RE: PIP Disputs and Grisby vs. Progressive Insurance Co.

[Guest guest]

"if a carrier denies even a single treatment it constitutes a “coverage denial” and as such the consumer can sue the PIP carrier in Circuit Court and as such the plaintiff attorney can charge attorney fees"

Yes, under the original SCt opinion in Grisby. I believe there was a rehearing in Grisby which changed some of the wording in the opinion but I believe it did not change the fact that a denial in whole of a given date of service is a denial of coverage. I'll have to look into it and get back to you...

"if a carrier denies $1 amount of care it constitutes a “coverage denial” and as such the consumer can sue the PIP carrier in Circuit Court and as such the plaintiff attorney can charge attorney fees"

Probably not, that looks a lot more like an "amount of benefits" dispute.

Chris

T. Hill, PC520 S.W. Sixth Avenue, Suite 1250Portland, OR 97204Tel: (503) 227-4330Fax: (503) 227-3230chill@...www.cthlaw.com

-----Original Message-----From: [mailto: ]On Behalf Of vsaboeSent: Wednesday, December 05, 2007 11:20 AM Subject: "PIP Disputs and "Grisby vs. Progressive Insurance Co."

Dear Colleagues,

I’ve been told of something that is very substantial when it comes to auto PIP carrier’s inappropriate denial of your outstanding bills/treatments. An attorney friend told me this morning that the Oregon Supreme Court “Grisby vs. Progressive” ruled that if a carrier denies even a single treatment or $1 amount of care it constitutes a “coverage denial” and as such the consumer can sue the PIP carrier in Circuit Court and as such the plaintiff attorney can charge attorney fees a.k.a. getting paid for his/her time unlike PIP arbitrations of the past or small claims court wherein they can’t even be present for the patient.

So if there is a nonsensical denial of your treatment make sure the claims rep knows you will send the patient to a pro-chiropractic attorney group who are more than willing to sue them in circuit court for your outstanding fees. Remember as well that I stand ready to support your necessary treatment by way of a file review and report via affidavit supporting the clinical necessity of your care for that particular case….if it was indeed necessary…don’t bother sending someone you over treated and you know it….as in doing what we all do from time to time lose the handle on a particular case. But if your patient has been trashed by the PIP carrier send me the file.

Cheers,

Vern Saboe, DC., FACO

[Guest guest]

Thanks

Please let us know….

Vern Saboe

From:

[mailto: ] On Behalf Of Hill

Sent: Wednesday, December 05, 2007

5:09 PM

vsaboe;

Subject: RE:

" PIP Disputs and " Grisby vs. Progressive Insurance Co. "

" if a carrier denies even a single treatment it constitutes a

“coverage denial” and as such the consumer can sue the PIP carrier

in Circuit Court and as such the plaintiff attorney can charge attorney

fees "

Yes, under the original SCt opinion in

Grisby. I believe there was a rehearing in Grisby which changed some of

the wording in the opinion but I believe it did not change the fact that a

denial in whole of a given date of service is a denial of coverage. I'll

have to look into it and get back to you...

" if a carrier denies $1 amount of care it constitutes a

“coverage denial” and as such the consumer can sue the PIP carrier

in Circuit Court and as such the plaintiff attorney can charge attorney

fees "

Probably not, that looks a lot more like

an " amount of benefits " dispute.

Chris

T. Hill, PC

520 S.W. Sixth Avenue, Suite 1250

Portland, OR

97204

Tel: (503) 227-4330

Fax: (503) 227-3230

chillcthlaw

www.cthlaw.com

-----Original

Message-----

From:

[mailto: ]On

Behalf Of vsaboe

Sent: Wednesday, December 05, 2007

11:20 AM

Subject:

" PIP Disputs and " Grisby vs. Progressive Insurance Co. "

Dear

Colleagues,

I’ve

been told of something that is very substantial when it comes to auto PIP

carrier’s inappropriate denial of your outstanding

bills/treatments. An attorney friend told me this morning that the Oregon

Supreme Court “Grisby vs. Progressive” ruled that if a carrier

denies even a single treatment or $1 amount of care it constitutes a

“coverage denial” and as such the consumer can sue the PIP carrier

in Circuit Court and as such the plaintiff attorney can charge attorney fees

a.k.a. getting paid for his/her time unlike PIP arbitrations of the past or

small claims court wherein they can’t even be present for the

patient.

