This post is a follow up to mine of 7/31/12—Not Just Another Dady’s Girl…. And a New Development on the Statute of Limitations in DE. I was happy to hear from claimant attorney Mike Sensor a few days ago, alerting me to the appellate status of “Daddy’s Girl.” You may recall this as the case where the claims handler made payment of medical after the 5 years SOL of Section 2361 had run; the issue was whether that payment resurrected the SOL for additional claims.
So here’s what Mike had to say:
“Do you remember the case I had last year where approximately $12,000.00 in medical payments were made 7 years after the running of the statute of limitations and the Board found that the SOL was tolled by the late payments after we filed a DACD petition? You covered it in this blog post:
Judge Rocanelli just issued an opinion affirming the Board’s Order. A copy is attached.
The Court did not address the issue of whether the claimant had notice of the statute of limitations prior to its running. Rather, the Court confined its analysis to whether the payments were made under a “feeling of compulsion” under Goodman and McCarnan, thereby tolling the SOL. The Court found that they in fact did toll the statute and that the payments were neither made gratuitously nor in error.”
So there you have it. Like Jesus, the SOL can rise from the dead. And like the many mysteries that surround His death and resurrection, I don’t entirely get it. The outcome I understand. You pay and you re-open the SOL. However both the Board and the appellate court specifically found that the payments for a $12,000 surgery made between 2009 and 2011 on a claim for which the last prior payment had been made in 2002 (7 years earlier), were done under a “feeling of compulsion” (and not in error) , pursuant to the prevailing case law.
How can that be? When the carrier issues a payment for which they have an unequivocal SOL defense, such that if they do not pay, they are not legally obligated to pay—how can that be anything other than an error? Perhaps this is simply Sassy Cassy having one of her blonde moments, but I cannot embrace the “compulsion” concept. The Oxford Dictionary defines “compulsion” as “the state of forcing or being forced to do something” or, “an irresistible urgent to behave in a certain way.” I doubt that the claim rep had an “irresistible urge” to pay those bills—heck, they don’t even have the “urge” to pay bills on the claims that they legally owe (many carriers “resist” those obligations quite well). And as for being forced to pay—isn’t that just plain factually incorrect given that the last payment on the claim occurred 7 years earlier?
I guess we shall simply leave it at I understand the outcome but not the rationale, lest I belabor this. Will be interesting to see if an appeal is taken.
And as for the photo below, this is Ketevan Sophia Sensor almost exactly a year later. She, along with today’s case, are Mike’s progeny….:>)
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