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I am hoping the vast accumulated law knowledge and experience of the posters here can offer some insight on a quick medical insurance issue: My wife has taken an over-the-counter pregnancy test and it shows positive. We initially scheduled a medical appointment to confirm if she is indeed pregnant. We then reviewed her current insurance plan and it appears that she did not sign up for short term disability insurance. This means that she will not be paid from the insurance company during the time she misses work due to having the baby (3 months unpaid). Once we realized this, we called back and canceled the appointment to delay official diagnosis pending open enrollment of her health insurance plan in a couple weeks. During open enrollment, we plan to sign up for the short term disability insurance. We then plan on rescheduling the medical appointment and getting the official medical diagnosis/confirmation after she has the disability insurance. Does this constitute insurance fraud? On one hand, she has not be formally diagnosed/confirmed pregnant by any medical authority whatsoever. On the other hand, we have unofficial knowledge that she is likely to be pregnant (from home pregnancy test). We are waiting until she signs up for short term disability insurance during her health insurance open enrollment period to get the official diagnosis. If it turns out that she isn't pregnant, then we wouldn't use the short term disability insurance anyway but still be paying for it. If she is confirmed pregnant, than we reap the benefits of having the short term disability insurance. Thoughts? e: AZ, USA. AircraftNoise fucked around with this message at 18:15 on Apr 15, 2013 |
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Apr 15, 2013 18:12
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As someone who is annoyed by insurance companies, I would recommend you check and make sure there's not a delay in when you can use the benefits. For example, my short-term disability insurance required that I pay premiums for 30 days before they covered anything but the most egregious of accidental injuries, and 3 months before it covered illness/medical issues. Hope it's alright that I chimed in here. A real lawyer might have better/more useful advice.
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Apr 15, 2013 18:30
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Sonic Dude posted:As someone who is annoyed by insurance companies, I would recommend you check and make sure there's not a delay in when you can use the benefits. For example, my short-term disability insurance required that I pay premiums for 30 days before they covered anything but the most egregious of accidental injuries, and 3 months before it covered illness/medical issues. 9 months is typically longer than 30 days.
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Apr 15, 2013 19:12
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Baruch Obamawitz posted:9 months is typically longer than 30 days. Yeah but but contract will be different also this is a really obvious kind of insurance fraud for obvious reasons.
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Apr 15, 2013 19:49
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It's weird that I'm posting this from a law firm, but my situation requires some explanation and if it's more than a passing, "What do you think of x?" I don't like to pester the attorneys with questions when I know how much they usually charge. I'm in sort of a sticky situation with my soon-to-be-former roommate. I don't know if this is landlord-tenant or criminal or small claims, but maybe someone can tell me at least that much, if nothing else. In case it's landlord-tenant, I'm in Portland, OR. Sorry for how long it is. I moved into my apartment last June with my roommate (who had lived there for a year already). We were both on the lease. At the time, my work schedule at the time was on a week-to-week basis and it was tough for me to figure out when my official move date would be in advance, so packing my things/moving in/bed delivery/etc. were all up in the air. Honestly, prior to me signing the lease, I was having second thoughts about moving in with this woman (nearly forty years my senior and sort of loudly eccentric), but I'd already told her I'd do it and the deal was sealed when she called and said, "I know I can count on you, so I just went ahead and paid your move-in costs (last month and deposit). You can just pay me back when you move in." She gave me the figure and we settled it once I got there. There are a few stories to go along with the next few months, but this isn't a "weird roommate" thread. Suffice to say that by September, she and I had a chilly relationship. She'd clearly been counting on a gal pal roommate and I was hardly home and kept to myself when I did. I respected her privacy, space, and all of her property, but I just didn't interact with her much. Frankly, she annoyed me. Her oddities led to her making up a bunch of pretty dumb rules that, in retrospect, I should have just said 'no' to. She was a control freak and it was clear she felt that, despite the fact that she was in no position of authority, she felt that it was her apartment and I was just allowed to live there. A privilege she tried to revoke in September. She emailed me while I was apartment sitting across town and gave me my thirty day notice. I replied making it clear that I regretted indulging her in her whims all summer because it clearly made her think she was more of a landlord to me than a roommate and that we were both on the lease so she had no right to tell me when to leave. Nothing else was said