Florida/Georgia Personal Injury & Workers Compensation

...Townsend of Maguire, Voorhis & Wells, P.A., Orlando, Robert P. Macina and Thomas W. Stanley, Jacksonville, for appellant. J. Russell Hornsby and Leon M. Boyajan, II, of Law Offices of J. Russell Hornsby, Orlando, for appellee. COWART, Judge. This case involves the construction of sections 627.667(1) and 627.6675, Florida Statutes, which assure employees certain benefits under group health and accident policies provided by employers....

...Because the employee was discharged from employment, she is no longer entitled to benefits under the group policy. The question in this case is what benefits, if any, is this totally disabled employee entitled to under the applicable Florida statutes. Section 627.667(1), Florida Statutes, provides, in effect, that every policy must contain a reasonable provision for extension of benefits for total disability when a policy or contract of group insurance is discontinued. The injured employee claims she is entitled to such an extension of benefits. The insurance company replies that the extension of benefits under section 627.667(1), Florida Statutes, relates only to when the entire group policy is discontinued and not to when the employee's rights under the group policy are terminated because employment is discontinued....

...However, the injured employee cannot require the employer to discontinue the group policy and, in this case, the employer desires to continue that coverage. The insurer says that the injured employee's remedy is to obtain a "converted policy" as provided for in section 627.6675, Florida Statutes....

...er the group policy. However, a totally disabled employee normally becomes unnecessary to the employer, is consequently normally discharged, and, for that reason, will usually lose all benefits under the group policy. According to the insurer, under section 627.6675, the employee is entitled to a "converted policy," but not to benefits equal to those provided by the group policy from which it is converted....

...e statutes should be interpreted to require that the totally disabled employee receive the benefits to which the employee was entitled under the group policy. The injured employee states that this can be done in either of two ways: (1) by construing section 627.667(1), Florida Statutes, to require an extension of benefits not only when the group policy is discontinued but when coverage to the employee is discontinued because of termination of employment due to injuries received while covered under the employer's group policy, or (2) construing section 627.6675, Florida Statutes, to require that the "converted policy" provide the same benefits as the group policy which it replaces. Although there is some authority to the contrary, [1] section 627.667(1), Florida Statutes, appears to relate only to the discontinuance of the group policy and not to the discontinuance of coverage in favor of a particular employee. The legislature should change this. However, the employee is correct as to the second argument. The intent of the legislature in section 627.6675 does appear to be to entitle an employee to a "converted policy" which provides the employee with the benefits that the employee was entitled to receive under a group policy....

...s statute would be only an illusion, if the insurance company could discharge its statutory duty by offering a totally disabled employee a "converted policy" providing substantially lesser benefits than those provided in the group policy. Therefore, section 627.6675 should be construed to require that every "converted policy" contain coverage and benefits to the employee comparable to the coverage and benefits the employee had under the group policy which the "converted policy" replaces. Accordingly, the trial judge is AFFIRMED. DAUKSCH and UPCHURCH, JJ., concur. NOTES [1] The Supreme Court, Appellate Division, of New York considered the predecessor statute to the present § 627.667, Fla....

...That court found Blue Cross liable to provide an insured with coverage who became a paraplegic due to injuries incurred while covered under a group policy and then was terminated from employment because of his inability to perform as an employee. The court held that section 627.667(1), Fla. Stat. (1977), did not require termination of the entire group contract for an extension of benefits to an individual. Section 627.6675 became law in 1978 and was therefore not in effect at the time of this action.

GLICKSTEIN, Judge. Appellant contends that pursuant to section 627.667, Florida Statutes (1983), he was entitled to a continuation of benefits under the Blue Cross/Blue Shield group policy as he was terminated from employment while totally disabled. In pertinent part, section 627.667, Florida Statutes, provided, then, as it does today, as follows: Extension of benefits.— (1) Every group, blanket, or franchise policy or contract renewed, delivered, or issued for delivery in this state shall contain a reasonable p...

...the employee. He acknowledges that a similar argument has been previously dealt with and rejected in Blue Cross/Blue Shield of Florida, Inc. v. Shufelt, 487 So.2d 1085, 1087 (Fla. 5th DCA 1986), where the Fifth District Court of Appeal found that “section 627.667(1), Florida Statutes, appears to relate only to the discontinuance of the group policy and not to the discontinuance of coverage in favor of a particular employee.” We affirm the trial court’s entry of final summary judgment and a...

...That a society cannot provide adequately for its ill is a negative attribute of that society. Appellant, being unable to obtain a converted policy because of a hapless economic condition occasioned by his total disability, makes an appealing argument that we should interpret section 627.667(1) Florida Statutes (1985), as the Appellate Division of the New York Supreme Court — not its Court of Appeals — did in Klein v....

...The Florida statute does not state what provision must be made for extension of benefits other than a “reasonable provision” with certain stated mínimums, leaving it to the “policy or contract” to describe the “applicable extension of benefits or accrued liability.” Id. § 627.667(4)....

...or expenses incurred during a period of disability or during a period of at least 90 days starting with a specific event which occurred while coverage was in force. The New York court undertook to achieve a humanistic result in its interpretation of section 627.667(1), Florida Statutes....

...Following surgery in January 1989, she did not return to work and has been totally disabled since December 1988. Ms. Clark received full medical benefits under the group plan through June 30, 1989, the effective date of her resignation. *1200 Then, from July 1, 1989 through June 30, 1990, pursuant to section 627.667, Florida Statutes (1989), she received an extension of her benefits....

...We have examined the various points raised by Northbrook and think only one merits discussion, i.e., the adequacy of the conversion policy issued. Northbrook argues it was only required to issue Ms. Clark a conversion policy providing benefits required in section 627.6675, not the original group policy. 1 We agree with the trial court and Ms. Clark that she is entitled to a conversion policy providing benefits equal to those which the group coverage provided her. Contrary to Northbrook’s argument, we think section 627.6675 merely sets forth minimum requirements to which an insurer must adhere....

...ge equal to the benefits provided in the group plan. Subject only to those limitations enumerated in the group policy, the conversion policy must afford a former group insured with coverage equal to that provided under the group policy. We interpret section 627.6675 merely as establishing the minimum criteria a conversion policy must meet....

...minimum requirements, the statute would govern. Our interpretation is bolstered by Blue Cross/Blue Shield of Florida, Inc. v. Shufelt, 487 So.2d 1085, 1087 (Fla. 5th DCA 1986). There, the Fifth District stated, “[t]he intent of the legislature in section 627.6675 does appear to be to entitle an employee to a ‘converted policy’ which provides the employee with the benefits that the employee was entitled to receive under a group policy.” Affirmed....

...We note that even under Northbrook’s own interpretation, it has not complied with its obligations. The evidence indicates that in the conversion policy, the use of a benefit factor multiplier would render it inadequate as compared to the minimum requirements of section 627.6675.