On February 20, 1992 an order was entered granting the Motion to Strike the Amended Petition (Rl-20). The Plaintiff filed an Amended Petition for Relief on March 12, 1992 (Rl-21). Defendant again filed a Motion to Dismiss and/or Strike Count I1 of Amended Cornplaint (R2-22), and shortly thereafter Plaintiff filed a Response to that 2
--------------------------------------------------------------------------------
Page 6
Motion. On May 14, 1992, an Order granting Motion to Dismiss and Motion to Strike Count I1 of Amended petition for declaratory relief was granted. Count I1 was dismissed for failure to state a cause of action. (R2-30). 0 On May 14, 1992, a status conference was held wherein the Plaintiff and Defendant agreed to a stipulation of facts. (R2-31) On June 23, 1992, Defendant filed its Memorandum for final ruling (R2-35). Plaintiff filed her Memorandurn on June 24, 1992 (R2-36). Notice of Supplemental Authority was filed by the Defendant on October 19, 1992 (R2-41). The Plaintiff filed a Notice of Supplemental Authority on October 19, 1992.(R2-42) On February 12, 1993 the Court filed its Memorandum of Opinion. (R2-43) The Memorandum Opinion declined to follow the Florida District Court of Appeal decisions of Blue Cross/Blue Shield v. Shufelt. 487 So.2d 1085 (Fla. 5th DCA 1986) and Northbrook Life Insurance v. Clark, 582 So.2d 1199 (Fla, 2nd DCA 1991). The Court further found that the provision of a $250,000 lifetime major medical benefit was all that was required under the plain language of subsections (8) and (11) of section 627.6675 (1990). (R2-43) Judgment was entered on February 12, 1993 for the Defendant and against the Plaintiff (R2-44). The Plaintiff filed her Notice of Appeal from the Final Judgment on March 15, 1993 (R2-45). The case was then briefed at the Court of Appeals for the Eleventh Circuit, and they chose to certify this question to the Florida Supreme Court. 3
--------------------------------------------------------------------------------
Page 7
STATEMENT OF FACTS This was an action for declaratory relief brought pursuant to Florida Statute 886.011, and an action for breach of contract in failing to comply with Florida Statute 8627.6675. That on or about January 29, 1986, the Plaintiff, BARBARA A. SAVONA, was employed by the Hotel Royal Plaza and was entitled to group health benefits under a policy issued PRUDENTIAL INSURANCE COMPANY. Further on that date, the Plaintiff, BARBARA A. SAVONA, was involved in a catastrophic motor vehicle accident which rendered her totally disabled, and as such she was eventually terminated from the group policy pursuant to the terms of that policy. That BARBARA A. SAVONA, after termination of the group policy, was entitled to a conversion to an individual policy; and the Defendant/Appellee eventually issued an individual conversion policy (on approximately November 26, 1987) after accepting BARBARA A. SAVONA’s application. However, the Defendant, PRUDENTIAL, did not 0 1 furnish timely copies of the policy, its terms, conditions, or premium rates prior to issuing said policy.( R 1-Zexhibi ts) In fact, Defendant, PRUDENTIAL, eventually refused to offer any other policy maximum limits besides $100,000.00 or $250,000.00, despite the fact that the Plaintiff, BARBARA A. SAVONA, was previously covered with a $1,000,000.00 lifetime policy and had requested those limits in the individual conversion. Plaintiff advised that said refusal was in violation of Florida Statute 8627.6675, and the established law in Florida as found in the Blue Cross/Blue Shield v. Shufelt, 487 So26 1085, (Fla. 5th DCA 1986). Litigation then followed. 4 0
--------------------------------------------------------------------------------