Uninsured medical expense claims after 30 days

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Latest post Fri, Jan 11 2013 1:10 PM by Drew. 19 replies.
  • Wed, Jan 9 2013 7:12 PM

    • irondad
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    Uninsured medical expense claims after 30 days

    Is there any case law that I can refer to regarding the reimbursement of medical expenses after 30 days?

    I am the noncustodial parent. Our separation agreement requires that all uninsured medical expenses be submitted to me within 30 days of payment by the custodial parent. It also requires that reimbursement be made within 30 days.

    With this agreement, can the custodial parent submit medical expenses (claiming over $2000) that date back nearly 2 years? 

    The magistrate hearing the case has stated that she will not uphold the terms of our separation agreement because "there is no case law to support it".

    That said, I have made multiple requests for the bills/receipts but have not been given anything yet. The only documentation I have been given is a spreadsheet created by the custodial parent...which does not show what she has actually paid and/or what has been paid by insurance...and the magistrate agrees that this is not adequate. 

    I am a supportive dad...have always made timely child support payments...and help with college tuition and fees. I'm not trying to get out of anything. But it seems very unreasonable and unfair that the custodial parent can hold on to expenses for 2 years and then submit a claim expecting prompt reimbursement.

    Is there any case law in New York regarding the timely submission of uninsured medical expenses?

    Is it within the magistate's power to disregard the terms of our separation agreement?

    Thank you in advance for your comments on this matter.

     

     

     

  • Wed, Jan 9 2013 7:22 PM In reply to

    Re: Uninsured medical expense claims after 30 days

    irondad:
    Is there any case law that I can refer to regarding the reimbursement of medical expenses after 30 days?

    Yes but that requires access to the dockets in your state.

    irondad:
    With this agreement, can the custodial parent submit medical expenses (claiming over $2000) that date back nearly 2 years?

    Of course they CAN.  The real question should be do you legally have to PAY it?

    irondad:
    The magistrate hearing the case has stated that she will not uphold the terms of our separation agreement because "there is no case law to support it".

    Personal opinion the magistrate doesn't have the power to over turn your divorce decree.  I would balk at that statement.  Just because the magistrate isn't aware of it doesn't mean it doesn't exist.

    irondad:
    That said, I have made multiple requests for the bills/receipts but have not been given anything yet.

    No bill, no receipt means no money from my pocket.  A spread sheet is NOT proof of a debt.  Sounds like your ex is hunting up for money for another reason.

    irondad:
    Is it within the magistate's power to disregard the terms of our separation agreement?

    My opinion NO.  There is a reason the court entered the order and if it were me I would fight the whole thing tooth and nail.  Let me guess:  ex sued you in small claims court which is why a magistrate has a hold of this.  If so, I would pay a lawyer a couple hundred bucks to give me some advice on how to make it go away quickly and cheaply.

    "That's just my opinion, then again I might be wrong."  Dennis Miller

     

  • Wed, Jan 9 2013 7:29 PM In reply to

    Re: Uninsured medical expense claims after 30 days

    irondad:
    But it seems very unreasonable and unfair that the custodial parent can hold on to expenses for 2 years and then submit a claim expecting prompt reimbursement.

    Sure.

    It's unreasonable and unfair.

    But that's how divorced people treat each other.

    irondad:

    Is there any case law in New York regarding the timely submission of uninsured medical expenses?

    What difference does it make?

    You owed the money when the bills were incurred. You still owe them and you aren't getting out from under them by hassling about the delay nor are you going to get any court to bring the wrath of god down on your ex for how she's handling it.

    That's the cold harsh reality of divorce. 

    irondad:
    Is it within the magistate's power to disregard the terms of our separation agreement?
     

    Yes.

    irondad:
    The only documentation I have been given is a spreadsheet created by the custodial parent...which does not show what she has actually paid and/or what has been paid by insurance...and the magistrate agrees that this is not adequate. 

    So do I.

    At the very least you ought to be able to get the magistrate to order her to submit copies of all the bills and the EOBs (Explanation of Benefits) generated by the insurance companies and you'll reimburse her when you get them.

    Meantime, unless you want to pay a lawyer $350 per hour to research case law for you, I suggest you resign yourself to your ex's behavior because it's not going to change, case law or no case law.