about it, but there was a part of her email that stood out when I read back. "I have your $350 deposit in savings, which will cover the utl that are coming till moving day, and the extra week in Oct. if so needed." Wait, what? That was half the amount I'd given her when I moved in. Why did she have it? Why didn't the landlord have it? That's what I'd given her the money for... However, things were tense enough between us and despite telling her I was staying, I was still a little bit of a wuss, so besides informing her that our utilities come out to approx. $65-70/month instead of $350, I didn't bring it up again. Now, though, I'm leaving for real and the issue has come back up. The property manager and I never did a walk through of the apartment and my roommate and I never recorded any pre-existing damage for posterity's sake (I was very naive about this stuff when I moved in). However, I didn't do any damage and my roommate knows it. So when I submitted my 30 day notice (via email and note) and brought up the deposit, she dodged the issue. Actually, she just gave me the silent treatment for five days. Since then, I've conducted everything over email so that I have solid record of the process. When I finally did get her to talk about the deposit (after finally laying out the fact that it was highly inappropriate of her to let me think it was for the landlord when really she took it for herself), she said that 1) It wasn't in her checking, but she'd created a separate savings account for it. (Is that supposed to make it more official?) 2) That we'd discussed it beforehand and was being used for closing costs (implying that it is nonrefundable). The brief talk I did have with an attorney at the office gave me more ammo. I told her that we didn't discuss it and she had lied to or, at least, misled me. That she is not a landlord (god, she genuinely thinks that being there first means she owns the place) and thus there are no "closing costs," so anything she chooses to do after I leave is purely elective and will be out of pocket for her. Thus, her using my money to do it could be called theft. I went on to outline the situations over the past year that make it obvious she's been taking advantage of me financially and that I have no reason to trust her to be fair or honest with money. I made a demand for a check in the amount she took from me by this Friday. But now it's back to the silent treatment. She will not acknowledge me at home or via email. She's acting like we are twelve. So I haven't gotten to talk to an attorney about the situation in detail and I'm wondering if there's anything up there that looks like she might have grounds to keep it? Do I have any options if she refuses to give it back?
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Apr 15, 2013 22:02
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HellaClassy posted:[co-tenant problems] I'm assuming you contracted the lease with the landlord, and did not contract a sub-let with your roomate. Have you checked with the landlord to make sure that you don't have any landlord problems? (breaking the lease, deposit, last month's rent, etc.) (this will also help make more clear / prove whatever monies roomie owes you) HellaClassy posted:Do I have any options if she refuses to give it back? 1. Have one of the attorneys in your firm send her a demand letter for you. 2. Roll the small claims dice
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Apr 15, 2013 22:21
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Baruch Obamawitz posted:9 months is typically longer than 30 days. Yes, but insurance companies are usually aware that pregnancy is an event that lasts for a period of time before the birth. It would not surprise me in the least if the official pregnancy test is what they use to determine the date of the "injury" or "illness" for which the leave was taken. I know for a fact that's how my short-term disability insurance works (or at least how it applied to my ex-wife), and I assume others will be similar. I was just trying to offer a perspective that it didn't sound like the OP had considered, since it caught me by surprise several years ago. Sonic Dude fucked around with this message at 23:38 on Apr 15, 2013 |
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Apr 15, 2013 23:31
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Sonic Dude posted:Yes, but insurance companies are usually aware that pregnancy is an event that lasts for a period of time before the birth. It would not surprise me in the least if the official pregnancy test is what they use to determine the date of the "injury" or "illness" for which the leave was taken. I would imagine any sane insurance company would say 'no birth within 9 months of the date of this policy' because they aren't idiots and people don't just happen to co-incidentally get that kind of short-term policy while they are already pregnant.
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Apr 15, 2013 23:55
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Dramatika posted:They've been shady the entire time I worked for them. I'm just going to document that I did not agree to work for free, look for a new job, show up for the free shift if they make me, clock in, and if they remove the hours I'll pursue that money through TWC as soon as I have new employment secured. I've been swaying towards finding somewhere new anyways. And restaurant job a dime a dozen in my town, and there's many places I could make more than I am right now. The management experience is nice, but honestly the company is a wreck and if I had to pick one thing this place is teaching me, it's bad habits. This is exactly why at will employment is bullshit.
