If you’ve driven in the city, you may have had the startling experience of a disheveled-looking man approaching your vehicle at a traffic light that spits on your windshield and wipes off your windshield with the arm of a soiled jacket.
Once he has completed this task, the disheveled man will raise his palm and ask you to pay for the service of having the vehicle's windshield “cleaned.”
You may not have known it then, but the law would call this man an “officious intermeddler,” or one who demands payment for services not expressly or impliedly requested.
Our Western legal response to the officious intermeddler goes back at least to Roman times when a Roman whose chariot may have been spat upon would have responded to the officious intermeddler by stating, Culpa est immiscere se rei ad se non pertinenti, or in English: “It is a fault for anyone to meddle in a matter not about him.”
Unjust Enrichment
Consider the following example. Let us say that 14-year-old Johnny is mowing neighbors’ yards for money. Johnny pushes his lawnmower down the street to neighbors’ doors and asks them if they would like their lawns mowed for $10.
Johnny arrives at Bill’s house. Bill has a large window in the front of his home and happens to be standing and enjoying the sunrise with a cup of coffee when Johnny comes into view. Johnny and Bill are visible to one another. Johnny points at his lawnmower and gives Bill a thumbs-up gesture. Bill simply continues to enjoy his morning coffee with no outward gesture of assent or disagreement.
Forty-five minutes later, Johnny knocks on Bill’s door after having completed a thorough job of mowing Bill’s yard. Johnny asks for $10 for mowing the yard. Bill refuses to pay since he argues that he neither expressly nor impliedly agreed to the service of having his yard mowed. Bill believes Johnny is an officious intermeddler, whereas Johnny thinks he should be paid for services rendered.
Are insurance companies officious intermeddlers?
No, insurance companies are not considered officious intermeddlers when they represent their insured in litigation. This is because they have a legal interest in the performance of their contractual duties.
Explanation
"Officious intermeddling" is a legal term that describes when someone interferes in another person's affairs without being asked or needed. The officious intermeddler rule protects people who are given unsolicited benefits and punishes those who give them.
A liability insurer has a legal interest in the performance of their contractual duties. This includes representing their insurer in litigation.
The practice of prior authorization for medical tests and treatments could be construed as meddling with patient care. It introduces obstructions for payments by insurers to physicians denying necessary care as indicated by a physician’s orders. What is required? Standards of care by insurance companies are determined and directed by their medical director, who is guided by several authorities including medical specialty boards, and state licensing authorities.
Providers and patients observe these business practices as harassment.
Recent very public events involving the murder of a prominent CEO of United Health Group have created public awareness.
Concerned providers and patients are seeking relief from these practices. Health insurers have the upper hand and have developed methods to delay, deny, and defeat efforts for payment of treatments.
Can these methods be defeated with legal injunctions and/or new regulations? Despite medical specialty groups and the American Medical Association little progress has occurred to reverse the authorization process.