     

    • The right of the people 
    • to keep and bear arms,
    • shall not be infringed.
  • Wed, Jan 9 2013 7:42 PM In reply to

    Re: Uninsured medical expense claims after 30 days

    I'm a lawyer, and my view is a bit different than ClydesMom. The problem here is that in order to form any good legal opinion on this, it matters EXACTLY what the agreement says and it matters EXACTLY what the issue was before the magistrate and EXACTLY what the magistrate's ruling was. Discussion of this in the abstract isn't going to be all that helpful because those details are extremely important. 

    For example, it's unclear what you mean by saying the magistrate won't uphold the terms of your separation agreement. I doubt that's literally what she said. Moreover, that's vague. Did she say she'd not enforce any part of it, even provisions that have nothing to do with the medical payments, that she's not enforcing the provision that you have to pay towards the medical payments, the provision that the custodial parent must be submitted within 30 days, or the provision that you must provide your share of the expenses within 30 days? As you can see, it matters exactly what the agreement says and what her ruling was in order to start analyzing this. Without that, I can only guess at what is going on, and guesses are not going to help you much.

    You also said that the magistrate agreed with you that the documentation she provided isn't good enough. So, what's the status with that? I'd assume the magistrate won't order you to pay it until she comes up with better documentation. That gives you some time to come up with money to pay the medical bills. And in the end, you will likely have to pay your share. In the usual case, I'd bet that the the magistrate won't hold that you don't have to pay these expenses at all. Assuming that she can come up with the documentation, she'll likely get the reimbursement. I think the issue instead will likely be how long you have to pay it — the court may determine that you have longer than 30 days to pay it since she didn't get the documentation to you timely. But again, without details, I'm only guessing at how things might play out.

    I suggest you take the agreement and the order to a family law attorney for advice on this.

  • Wed, Jan 9 2013 7:55 PM In reply to

    • Drew
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    Re: Uninsured medical expense claims after 30 days

    Just a layman but I sure do not agree you owe if the order I is clear she mu.u.st present proof of payment within 30 days of same...there may be roOm for modest deal but this is over the top plus a mere spreadsheet is not even close to proof of payment. .....but why is this before a magistrate?   I would think is this is an order then the language of the order stands until some court changes it upon proper petition to do so ,....not some retroactive application of personal view.... 



  • Wed, Jan 9 2013 8:17 PM In reply to

    • irondad
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    Re: Uninsured medical expense claims after 30 days

    Thank you for your prompt response to my post. Regarding your questions...

    My separation agreement specifically states "In the event that one party incurs an uninsured medical expense for the child, that party shall submit the bill/receipt for such expense to the other party within 30 days and such other party shall pay his/her share of the expense within 30 days".

    The magistrate was specifically refering to the 30 day requirement within the agreement when she said she will not enforce the terms of the agreement because "there is no case law to support it". She also told my ex that "you will get your money...give him the receipts".

    I haven't received any bills/receipts to date...just a spreadsheet of her claims. As previously stated, the expenses go back 2 years. 

    So...can a magistrate disregard the terms of our agreement?

  • Wed, Jan 9 2013 8:57 PM In reply to

    • Drew
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    Re: Uninsured medical expense claims after 30 days

    I can understand where a magistrate played Solomon and effectively said produce proof of payment and only then do you get paid and no receipt equals no reimbursement.   Now my personal lay view this is not what the order says ..but if you want to appeal that y

    You need to make timely appeal ..lots of cost...hey with luck she cannot produce valid bills and proof of payment....is mom likely into games or just sloppy?

    as an aside you need not pay one dime more than the order says you must pay



  • Thu, Jan 10 2013 8:00 AM In reply to

    • Drew
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    Re: Uninsured medical expense claims after 30 days

    There have been several posts here as to timeframes for submissions of medical bills in child support actions  and I'm sure you could get some paid resources as to how it works in NY given that type of language you post--but you need to decide if thats cost effective --and to make a timely appeal (30 day?) to a higher court  --for small amounts it may be cheaper to pay the ones she can prove she paid.  It sure seems the bills are too stale --but I'm not faulting magistrate for playing Solomon --in a way it was  some of your duty to present the back up for the rigid nature of the timeframes

    You didn't answer if mom was into games or just sloppy .

