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In this most recent case, Dr. Vanderwerff, with whom some of you may already be familiar, argued that he was entitled to payment from Travelers because its network provider list was given to the claimant by a website link instead of on paper. Therefore, he argued, the claimant was not given the proper notice of network requirements so the claimant was free to treat out-of-network with Dr. Vanderwerff.
In an opinion issued June 28, 2018, the Dallas Court of Appeals rejected Dr. Vanderwerff's argument. The court held that the term "written description" as used in section 1305.451 of the Insurance Code includes an electronic format rather than paper only. The Court noted that when asked in oral argument, “Are words any less written if they are written electronically rather than on paper?,” Dr. Vanderwerff’s counsel conceded, “No.” Dr. Vanderwerff was represented by claimant attorney Brad McClellan.
The Court also declined Dr. Vanderwerff’s request to reconsider its 2015 opinion in this same case. In that opinion, the Court, citing the redundant remedies doctrine, held that Dr. Vanderwerff cannot seek declaratory relief on the same issue in his suit for judicial review in order to try and recover attorney's fees. It also held that he can’t bring claims for declaratory relief on issues which the Division has exclusive jurisdiction and where he has failed to exhaust his administrative remedies.
Among other things, the Court's opinion means that carriers and employers will not have to start handing out 400 page paper provider directories to employees. The Court’s opinion can be readhere.
James Loughlin, with the Firm, represented Travelers in the case.
- Copyright 2018,Stone Loughlin & Swanson, LLP