Can my orthodontia provider legally take my claim payment? I am currently getting Invisalign treatment through an Orthodontia Provider in California. I paid for the treatment up front at $3,000. I was told by the provider that it was unlikely that insurance would cover any of this. A few months into the treatment, I checked with my insurance and discovered that they do cover this. When I called my provider, I was told that they would file the claim and it would take 6-8 weeks for me to receive a check. 7 weeks later I called my insurance and discovered that they had the payment sent to them and it was electronically deposited immediately (7 weeks ago)! When I called my provider and asked why it would take 6-8 weeks for me to receive a check, they said "Management has to approve it". This honestly sounds very sketchy to me and I'm worried I will never receive my claim payment. So two questions: 1) Why would an Orthodontia provider want to receive this payment at all in the first place? I was thinking maybe tax reasons. 2) If they never end up sending me the claim refund, do I have any legal power to fight against this? I have all of the original receipts and an EOB report.
1) Why would an Orthodontia provider want to receive this payment at all in the first place? I was thinking maybe tax reasons. Less cynically, medical providers request that insurance payments be sent directly to them (and you routinely agree to allow them to do so in the fine print of your insurance contract and the paperwork you will out with the provider), every time that they request payment through insurance, because it is extremely uncommon for someone to pay in full and then come up with insurance through which a claim can be submitted. It is set up this way, in part, because medical providers have a lien on insurance payments made to compensate any not previously paid for services that they provided. So, anyway, bureaucratic inertia causes it to happen this way in your quirky case where it really doesn't make sense. Also, insurance companies routinely see claims failed by providers and handle them uncritically, while rarely seeing claims filed by insured for services that have already been rendered and paid for, and so look at those claims more critically, so it was probably in your interest to have the provider make the claim for you on your behalf. More cynically, even if the medical providers doesn't get to keep the money, holding onto it helps their cash flow. It may allow them to borrow less money for operations, or to invest it and earn a return on it. Having money has value even if it is temporary. 2) If they never end up sending me the claim refund, do I have any legal power to fight against this? I have all of the original receipts and an EOP report. Yes. You could write a demand letter, including copies of your evidence, and if they refused to comply within a reasonable time, you could sue, either with a lawyer, or in small claims court. You would have an extremely strong chance of prevailing and in all likelihood they would refund the money before the case went to trial rather than fighting a losing case in court. You have solid evidence that they were paid twice for the same thing. You don't need to bring the insurance company into it (which would make the case much more complicated). You just need to show that your local medical provider got a double recovery and didn't provide a refund. Six to eight weeks is unreasonable when they have already been paid twice. But, given the cost, aggravation and delay associated with suing, you might want to give them some time to provide a refund, although the next monthly billing cycle for them ought to be more than generous accommodation from you.
I do not have a written agreement of her saying she will pay 1/5 of utilities cost. Can I still take her to small claims court to get my money back? Yes. This type of agreements does not need to be in writing. Proving the other roommates' timely payments is strong evidence that also she is under a similar agreement. You did not elaborate on the form of her refusals. If these are stated in writing, they might evidence elements that further weaken her legal position. For instance, these might reflect her inconsistencies and/or bad faith. Even if you were unable (which seems very unlikely) to prove that there is an agreement to the effect of splitting costs, you might still prevail on grounds of equity.
What awards can I expect? In what ways would a judge's decisions about awards be legally limited? $500? Interest? Time spent pursuing collections? Filing fee? Anything else? My research so far suggests $500 plus reasonable (less than credit card) interest. Your lawsuit would be for breach of contract, probably filed in California small claims court for this small dollar amount. An award for breach of contract includes: the amount not paid pursuant to the contract, pre-judgment interest from the date that payment was due at the statutory rate in California (the legal rate specified in the contract applies until the contract is superseded by the verdict, but if the prejudgment interest rate is not specified in the contract, the rate is ten percent per annum from the date of the breach, California Civil Code § 3289), post-judgment interest at the statutory rate in California (10% per annum in a contract if not otherwise specified), and out of pocket costs incurred in filing the lawsuit (typically, the filing fee, the service of process fee, postage, copying costs incurred for trial exhibits, and any court fees incurred to collect the judgment if it is entered). Attorney fees are not available unless the contract says so. You are not entitled to any recovery for time spent pursuing collections. Often you have have a collections agency collect it for a percentage of the amount recovered (probably 50% in a claim of this size) plus a small fee, although they might not accept such a small dollar amount debt to collect. The main virtue of this is that it hurts the credit of the person who owes the money, a harm to the non-paying customer that is often far worse than not paying the amount owed on time. Are there any other legal disincentives for this behavior? A well drafted contract can provide for an award of attorney fees incurred in collecting the debt, can set a non-usurious interest rate and late fees for non-payment, and can take steps like requiring a deposit up front, or consenting to service of process by mail, to make collection more likely and to create stronger incentives to pay. Also, if the non-payment rate is low enough and the value of your time doing what you normally get paid to do is high, it may not make economic sense to pursue bad debt which takes some time and some money to get a small potential recovery, as opposed to letting it slide and doing more work that does pay. A small claims lawsuit is probably ten to thirty hours of work for which you will not be compensated even if you win. Depending upon your average hourly rate for your labor, and the percentage of your billings that go uncollected, it may not make economic sense to collect the unpaid bill, or you may want to delegate the job to someone else whose effective hourly rate of labor value is lower. Courts are cost effective places to collect large debts, and can be cost effective if many people owe you money and you can mass produce your collections process (as, for example, credit card companies do). But courts are often not cost effective for collecting one off small dollar amount debts, despite the streamlined process and reduced filing fees that are available in small claims court. if only a fraction of contractors seek justice, and the award never exceeds the originally agreed upon amount, then the rational decision would seem to be, don't pay the contractor. Consumers are not purely rational actors on a transaction by transaction basis in these matters. The vast majority of the time, people pay as agreed even though they could get away with paying less by forcing the person who did business with them to sue them to get paid. On a case by case basis, this is often not rational, but as a long term strategy for all transactions that a consumer enters into, it often does make rational sense. In small dollar transactions, blacklisting people from future business and harming their credit records is usually enough of an incentive to make uncollectible invoices an acceptable cost of doing business. But a good business person does evaluate every customer to whom trade credit is extended for creditworthiness if the customer does not pay in advance. On the other hand, as a business person, you may have a strategic interest in pursuing every unpaid invoice even if it isn't cost effective to do so when considering that unpaid invoice in isolation, in order to instill in your customers the knowledge that when you say you will sue them if you aren't paid, that you are making a credible threat. This may discourage people from not paying you in the first place.