    Some folks simply do not pay the deductibles --be sure you are looking at credible payment receipts .(I believe I could get falsified receipts many places...) Me I'd double check some of them with provider.

    Some folks never pay anything timely --if mom was so sloppy as to get collection and late fees piled on I don't see where that is your problem . Check the details of the bills if you are not confident.



  • Thu, Jan 10 2013 12:11 PM In reply to

    Re: Uninsured medical expense claims after 30 days

    After reading through this thread, there are a few rather important questions that remains unanswered.

    You have referred to a "separation agreement," but I didn't see any reference to a judgment or decree or order issued by the court. Was your "separation agreement" incorporated by the court into a judgment, decree, or order, or is it just a private agreement between you and your child's other parent?

    If the "separation agreement" was incorporated into a judgment, decree, or order, then no, the magistrate does not have the power to disregard it, but it's not clear that's what the magistrate was doing.

    You said that the "separation agreement" requires your child's other parent to "submit the bill/receipt for [unreimbursed medical] expense[s] to [you] within 30 days."  Ok; that's fine, but it doesn't tell us much.  First, "within 30 days" of what?  Does it say?  If it doesn't say, then it is open to interpretation.  It would be unreasonable to interpret it to mean "within 30 days" of the date on which the expense was incurred (which I bet is how you'd like to interpret it) because there may be times where the party incurring the expense won't know if it will get reimbursed (either fully or in part) until after 30 days from the date on which the expense was incurred.  The more reasonable interpretation would be to require submission of the bill/receipt "within 30 days" of the date on which the expense was incurred or, if later, the date on which the party incurring the expense learned that the expense would be either fully or partly unreimbursed.

    More importantly, what, if anything, does your "separation agreement" say is the consequence of not submitting a bill/receipt "within 30 days"?  My guess (and I could, of course, be wrong) is that it says nothing about consequences.  If so, then the document was poorly drafted because, again, it leaves the matter open to interpretation, which means that your allegation that the magistrate was "disregard[ing] the terms of [y]our separation agreement" isn't well taken.

    My guess is that you'd like to interpret the agreement such that your child's other parent forfeits her right to reimbursement from you if she fails to send you a copy of a bill/receipt "within 30 days."  But a court is not going to apply such a harsh interpretation without clear evidence in the language of the agreement that it was the parties' intent that this would be the consequence.  Since you have not mentioned anything about a provision in the "separation agreement" that provides for consequences, I have to assume none exists.

    So what is the court likely to do?  Probably (and this is where case law comes in, but no one on a message board is going to research case law for you), because the law generally abhors forfeitures, the court is going to want you to demonstrate that the other parent's delay cause you prejudice.  Let's say that, on January 10, 2011, your child's other parent incurred $100 in medical expenses that she knew on that day would not be covered by insurance.  On January 10, 2013, she presents the bills/receipts for those expenses to you.  How have you been prejudiced?  As an initial matter, you will have to overcome the fact that the delay actually benefits you to some extent.  How?  Let's pretend that you are able to earn interest of 5% per annum on money that you don't have to spend immediately (of course, that rate of return isn't readily available in this day and age, but it illustrates the point).  In this case, you have earned $10 in interest on the $100 you didn't have to spend on January 10, 2011 and, accordingly, have benefited from the other parent's delay.

    One possible way of demonstrating prejudice:  Let's say your child needs a prescription every month that has a $150 co-pay.  It might be fairly easy for you to come up with $75 per month (1/2 of the co-pay).  However, coming up with $1,800 (24 months x $75) in one lump sum might present a hardship for you.

    Even if you can demonstrate prejudice, it might not result in forfeiture.  Taking the prior example about the prescription, the court might simply order you to pay the other parent $75 per month for 24 months.  It might present a slight hardship (since you'll be paying your share of the current co-pay plus your share of the former co-pay), but it's a far less significant hardship then coming up with $1,800 in a lump sum.

    When the magistrate said "there is no case law to support it," he probably was referring to the general reluctance to find a forfeiture in the absence of clear contractual intent.

    I hope this provides you with a helpful framework for dealing with this issue going forward.