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Apr 16, 2013 00:23
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So, here's a thing. IANAL, but I work for an IP law firm abroad, and recently even though it's not at all my job they asked me to help chase down past due invoices. Just, to help fill my hours, friendly-like. Anyway, this being IP, all of our "clients" are really just other law firms in other countries. I've gotten about half of the invoices remitted through a combination of ferreting out neglected/misfiled/unsent debit notes and speaking softly while carrying a big stick, but one eludes me. The guy is a solo practice in California, doing well, taking on new clients. Accounts receivable is about 60k USD, dating back to 2009. He didn't contest the invoices, didn't lose them, didn't defer payment. Just, up and said "nah, don't want to. Make me." Using basically those words. My natural inclination here is to gently caress him slowly (I don't care about the business relationship at this point) but as mentioned this isn't my thing and I'm not sure what sort of avenues for collection there are, especially given the international angle. We're in Korea, for reference, and if it matters I'm also a US citizen that is empowered to file whatever documents on behalf of the firm. Any thoughts?
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Apr 16, 2013 01:34
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joat mon posted:A local attorney you work with is a better bet than an anonymous internet one. Yes, all paperwork was through the landlord. He and I talked already and are squared away on everything for my move at the end of the month. I sent one last email before heading to class tonight, asking for a clear answer so I could prepare for any further action, if I needed to. She finally just responded that I'd get my check by Friday, so there's good news. As long as she doesn't back out, we're golden. Thanks!
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Apr 16, 2013 05:04
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If there were more jobs than workers at will work laws would benefit the workers. But that has happened never.
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Apr 16, 2013 16:14
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joat mon posted:1. Have one of the attorneys in your firm send her a demand letter for you.
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Apr 16, 2013 16:54
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No one pays attention to pro se demands.
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Apr 16, 2013 16:55
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tirinal posted:The guy is a solo practice in California, doing well, taking on new clients. Accounts receivable is about 60k USD, dating back to 2009. He didn't contest the invoices, didn't lose them, didn't defer payment. Just, up and said "nah, don't want to. Make me." Using basically those words. Your options basically boil down to: 1) sue him, try really hard to collect on the judgment (good luck, but if you know where he lives you have a better chance - local counsel helps but makes it more expensive); or 2) leave the debt on his credit history and hope he gets grumpy about it (he won't). If you sue him, make sure to cross all your t's and dot all your i's (pay attentions to statutes of limitation, then once you win look into the garnishment and execution statutes, but be careful for the exemptions, which, since he's a solo, he'll probably be able to use to shield all his assets).
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Apr 16, 2013 17:03
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Arcturas posted:since he's a solo, he'll probably be able to use to shield all his assets Hell yeah! If I lose a person's house, they get my law school laptop. WOoo! I wonder if that debt could be a bar problem for that solo. Not that all debts are fraud, but his aggressive position might at least raise his profile with bar compliance. If he billed clients for your invoices and pocketed the money, that could be a bar violation. Or picking at that accounting could open up his client trust account to bar scrutiny, which I'd bet $100 he does not want. It's just an idea to gain leverage, which may turn out to be nothing or inspire him to settle. woozle wuzzle fucked around with this message at 17:46 on Apr 16, 2013 |
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Apr 16, 2013 17:43
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woozle wuzzle posted:Hell yeah! If I lose a person's house, they get my law school laptop. WOoo! This is a thing quote:Defaulting on student loans and indebtedness in general is a serious issue potentially subject to discipline. Typically it is not just default, it is failing to pay on a judgment where the lawyer has the ability to pay using Rule 3.4(c) (violate rules of tribunal) or 8.4(d) under the ABA Model Code as the basis for discipline according to Eric Cooperstein, a former Assistant to the Director of the Minnesota Lawyers Board of Professional Responsibility. I'd say "No, go gently caress yourself and make me pay you what I owe" (paraphrased) seems like a pretty clear and rational connection between that firm's trustworthiness/reliability in carrying out its obligations, and the likelihood that they will do the same to a client. Though why they are making a non-lawyer do this is not exactly clear to me.
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Apr 16, 2013 18:42
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Hmm... That could be a winning way to collect. I have no idea how california works, they probably pay bar dues in bitcoins and handjobs. But I've seen disciplinary dispositions that require the attorney to pay off various debts to stay in good standing. Maybe tell the attorney that he can settle or you'll go to the bar. Cite the california professional rules for him. And if he fails to pay, file a bar complaint. Worst case scenario is that you seriously irritate him, which is better than nothing. But best case scenario is pretty good.
