An interesting observation from a District Court decision

Back to Back Chiropractor, P.C. v State Farm Mut. Auto. Ins. Co., 2012 NY Slip Op 51088(U)(Dis. Ct. Suffolk Co. 2012)

This opinion is interesting and worth reading because it addresses a few issues that are going to have to be tackled at some point by an appellate court.  They form the bane of many lower arbitrators’ decisions.

1) “Nonetheless, defendant’s request for the production of documents and information seven days prior to the EUO is troubling to the Court. The request, as plaintiff contends, is clearly outside the scope of permissible information. Lower Courts have found this type of EUO request for documents and information to be “palpably improper”.

The Court addresses the discoverability of tax returns.  I think corporate tax returns are openly discoverable during verification.

Despite the above: “However it is the plaintiff’s reaction to the “palpably improper” document demand of defendant’s EUO request that vitiates its causes of action. Here, the plaintiff did nothing and did not contact the defendant’s counsel to protest the document request.  There is no provision in the no-fault regulations which permit a claimant or an insurance company to ignore communications from each other “without risking its chance to prevail in the matter”

2) The plaintiff’s assignee also did not show up at either date for the EUO’s. Again, there was no protest of the fact that the EUO’s were scheduled at the inconvenient location of Poughkeepsie, New York, a few hours upstate from plaintiff’s office in Nassau County. Nor did the plaintiff request reimbursement for time and travel expenses “thereby preserving its defenses concerning the EUO notices”

I think the Court is correct: show up to the EUO and send a bill for your time and mileage.  Deal with the other issues after you show up.

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3 Responses

  1. “The Court addresses the discoverability of tax returns. I think corporate tax returns are openly discoverable during verification.”

    Care to support position given that corporate tax returns are proper veri requests when the insurer has no reasonably founded suspicion that the practice is not properly licensed?

    It doesn’t concern the claim and is necessarily a fishing expedition seeking support for a hyper-technical defense that does not concern whether services were properly rendered and whether the claim amount is proper in light of the services rendered. And if the tax returns are subject to veri without cause, pretty much anything and everything can be demanded simply to stonewall claims.

    Are you taking the position that tax records should be freely available to only insurance companies operating in No-Fault or to all litigants with, similarly, no foundation for their need? i.e. eliminating the discovery restriction regarding private financial information.

    If not, why should a No-fault insurer be free from the rule of law on this point, as opposed to all other entities?

  2. Your position like making a provider needlessly prove mailing is actually criminal under 5106 and violates legions of regulations and other laws including penal laws.

    An insurance company is not supposed to be allowed to willy nilly hold onto the money as Justice Stone told me they could do at will during an unrecorded oral argument. “They’re just trying to hold onto their money.”

    No its not their money. Its the citizen consumer’s money that the insurance companies steal through a law that mandates that you purchase insurance from them and a bunch of unenforced laws — all three branches — that state that insurance companies must pay legitimate claims.

    No fault is another corporate-government scam to steal money from working class. The three branches of the government hang like puppet caricatures of tawdry hookers from the hands of the insurance industry.

    Oh and now they are getting into banking too. Friggin stat — on home loans they are only approving ten percent of the applications. In reality based upon the financial condition of applicants it should be forty percent.

    Why loan money when you can charge fees up the ying yang and charge usurious credit card interest rates.

    Amerika is the bung hole of the world.

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