Provider Suit

Court/Case No: 31st Judicial District Court/2018-00578-GC

Tried/Argued Before: Judge

Demand: $29,511.77

Verdict: $0 – Motion for summary disposition granted

Name of Judge(s): Honorable Alexis Grace Krot

Keys to the Case:

Plaintiff filed this provider lawsuit seeking payment for medical and diagnostic imaging performed on the underlying claimant. Plaintiff claimed the treatment was related to injuries to the underlying claimant’s neck, back, right leg, and right side arising out of a motor vehicle accident. The underlying claimant’s automobile policy was coordinated with his health insurer.

Explanation of Benefits forms from the health insurer showed that Plaintiff’s bills had been submitted to the health insurer, but some were paid, and some were denied. Defendant obtained an affidavit from the health insurer stating that Plaintiff’s bills had either been denied, based on its failure to comply with the health insurer’s requirements, or had been paid-in-full, per a fee agreement. The affidavit also indicated that Plaintiff had failed to appeal the health insurer’s decision or attempt to remedy the bases for denial.

Defendant filed a Motion for Summary Disposition arguing that the health insurer is the highest in priority for Plaintiff’s bills, pursuant to the coordinated policy, and the affidavit from the health insurer confirms that the Defendant no-fault insurer was not responsible for payment of same. The Court granted Defendant’s Motion and dismissed Plaintiff’s claims with prejudice.

Defense SW attorney(s) Involved in Case: