Opinion ID: 2263396
Heading Depth: 3
Heading Rank: 1

Heading: Authorization from Insurance Carrier.

Text: The Caulfields contend that Dr. Stark and the Medical Group misrepresented to Ms. Caulfield that her insurance carrier had denied approval for her colonoscopy. Although there is no clear and convincing evidence in the record to explain why the Medical Group did not obtain insurance carrier authorization for the colonoscopy, the insurance carrier records support Ms. Caulfield's position that there was no authorization on file. But why was there none? It is possible that the Medical Group's administrative staff was negligent in failing to follow the insurance carrier's authorization procedures, or that the staff did not follow through because Ms. Caulfield cancelled the procedure; [4] the record does not provide an answer. That said, however, there is no evidence in the record to support the Caulfields' contention that Dr. Stark or any representative of the Medical Group made any false statement with an intent to deceive [Ms. Caulfield]. [5] [M]isrepresentations believed to be true, though the result of ignorance or negligence, will not sustain the action. New York Title & Mortgage Co. v. Hutton, 63 App.D.C. 266, 271, 71 F.2d 989, 994, cert. denied, 293 U.S. 605, 55 S.Ct. 122, 79 L.Ed. 696 (1934). At most, on this record, Ms. Belle's actions in failing to follow the insurance carrier's policies for authorization of medical procedures constituted negligence. No reasonable jury could have found otherwise.