  • Thu, Jan 10 2013 12:56 PM In reply to

    • Drew
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    Re: Uninsured medical expense claims after 30 days

    Well, unless you can find some NY case law that interprets the XX day requirement to submit the required paperwork to the other side or they are unenforceable  (some orders are apparently quite clear to parents-snooze and you lose--your's is not clear.) and file a timely appeal  you appear stuck to pay your required share of just those bills for which she can prove she paid them. (and at least in context of your post she has not done that yet!!!)



  • Thu, Jan 10 2013 1:13 PM In reply to

    • Drew
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    Re: Uninsured medical expense claims after 30 days

    As an aside :

    If this is a NY order remember that CS runs to 21 in NY not 18 as in many places.

    If you pay your daughter directly that does NOT count as to meeting your CS obligations ..you made a nice gift  but it doesn't count as to meeting your duty to pay mom 

    If you have a choice as to meeting your apparent duty to pay mom or helping daughter in college --the only safe legal answer is pay your duty to mom.

     



  • Thu, Jan 10 2013 2:18 PM In reply to

    Re: Uninsured medical expense claims after 30 days

    I agree with ca19lawyer2. The issue appears to be one of interpretation rather than ignoring the agreement. The agreement as you posted it says that the spouse who incurs the medical bills must submit the bills to the other parent in 30 days. The other parent then must pay within 30 days. The problem is that the agreement does NOT say what happens when either parent doesn't meet his/her 30 day requirement. So, the magistrate has to determine what the intended consequence is of those failures. That's requires the magistrate to interpret the agreement.

    You think that not submitting the bills in 30 days means that she should not reimbursed at all. I can see from your perspective why that interpretation would be appealing to you. But forfeiture of her reimbursement for being late (even by one day, which is the result your interpretation would be have) is a harsh one, and the courts tend to disfavor forfeitures for that reason. Your approach is also unfair, in that there is no similarly harsh consequence for you for not paying in 30 days. What happens to you if you are one day late in reimbursing her? So, under your approach, if she's a day late, she doesn't get anything of what she's entitled to, but if you are one day late, nothing happens to you. That's obviously not balanced and would strike most people, including judges, as unfair. I think that it's not too hard a stretch to conclude that this unbalanced arrangement you are advocating wasn't what the parties to the agreement (especially your ex, who would incur most of these bills) intended when making the agreement. And that's why the magistrate will be reluctant to interpret the agreement that way when she's not been given any case law saying she must interpret it that way.

  • Thu, Jan 10 2013 3:36 PM In reply to

    Re: Uninsured medical expense claims after 30 days

    Taxagent:
    So, under your approach, if she's a day late, she doesn't get anything of what she's entitled to, but if you are one day late, nothing happens to you. That's obviously not balanced and would strike most people, including judges, as unfair.

    But what is to stop the ex-spouse from holding bills for years and then suddenly presenting receipts totalling thousands of dollars and expecting to be paid in 30 days?  Even under credit law there is a time limit to pursue claims.  Isn't that the point to putting a deadline on submitting the expenses?  If a medical provider waited two years to pursue payment for fees owed they would be told in many states that the time limit to pursue it in court had expired.  Why should that be different merely because the parties were once married?

    Taxagent:
    Your approach is also unfair, in that there is no similarly harsh consequence for you for not paying in 30 days.

    I would disagree.  If the spouse submits all the receipts in a timely fashion even if one or two are a day or even a month late and the ex refuses to pay and not that they are 30 days late but it drags on then there is recourse with harsh consequence:  sanctions by the court and interest penalties can be added. 

    The OP isn't balking because his spouse waited 31 days.  She waited TWO years to present alleged expenses with no receipts.  Two years after the expenses are incurred is VERY outside what was agreed to and unreasonable to suddenly expect him to come up with thousands of dollars in 30 days because she waited two years.  How is that fair?

     

    "That's just my opinion, then again I might be wrong."  Dennis Miller

     

  • Thu, Jan 10 2013 4:58 PM In reply to

    Disagree [)*(] Re: Uninsured medical expense claims after 30 days

    ClydesMom:
    But what is to stop the ex-spouse from holding bills for years and then suddenly presenting receipts totalling thousands of dollars and expecting to be paid in 30 days?

