Liberty Care Plan v. Department of Insurance

710 So. 2d 202, 1998 Fla. App. LEXIS 4849, 1998 WL 216047
CourtDistrict Court of Appeal of Florida
DecidedMay 5, 1998
DocketNo. 96-3909
StatusPublished

This text of 710 So. 2d 202 (Liberty Care Plan v. Department of Insurance) is published on Counsel Stack Legal Research, covering District Court of Appeal of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Liberty Care Plan v. Department of Insurance, 710 So. 2d 202, 1998 Fla. App. LEXIS 4849, 1998 WL 216047 (Fla. Ct. App. 1998).

Opinions

BARFIELD, Chief Judge.

Appellant challenges a declaratory statement of the Department of Insurance (DOI), pursuant to section 120.565, Florida Statutes (1995), which determined that the sale of its home health care plan (the Plan) would be the sale of “insurance” as defined in section 624.02 and “health insurance” as defined in section 627.603. We reverse.

For an annual fee of $1875.00, the Plan provides a guaranteed “membership,” renewable for life without any age or pre-existing condition requirements, which entitles the member to purchase home health care from a specific provider, Maxim Healthcare Service, Inc., at discounted rates whenever the member so chooses, without prior hospitalization, convalescent care, doctor’s orders, or third party ease management. The home health care services are provided for eight or twenty-four hours per day at two levels: Level I (homemaker/companion) care includes cooking, shopping, assistance with the telephone, laundry, housekeeping, and driving (either the member’s vehicle or the caregiver’s vehicle); Level II (home health aide) care includes the above-mentioned services plus feeding, bathing, dressing, toileting, and transferring. The daily charges for these services to members in the Orlando and Sarasota areas are $85 and $95, respectively, plus a $150 assessment fee for Level II care. In the other areas (Jacksonville, Tampa, St. Petersburg, Lakeland, West Palm Beach, Ft. Lauderdale, and Miami), the charges are $71 and $81, respectively, plus a $150 assessment fee for Level II care. The Plan states: “Member must pay directly to Maxim Healthcare Services, Inc. whatever charges are incurred over and above Liberty Care Plan discount at the end of each seven (7) day period” (this is referred to in the contract as a “co-payment”). These charges for home health services are not deductible from the annual fee. Increases in the charges are guaranteed not to exceed the cost of living or 4% annually, whichever is less, as long as the membership remains current. The contract documents state in bold letters: “THIS IS NOT INSURANCE.”

The parties stipulate that there was no formal hearing and that the record consists of appellant’s handwritten request for a declaratory statement, a copy of the Plan, the declaratory statement, and the notice of appeal.1 In its declaratory statement, DOI found that section 624.02, Florida Statutes (1995), defines “insurance” as “a contract whereby one undertakes to indemnify another or pay or allow a specified amount or a determinable benefit upon determinable contingencies” and that section 624.603, Florida Statutes (1995), defines “health insurance” as “insurance of human beings against bodily injury, disablement, or death by accident or accidental means, or the expense thereof, or against disablement or expense resulting from sickness, and every insurance appertaining thereto.” Its analysis also relied upon Boyle v. Orkin Exterminating Co., 578 So.2d 786 (Fla. 4th DCA 1991) (“whether or not a contract is one of insurance depends on its purpose, effect, contents and import, and is not determined merely by the terminology used”), and Professional Lens Plan, Inc. v. Department of Insurance, 387 So.2d 548 (Fla. 1st DCA 1980).

