Is what the customer service of a health insurance company tells one of their customers legally binding? In the United States, is what the customer service tells a customer legally binding? Example: A customer calls their health insurance company, they say X is covered, 1 month later the customer receive the bill where customer sees X was no covered. Can the customer claim coverage based on what customer service told the customer? The communications between the customer and the customer service are either by phone or email. All calls are legally recorded, and emails are saved. If the answer is State-dependent, I am mostly interested in cases where the customer lives in California or Massachusetts.
If I may paraphrase the scenario: The customer has a contract with the insurer The customer is contemplating undergoing a certain procedure and is unsure if it is covered under the contract The customer calls the insurer to ask this specific question The insurer says "yes" The customer undergoes the procedure The insurer refuses to pay on the ground that it is not covered under the contract. Let's put aside issues of evidence and what can be proved and assume these facts are not in dispute. There is no question that the contract has been renegotiated; it hasn't. This avoids the necessity of considering if the insurer's employee has the authority to do this or it the customer can rely that they do even if they don't. There are two possibilities: The procedure is covered and the insurer must pay under contract The procedure isn't covered and the insurer must pay under the tort of negligent misstatement. The insurer is vicariously liable for the actions of its employee. The insurer owes a duty of care to a customer who asks such a question to answer it correctly. It is foreseeable that the customer would act on the insurer's advice and incur costs that they may have avoided if the correct advice had been given. Nothing is ever certain in the law but this is as close as you can get.
There is no requirement that a service company do customer surveys at all, or that it report the results. If they use customer surveys in advertising and the results are falsified or misleading, that might constitute false advertising, and be subject to government enforcement. But if the report survey data as of a particular date, and mentions that date in the ad, that is probably not misleading enough to be unlawful, even if the company knows that later surveys show different results. If the company just tosses all bad survey results and reports only the good ones, that is probably misleading. But they can report specific &quot;customer testimonials&quot; even if they are not typical, as long as they do not claim that they represent the average customer experience.
Your question isn't quite as simple as it sounds; some civil cases are tried before juries, and though a judge can give directions to a jury to give a particular verdict, they are not always required to obey; there are eighteenth-century English cases on the point that established that principle for most related jurisdictions. But your last sentence does have a simple answer: No. A judge usually takes an oath on assuming office, to administer the law without fear or favour. That means he will investigate the relevant law (with the assistance of the parties' lawyers), and enforce what it says. "This law would be unfair to the customer, so I will ignore it" would be just as bad as "The mechanic threatened to hit me with a wrench, so I find for him". Of course, most jurisdictions do have overriding principles of fairness; it may be that this contract term was not shown to the customer, so is not enforceable, or it may be that it is contrary to public policy to be uncertain what repairs will cost. But unless there is an explicit legal reason, the judge will have to find for the mechanic. It would be neither improper nor unusual for the judgment to include the sentence "This result is clearly unfair to the customer, and I urge the legislature to look at closing the loophole; nevertheless, the law is clear, and I find the customer must pay the increased price."
Prove my work is not a trade secret violation Please don't. It's not your job to prove your innocence. The burden is on them to be specific, explain fully, and prove specific claims about your actions. In other words, don't justify, don't explain, and don't defend yourself to them. It's actually best you do not say anything to them, and just forward the letter to your legal counsel (Since you're selling software to be used in the medical field, I assume you already have some kind of legal counsel). For instance, even saying something as innocuous as "Managing patients, Exams, Bills etc are all public knowledge." could be used against you. Because it establishes the fact that you've been working on those features with them and that you've been working on those features with your new company (which doesn't necessarily follow, for all they know, you could have purchased a library module from someone else with those exact features). In other words, even if you were to reply with such an innocuous-sounding statement, you could be saving them months of cross-border discovery and litigation about some of their claims (even if you believed you were being entirely reasonable by defending yourself). But at the same time, don't take what I'm saying to mean that you should lie to them about which features you recently worked on. When I say that you shouldn't be talking to them. I mean that you should not be talking to them. You shouldn't be engaging with them and you shouldn't be giving them any shred of information whatsoever (implied or otherwise). It's not your job to make their job any easier. Do not reply to them. Don't even acknowledge the receipt of the letter (unless you already did by signing for it, which can't be helped). Use a legal intermediary. Give the letter to your own legal counsel (whether you signed for the letter, or not) and leave any reply to him or her (assuming he/she thinks this warning letter even warrants a response). And if this former employer gives you a phone call, kindly refer them to your legal counsel without saying another word.
In general, no. When the salesperson quoted the price and you accepted it you were each bound to that price by contract. Consideration under a contract must be sufficient (something of value for something of value) but it doesn't have to be fair: you can be obliged to pay $2 million for a cupcake or sell your Picasso for $1. You were and are under no obligation to pay and could successfully sue for the return of your money. To further clarify, it doesn't matter if the store has or has not provided the goods or services when they discover their error: they are obliged to perform their side of the contract without additional payment. Further, if this was a consumer contract then some sort of consumer protection law almost certainly applies. This would probably make what the store did not only a breach of contract but an offence against the state as well.
