Volume 47 Number 63
Produced: Wed Apr 13 6:53:01 EDT 2005
Subjects Discussed In This Issue:
Car Damage (2)
[Tzvi Stein, Bernard Raab]
Insurance Query (5)
[Perets Mett, Carl Singer, W. Baker, Stuart Feldhamer, Carl
Singer]
Pope (5)
[I. Balbin, <rubin20@...>, J Friedman, Yisrael Medad,
Menashe Elyashiv]
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From: Tzvi Stein <Tzvi.Stein@...>
Date: Sun, 10 Apr 2005 08:24:52 -0400
Subject: Re: Car Damage
According to the insurance laws in my state, the insurance company must
return the vehicle to pre-accident condition. "Offsetting prior damage"
would seem to contradict that.
Tzadik
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From: Bernard Raab <beraab@...>
Date: Mon, 11 Apr 2005 02:01:43 -0400
Subject: RE: Car Damage
>From: Tony Fiorino
>Thus the insurance company has no real economic basis for making a claim
>that they are only responsible for the cost of the repair minus what it
>would have cost to fix the initial damage. I do not know for certain,
>but I believe the insurance company assumes the burden of REPAIRING the
>car - there is only one repair possible, that is to repair the car
>completely - and, by the way, I am certain the companies set their
>premiums based on this assumption.
Insurance laws vary by state (and country). In my state (New Jersey)
that is not the case. They are responsible for reimbursing you for your
loss. They are not responsible for reparing your car, although they may
offer to do so for their own purposes of quality and cost control.
Furthermore, I will quote from my auto insurance policy; I think it
likely that you will find a similar statement in all states: "We do not
provide coverage for any "insured" who has made fraudulent statements or
engaged in material concealment or fraudulent conduct in connection with
any accident or loss for which coverage is sought under this policy."
"Materiel concealment" means witholding any fact which impacts their
liability. You can bet that includes prior damage as a major item of
concealment.
b'shalom--Bernie R.
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From: Perets Mett <p.mett@...>
Date: Sun, 10 Apr 2005 16:05:53 +0100
Subject: Insurance Query
Ira Bauman wrote:
> Reuven has dental insurance paid for by his employer. All his dental
> needs are provided by his brother-in-law, Shimon. Shimon would not
> charge Reuven any fee because of family courtesy. Since the fee to
> Shimon if he were a private patient would be $0, the insurance company
> says that no insurance claim can be made to the company for the
> services rendered. The insurance company gets to cash the premium
> check. The dentist would get no reimbursement at all for the
> treatment rendered. Must Reuven disclose the relationship and not
> submit a claim?
I don't understand the basis of this query. When Shimon provides
treatment for Reuven, he is entitled to charge at the going rate.
No-one can expect Shimon to work unpaid. As a gesture of friendship,
Shimon may (and does) waive his fee. That does not mean that Shimon is
not entitled to his fee, merely that he chooses to save Reuven the
expense of paying the bill. Shimon reckons that the loss of $100 (or
whatever) is worth the relationship.
If Reuven is not liable for his bills (because he is insured), Shimon
gains nothing from Reuven by waiving his fee (since Reuven would not pay
in any event). If Shimon is now precluded from presenting his bill, he
has worked for nothing. Why should Shimon be expected to work for no
return?
i see absolutely no reason why Shimon should be debarred from presenting
Reuven with a bill.
Perets Mett
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From: Carl Singer <casinger@...>
Date: Sun, 10 Apr 2005 11:31:05 -0400
Subject: Insurance Query
Let's reword this a bit -- and with apologies in advance for seeming
dogmatic.
There is a market dollar value for Shimon's dental services (his
"normal" fee to non-relatives.) Shimon performs the service earning his
fee, but due to "family courtesy" chooses not to bill Reuven. Reuven's
insurance would normally pay this "normal" fee but for that fact that
Reuven is receiving "family courtesy."
Since "family courtesy" -- is just that, a courtesy, not an obligation
-- Shimon might consider a lesser form of "family courtesy" -- that is
waving Reuven's responsibility for any difference over and above the
insurance reimbursement that he gets for rendering dental service to
Reuven and his "normal" fee -- i.e., the deductible or % not paid.
