Opinion ID: 857425
Heading Depth: 4
Heading Rank: 2

Heading: Medical bill reviews

Text: of the medical expenses and services to determine if they are reasonable and necessary for the bodily injury sustained. 2. Use a medical examination of the injured person to determine if: a. The bodily injury was caused by a motor vehicle accident; and 18 No. 2011AP2067.dtp b. The medical expenses and services are reasonable and necessary for the bodily injury sustained. ¶116 Here, IDS sought:

(f) depositions of treating healthcare providers. (g) defense medical examinations. ¶117 Depositions of the plaintiffs and of the treating healthcare providers are explicitly authorized by Wis. Stat. § 788.07. ¶118 A defense medical examination is authorized by the contractual requirements to submit to physical exams by physicians we select and a medical examination of the injured person. ¶119 Requests for production of documents and medical and employment authorizations appear to overlap. These demands are grounded in the contractual authority to obtain medical reports and other pertinent records, proof of loss, and [m]edical bill reviews. ¶120 Requests for income tax return releases may be related to plaintiff's medical expense deductions and/or plaintiff's income over time. Such returns would have to be relevant and might require justification to the arbitrators but they are certainly not irrelevant per se. 19 No. 2011AP2067.dtp ¶121 Written interrogatories can be construed as falling under the requirement to answer questions under oath when asked. ¶122 This case is factually different from the Borst case. Plaintiff Borst maintained that there was no real need for discovery, given that there was no claim of permanent injury, the medical records and bills had been supplied, and Allstate claimed to have fully assessed liability before it made a settlement offer. See ¶96, supra. Here, purportedly, there is a claim of permanent injury, and a request for medical records and bills that have not been supplied; furthermore, causation is at issue. See ¶76, supra. ¶123 Consequently, I believe it is imperative for the majority to explain why the discovery sought by IDS was not explicitly authorized by the insurance contract. If an insurer's agreement to participate in arbitration serves to nullify the insurer's contractual rights to obtain information from its insured, insurers will face a powerful disincentive to agree to arbitration, and the arbitration of contractual disputes will suffer a major setback.