Jones v. State Farm Mutual Automobile Insurance

491 S.E.2d 830, 228 Ga. App. 347, 97 Fulton County D. Rep. 3319, 1997 Ga. App. LEXIS 1131
CourtCourt of Appeals of Georgia
DecidedSeptember 3, 1997
DocketA97A1194
StatusPublished
Cited by12 cases

This text of 491 S.E.2d 830 (Jones v. State Farm Mutual Automobile Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals of Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Jones v. State Farm Mutual Automobile Insurance, 491 S.E.2d 830, 228 Ga. App. 347, 97 Fulton County D. Rep. 3319, 1997 Ga. App. LEXIS 1131 (Ga. Ct. App. 1997).

Opinion

Andrews, Chief Judge.

Gloria Jones’s minor child was insured under an automobile liability policy issued by State Farm Mutual Automobile Insurance Company covering injuries the child sustained in an automobile accident on or about October 9, 1993. After paying policy benefits for medical treatment rendered to the child immediately after the accident, State Farm refused to pay for medical treatment given to the child over five months after the accident on the basis that the subsequent treatment was not for injuries arising from the accident. On behalf of her child, Jones sued State Farm for breach of its contractual obligation to pay benefits under the policy, for a bad faith penalty and attorney fees under OCGA § 33-4-6, for invasion of privacy for unauthorized release of the child’s medical records, and for fraud and punitive damages.

State Farm denied the claims and moved for partial summary *348 judgment and, pursuant to OCGA § 9-11-17 (a), moved for substitution of the real party in interest as plaintiff or for dismissal. The trial court granted summary judgment to State Farm on Jones’s claim for invasion of privacy, for damages pursuant to OCGA § 33-4-6, and for punitive damages. As to State Farm’s motion pursuant to OCGA § 9-11-17 (a), the trial court held that, because Jones had assigned the right to receive the State Farm insurance benefits to Dr. Hill, the chiropractor who rendered the subsequent medical treatment at issue, Dr. Hill rather than Jones was the real party in interest as to the remaining contract claim. Accordingly, the trial court dismissed the action for failure to substitute Dr. Hill as the real party in interest. The trial court also granted summary judgment, sua sponte, to State Farm on an allegation by Jones in her response to summary judgment that State Farm violated the Fair Business Practices Act.

On appeal, Jones claims the trial court erred by granting summary judgment to State Farm on her invasion of privacy claim and on her claim for damages pursuant to OCGA § 33-4-6. She also claims the trial court erred by dismissing her claim for benefits under the policy on grounds that she was not the real party in interest.

1. The trial court correctly granted summary judgment in favor of State Farm on Jones’s claim that State Farm invaded her child’s privacy by having the child’s medical records reviewed by an independent medical provider.

Jones sought payment of policy benefits by State Farm for medical care provided by Dr. Hill in the amount of $2,825. Dr. Hill sent medical bills to State Farm requesting payment and stated that the medical treatment given to the child was for injuries arising from the October 1993 automobile accident. In response to State Farm’s request for documentation to support the claim that the treated injuries arose from the covered accident, Dr. Hill sent State Farm the child’s medical records. Dr. Hill had permission from Jones to release the medical records to State Farm because Jones signed a document on behalf of her child authorizing Dr. Hill “to release any information pertinent to my case to any insurance company, adjuster or attorney to facilitate collection [of the medical bills].” Upon receipt of the medical records from Dr. Hill, State Farm sent them to International Healthcare Consultants, Inc. (IHC) for the purpose of being independently reviewed by an IHC chiropractor to determine if the treatment was related to injuries incurred by the child in the October 1993 accident.

We find no logic in Jones’s position that State Farm needed her permission to have the child’s medical records reviewed by an independent medical provider to determine if the medical treatment was for injuries covered by the insurance policy. When an insured claims that an insurer is obligated to pay for medical treatment allegedly *349 covered under an insurance policy, the insured waives the right to privacy in the medical treatment records to the extent necessary for the insurer to conduct a reasonable review and investigation of the claim. See Orr v. Sievert, 162 Ga. App. 677, 679-680 (292 SE2d 548) (1982). As in the present case, this may include submission of the records by the insurer to an' independent medical provider for the purpose of determining whether or not the treatment was for a condition covered by the policy. Id.

2. Jones claims the trial court erred by dismissing her claim for benefits under the insurance policy. The trial court dismissed Jones’s claim against State Farm for payment of medical benefits under the policy on the basis that Jones was not the real party in interest on this claim and that Dr. Hill, as assignee of contractual benefits under the policy, was the real party in interest. In granting dismissal, the trial court held that “[t]he Plaintiff [Jones], as of this date, has failed to substitute Dr. Hill as the Real Party in Interest in the instant case.”

It is undisputed that Jones assigned contractual benefits under the insurance policy to Dr. Hill on March 11, 1994, prior to the date she filed her suit against State Farm on September 29, 1995. This assignment transferred the cause of action for the policy benefits to Dr. Hill and divested Jones of the right to bring the cause of action. Allianz Life Ins. Co. &c. v. Riedl, 264 Ga. 395, 396-398 (444 SE2d 736) (1994); Blue Cross & Blue Shield v. Bennett, 223 Ga. App. 291 (477 SE2d 442) (1996).

In response to State Farm’s motion to dismiss, Jones filed an affidavit regarding the assignment from Dr. Hill in which Hill stated in part that, “I determined that the irrevocable assignment would be relinquished . . . and I released Gloria Jones from said assignment.” Although the affidavit does not explicitly state that Dr. Hill reassigned contractual benefits under the policy to Jones or when, the clear import of the statement is that the cause of action for the policy benefits was reconveyed by Hill to Jones. Accordingly, when the trial court dismissed the cause of action for failure of Jones to substitute Dr. Hill as the real party in interest there was evidence that, at some point after the March 11,1994 assignment date, Dr. Hill relinquished his right to the cause of action for the policy benefits and returned the cause of action to Jones. It is not clear whether the alleged reassignment may have occurred before or after the cause of action for the benefits was filed by Jones on September 29, 1995. But even if Jones was not the real party in interest when the cause of action for benefits was filed by her, a subsequent reassignment of the cause of action from Dr. Hill to Jones would, at that point, have made Jones the real party in interest and allowed her, within a reasonable time after objection, to ratify the commencement of the action pursuant to *350 OCGA §

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Cite This Page — Counsel Stack

Bluebook (online)
491 S.E.2d 830, 228 Ga. App. 347, 97 Fulton County D. Rep. 3319, 1997 Ga. App. LEXIS 1131, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jones-v-state-farm-mutual-automobile-insurance-gactapp-1997.