Reuven and / or his employer are paying for the insurance which covers
that dental fee so Reuven should be entitled to some reimbursement from
the insurance company. IF Reuven feels an hakorets haTov to Shimon for
waving this fee difference (deductible, etc.) then he might make a
contribution to Tzedukah in that same amount in honor of Shimon.
However, if Reuven files for an insurance reimbursement check for a fee
that he did not pay, it is likely fraud as the insurance covers some
portion of reimbursement of bill for rendered service -- not some
portion of the "value" of the rendered service.
Carl
Carl A. Singer, Ph.D.
Passaic, NJ 07055-5328
<casinger@...>
See my web site: www.ProcessMakesPerfect.net
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From: W. Baker <wbaker@...>
Date: Sun, 10 Apr 2005 11:31:46 -0400 (EDT)
Subject: Re: Insurance Query
I guess these legal-ethical issues interest me, so here goes:
All these are based on the premise that you do not return some favor to
Shimon in the form of, say doing his income taxes for you, a
professional accountant. In that case you are actually "paying.." I see
a few options: switch dentists to one who charges, not necessarily a
great idea, even for shalom bayit, Tell Shimon to charge his and collect
the fee rather than doing him the favor, Tell you employer that you do
not require dental insurance and continue to go to Shimon.
I prefer the last suggestion, although the company may not be able to
remove one employee from a group plan. I don't think that you should
make an insurance claim at all unless you tell Shimon to charge you. In
any even, if you did not disclose your relationship to Shimon, how is he
going to fill out the insurance form that asks him for the charges?
You, certainly, shouldn't even hint to him to lie on that.
If you like Shimon's work and want to use him, you could discuss with
him, about how you might handle it. If you don't reciprocate in any
way, why should he be out your fees when you have paid u insurance? He
might be willing to accept the insurance fee as paid in full, which I
find is never the case with my dental insurance. I always have extra to
pay to the dentist.
Wendy Baker
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From: Stuart Feldhamer <Stuart.Feldhamer@...>
Date: Sun, 10 Apr 2005 13:30:32 -0400
Subject: RE: Insurance Query
OK, this is pretty clear. If Shimon is able to get paid by the
insurance, he's not going to charge $0 but will charge his regular fee.
He should do so.
Regarding the car issue, I think people are thinking about this the
wrong way. As I understand the rules, Reuven was obligated to tell the
insurance company when he first got into the accident with Shimon (or
when Shimon hit his car or whatever). Like most people, he chose not to
do so because he didn't want the insurance company to raise his
premiums. Shimon was happy to pay because it was his fault and because
he didn't want his insurance company to find out and raise his rates. So
both of them were tricking the insurance companies. I don't believe it's
an option to pick and choose which accidents to report and which not to
report. I could be wrong. If so, someone please correct me.
Assuming the above is true then Shimon got lucky and after the damage
has been paid for by the insurance company (as it should have been all
along), then he is no longer obligated to pay anything (if he ever
was...maybe the whole transaction between Reuven and Shimon was
illegal). The only problem we are left with is that the insurance
company thinks that Reuven was in one accident when in fact he was in 2.
From my experience, insurance companies will ignore one accident, but
two constitute a pattern in their eyes and will lead them to raise
insurance premiums. So Reuven may in fact be cheating the insurance
company in order to get a lower premium and actually owe them money from
that respect.
Stuart
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From: <casinger@...> (Carl Singer)
Date: Sun, 10 Apr 2005 14:39:51 -0400
Subject: Re: Insurance Query
From: <Yisyis@...>
> Hi Carl,
> There is a wrinkle to this that you may not have considered. The
> patient is not submitting the claim. The dentist is. When he submits
> a number, that number represents the entire fee charged to the patient
> according to insurance rules. Therefore a $100 procedure that will be
> paid at 70% by the insurance company must be charged to the patient at
> $100 with the $30 copayment collected. If the $30 is forgiven, the
> true amount charged to the patient is $70 and the dentist is charged
> with fraud for inflating the fee to the insurance company. I picked a
> case where the whole fee would normally be forgiven such as a close
> relative. The she'elah would also apply to a member of my shul that I
> would like to forgive any copayment. Ira
Yes.