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Apr 16, 2013 18:55
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I have a dilemma to pose to anyone familiar with Mississippi law. I live in one half of a rented duplex within an apartment complex. Both halves of the duplex have their own separate utilities, but both sides' air conditioner units are located adjacent to one another on the flat rooftop. This means that both units vent air to the same location and draw air from the same location. The problem with this is that the residents of the other half of the building are frequent smokers. Whenever they smoke, I get the smell vented in on my side. I've been complaining to management about this since October. At first the manager claimed that what I stated was impossible and posited that maybe it was coming through the walls, and that dealing with things like this was "Just part of being a neighbor." When I kept pressing it and explained how I figured it was working, she said she'd speak with their contracted air conditioning technicians. I never got a call back, but today when I called to check in, I was told by the apartment manager that she'd spoken with the AC people and they'd stated that there was nothing they could do to fix this short of replacing the entire roof. As such, she stated flat out in a snappy tone that they had no intention of doing anything to fix my problem, and when I asked about the possibility of installing window AC units without rooftop access, that idea was also firmly rejected. I pointed out that this meant I was being exposed to carcinogens against my will. Her response was that I was free to leave if I didn't like it. I haven't gotten the neighbors in question involved in this because honestly, it's their right to smoke in their own home, and I'm not out to antagonize smokers. There's also nothing about smoking in my lease contract. What I would like to know is whether or not this situation violates any standing health regulations in state or federal law, or any other laws, for that matter. I would really like to report this somewhere, but I'm not sure where to start.
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Apr 16, 2013 20:41
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If she's says you're free to leave, does that mean she'll let you out of your lease with no repercussions? Sounds like your best option if that's on the table.
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Apr 16, 2013 21:56
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Also, if you buy good air filters for your AC and replace them every month or two you should notice an improvement.
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Apr 16, 2013 22:02
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Yes, that's correct, but we weren't actually on a standing lease to start with, so that's not much benefit over what we already had. We were always free to leave. The point is that the apartment is exposing nonsmokers in units that are supposed to be individually isolated to carcinogens from neighbors, willfully and without a single care. I can't even close the vents all the way to block the smoke off. Is this really legal?
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Apr 16, 2013 22:03
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Lets say you were to file a nuisance claim -- what would your damages be?
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Apr 16, 2013 22:09
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There would be no damages. I've had no provable health problems resulting from this. I only want to know if this violates any standing health codes or other laws.
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Apr 16, 2013 22:12
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Hokuto posted:There would be no damages. I've had no provable health problems resulting from this. I only want to know if this violates any standing health codes or other laws. In CA, maybe. In MS? No.
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Apr 16, 2013 22:19
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That's a shame, but thank you, that's what I wanted to know.
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Apr 16, 2013 22:22
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Hokuto posted:I have a dilemma to pose to anyone familiar with Mississippi law. Unless your A/C system has a fresh air intake and exhaust system (which isn't common, especially in the South and especially in a cheap apartment), the rooftop unit is just a compressor, which compresses the refrigerant and uses a fan to aid the heat transfer, and the only thing that travels between it and your blower unit inside is a sealed refrigerant conduit. The cigarette odor is almost certainly coming through the drywall between your units, cracks and openings in the walls or doors, or through a shared attic or crawlspace, and messing with the A/C condensers on the roof would have no effect on the odor. This is just something you have to deal with when you live in multi-unit housing. There aren't any laws about your neighbor smoking inside their own home in MS. You might want to try asking them politely if they would mind smoking outside (and away from your side of the unit), but they're under no obligation to do so, nor is the landlord responsible (unless your lease has some clause prohibiting "offensive odors" or something, which is unlikely). dennyk fucked around with this message at 00:54 on Apr 17, 2013 |
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Apr 17, 2013 00:50
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On the other hand, the "free to leave if you don't like it" sounds like an offer to break your lease for free that you might want to accept?
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Apr 17, 2013 03:37
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I just need some general advice before I proceed with a situation. I've been renting an apartment in Ontario since November. In December, I started renting a makeshift bedroom in the apartment to an acquaintance. Because it was a fairly casual agreement, nothing was signed at all. Only my name and my father's name (the landlord required someone to have steady, full time employment to sign and I only had a part-time job at the time) is on the lease. Since then he and his girlfriend have been doing all their fighting here, involving me in everything, and basically making my life a living hell. I also found out that he gave said girlfriend a key. I have another prospective roommate who is willing to pay me more money, and who I've lived with before no problem. So, obviously, I want to kick this loser out and bring the good one in. I just want to know if this is something that will come back to bite me in the rear end. Internet searches are telling me different things (mostly because I can't seem to find an Ontario specific source), some say that since he's been here over 30 days I'm hosed, some say that he's considered a lodger or a boarder and I'm fine, but I dunno. I know his parents live in the city and he was living with them until December, so I was just planning to give him a month and a half to move his poo poo back and get the new one in in June, if it matters.