    Consideration of this hypothetical is pointless since (a) the hypothetical is incomplete, (b) we don't know whether the "separation agreement" at issue has been adopted as part of a judgment, decree, or order, and (c) we don't know whether the document in question says anything about consequences of filing to turn over the bills/receipts within 30 days (of what?).  That said, rather obviously, nothing stops her from doing that.  How the court would decide the issue if the poster didn't pay is impossible to know without more information and legal research.

     

    ClydesMom:
    Even under credit law there is a time limit to pursue claims.

    Right -- statutes of limitations.  But there's no statute of limitations applicable here.

     

    ClydesMom:
    Isn't that the point to putting a deadline on submitting the expenses?

    No one's arguing that the point of the provision isn't so that the custodial parent presents the bills/receipts for reimbursement in a timely manner.

     

    ClydesMom:
    If a medical provider waited two years to pursue payment for fees owed they would be told in many states that the time limit to pursue it in court had expired.  Why should that be different merely because the parties were once married?

    I don't see the point of this question.  The two situations ARE different.  Asking why they're different hardly seems productive.  However, since you want to compare these two situations, the statute of limitations on contract claims in New York is six years (that the SOL in some other states is shorter isn't relevant), so this isn't a very strong argument.

     

    ClydesMom:

    Taxagent:
    Your approach is also unfair, in that there is no similarly harsh consequence for you for not paying in 30 days.

    I would disagree.  If the spouse submits all the receipts in a timely fashion even if one or two are a day or even a month late and the ex refuses to pay and not that they are 30 days late but it drags on then there is recourse with harsh consequence:  sanctions by the court and interest penalties can be added.

    You're changing the hypothetical.  Under the hypothetical presented, the custodial parent loses all right to reimbursement if the 30 day deadline is missed but there are no harsh consequences if the poster is late with payment.  You're now saying that the 30 day limit isn't a hard limit -- that the custodial parent doesn't lose the right to reimbursement if she is "a day or even a month late."  So being "a day or even a month late" is ok, but nearly two years isn't.  Where is the line drawn between 30 and 730 days late?  And why is the line there as opposed to somewhere else?  What principle of law supports your conclusion?  Of course, the answer is that no legal principle supports what you're saying here.  You're just making stuff up based on your own personal value judgments.  It's ok for you to do that, but judges can't legally do that.  They have to follow established legal principles.  Either missing the deadline works a forfeiture or it doesn't.  If the judge decides that it does, that decision must be supported by proper legal reasoning.  You want to add penalties?  Let's say the expense in question is $100.  If the custodial parent is a day late, she forfeits $100.  If the poster is late with payment, what's the "penalty"?  A day's interest at what rate?  Even at 10% per annum, a day's interest on $100 is 3 cents.  Hardly equitable.

     

    ClydesMom:
    The OP isn't balking because his spouse waited 31 days.  She waited TWO years to present alleged expenses with no receipts.  Two years after the expenses are incurred is VERY outside what was agreed to and unreasonable to suddenly expect him to come up with thousands of dollars in 30 days because she waited two years.  How is that fair?

    I'm curious how you purport to know what the custodial parent's expectations are.  Have you contacted the poster and then contacted the custodial parent?  I ask because the poster never mentioned the custodial parent's expectations in any of his posts, so I assume this is more stuff that you're making up.

    The point is that it does a disservice to people who post here when you answer legal questions simply by imposing your own personal values.  It's one thing to hold an opinion that the consequences of the law are unfair, but it is quite another to say that the law is X because, according to your own personal sensibilities, a different result would be unfair.

  • Thu, Jan 10 2013 8:23 PM In reply to

    • irondad
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    Re: Uninsured medical expense claims after 30 days

    Yes...my separation agreement is part of a divorce decree.

    Yes...in hind site the terms of my agreement were poorly written...but isn't that why you hire and pay a divorce attorney. I am not an attorney...I have never been divorced and have no experience with writing the terms of a separation agreement from a legal view point.

    That said, any reasonable person would recognize that the terms were written with the intent of preventing one party from ambushing the other with a large claim. Her claim is clearly outside of the boundaries and intent that it was written. So wouldn't it be reasonable to impose a penalty for not adhering to the reasonable terms of a legal agreement?

     

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