Here in the states it varies re: who physically submits the claim, but
of greater importance is whether or not the provider (dentist /
physician) "accepts assignment."
Some the provider "accept assignment" -- that is they will base their
fee on the insurance company's rate schedule and deal with the paperwork
and await reimbursement. So if that particular insurance company says
the procedure is $100. They'll submit a bill for $100. The insurance
company sends them a check for whatever amount $70 (less 30% co-pay) or
$20 (less 30% co-pay and $50 annual deductable.) and the patient is
responsible for the difference ($30 or $80.)
Some providers who are tired of dealing with insurance companies leave
it entirely to the patient. That is they will bill you whatever their
fee schedule is. (Some doctors demand payment "at time of service.")
Say it's $110. The patient pays $110 at time of service and submits the
form to the insurance company. The insurance company would then
calculate as follows: Patient billed amount $110. Schedule amount $100.
co-pay 30% = $30. Check to patient for $70. Patient out of pocket
expense $40.
I don't think it matters much whether Shimon or Reuven submits the claim
if both are aware of the situation. Let's say (as a stretch) that
Shimon does nothing and has his billing clerk (who knows nothing about
the "courtesy") submit the claim. Now it's an issue of inaction on
Shimon's part vs. action on his part.
Carl Singer
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From: I. Balbin <isaac@...>
Date: Mon, 11 Apr 2005 08:32:04 +1000
Subject: Re: Pope
Germane to this topic in broad terms, there is a family in Melbourne who
relates that in their father's home in Poland, Karol Wojtila, the
deceased Pope, was, as a young lad, their Shabbos Goy. [Their father was
a Talmid Chochom who eventually lived in Yeusholayim, and I can recall
being in his house over 20 years ago]
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From: <rubin20@...>
Date: Fri, 8 Apr 2005 08:28:43 -0400
Subject: Re: Pope
> It also had information connected to him and anti-semitism and a famous
> story which may or may not be true where he told a family after the
> churban not to have the Jewish child who had lived with them but to let
> him return to his family
FWIW, Citizen Koch, a biography of former NYC mayor Ed Koch has Ed Koch
recounting the story to the pope, who declaimed any such incident.
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From: <FriedmanJ@...> (J Friedman)
Date: Fri, 8 Apr 2005 13:10:55 EDT
Subject: Re: Pope
[Re same story as above]
The story is true, and he wouldn't let them baptize the children,
either.
The expert on the Pope is Yaffa Eliach. Her exhibit on him is in
Cinncinnati.
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From: Yisrael Medad <ybmedad@...>
Date: Fri, 08 Apr 2005 16:55:04 +0200
Subject: Pope
This is a sort of spin-off from a Pope story I once heard in high school
(Chofetz Chaim, Forest Hills) that a fat pope is better than a very thin
one I guess my Rebbe was comparing Pius 12 vs. John 24 in that a fat one
would be jolly, and life loving and therefore more humanistic and
ultimately, less of an anti-Jew whereas a Pope that starved himself and
treated his body with an outlook of unworldliness and pain would be more
inclined.
How does the list think about the link between one's character and the
type of Judaism one practices? A more cranky person copuld be thought
to prefer the stern, cold Litvak stream and the more bohemian would
gravitate to Breslav.
Of course, this is a mere generalization and may actually only refer, if
there is any truth in it, to either chozrim b'tshuva or those who
cross-over. In each category of Judaism one finds enough of each type
of person's character to disprove the suggestion but if one thinks hard
enough, there are enough reflections of the sociological thesis.
Yisrael Medad
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From: Menashe Elyashiv <elyashm@...>
Date: Sun, 10 Apr 2005 11:57:05 +0300 (IDT)
Subject: Pope
Yatad & Hamodia (hebrew) had a very short news item saying that he died,
with out the stories that appeared in the english editions. I did not
check the weekend editions.
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End of Volume 47 Issue 63
