How Huntington/Travelers can play out

Huntington Med. Plaza, P.C. v Travelers Indem. Company

This was previously discussed on here.  Many of us believe this was a half baked decision.

Some claims manager wanted me to put this question out here.  I am seeking comments.  You represent an insurance carrier and Huntington Regional, OrthoCare, Station Medical or some other entity bombards you with many cases in different courts and through arbitration involving the same assignor, accident and types of service.

How do you efficiently defend these cases?

First, you can file a DJ action, join all of these actions and have one trial.  That is the most efficient way to handle these case; yet, can be problematic at times due to internal issues involving assignment of files, etc., and Ins Law 5106 (when these cases are in arbitration) giving the Claimant the right to chose arbitration as the dispute resolution process.

Assume option number one is not practical and you need to take a “verdict” or something like that after a trial on Huntington Regional (or something similar), like Travelers did, knowing that many other cases are following behind.

The Court in Huntington/Travelers phrased the order at the bench trial (which was not given collateral estoppel effect) solely as a medical necessity issue, and the order probably read something like this: Defendant proved that further services lacked medical appropriateness and Plaintiff did not provide persuasive evidence as to the continued treatment’s medical appropriateness.  Judgment to be entered for Defendant.   I am just guessing what was in the order at the bench trial.

Here is my thought.  Is it possible for an insurance carrier at a trial to demand special interrogatories be answered by the finder of fact.  I think this is possible and this is what I am thinking:

Question #1: Did Defendant prove through a fair preponderance of the evidence that on (Date of IME), there was no further disability?

Answer this question “yes” or “no”.

Question #2: Did Defendant prove through a fair preponderance of the evidence that services following the IME were not medically necessary?

Answer this question “yes” or “no”.

(Only reach question #3 if 5 out of 6 jurors answered question #1  and/or question #2 in the affirmative.  If both question #1 and question #2 are answered in the negative, then proceed to question #4)

(3) Did Plaintiff prove through a fair preponderance of the evidence that the services rendered after the IME dated (Date of IME) were medically necessary?

(Only reach question #4 if 5 out of 6 jurors answered question #3 in the affirmative)

(4) How much do you award Plaintiff in unpaid no-fault benefits?

Under this construct, a finding as to question number #1 in the affirmative and question number 3 in the negative would be collateral estoppel because a finder of fact has now found as a matter of fact that on a given date there was no further disability.  This would more or less fall in line with Matin v. Geico and Lobel v. Allstate which gives collateral estoppel effect to judgments and awards finding that further benefits are inappropriate.

Answering #1 in the negative and number #2 in the affirmative, with #3 in the negative would still be a win for the carrier, but allow the rest of the medical providers’ cases to remain active since there is no affirmative finding that a disability ceased and the “wax and wane” of the pain may play out on another day.

Of course answering question #3 in the affirmative or answering questions #1 and #2 in the negative is a win for the provider.  This would be collateral estoppel against the provider.