G. W., C/O Jenna Prosser W/ Platinum Benefits v. Dept. of Children & Families
CourtDistrict Court of Appeal of Florida
Date FiledDecember 2, 2022
Docket2D21-2800
StatusPublished
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Full Opinion
DISTRICT COURT OF APPEAL OF FLORIDA
SECOND DISTRICT
G.W.,
c/o Jenna Prosser with Platinum Benefits,
Appellant,
v.
DEPARTMENT OF CHILDREN AND FAMILIES,
Appellee.
No. 2D21-2800
December 2, 2022
Appeal from the Department of Children and Families.
Jean M. Henne of Jean M. Henne, P.A., Winter Haven, for
Appellant.
Jane Almy-Loewinger, Assistant General Counsel, Department of
Children and Families, Daytona Beach, for Appellee.
SILBERMAN, Judge.
G.W., now deceased, in care of Jenna Prosser with Platinum
Benefits (G.W.), filed an application with Florida's Department of
Children and Families (the Department) for Institutional Care
Program (ICP) Medicaid benefits. The Department denied her
application after concluding that the value of her assets was too
high for the program due to the cash value attributable to four life
insurance policies. G.W. filed an appeal and a request for hearing
with the Department's Office of Appeal Hearings, challenging the
denial of her application. Following an evidentiary hearing, the
hearing officer entered a final order affirming the denial of G.W.'s
application for ICP benefits. G.W. now appeals that final order. We
reverse.
FACTUAL AND PROCEDURAL BACKGROUND1
1 The facts recited in this opinion were not the subject of any
dispute at the evidentiary hearing. The hearing officer made other
factual determinations, some of which are challenged by G.W. as
unsupported by the record or irrelevant to the discrete issue
presented to the hearing officer: whether transfer of ownership of
the insurance policies had been accomplished by virtue of an
assignment from G.W. to her son, Harold, or whether the transfer
was not effective until the insurance company verified the transfer.
Resolution of that issue bears on whether the cash value of the
policies was properly included as an asset of G.W. The Department
does not present any argument disputing G.W.'s challenge to
certain of the findings. Because the key facts relevant to the issue
before us are not in dispute, we do not discuss G.W.'s challenge to
other factual findings as they do not impact our analysis.
2
G.W.'s request for ICP Medicaid benefits was filed on October
23, 2020. On December 18, 2020, G.W. executed a durable power
of attorney (DPOA) naming her son, Harold, as her agent. On
December 31, 2020, pursuant to the DPOA, Harold executed an
irrevocable assignment on G.W.'s behalf transferring ownership of
four life insurance policies, including future proceeds and
payments, from G.W. to himself. On that same date, Harold also
executed a "Lifetime Contract for Personal Services" on G.W.'s
behalf outlining the services and assistance he would provide to
G.W. and how he would be compensated.
G.W. passed away on January 8, 2021. On February 9, 2021,
the Department issued a notice of case action to G.W. requesting
verification from the insurance company that the life insurance
policies were transferred from G.W.'s ownership.
The record establishes that after G.W. had assigned the life
insurance policies to Harold, the insurance company began its
internal process to review and document the transfer of ownership.
However, the insurance company stopped that process upon
learning of G.W.'s death. As a result, the insurance company did
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not provide its verification of the change in ownership to the
Department.
Based on the absence of verification by the insurance
company, the Department included the cash value of the policies in
calculating the total value of G.W.'s assets. This resulted in a
determination that G.W.'s assets exceeded the maximum allowable
amount that would permit her to receive ICP benefits. The
Department then denied G.W.'s application for benefits based on
the absence of verification from the insurance company recognizing
the change in ownership of the policies. The Department's position
was that the policies were "still [G.W.'s] until the [insurance]
company says ownership has changed."
After the hearing on G.W.'s challenge to the denial of benefits,
the hearing officer upheld the Department's denial of benefits. The
hearing officer concluded that when G.W. died, she was still the
owner of the policies because the insurance company stopped its
"process of re-assigning/transferring ownership" of the policies
upon learning of G.W.'s death. For that reason, the hearing officer
upheld the Department's determination that G.W.'s resources were
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not less than or equal to $2,000, the amount necessary for her to
be eligible for ICP Medicaid benefits.
On appeal, G.W. argues that the hearing officer erred by
rejecting G.W.'s argument that the executed assignment was
immediately effective to transfer ownership of the policies to Harold
regardless of the insurance company's delay and failure to
document the ownership change in its records before G.W.'s death.
