Ah, yes. And it is amazing to me that some doctors won't fill out the forms. Incredibly selfish.
Unfortunately, the law doesn't force her to if you didn't hire her to do so (i.e. that agreement). Filling out forms is not the same obligation as providing competent treatment which IS part of the law.
But, that begs the question, and my thoughts are: Did you have an agreement (implied?) where you treated with her with the clear understanding that she would cooperate in filling out forms? In other words, if you went to her because you understood from that practice or her, that she would fill out necessary forms when needed, that concern the health matters for which she treats you, and you did treat with her and pay her ( you fulfilled your obligations) and she is now not performing her obligations under that agreement, this COULD be a breach of contract. For instance, is there a notice in the office that indicates patients can expect the cooperation in filling out forms? That could help show this implied agreement. OR, had she in all previous years filled out the paperwork, and suddenly refuses, which can help show it WAS a part of your treatment agreement. I think a jury would certainly believe that a disabled individual who must have medical documentation to fulfil her policy rights, would NOT agree to be treated by a doctor if that doctor would not be willing to fill out the forms needed that pertain to her treatment. It may tend to show that there was an implied agreement that was never terminated - i.e. the doctor didn't say to you 2 years ago, "by the way, this is the last time I will fill this out", in which case, you could have moved on to another doctor. So, while pretty novel as far as I know, I could see a potential argument if your favor if the facts were as above.
As an aside, you may want to APPEAL the denial by the insurance
company. Consider taking the paperwork to an attorney (just to consult) who can review it to see if that was a bad faith denial - if forms filling is NOT required under the policy, and if you had medical records that confirm that no significant improvement has been made to your medical condition and limitations - you may be able to get this overturned. I hope this helps! Let me know if you need follow up before or after RATING me. And PLEASE know that my job depends on a POSITIVE rating now and at least an 8-10 feedback rating later. Thanks! I won't forget your support.
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