In the latter ease, this court held that the appellant, which acted as a sort of referral service for a plan whereby optometrists [204]*204would furnish replacement contact lenses to their patients for an annual fee plus a fixed dispensing fee (about 50% of the retail cost of the lenses), was not engaged in the business of insurance because there was “no contractual obligation or duty” between the appellant and the patient. In dicta, the court observed that the contract between the optometrists and their patients was not “insurance,” based on an analysis of the five elements “normally present in an insurance contract”: 1) an insurable interest; 2) a risk of loss; 3) an assumption of the risk by the insurer; 4) a general scheme to distribute the loss among the larger group of persons bearing similar risks; and 5) the payment of a premium for the assumption of the risk. Noting that under the plan, the patient must still pay for the actual cost of the contact lenses, the court found that only the first two of these five elements were present in the optometrist/patient contract:

[A] patient may obviously have an “insurable interest” in his contact lenses. Admittedly there is a “risk of loss” of his lenses. It must also be recognized, however, that the contract provides terms upon which lenses may be purchased entirely apart from any question of “insurable interest,” or loss or damage to the patient’s existing lenses. Even if it is conceded, as the Department argues, that the “primary object” of the agreement is to provide for replacement of lost or damaged lenses, we cannot agree that the PLP is thereby transformed into a contract of insurance. The contractual arrangement is lacking in the other elements, viz, assumption of risk by the insurer, distribution of a loss, and payment of a premium for assumption of a risk-the “contract ... to indemnify” aspect of the statute (Section 624.02).
... [T]he contract between the optometrist and his patient is not one of indemnity, but rather, it is one providing for the purchase of additional or replacement contact lenses by a patient. Neither Professional nor the optometrist suffers any “loss” by virtue of a patient’s exercise of his option, under the contract, to purchase as many additional sets of lenses as he desires.... There is no “distribution of loss” under this arrangement, nor is there payment of a “premium,” since no part of the annual fee paid by the patient is utilized in paying the cost of the replacement lenses. The annual fee paid by each patient resembles more closely a consideration paid for an option to purchase lenses at a fixed price ...

387 So.2d at 550-51.

In its declaratory statement, DOI found that several aspects of the Plan “make it apparent that the contract was developed for and intended to furnish services in the event of sickness or disability.” It noted that appellant had furnished documentation which indicated that the average daily retail charges for Level I and Level II care in Florida are $150 and $175, respectively, and concluded that appellant “is insuring 50% of the price of the services by means of the contract.” It found that the large annual membership fee “can only be justified if it is viewed as a guarantee that the services will be available at a reduced price (50% of retail) in the event of sickness or disability” and that “this guarantee of a reduced retail price for the services makes the Liberty Plan a contract of insurance.” It found that the member’s portion of the retail price, “regardless of to whom paid, is the equivalent of a deductible,” the functional purpose of which “is simply to indicate the point at which the insurance company’s obligation to pay ripens.” It found that the portion of the retail price absorbed by appellant “is in actuality that portion of the retail cost they are insuring.” It cited Professional Lens Plan as “[t]he leading case in Florida in determining whether a membership arrangement is insurance,” and noted:

The court in that easq used the five elements set forth in Guaranteed Warranty Corp., Inc. v. State ex rel. Humphrey, 23 Ariz.App. 327, 533 P.2d 87 (1975), as the test for determining whether a contract is insurance. The Liberty Care Plan meets all five elements:

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Related

Boyle v. Orkin Exterminating Co., Inc.
578 So. 2d 786 (District Court of Appeal of Florida, 1991)
Guaranteed Warranty Corp. v. State Ex Rel. Humphrey
533 P.2d 87 (Court of Appeals of Arizona, 1975)
Transportation Guarantee Co. v. Jellins
174 P.2d 625 (California Supreme Court, 1946)
Professional Lens Plan v. Department of Ins.
387 So. 2d 548 (District Court of Appeal of Florida, 1980)
State Ex Rel. Long v. Mynatt
339 S.W.2d 26 (Tennessee Supreme Court, 1960)
State, Ex Rel. Landis v. De Witt C. Jones Co.
147 So. 230 (Supreme Court of Florida, 1933)
Brock v. Hardie
154 So. 690 (Supreme Court of Florida, 1934)
Sun Coast Home Care, Inc. v. State, Department of Insurance
710 So. 2d 120 (District Court of Appeal of Florida, 1998)

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Bluebook (online)
710 So. 2d 202, 1998 Fla. App. LEXIS 4849, 1998 WL 216047, Counsel Stack Legal Research, https://law.counselstack.com/opinion/liberty-care-plan-v-department-of-insurance-fladistctapp-1998.