ANALYSIS
When reviewing an agency decision, a reviewing court cannot
"reject an administrative hearing officer's findings of fact, as long as
those findings are supported by competent, substantial evidence in
the record." Yerks v. Sch. Bd. of Broward Cnty., 219 So. 3d 844,
848 (Fla. 4th DCA 2017) (quoting Maynard v. Fla. Unemployment
Appeals Comm'n, 609 So. 2d 143, 145 (Fla. 4th DCA 1992)); see
also Cont'l Baking Co. v. Vilchez, 219 So. 2d 733, 734 (Fla. 2d DCA
1969) (stating that a reviewing court may not reverse the findings of
an appeals referee if there is competent, substantial evidence
sufficient to support the referee's findings). However, when
reviewing an agency's decision, a court may "set aside agency action
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if the agency's action depends upon any finding of fact that is not
supported by competent, substantial evidence established in the
record of the administrative hearing." M.H. v. Dep't of Child. & Fam.
Servs., 977 So. 2d 755, 759 (Fla. 2d DCA 2008). We review
conclusions of law de novo. Id.
"A life insurance policy is a mere chose in action, and, unless
some provision of the contract forbids its assignment, it may be
assigned as other choses in action." Moon v. Williams, 135 So. 555,
557 (Fla. 1931). Once a valid assignment of an insurance policy
has been made, the assignor relinquishes his or her rights or
interest in the policy. See Bioscience W., Inc. v. Gulfstream Prop. &
Cas. Ins., 185 So. 3d 638, 641 (Fla. 2d DCA 2016). The effect of a
valid assignment, made in accordance with the policy terms, is that
the assignee is placed in the same status as to all rights and
liabilities under the policy that the insured occupied before the
assignment. Moon, 135 So. at 557.
The Department did not base its decision to deny benefits on
any contention that the policies prohibited the assignment of
ownership from G.W. to Harold, that the DPOA was invalid, or that
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the assignment was deficient or not authorized by the DPOA.
Instead, as noted by the hearing officer, the Department sought
verification of when the policies "were actually transferred to the
son" and "this verification needs to come from the" insurer. The
hearing officer found that the insurer "stopped the process of re-
assigning/transferring ownership" of the policies from G.W. to
Harold due to G.W.'s death and that G.W.'s death had occurred
after the assignment had been executed.
The sole issue that was presented to the hearing officer for
resolution and that is argued in this appeal concerns whether the
assignment of the policies was immediately effective on execution or
whether it was only effective after the insurance company
completed its process of "re-assigning/transferring ownership"
within its own records. In its brief, the Department argues that
section 627.422, Florida Statutes (2020), "requires that the
insurance policy issuer accept the assignment, which did not occur
in this case, due to [G.W.'s] death during the assignment process."
Nothing in the plain language of section 627.422 requires that
an insurance company must first document the assignment or
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transfer of ownership of an insurance policy in order to make such
an assignment effective. And nothing the Department cites reflects
that an assignment such as the one here is not valid until the
insurance company verifies the change of ownership to the
Department. While a policy may or may not be assignable, based
on the terms of the policy, neither the Department nor the
insurance company rejected the assignment based on any policy
language. Indeed, the Department simply relied on the fact that the
insurance company did not provide its own verification of the
ownership change.
Florida Administrative Code Rule 65A-1.303(2) provides that
"[a]ny individual who has the legal ability to dispose of an interest
in an asset owns the asset." Here, the record reflects that G.W.,
through her authorized agent, had disposed of her ownership
interest in the policies by assignment to Harold. Thus, Harold
acquired the legal ability to dispose of his interest in the policies,
and G.W. no longer had any ownership interest in the policies.
Nothing in the record refutes Harold's position that the assignment
was valid and enforceable upon execution. Moreover, the
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Department did not establish that the assignment was legally
invalid or unenforceable.
Rule 65A-1.303(3) provides that an asset is considered to be
available to an applicant such as G.W. "when the individual has
unrestricted access to it." Further, assets "determined not to be
available are not considered in determining eligibility." Id. Based
on this record, the assignment of the life insurance policies to
Harold was effective to convey ownership of the policies to Harold
upon execution. The assignment was given in conjunction with the
contract for Harold to provide personal services to G.W.; as a result,
the life insurance policies were not available to G.W. and should not
have been considered in determining her eligibility for ICP benefits.
CONCLUSION
The assignment of the four life insurance policies from G.W. to
Harold on December 31, 2020, was effective upon execution.
Therefore, the hearing officer erred in denying G.W.'s appeal and
upholding the Department's decision to deny G.W.'s application on
the basis that the insurance company had not completed its
process to verify and recognize the transfer of ownership at the time
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of G.W.'s death. Accordingly, we reverse the final order denying ICP
benefits to G.W. and remand with instructions that the benefits be
provided to G.W. for the period at issue.
Reversed and remanded.
MORRIS, C.J., and BLACK, J., Concur.
Opinion subject to revision prior to official publication.
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