Romo v. Amedex Ins. Co.

930 So. 2d 643, 2006 WL 399503
CourtDistrict Court of Appeal of Florida
DecidedFebruary 22, 2006
Docket3D05-1400
StatusPublished
Cited by47 cases

This text of 930 So. 2d 643 (Romo v. Amedex Ins. Co.) 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
Romo v. Amedex Ins. Co., 930 So. 2d 643, 2006 WL 399503 (Fla. Ct. App. 2006).

Opinion

930 So.2d 643 (2006)

Karem Elena ROMO, individually and as personal representative of the Estate of Magali Romo, Appellant,
v.
AMEDEX INSURANCE COMPANY, Cincinnati Equitable Insurance Company, and Fernando Nava d/b/a F. Nava & Company, Appellees.

No. 3D05-1400.

District Court of Appeal of Florida, Third District.

February 22, 2006.
Rehearing Denied June 27, 2006.

*646 Greenberg Traurig and Charles M. Auslander; Mintz, Truppman, Clein & Higer and Michael J. Higer, Miami, for appellant.

Hunton & Williams and Christopher N. Johnson, Miami, for appellees.

Before GREEN, RAMIREZ, and ROTHENBERG, JJ.

ROTHENBERG, J.

The plaintiff, Karem Elena Romo, etc., appeals from an order dismissing her second amended complaint with prejudice as to defendants Amedex Insurance Company ("Amedex"), Cincinnati Equitable Insurance Company ("Cincinnati Equitable"), and Fernando Nava d/b/a F. Nava & Company ("Nava"). We reverse and remand for further proceedings.

THE COMPLAINT

The plaintiff filed a ten-count Second Amended Complaint ("Complaint") against Amedex, Cincinnati Equitable, Nava, and Humberto Martinez. The Complaint alleges that Amedex is a Florida corporation authorized to sell health insurance products to residents of Mexico, including Magali Romo and her family. Amedex recruited agents, including Martinez and Nava, to sell its health insurance policies, and Amedex supervised these agent relationships. Beginning in 1986, Amedex, which at that time was known as Cincinnati Assurance International Corporation, started to administer, market, and sell health insurance policies on behalf of Cincinnati Equitable. However, in July 1997, Amedex acquired Cincinnati Equitable's policies and began to issue renewal policies under its own name. At all material times, Martinez was Nava's agent; Nava and Martinez were both insurance agents of Amedex and Cincinnati Equitable; and these agents were authorized to transact insurance business on behalf of Amedex and Cincinnati Equitable.

In 1991, Magali Romo and her husband, Jesus Fernandez Romo, Sr. (collectively referred to as "the Romos"), applied for a family health insurance policy through Cincinnati Equitable. In applying for insurance, the Romos were presented with an application for insurance, which was filled out and signed by Mr. Romo.[1] The application contains the following merger clause, which has been translated from Spanish to English:

I understand that no agent is authorized to change or modify in any way these contracts or waive one or some of the requirements [sic] this company, or are they able to bind the company by way of promises, representations or information unless placed in writing and form part of an insurance contract or in favor of this application.

*647 Cincinnati Equitable issued to the Romos an insurance policy, effective February 15, 1991, bearing a policy number of B91-2217-13. This policy provided for liability limits of $2,000,000, a deductible of $500, and coverage for organ transplants. The Romos renewed this policy for numerous years. As to the sale of the initial policy and the subsequent renewals of this policy, Martinez acted as an agent for Nava and Cincinnati Equitable; Nava acted as an agent for Cincinnati Equitable; and Amedex acted as Cincinnati Equitable's sales representative in Florida.

In December 1995, the Romos once again discussed the renewal of the policy with Martinez. He represented to the Romos that they could reduce their insurance premiums and still renew their policy if they would agree to a reduction of the policy limits from $2,000,000 to $1,000,000 and an increase of the deductible from $500 to $1,000. Martinez represented to the Romos that, except for the changes in the policy limit and the deductible, these policies would provide the same coverage and benefits as provided in the prior insurance policies that had been issued to them from 1991 through 1995. In reliance upon Martinez's representations, the Romos purchased the Plan Select Worldwide renewal policy from Cincinnati Equitable and Amedex. Mr. Romo forwarded the premium check and a letter to Amedex which states, as translated, as follows: "THIS IS TO INFORM YOU THAT I WISH TO CHANGE FROM "PLAN B" TO THE NEW PLAN NAMED WORLDWIDE SELECT PLAN ... WITH THE UNDERSTANDING THAT I WILL NOT LOSE SENIORITY, I AM ENCLOSING A CHECK FOR $1,793.00 TO COVER THE ANNUAL CHARGES."

In February 1996, the policy in question was issued under policy number PSW91-2217-13, with the original effective date of February 15, 1991.[2] The Romos did not read this policy to confirm Martinez's representations because they accepted his representations as true.

Following the issuance of the Plan Select Worldwide policy in 1996, Amedex issued subsequent renewals. In 1998, Mrs. Romo became ill and notified Amedex and Cincinnati Equitable that she needed a liver transplant. Initially, Amedex and Cincinnati Equitable advised Mrs. Romo's medical providers that they would provide coverage for the liver transplant; however, shortly thereafter, they advised the medical providers that Mrs. Romo's current policy did not provide coverage for liver transplants. Magali Romo died on September 13, 2002, and Amedex and Cincinnati Equitable have refused to reimburse the Romo family for the medical expenses incurred for the treatment of Mrs. Romo.

MOTION TO DISMISS

Amedex and Cincinnati Equitable filed a motion to dismiss the Complaint, which was joined by Nava, but not Martinez. Based primarily upon the merger clause contained in the 1991 insurance application, the trial court granted the motion to dismiss with prejudice.

The plaintiff contends that the trial court erred by granting the motion to dismiss. We agree.

A trial court's ruling on a motion to dismiss for failure to state a cause of action is an issue of law, thereby mandating de novo review. Roos v. Morrison, 913 So.2d 59 (Fla. 1st DCA 2005); Susan Fixel, Inc. v. Rosenthal & Rosenthal, Inc., *648 842 So.2d 204, 206 (Fla. 3d DCA 2003). When ruling on a motion to dismiss for failure to state a cause of action, the trial court must "treat as true all of the . . . complaint's well-pleaded allegations, including those that incorporate attachments, and to look no further than the . . . complaint and its attachments." City of Gainesville v. State, Dep't of Transp., 778 So.2d 519, 522 (Fla. 1st DCA 2001). Moreover, the "reviewing court operates under the same constraints." Id. (quoting Andrews v. Fla. Parole Comm'n, 768 So.2d 1257, 1260 (Fla. 1st DCA 2000)) (citations omitted). As each of the ten counts state a cause of action, we conclude that it was error to dismiss the Complaint.

COUNT I — DECLARATORY JUDGMENT

Count I of the Complaint is an action for declaratory judgment filed pursuant to Chapter 86, Florida Statutes, against defendants Amedex and Cincinnati Equitable. "`A motion to dismiss a complaint for declaratory judgment is not a motion on the merits. Rather, it is a motion only to determine whether the plaintiff is entitled to a declaration of its rights, not to whether it is entitled to a declaration in its favor.'" Royal Selections, Inc. v. Fla. Dep't of Revenue, 687 So.2d 893, 894 (Fla. 4th DCA 1997); see also Smith v. City of Fort Myers, 898 So.2d 1177, 1178 (Fla.

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