Legal Topics

Insurance — Personal injury protection — Coverage — Medical expenses — Deductible — No merit to argument that insurer that received bill

Sep 03rd, 2018 in News by admin

Insurance — Personal injury protection — Coverage — Medical expenses — Deductible — No merit to argument that insurer that received bills from multiple medical providers on same day is required to look to dates of service and apply deductible to earliest date of service first — Exhaustion of policy limits — Insurer did not act in bad faith by making decision to use 2007 Medicare fee schedule as a baseline for reimbursement of providers — Even if insurer had ability to reimburse other providers’ claims at less than fee schedule amounts, decision to use fee schedule does not alter fact that provider exhausted benefits through payment of bills for reasonable, related and necessary services — Further, insurer’s decision to issue additional reimbursements to some providers upon receipt of pre-suit demand letters was proper and consistent with insurer’s obligations under law — Insurer’s motion for summary judgment on issue of exhaustion of benefits is granted