It is cl;early not legal to charge for an optional warranty without ever having gotten approval for it. The customer could simply ask for a refund on teh ground that this was an error, and take it to small claims if that was refused. I am sure it is legal to offer such an optional warranty and point out its (alleged) benefits. I do not know if consumer law forbids making this pitch multiple times in the same selling encounter.
Read the terms It’s quite likely that, if you took this to court, the employer would be liable to pay your daughter interest on the underpayment and possibly be fined by the state for failing to follow the law. The terms probably are offering to pay the back pay with no interest and your daughter agreeing to confidentiality about the breach. Probably - I haven’t read them. In other words, they’re asking her to sign a contract saying she gets $XXX now, and can’t make any further claims against them. Such releases are commonplace when setting a dispute and there’s probably nothing underhanded going on. Probably - I haven’t read them. Because minors can void contracts if they are not in their interest, they want you, as her legal guardian, to also sign so that can’t happen. A relatively prudent precaution on their part. The alternative is to not sign the document and they presumably won’t pay. It will then be up to you whether to sue them which will cost you money, possibly more than you will get if you win. As to whether there is a dispute: they want your signature, you don’t want to sign - that’s a dispute. Any admissions they have made in their settlement offer are almost surely without prejudice, meaning they are inadmissible in court. If you want to sue, you would have to prove the underpayment without relying on their admissions. As stated above, maybe there is no underpayment. Only you and your daughter can decide if this is a good deal.
Is this how it works? Am I supposed to pay the full quote regardless? No. The contractor is plain wrong. Your agreed commitment to obtain materials directly from the retailer supersedes the initial agreement that totaled 30K. In other words, you two amended the contract. Since then, your obligations under the amended contract were to provide the materials he requested and to pay for labor costs. the contractor is insisting on the full amount, claiming that had I not paid the material I wouldn't have known the difference in cost and he was taking the risk with the quote. That is inaccurate. Once he delegated to you the task of obtaining materials directly from retailer, he exempted himself from any and all risks of giving an inaccurate estimate of the cost of materials. In fact, he shifted to you that risk.
The question does not say what reasons the other party gives for not paying, and so one cannot judge whether such reason is covered by the terms quoted in the question. In general a contract need not be highly specific if the intent is clear. However, any ambiguity will usually be resolved against the party who wrote the contract, so it is in that party's interest to be as clear and specific as possible. It is not clear from the quoted terms that they form a contract at all. No consideration is stated. Contractual provisions which deny all recourse are not always enforceable. They may be overruled by law or regulation, or by prior court decision or by an equitable decision. If there is a serious problem with the service provided, particularly in a consumer transaction, a court might reject a provision denying all refunds even if it is quite specific and clear. The question does not list the jurisdiction (country and, for federal countries, state or province). Laws on contracts and enforceable terms vary significantly in different jurisdictions. Without this a specific answer is not possible.
In the absence of a contractual agreement saying otherwise, the lawsuit would probably just be subject to normal rules of tort liability. In that case, the contractor would probably lose his case unless he could prove that the one worker infected another through an act of negligence or could otherwise prove that the infected worker knew he was infected and posed a risk to others. In the basic negligence situation, the contractor would likely rely on the general duty we all have to avoid creating unreasonable risks of injury to third parties, and he would need to argue that Worker A somehow breached that duty. Coming to work knowing you're infected would almost certainly satisfy that standard, but it might be enough to simply show that Worker A was at a large gathering of unmasked people whose vaccination status was unknown. From there, he would also need to prove that breaching that duty caused him some injury, presumably by infecting Workers B through M, causing a work slowdown, causing missed deadlines, causing late fees, etc. The contractor might also pursue a claim for reckless, rather than negligent, conduct, if Worker A knew he was infected and came to work just the same. Or he might pursue an intentional tort claim if there was some reason to believe that Worker A was actually trying to get other people sick, as opposed to just ignoring the fact that such a risk existed. As I understand it, several states have also passed laws limiting liability for exposure to COVID in the workplace, so it's possible that none of these claims would be viable, no matter how strong the evidence.