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Apr 17, 2013 04:18
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Tortious assault question: Assault requires apprehension of imminent harm on the part of the victim. Whether or not said apprehension caused fear in the victim is irrelevant to establishing assault. Does the harm apprehended have to be real harm, or can it simply be any interference that will be actionable on-the-case? If an imminent battery is apprehended, but said battery is not going to cause real harm to the victim (say it's an unwanted stroke of the hand or whatever - 'slightest touch') and the victim knows this, has assault occurred? Obviously battery doesn't require proof of injury, and neither does assault. But does apprehension of an imminent battery that will not cause injury satisfy the requirements for assault?
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Apr 17, 2013 08:10
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Cobalt Chloride posted:I just need some general advice before I proceed with a situation. I've been renting an apartment in Ontario since November. In December, I started renting a makeshift bedroom in the apartment to an acquaintance. Because it was a fairly casual agreement, nothing was signed at all. Only my name and my father's name (the landlord required someone to have steady, full time employment to sign and I only had a part-time job at the time) is on the lease. Since then he and his girlfriend have been doing all their fighting here, involving me in everything, and basically making my life a living hell. I also found out that he gave said girlfriend a key. I have another prospective roommate who is willing to pay me more money, and who I've lived with before no problem. So, obviously, I want to kick this loser out and bring the good one in. I'd be more worried about the landlord finding out there are more people living there than what is on the lease.
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Apr 17, 2013 15:36
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Smudgie Buggler posted:Tortious assault question: This sounds to me like you are preparing to sue your little brother for going "I'm not touching you, I'm not touching you, does this bug you, huh?"
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Apr 17, 2013 15:49
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You don't have any damages so it doesn't matter.
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Apr 17, 2013 16:00
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Smudgie Buggler posted:Tortious assault question: Sounds more like a defense than it is something that would prevent the tort from completing.
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Apr 17, 2013 16:47
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Gounads posted:I'd be more worried about the landlord finding out there are more people living there than what is on the lease. The landlord knows, he doesn't seem to care.
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Apr 17, 2013 17:33
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Cobalt Chloride posted:The landlord knows, he doesn't seem to care. Just tell him he's got a month to move out. If he balks at it or starts doing landlord/tenant law research and whatnot, then maybe you should start to worry. But I really doubt he knows anything about those laws and probably assumes that not being on a lease = you can be made to leave at any time.
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Apr 17, 2013 20:00
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echopapa posted:This sounds to me like you are preparing to sue your little brother for going "I'm not touching you, I'm not touching you, does this bug you, huh?" euphronius posted:You don't have any damages so it doesn't matter. xxEightxx posted:Sounds more like a defense than it is something that would prevent the tort from completing. Smudgie Buggler fucked around with this message at 06:19 on Apr 18, 2013 |
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Apr 18, 2013 06:16
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Hi lawgoons, I have a general question about the force of non-compete clauses in employment contracts. At least, that's what I think they're called. They're clauses that state the employee basically can't leave and work for the competition. Not laying out any penalties or anything, just flat-out stating that they can't do it. Do these have force of law in the U.S.? Can a company actually forbid you from entering a contract with another entity, especially after your contract with them ends? Can you sign away that right in a contract? For extra bonus no one is gonna know the answer: how about in the PRC?
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Apr 18, 2013 07:02
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In the US, it largely depends on where you are, and then scope of the non-compete. "You cannot be a fry cook within 20 miles of the north redding mcdonalds" is very different from "you cannot cook for anyone else ever". The wording and jurisdiction are key to the actual answer.
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Apr 18, 2013 07:09
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Arglebargle III posted:Hi lawgoons, I have a general question about the force of non-compete clauses in employment contracts. At least, that's what I think they're called. They're clauses that state the employee basically can't leave and work for the competition. Not laying out any penalties or anything, just flat-out stating that they can't do it. Generally yes, but they have to be reasonable, and usually limited in geographic scope and duration. A veterinarian who worked for a veterinary practice in a small town, for example, might be forbidden from practicing within a certain radius of that town for a couple years after leaving, maybe. But a non-compete that covered the United States, or was in perpetuity, or something like that, would not be upheld. It's based on state law, though, so the enforceability of a clause could vary depending on what state it's in--some don't enforce them at all, some are very strict about what they'll accept, some are more willing to entertain them. Also, states vary in what they will do with a clause that is too broad--some state courts will simply not enforce it at all, while some will strike portions of clause, or rewrite it to fit what the court believes is reasonable for the parties under the circumstances.
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Apr 18, 2013 07:22
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