You buy a piece of property. The seller gives you a deed. All is good with the world. Forty years later, you are in court. And, the court says, “you don’t own this property anymore.” Why? You did not do enough to protect your investment, and someone else owns your property. Welcome to the world of adverse possession.
Adverse possession is a legal concept. It allows one person to literally take another person’s land. The only requirements are that the thief take possession of the property:
(a) Openly
(b) Hostilely
(c) Exclusively
(d) Continuously for a period of time
In Tennessee, it is not necessary the thief to erect a fence. It may be enough if the thief just uses the property. In one case, the thief placed a house trailer, built a storage shed, installed a culvert and driveway, mowed the area and kept horses on the property. The court said that was enough.
The owner’s problem – he had not been on the property in years. And, when he discovered the squatters, he did nothing to stop it.
The period of time required ranges from seven (7) years to thirty (30) years depending on the facts and circumstances.
THE MORAL OF THIS STORY: If someone is using your land without your permission, don’t ignore it – you may discover that it is not your land any more.
Other moral, if you own land and cannot find the time to visit it every seven years, you need to sell the land.
For more on adverse possession, see Roy G. Butler v. David a Still, No. M2009-01729-COA-R3-CV (Aug. 24, 2010).
Thursday, August 26, 2010
Tuesday, August 24, 2010
PRE-AUTHORIZATION DOES NOT MEAN COVERAGE
It is a common story. The doctor tells the patient that surgery is needed. The doctor’s office contacts the insurance company, and the insurance company issues a “pre-authorization” letter. The surgery goes well and the patient recovers until the bills arrive with the notation -- NO COVERAGE UNDER POLICY.
A pre-authorization letter is just that – a determination by the insurance company that the procedure is “medically necessary.” It is not a determination that the insurance policy provides coverage for the procedure. That determination is usually not made until after the bills are submitted.
The insured can request a pre-determination of coverage. That should be done in situations in which the insurance policy includes riders. Riders are amendments to the insurance company’s form policy that limit or exclude coverage.
In Wellmont Health System v. John Quinton Qualls, No. E2009-00918-COA-R3-CV (Aug. 20, 2010), the patient discovered the importance of riders and exclusions to coverage. In that case, the insurance policy possessed two exclusions: one for pre-existing conditions and another specifically for diverticulitis. The patient had surgery for diverticulitis. The insurance company denied coverage after the surgery.
The patient argued that the insurance company issued a pre-authorization letter and that constituted a change to the policy. The court said no – the letter just confirmed that the surgery was “medically necessary.”
The patient then argued that he was confused about the exclusions. The “pre-existing condition” exclusion ended after 12 months. He had diverticulitis when the policy commenced; therefore, it was a pre-existing condition. He did not have the surgery until after the 12 month period ended. Therefore, the exclusion did not apply. Correct, the court said. If the insurance policy had only one exclusion -- the pre-existing condition exclusion, the insurance company would be paying the claim. But, the policy possessed two exclusions. The specific exclusion for diverticulitis lacked an expiration date. Consequently, that exclusion applied at the time of the surgery and the insurance company properly denied coverage.
THE MORAL OF THIS STORY: The words in red in the insurance policy really do have meaning. If you have any questions regarding coverage – ask the insurance company. If you are about to spend a lot of money for surgery, ask the insurance company if it is covered by the policy. And, make sure that the answer is in writing.
A pre-authorization letter is just that – a determination by the insurance company that the procedure is “medically necessary.” It is not a determination that the insurance policy provides coverage for the procedure. That determination is usually not made until after the bills are submitted.
The insured can request a pre-determination of coverage. That should be done in situations in which the insurance policy includes riders. Riders are amendments to the insurance company’s form policy that limit or exclude coverage.
In Wellmont Health System v. John Quinton Qualls, No. E2009-00918-COA-R3-CV (Aug. 20, 2010), the patient discovered the importance of riders and exclusions to coverage. In that case, the insurance policy possessed two exclusions: one for pre-existing conditions and another specifically for diverticulitis. The patient had surgery for diverticulitis. The insurance company denied coverage after the surgery.
The patient argued that the insurance company issued a pre-authorization letter and that constituted a change to the policy. The court said no – the letter just confirmed that the surgery was “medically necessary.”
The patient then argued that he was confused about the exclusions. The “pre-existing condition” exclusion ended after 12 months. He had diverticulitis when the policy commenced; therefore, it was a pre-existing condition. He did not have the surgery until after the 12 month period ended. Therefore, the exclusion did not apply. Correct, the court said. If the insurance policy had only one exclusion -- the pre-existing condition exclusion, the insurance company would be paying the claim. But, the policy possessed two exclusions. The specific exclusion for diverticulitis lacked an expiration date. Consequently, that exclusion applied at the time of the surgery and the insurance company properly denied coverage.
THE MORAL OF THIS STORY: The words in red in the insurance policy really do have meaning. If you have any questions regarding coverage – ask the insurance company. If you are about to spend a lot of money for surgery, ask the insurance company if it is covered by the policy. And, make sure that the answer is in writing.
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