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Regulatory Reform

In addition to testifying on multiple occasions before various committees of the Colorado legislature, Samuel G. Livingston works closely with the Colorado Division of Insurance to curb insurance abuses. The circumstances surrounding Mr. Dale Davis and Med Ops Management involved a company which arranged for independent medical examinations on behalf of insurance companies and either pressured doctors to change the results of their examination findings or outright forged reports to reflect false outcomes of independent medical examinations. Those reports were used by insurance companies to deny claims based upon inaccurate information created or coerced by Med Ops.

By letter of February 7, 2007, this office referred the matter to the Colorado Division of Insurance and met with Commissioner Marcy Morrison regarding the circumstances. Within one month of that report and meeting, the Insurance Commissioner's office passed Bulletin No. B-5.20 which required that physicians preparing IME reports must authenticate and physically sign all reports, as opposed to allowing the use of electronic signatures, which had been a method used by Dale Davis of Med Ops to change reports without a doctor's knowledge.

This office corresponded again with the Division of Insurance and pointed out that the provisions of Bulletin B-5.2 would not be adequate to prohibit practices involving direct communications with doctors in an effort to coerce the physicians into changing their medical reports directly. This method had been used by Dale Davis to influence medical findings. The correspondence of May 9, 2007 to the Commissioner's Office also pointed out that a simple solution to the problem would be to adopt prior regulations from the Colorado No-Fault Act, and make those regulations uniform as to all independent examinations conducted in the State of Colorado. In response, the Commissioner's Office promulgated Bulletin No. B-6.2 which provides in pertinent part that "Effective immediately all communication between the Independent Medical Examiner, the insured or the insurer's representative.... pertaining to the substance of the IME report or examination shall be in writing with copies sent to the other parties. No communications may take place between any of the aforementioned parties without the participation of all parties..."

Most property insurance policies contain appraisal clauses which either require or provide an optional appraisal provision for the parties to resolve their disputes. During the course of involvement in multiple disputes concerning the appraisal clause, this office encountered many instances of insurance companies selecting appraisers whom they either had an inappropriate relationship with, and/or thereafter undertook inappropriate communications with, to influence the outcome of the appraisal process. Those matters were reported to the Division of Insurance by correspondence dated December 9, 2008 with documented examples of abuses in the appraisal process. In response, the Commissioner's Office promulgated Bulletin No. B-5.26 which provided that "It has come to the Division's attention that insurers may not be selecting 'fair and impartial' appraisers. Furthermore, disputed claims subject to appraisal are being delayed and insurers are not communicating in a fair and consistent manner, causing significant harm to Colorado consumers..." The bulletin went on to impose the requirements of the Uniform Arbitration Act, C.R.S. 13-22-201 et seq. surrounding the standards which must be complied with in terms of selecting an impartial individual by both parties to serve as an appraiser, and also precluded ex parte communications between any of the parties and their selected appraisers during the course of an appraisal process.

 

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The Law Office of Samuel G. Livingston, P.C.
25188 Genesee Trail Road,
Suite 140,

Golden, CO 80401

Phone: 720-443-5876
Fax: 720-904-0471
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