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[Thomas Beckett <thomas AT tbeckett.com>]

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Scott Chilcote wrote:
> It might be worth checking to see if your husband signed a statement of 
> responsibility for payment when he completed the initial paperwork to 
> begin using this dentist.  I recall having been required to sign such a 
> document couple of times when I first began using a medical service.

Even signing such a contract doesn't trump hubby's reliance upon a
reasonable expectation that the dentist would file for insurance.  (This
reliance interest is called "estoppel" in legalese.  The dentist is
"estopped" or precluded from asserting the contractual claim because he
induced hubby not to make the insurance claim on his own behalf and then
failed to obtain insurance payment himself, leaving hubby no way to help
himself.)

The financial responsibility documents that I have seen say that the
provider will file for insurance but that the patient will still be
responsible for paying the bill.

It is definitely a good idea to get a copy of such a document if it
exists.  It may even help you as a written assertion that the dental
office was going to submit the insurance claim.

> If he did sign one, there is a contractual obligation to provide 
> payment.  

But the dentist is precluded (estopped) from asserting that obligation
by his own failure to a) submit the insurance claim and b) tell hubby
that he did not do so in time for hubby to take action and receive the
benefit of the insurance policy.

There's also a good argument that by waiting so long to file the
insurance the dentist waived this contractual right.

There may indeed be a valid contract, but estoppel and waiver are both
defenses to enforcement of the contract.

> The wording of that contract would then play a major role in 
> the court's decision.  

Yup.

> He would probably have been given a copy, which 
> you could have read by an attorney.

This is an opportunity for a small-claims courtroom judo move.  If the
dentist presents a financial responsibility form to the magistrate (and
the opposing party is entitled so see all documents presented as
evidence at the time they are presented), hubby can then (at the proper
time, not interrupting the dentist's case) say, "you see, this shows
that he agreed to handle the insurance claim.  He promised in writing
and I expected him to hold up his end.  He can't ignore his duty to
present the insurance claim and then expect me to pay after it is too
late to get reimbursed from the insurance company."

Flip!  The dentist's evidence becomes your evidence.

Disclaimer:  nothing ever happens in a courtroom the way you expect it.
  Never.  One has to be prepared for all possibilities.  (Which is one
reason why lawyers are so expensive.)  The judo-move scenario describes
one possibility and one good way of dealing with it.

Disclaimer:  the foregoing discussion is offered for illustrative and
educational and entertainment purposes only to this group as a whole and
not as legal advice to any individual.  Legal advice is only offered
privately, personally, and after a thorough examination of the facts of
the situation and all related documents.

All the same, I hope it is helpful.

Thomas

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Thomas A. Beckett, JD & MBA                  Business Law and Consulting
828-713-1668            <http://www.tbeckett.com>           919-824-5696
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