Court Opinion

ID: 9569170
Source: CourtListenerOpinion
Date Created: 2023-08-21 20:11:10.033188+00
Date Added: 2024-06-11T11:50:09.004787
License: Public Domain

Beasley, Judge,
concurring in part and dissenting in part.
I respectfully dissent in part because the law which the majority applies supports the trial court’s order in its entirety.
The three medical bills about which I depart from the majority opinion were received by the insurer on February 19 attached to a *429standard loss notice accord form signed by the insurance producer’s representative. Two days later insurer’s claims adjuster contacted claimant and sent to her a benefit application form and, as it related to the medical bills, attending physicians’ report forms for her to take to the treating physicians. This was requested as proof that the medical bills were for treatment related to the auto collision. The application and medical bill verification were received back by insurer on March 14, and payment was made on April 7, less than thirty days later.
Decided March 3, 1988
Rehearings denied March 18, 1988
W. Douglas Adams, for appellant.
The majority relies on the statutory test as it is refined and explained in the quotation from Hufstetler v. Intl. Indem. Co., 183 Ga. App. 606, 607 (2) (359 SE2d 399) (1987), a case which as to Division 2 is physical precedent only. Rule 35 (b). I agree that its framing of the test is proper, however. Applying it here, the trial court correctly concluded that “sufficient proof” of claimant’s entitlement to payment for the three medical bills was not received until March 14. The mere submission of bills, by themselves and unsupported by anything showing their purported validity and relationship to the covered incident, and without a benefit application signed by claimant, would not trigger the insurer’s obligation to pay claimant for them within thirty days. Such a rule would leave wide open the door for fraudulent claims by compelling payment without adequate proof in order to avoid penalty and fees.
The application containing pertinent information and the simple proof of loss requested by the insurer from the providers of service through claimant, was reasonable as a matter of law. This is so because it did not exceed that which the insurer is permitted to request from the insured in order “to enable [it] to verify or disprove, through the exercise of reasonable diligence, the basic components of the insured’s claim.” Jones v. State Farm &c. Ins. Co., 156 Ga. App. 230, 235 (2) (274 SE2d 623) (1980), overruled on other grounds, Atlanta Cas. Co. v. Flewellen, 164 Ga. App. 885 (300 SE2d 166) (1982). See Canal Ins. Co. v. Henderson, 183 Ga. App. 880, 882 (1) (360 SE2d 435) (1987); Waco Fire & Cas. Ins. Co. v. Goudeau, 178 Ga. App. 426, 428 (343 SE2d 131) (1986). Promptly sending the application form and physician report forms to claimant constituted action to verify the bills and their recoverability.
In all other respects, I concur in the opinion.
I am authorized to state that Presiding Judge Banke and Judge Pope join in this opinion.
*430John E. Bumgartner, for appellee.