PIP Carrier May Not Obtain Provider's Records Unrelated To Medical History, Condition, Treatment, Dates & Costs of Treatment - Selective Ins. Co. of America v. Hudson East Pain Management, A-105-10
Thursday, July 19, 2012
Per The New Jersey Law Journal:
"A unanimous New Jersey Supreme Court on Wednesday turned back a health insurance carrier's quest for information about medical providers' ownership structures and business practices, finding no basis in statute or contract.
"'We may not, under the guise of statutory construction, expand its scope in the boundless fashion plaintiff seeks merely because plaintiff has formed the belief that the defendants may not have complied with the requirements of other statutes or regulations,' the court said in Selective Ins. Co. of America v. Hudson East Pain Management, A-105-10."
From the syllabus, with Judge Wefing writing for the Court:
"This appeal presents a discrete, narrow legal question: is a health care provider who has received an assignment of personal injury protection (PIP) benefits from an insured obligated upon request to furnish to the insurer broad information with respect to the provider’s ownership structure, billing practices, and regulatory compliance?
***
"HELD: An insured had no duty to provide information to plaintiff with respect to the ownership structure, billing practices, or referral methods of the medical providers from whom he or she sought treatment for his or her injuries. Because an insured had no obligation to supply that information to plaintiff, the assignment of benefits executed by an insured could not serve to impose that duty on the providers."
More after the jump...
"A unanimous New Jersey Supreme Court on Wednesday turned back a health insurance carrier's quest for information about medical providers' ownership structures and business practices, finding no basis in statute or contract.
"'We may not, under the guise of statutory construction, expand its scope in the boundless fashion plaintiff seeks merely because plaintiff has formed the belief that the defendants may not have complied with the requirements of other statutes or regulations,' the court said in Selective Ins. Co. of America v. Hudson East Pain Management, A-105-10."
From the syllabus, with Judge Wefing writing for the Court:
"This appeal presents a discrete, narrow legal question: is a health care provider who has received an assignment of personal injury protection (PIP) benefits from an insured obligated upon request to furnish to the insurer broad information with respect to the provider’s ownership structure, billing practices, and regulatory compliance?
***
"HELD: An insured had no duty to provide information to plaintiff with respect to the ownership structure, billing practices, or referral methods of the medical providers from whom he or she sought treatment for his or her injuries. Because an insured had no obligation to supply that information to plaintiff, the assignment of benefits executed by an insured could not serve to impose that duty on the providers."
More after the jump...