So if

there is a nonsensical denial of your treatment make sure the claims rep knows

you will send the patient to a pro-chiropractic attorney group who are more

than willing to sue them in circuit court for your outstanding fees.

Remember as well that I stand ready to support your necessary treatment by way

of a file review and report via affidavit supporting the clinical necessity of

your care for that particular case….if it was indeed necessary…don’t

bother sending someone you over treated and you know it….as in doing what

we all do from time to time lose the handle on a particular case. But if

your patient has been trashed by the PIP carrier send me the file.

Cheers,

Vern

Saboe, DC., FACO

[Guest guest]

I reviewed Grisby v Progressive 2 today. Here's the opinion: http://www.publications.ojd.state.or.us/S54196A.htm And here's Grisby 1 again: http://www.publications.ojd.state.or.us/S54196.htm

Basically what Grisby 2 says is there is one decision about coverage and multiple claims for benefits made rather than multiple coverage decisions which are made with each submission of new bills. But, if the insurer injects any other issue, e.g. causation, then the insured can get attorney's fees. This passage from Grisby 1 is still good law:

"Defendant here disputed not only the "amount" of the claim for the services provided by the chiropractor; it also disputed whether it should pay for those services at all, arguing that they were unrelated to plaintiff's accident.

"***

"For the reasons discussed above, this is not a case in which..."the only issue is the amount of benefits due the insured[.]" ORS 742.061(2)(a)."

Chris

T. Hill, PC520 S.W. Sixth Avenue, Suite 1250Portland, OR 97204Tel: (503) 227-4330Fax: (503) 227-3230chill@...www.cthlaw.com

-----Original Message-----From: vsaboe [mailto:vsaboe@...]Sent: Wednesday, December 05, 2007 5:15 PM' Hill'; Subject: RE: "PIP Disputs and "Grisby vs. Progressive Insurance Co."

Thanks

Please let us know….

Vern Saboe

From: [mailto: ] On Behalf Of HillSent: Wednesday, December 05, 2007 5:09 PMvsaboe; Subject: RE: "PIP Disputs and "Grisby vs. Progressive Insurance Co."

"if a carrier denies even a single treatment it constitutes a “coverage denial” and as such the consumer can sue the PIP carrier in Circuit Court and as such the plaintiff attorney can charge attorney fees"

Yes, under the original SCt opinion in Grisby. I believe there was a rehearing in Grisby which changed some of the wording in the opinion but I believe it did not change the fact that a denial in whole of a given date of service is a denial of coverage. I'll have to look into it and get back to you...

"if a carrier denies $1 amount of care it constitutes a “coverage denial” and as such the consumer can sue the PIP carrier in Circuit Court and as such the plaintiff attorney can charge attorney fees"

Probably not, that looks a lot more like an "amount of benefits" dispute.

Chris

T. Hill, PC520 S.W. Sixth Avenue, Suite 1250Portland, OR 97204Tel: (503) 227-4330Fax: (503) 227-3230chillcthlawwww.cthlaw.com

-----Original Message-----From: [mailto: ]On Behalf Of vsaboeSent: Wednesday, December 05, 2007 11:20 AM Subject: "PIP Disputs and "Grisby vs. Progressive Insurance Co."

Dear Colleagues,

I’ve been told of something that is very substantial when it comes to auto PIP carrier’s inappropriate denial of your outstanding bills/treatments. An attorney friend told me this morning that the Oregon Supreme Court “Grisby vs. Progressive” ruled that if a carrier denies even a single treatment or $1 amount of care it constitutes a “coverage denial” and as such the consumer can sue the PIP carrier in Circuit Court and as such the plaintiff attorney can charge attorney fees a.k.a. getting paid for his/her time unlike PIP arbitrations of the past or small claims court wherein they can’t even be present for the patient.

So if there is a nonsensical denial of your treatment make sure the claims rep knows you will send the patient to a pro-chiropractic attorney group who are more than willing to sue them in circuit court for your outstanding fees. Remember as well that I stand ready to support your necessary treatment by way of a file review and report via affidavit supporting the clinical necessity of your care for that particular case….if it was indeed necessary…don’t bother sending someone you over treated and you know it….as in doing what we all do from time to time lose the handle on a particular case. But if your patient has been trashed by the PIP carrier send me the file.

Cheers,

Vern Saboe, DC., FACO