NIVALDO F. CRUZ, JR., APPELLANT,
v.
UNION GENERAL INSURANCE, APPELLEE
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Nivaldo Cruz appealed the dismissal of his declaratory relief action against his insurer, Union General Insurance, challenging whether an independent medical examination could form the basis for denying his personal injury protection (PIP) benefits. The Florida appellate court affirmed the dismissal, holding that Cruz's claim required factual determinations inappropriate for declaratory relief and that he could not seek relief for future medical expenses.
The dismissal of the declaratory relief action was proper because Cruz's claim requires a purely factual determination of whether medical expenses were reasonable, related, or necessary—factual questions that do not support declaratory relief. Additionally, Cruz has no right to seek declaratory relief regarding future medical expenses, as his right to compensation is limited to benefits that have already accrued.
[1] A claim for declaratory relief is not appropriate when the resolution of the claim requires a purely factual determination.
[2] A plaintiff's right of action for an insurer's failure to pay benefits is generally limited to benefits that have accrued at the time of the suit, unless the insurer repu…
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Join FLexlaw to unlock all legal intelligence“Questions of fact will not support a declaratory relief action.”
Establishes the primary legal principle that declaratory relief is limited to questions of law, not fact.
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Join FLexlaw to unlock all legal intelligenceCruz was injured in an automobile accident in July 1989 and was insured by Union General for personal injury protection. Pursuant to statute, Union Ge…
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PER CURIAM.
Nivaldo Cruz appeals from an order dismissing with prejudice his action for declaratory relief. We affirm.
Cruz was injured in an automobile accident in July, 1989. He was insured by Union General Insurance for personal injury protection. Upon the insurer’s request pursuant to section 627.736(7), Florida Statutes (1989), Cruz underwent an independent medical examination. After receiving the medical report from the independent examiner, Union General notified Cruz that it would no longer make voluntary payments for medical bills incurred after the date of the letter. Cruz sued Union General for declaratory relief and for breach of contract. In the count for declaratory relief, Cruz sought a determination whether, under section 627.-736(7), the examination and ensuing report by the independent medical examiner could properly form the basis for a denial of accrued and future medical expenses, relative to any and all medical specialties.
The trial court, upon Union General’s motion, dismissed the count for declaratory relief and transferred the breach of contract action to County Court.
The trial court was correct in dismissing the action for declaratory relief. Cruz’s claim for incurred medical expenses requires a purely factual determination of whether his medical expenses were “reasonable, related, or necessary.” Section 627.736(7).
Questions of fact will not support a declaratory relief action. Columbia Casualty Co. v. Zimmerman, 62 So. 2d 338 (Fla.1952); Hartford Life Ins. Co. v. Albert, 191 So. 2d 579 (Fla. 3d DCA 1966).
Cruz’s avenue of redress, therefore, is an action for breach of contract, which remains pending. Cf. Ponders v. Fortune Ins. Co., 578 So. 2d 1129 (Fla. 3d DCA 1991) (declaratory action maintained to determine whether, under section 627.736(7), insurer had waived right to deny PIP benefits for insured’s failure to keep appointment with independent medical examiner by rescheduling medical exam at location more convenient to insured); Frielingsdorf v. Allstate Ins. Co., 497 So. 2d 289 (Fla. 3d DCA 1986) (declaratory action maintained to determine whether insured who sought PIP benefits and did not live in city was required, under section 627.736(7), to submit to independent medical examination in city in adjacent county), rev. denied, 506 So. 2d 1040 (Fla.1987).
Because Cruz has a right to be compensated only for benefits that have already accrued, his complaint likewise failed to state a claim for declaratory relief regarding future medical expenses. See Aetna Life Ins. Co. v. Smith, 345 So. 2d 784, 787 (Fla. 4th DCA) (except where insurer repudiates entire contract, right of action for insurer’s failure to pay benefits limited to installments that have accrued at time of suit), cert. denied, 353 So. 2d 678 (Fla.1977); Monsanto Co. v. Fuqua, 280 So. 2d 496 (Fla. 1st DCA), cert. denied, 286 So. 2d 205 (Fla.1973); Levenson v. Motor Union (Aviation) Orion Ins. Co., 176 So. 2d 125 (Fla. 3d DCA 1965).
Affirmed.
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Allstate Ins. Co. v. Conde, 595 So. 2d 1005 (Fla. 5th DCA 1992)…n was later cited by the supreme court in Bergh v. Canadian Universal Ins. Co., 216 So. 2d 436 (Fla.1968). District courts have taken divergent views on this issue. One view strictly adheres to Zimmerman. See, e.g., Cruz v. Union General Insurance, 586 So. 2d 91 (Fla. 3d DCA 1991); New Amsterdam Casualty Co. v. Intercity Supply Corp., 212 So. 2d 110 (Fla. 4th DCA 1968). Another view apparently allows a declaratory action even if the policy provisions are unambiguous and only disputed factual issues are invo…
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Dino Kaklamanos and Keely Kaklamanos v. Allstate Ins. Co., 796 So. 2d 555 (Fla. 1st DCA 2001)…any damages as a result of the Defendant’s alleged breach. Further, a plaintiff cannot obtain a judgment for insurance benefits which have not as yet accrued. Aetna Life Ins. Co. v. Smith, 345 So. 2d 784 (Fla. 4th DCA 1977); Cruz v. Union Gen. Ins., 586 So. 2d 91 (Fla. 3d DCA 1991); Monsanto Co. v. Fuqua, 280 So. 2d 496 (Fla. 1st DCA 1973); Walden. Since the Plaintiff did not incur any medical expenses which the Defendant did not reimburse, and any damages the Plaintiff might have sustained as a result of th…
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Peachtree Cas. Ins. Co. v. Walden, 759 So. 2d 7 (Fla. 5th DCA 2000)…So. 2d 784 (Fla. 4th DCA), cert. denied, 353 So. 2d 678 (Fla.1977), Peachtree’s notice gave rise to a cause of action for breach of contract with respect to the claims that accrued by the time of the litigation, see id.; Cruz v. Union General Ins., 586 So. 2d 91 (Fla. 3d DCA 1991); State Farm Mut. Auto. Ins. Co. v. Gil, 573 So. 2d 90 (Fla. 3d DCA 1991). We do not agree with Peach-tree that this result renders the 30-day provision of the statute meaningless. Insurers have 30 days to provide the benefits unle…
Previewing 3 of 7 citing cases — full citator treatment, depth of discussion, and citing context are member features.
Join FLexlaw to unlock all legal intelligenceAuthorities Cited
- Columbia Cas. Co. v. Zimmerman, 62 So. 2d 338 (Fla. 1952)
- AETNA Life Ins. Co. v. Smith, 345 So. 2d 784 (Fla. 4th DCA 1977)
- Nationwide Mut. Ins. Co. v. DeOCA, 280 So. 2d 496 (Fla. 3d DCA 1973)
- Frielingsdorf v. Allstate Ins. Co., 497 So. 2d 289 (Fla. 3d DCA 1986)
- Davis v. State, 176 So. 2d 125 (Fla. 1st DCA 1965)
- Fuqua v. Monsanto Co., 286 So. 2d 205 (Fla. 1973)
- Miller v. Camblin, 286 So. 2d 205 (Fla. 1973)
- Willis v. State, 176 So. 2d 125 (Fla. 2d DCA 1965)
- Hartford Life Ins. Co. OF Boston v. Albert, 191 So. 2d 579 (Fla. 3d DCA 1966)
- Berineth Ponders v. Fortune Ins. Co., 578 So. 2d 1129 (Fla. 3d DCA 1991)