Legal Question in Insurance Law in Pennsylvania
insurance claim
We verified insurance coverage at a plastic surgeons office for my son who needed stitches. I spoke in detail about how he could go to emergency room and be covered fully. Later we were told they were mistaken and we have to pay 600.00. We refused and they have taken us to court. The judge seemed to agree with us but said he would give a decision in writing in 10 days. 3 months later he rules against us with reasons that don't pertain- insurance back log , he signed a contract. ( which said verify insurance first) It's as if he's forgotton the details. Would you recommend that we appeal? This is in my son's name who is a college student, no credit cards, very little money. If he sends payments do they have to cash them ? They say we must pay in full. What can they do to him?
Insurance co. says I should report them to better business bureau.
1 Answer from Attorneys
Re: insurance claim
Unfortunately, in my view it is likely inappropriate for any attorney here to "recommend" that you appeal or not without having first met with you, discussed the situation in depth, and reviewed the paperwork.
That said, there are some general legal principles that apply to your situation. From what you wrote, it sounds like the physician sued your son in small claims court and the judge just issued a verdict against your son. The very most important thing for you to keep in mind is that your time to file an appeal is very limited. The timeline may be on the verdict itself; either way, you will need to act fast, the deadline is frequently 30 days from the verdict.
It sounds like you have some legitimate grounds for appeal in a claim for fraudulent misrepresentation. Given your potential of winning, coupled with the expenses the physician would have to bear in the lawsuit in the Court of Common Pleas, you have some bargaining power for a settlement below the $600 judgment. You may want to explore that option, but again keep in mind the very limited time for appeal. After that the physician has the upper hand.
"What they can do to your son" is to begin the collections process, which will result in a sheriff coming to your son's property to seize items (cars, stereos, jewelry, etc) sufficient to satisfy the judgment at a sheriff's sale. There may also be a possibility of garnishment of wages. Further, the event may appear on your son's credit report.
If you send any payments, that amount will be deducted from the verdict that the sheriff tries to satisfy, but there is no requirement that the physician accept a particular payment plan: they are entitled to the full value of the verdict. Nonetheless, as described above, you are certainly allowed to negotiate some sort of payment plan with the physician.
A complaint to the Better Business Bureau is certainly an option, as is a complaint to the Board of Medicine. You may wish to point out these possibilities to the physician. Their continued pursuit of a claim that you believe is wrongful is relevant to the complaint itself.
If you do settle or reach any other understanding with the physician, get it in writing.
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