Main Question: Most likely not under Magnuson-Moss or U.C.C.. Question 1: If a charge payable before hand was not set forth in any written warranty, it is most likely not legal to deny remedy to the consumer. However, even if it was, it is possible that it would not meet the federal minimum standards for warranties as, per paragraph (d) a warranty has to provide for remedy without a charge. If there is absolutely no way for you to obtain the information to prove that a remedy is due — for e.g. no third party has legal or technical capacity to diagnose the vehicle — that is likely also a term to be found unconscionable and void, and may be found fraudulent, malicious and/or oppressive which may entitle one to collect punitive damages. (It is worth obtaining written confirmation of whether this decision is made in accord with their policies or on a line that they announce to be recorded) Question 2: Most likely same as Question 1. Question 3: Most likely same as Question 2. According to 15 U.S.C., subsection (a) of Section 2302 entitled &quot;Full and conspicuous disclosure of terms and conditions; additional requirements for contents: &quot;In order to improve the adequacy of information available to consumers, prevent deception, and improve competition in the marketing of consumer products, any warrantor warranting a consumer product to a consumer by means of a written warranty shall, to the extent required by rules of the Commission, fully and conspicuously disclose in simple and readily understood language the terms and conditions of such warranty. (4) A statement of what the warrantor will do in the event of a defect, malfunction, or failure to conform with such written warranty—at whose expense—and for what period of time.&quot; (5) A statement of what the consumer must do and expenses he must bear. (6) Exceptions and exclusions from the terms of the warranty. (7) The step-by-step procedure which the consumer should take in order to obtain performance of any obligation under the warranty, including the identification of any person or class of persons authorized to perform the obligations set forth in the warranty. (12) The characteristics or properties of the products, or parts thereof, that are not covered by the warranty. (13) The elements of the warranty in words or phrases which would not mislead a reasonable, average consumer as to the nature or scope of the warranty. It may, in addition to any or all of the above, be a violation of paragraph (8), (9), (10) and/or (11) based on specific fact patterns. To the 2nd point added: If the manufacturer stated that the vehicle would run at least a certain number of miles on a full charge for a certain number of miles driven or number of years, and did not stipulate it otherwise, they would have to remedy this. It is highly likely that they tried to evade making such written statement (if not written, it's not a warranty under Magnuson-Moss). If they did, and they did not define the scope of what they would have to do in the case of a defect or malfunction, they would have to remedy it by repairs within a reasonable time; if they fail, they would have to refund or replace. This does not mean that it is likely worth pursuing the matter in court other than maybe in small claims (See: ohwilleke's reply to this question for a general explanation). Moreover, most auto manufacturers put arbitration provisions in their sale contracts and/or their warranties and generally it may be required of one to opt out of it within 30 days of entering into the agreement. If that took place, first the dispute would likely need to be disputed through a qualified dispute resolution mechanism of the manufacturer, dealer, distributor and/or sellers choice depending on who gave the warranty. The specific State's lemon laws may provide for civil penalties for willful violations which may or may not be a very high bar to meet depending on the State's case law, and which is more likely to make it worth for &quot;lemon&quot; lawyers to take the case, but generally they are not a great deal more like hyenas of this segment of the law. It may still be worth considering for one depending on the specific facts, including State jurisdiction and the impeding nature of the nonconformity. (Please specify a State for the State's lemon laws applicable in this hypo)
what would be the threshold for a lie to be actionable where you could claim a damage? There is no award for &quot;lies&quot; which clearly are inconsequential. A customer will never make decisions based on whether &quot;menu options have changed&quot; or whether the business is honest on the statement &quot;your call is important to us&quot;. The impact that the duration of these statements have on the customer is negligible at best, since omitting these statements does not improve the company's response time anyway. The statement &quot;your call is important to us&quot; might not even be a lie. Many companies know that it is in their best interest to gather information from their customers on what to improve, lest customers switch to a competitor or file suit. The lack of objective standards renders statements such as &quot;best pizza in town&quot; unascertainable. Accordingly, it would be unreasonable for a customer to rely on criteria that are subjective, undefined, unclear, and/or palpably fictitious. Only statements like &quot;scientifically proven&quot; and &quot;lose x pounds in y hours&quot; might be within scope of consumer protection laws (see also unfair and misleading practices). The assessment of those scenarios requires more detail, including disclaimers and other &quot;small letters&quot; that are --or ought to be-- disclosed no later than the formation of the contract.
Generally the insurer appoints a solicitor from its panel and instructs the solicitor to defend the claim in the name of the insured on the basis of the insurance policy. In the circumstances the solicitor has two clients, the insured and the insurer - a 'joint retainer'. The solicitor must not behave as if there is a 'primary client' or preferred client. A conflict of interest may arise. The solicitor has a duty not to act in the matter if there is a conflict of interest or a significant risk of one. The solicitor should ensure the insurer is aware of its duty to have regard to its own interests and the insured's interests. If the solicitor gets this wrong the insured may have a cause of action against the solicitor for breach of contract; the solicitor may face disciplinary proceedings for breaching the solicitor's Code of Conduct; a complaint could be addressed to the Legal Ombudsman (which may award compensation).