State Farm Refuses To Pay Med Pay Because Insured Had HMO Coverage and Therefore Only "Incurred" Co-pay Amounts. Advice?

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Does client's HMO coverage mean that medical expenses have not been "incurred" and that med pay must pay co-payments amounts only and no more? This is what State Farm is arguing.

-- Anonymous, April 10, 2000

Answers

[First response from Listserve.] This sounds like a great thing for the Academy to pursue.

-- Anonymous, April 10, 2000

[Second response from Listserve.]

One plaintiff in Durham won summary judgment and unfair and deceptive claims against an insurer on this. The plaintiff attorney's name was (see Listserve.)

-- Anonymous, April 10, 2000


[Third Listserve response.]

The plaintiff's attorney in the case cited above hired several adjusters as expert witnesses and deposed 2 XYZ Co. (see Listserve) adjusters. The plaintiff won summary judgment on coverage and bad faith. May this attorney can speak at our seminar.

-- Anonymous, April 10, 2000


[Fourth Listserve response.]

The Academy should get involved with this.

-- Anonymous, April 10, 2000


[Fifth Listserve response.]

Great work. I hope the attorney can speak at the seminar.

-- Anonymous, April 10, 2000



[Sixth Listserve response.] The above response is in error. The case in Durham did not get summary judgment on bad faith or on unfair and deceptive trade practices. Instead the case was settled after summary judgment was awarded on the contract issues. State Farm argued that expenses were not incurred.

-- Anonymous, April 10, 2000

[Seventh Listserve response.]

I hope we can get this attorney to speak at our section meeting.

-- Anonymous, April 10, 2000


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